|
NAIL X405
|
Facility
|
IP
|
$7,247.58
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64907332
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,623.79 |
| Max. Negotiated Rate |
$3,623.79 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,623.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,623.79
|
|
|
NAIL X80MM
|
Facility
|
IP
|
$866.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64907108
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$433.12 |
| Max. Negotiated Rate |
$433.12 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$433.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$433.12
|
|
|
NAIL X80MM
|
Facility
|
OP
|
$866.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64907108
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$909.56 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$476.44
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Brighton Health Commercial |
$519.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$433.12
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$498.09
|
| Rate for Payer: EmblemHealth Commercial |
$433.12
|
| Rate for Payer: Fidelis Medicare Advantage |
$909.56
|
| Rate for Payer: Group Health Inc Commercial |
$433.12
|
| Rate for Payer: Group Health Inc Medicare |
$303.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$433.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$433.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$563.06
|
|
|
NALOXONE 0.4 MG/ML INJ 10 ML
|
Facility
|
IP
|
$26.53
|
|
|
Service Code
|
HCPCS J2310
|
| Hospital Charge Code |
41644246
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.26 |
| Max. Negotiated Rate |
$13.26 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$13.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.26
|
|
|
NALOXONE 0.4 MG/ML INJ 10 ML
|
Facility
|
OP
|
$26.53
|
|
|
Service Code
|
HCPCS J2310
|
| Hospital Charge Code |
41644246
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.29 |
| Max. Negotiated Rate |
$2,020.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$14.59
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$10.93
|
| Rate for Payer: Aetna Government |
$10.93
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$45.45
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$45.45
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$20.20
|
| Rate for Payer: Amida Care Medicaid |
$20.20
|
| Rate for Payer: Brighton Health Commercial |
$15.92
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$13.26
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$15.25
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,020.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$20.20
|
| Rate for Payer: Fidelis Essential Plan QHP |
$20.20
|
| Rate for Payer: Fidelis Qualified Health Plan |
$21.21
|
| Rate for Payer: Group Health Inc Commercial |
$13.26
|
| Rate for Payer: Group Health Inc Medicare |
$9.29
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$20.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.26
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$20.20
|
| Rate for Payer: Healthfirst Essential Plan |
$45.45
|
| Rate for Payer: Healthfirst QHP |
$20.20
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$20.20
|
| Rate for Payer: SOMOS Essential |
$20.20
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$45.45
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$22.22
|
| Rate for Payer: United Healthcare Medicaid |
$20.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$17.24
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$20.20
|
|
|
NALOXONE 0.4 MG/ML INJ 10 ML
|
Facility
|
IP
|
$26.53
|
|
|
Service Code
|
HCPCS J2310
|
| Hospital Charge Code |
41654246
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.26 |
| Max. Negotiated Rate |
$13.26 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$13.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.26
|
|
|
NALOXONE 0.4 MG/ML INJ 10 ML
|
Facility
|
OP
|
$26.53
|
|
|
Service Code
|
HCPCS J2310
|
| Hospital Charge Code |
41654246
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.29 |
| Max. Negotiated Rate |
$2,020.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$14.59
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$10.93
|
| Rate for Payer: Aetna Government |
$10.93
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$45.45
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$45.45
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$20.20
|
| Rate for Payer: Amida Care Medicaid |
$20.20
|
| Rate for Payer: Brighton Health Commercial |
$15.92
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$13.26
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$15.25
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,020.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$20.20
|
| Rate for Payer: Fidelis Essential Plan QHP |
$20.20
|
| Rate for Payer: Fidelis Qualified Health Plan |
$21.21
|
| Rate for Payer: Group Health Inc Commercial |
$13.26
|
| Rate for Payer: Group Health Inc Medicare |
$9.29
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$20.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.26
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$20.20
|
| Rate for Payer: Healthfirst Essential Plan |
$45.45
|
| Rate for Payer: Healthfirst QHP |
$20.20
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$20.20
|
| Rate for Payer: SOMOS Essential |
$20.20
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$45.45
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$22.22
|
| Rate for Payer: United Healthcare Medicaid |
$20.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$17.24
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$20.20
|
|
|
NALOXONE 0.4 MG/ML INJ 1 ML
|
Facility
|
IP
|
$51.27
|
|
|
Service Code
|
HCPCS J2310
|
| Hospital Charge Code |
41644152
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$25.64 |
| Max. Negotiated Rate |
$25.64 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$25.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$25.64
|
|
|
NALOXONE 0.4 MG/ML INJ 1 ML
|
Facility
|
IP
|
$51.27
|
|
|
Service Code
|
HCPCS J2310
|
| Hospital Charge Code |
41654152
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$25.64 |
| Max. Negotiated Rate |
$25.64 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$25.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$25.64
|
|
|
NALOXONE 0.4 MG/ML INJ 1 ML
|
Facility
|
OP
|
$51.27
|
|
|
Service Code
|
HCPCS J2310
|
| Hospital Charge Code |
41654152
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.93 |
| Max. Negotiated Rate |
$2,020.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$28.20
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$10.93
|
| Rate for Payer: Aetna Government |
$10.93
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$45.45
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$45.45
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$20.20
|
| Rate for Payer: Amida Care Medicaid |
$20.20
|
| Rate for Payer: Brighton Health Commercial |
$30.76
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$25.64
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$29.48
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,020.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$20.20
|
| Rate for Payer: Fidelis Essential Plan QHP |
$20.20
|
| Rate for Payer: Fidelis Qualified Health Plan |
$21.21
|
| Rate for Payer: Group Health Inc Commercial |
$25.64
|
| Rate for Payer: Group Health Inc Medicare |
$17.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$20.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$25.64
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$20.20
|
| Rate for Payer: Healthfirst Essential Plan |
$45.45
|
| Rate for Payer: Healthfirst QHP |
$20.20
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$20.20
|
| Rate for Payer: SOMOS Essential |
$20.20
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$45.45
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$22.22
|
| Rate for Payer: United Healthcare Medicaid |
$20.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$33.33
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$20.20
|
|
|
NALOXONE 0.4 MG/ML INJ 1 ML
|
Facility
|
OP
|
$51.27
|
|
|
Service Code
|
HCPCS J2310
|
| Hospital Charge Code |
41644152
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.93 |
| Max. Negotiated Rate |
$2,020.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$28.20
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$10.93
|
| Rate for Payer: Aetna Government |
$10.93
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$45.45
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$45.45
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$20.20
|
| Rate for Payer: Amida Care Medicaid |
$20.20
|
| Rate for Payer: Brighton Health Commercial |
$30.76
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$25.64
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$29.48
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,020.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$20.20
|
| Rate for Payer: Fidelis Essential Plan QHP |
$20.20
|
| Rate for Payer: Fidelis Qualified Health Plan |
$21.21
|
| Rate for Payer: Group Health Inc Commercial |
$25.64
|
| Rate for Payer: Group Health Inc Medicare |
$17.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$20.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$25.64
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$20.20
|
| Rate for Payer: Healthfirst Essential Plan |
$45.45
|
| Rate for Payer: Healthfirst QHP |
$20.20
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$20.20
|
| Rate for Payer: SOMOS Essential |
$20.20
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$45.45
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$22.22
|
| Rate for Payer: United Healthcare Medicaid |
$20.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$33.33
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$20.20
|
|
|
NALOXONE 1 MG/ML INJ 2 ML
|
Facility
|
IP
|
$13.36
|
|
|
Service Code
|
HCPCS J2310
|
| Hospital Charge Code |
41643058
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.68 |
| Max. Negotiated Rate |
$6.68 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.68
|
|
|
NALOXONE 1 MG/ML INJ 2 ML
|
Facility
|
IP
|
$13.36
|
|
|
Service Code
|
HCPCS J2310
|
| Hospital Charge Code |
41653058
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.68 |
| Max. Negotiated Rate |
$6.68 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.68
|
|
|
NALOXONE 1 MG/ML INJ 2 ML
|
Facility
|
OP
|
$13.36
|
|
|
Service Code
|
HCPCS J2310
|
| Hospital Charge Code |
41653058
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.68 |
| Max. Negotiated Rate |
$2,020.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.35
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$10.93
|
| Rate for Payer: Aetna Government |
$10.93
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$45.45
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$45.45
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$20.20
|
| Rate for Payer: Amida Care Medicaid |
$20.20
|
| Rate for Payer: Brighton Health Commercial |
$8.02
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.68
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7.68
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,020.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$20.20
|
| Rate for Payer: Fidelis Essential Plan QHP |
$20.20
|
| Rate for Payer: Fidelis Qualified Health Plan |
$21.21
|
| Rate for Payer: Group Health Inc Commercial |
$6.68
|
| Rate for Payer: Group Health Inc Medicare |
$4.68
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$20.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.68
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$20.20
|
| Rate for Payer: Healthfirst Essential Plan |
$45.45
|
| Rate for Payer: Healthfirst QHP |
$20.20
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$20.20
|
| Rate for Payer: SOMOS Essential |
$20.20
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$45.45
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$22.22
|
| Rate for Payer: United Healthcare Medicaid |
$20.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8.68
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$20.20
|
|
|
NALOXONE 1 MG/ML INJ 2 ML
|
Facility
|
OP
|
$13.36
|
|
|
Service Code
|
HCPCS J2310
|
| Hospital Charge Code |
41643058
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.68 |
| Max. Negotiated Rate |
$2,020.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.35
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$10.93
|
| Rate for Payer: Aetna Government |
$10.93
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$45.45
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$45.45
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$20.20
|
| Rate for Payer: Amida Care Medicaid |
$20.20
|
| Rate for Payer: Brighton Health Commercial |
$8.02
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.68
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7.68
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,020.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$20.20
|
| Rate for Payer: Fidelis Essential Plan QHP |
$20.20
|
| Rate for Payer: Fidelis Qualified Health Plan |
$21.21
|
| Rate for Payer: Group Health Inc Commercial |
$6.68
|
| Rate for Payer: Group Health Inc Medicare |
$4.68
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$20.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.68
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$20.20
|
| Rate for Payer: Healthfirst Essential Plan |
$45.45
|
| Rate for Payer: Healthfirst QHP |
$20.20
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$20.20
|
| Rate for Payer: SOMOS Essential |
$20.20
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$45.45
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$22.22
|
| Rate for Payer: United Healthcare Medicaid |
$20.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8.68
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$20.20
|
|
|
NALOXONE HCL 0.4 MG/ML IJ SOLN [5373]
|
Facility
|
OP
|
$23.72
|
|
|
Service Code
|
HCPCS J2310
|
| Hospital Charge Code |
67457029200
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.06 |
| Max. Negotiated Rate |
$2,020.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$13.05
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$10.93
|
| Rate for Payer: Aetna Government |
$10.93
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$45.45
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$45.45
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$20.20
|
| Rate for Payer: Amida Care Medicaid |
$20.20
|
| Rate for Payer: Brighton Health Commercial |
$17.79
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$18.98
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$16.13
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,020.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$20.20
|
| Rate for Payer: Fidelis Essential Plan QHP |
$20.20
|
| Rate for Payer: Fidelis Qualified Health Plan |
$21.21
|
| Rate for Payer: Group Health Inc Commercial |
$11.86
|
| Rate for Payer: Group Health Inc Medicare |
$8.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$20.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$11.86
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$20.20
|
| Rate for Payer: Healthfirst Essential Plan |
$45.45
|
| Rate for Payer: Healthfirst QHP |
$20.20
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$8.06
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$8.54
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$8.54
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$8.54
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$20.20
|
| Rate for Payer: SOMOS Essential |
$20.20
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$45.45
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$22.22
|
| Rate for Payer: United Healthcare Medicaid |
$20.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$15.42
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$20.20
|
|
|
NALOXONE HCL 0.4 MG/ML IJ SOLN [5373]
|
Facility
|
OP
|
$14.95
|
|
|
Service Code
|
HCPCS J2310
|
| Hospital Charge Code |
55150032710
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.23 |
| Max. Negotiated Rate |
$2,020.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$8.22
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$10.93
|
| Rate for Payer: Aetna Government |
$10.93
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$45.45
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$45.45
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$20.20
|
| Rate for Payer: Amida Care Medicaid |
$20.20
|
| Rate for Payer: Brighton Health Commercial |
$11.21
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$11.96
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$10.17
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,020.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$20.20
|
| Rate for Payer: Fidelis Essential Plan QHP |
$20.20
|
| Rate for Payer: Fidelis Qualified Health Plan |
$21.21
|
| Rate for Payer: Group Health Inc Commercial |
$7.48
|
| Rate for Payer: Group Health Inc Medicare |
$5.23
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$20.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.48
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$20.20
|
| Rate for Payer: Healthfirst Essential Plan |
$45.45
|
| Rate for Payer: Healthfirst QHP |
$20.20
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$8.06
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$8.54
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$8.54
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$8.54
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$20.20
|
| Rate for Payer: SOMOS Essential |
$20.20
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$45.45
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$22.22
|
| Rate for Payer: United Healthcare Medicaid |
$20.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$9.72
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$20.20
|
|
|
NALOXONE HCL 0.4 MG/ML IJ SOLN [5373]
|
Facility
|
OP
|
$6.00
|
|
|
Service Code
|
HCPCS J2310
|
| Hospital Charge Code |
36000030810
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.10 |
| Max. Negotiated Rate |
$2,020.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$10.93
|
| Rate for Payer: Aetna Government |
$10.93
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$45.45
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$45.45
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$20.20
|
| Rate for Payer: Amida Care Medicaid |
$20.20
|
| Rate for Payer: Brighton Health Commercial |
$4.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.08
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,020.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$20.20
|
| Rate for Payer: Fidelis Essential Plan QHP |
$20.20
|
| Rate for Payer: Fidelis Qualified Health Plan |
$21.21
|
| Rate for Payer: Group Health Inc Commercial |
$3.00
|
| Rate for Payer: Group Health Inc Medicare |
$2.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$20.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$20.20
|
| Rate for Payer: Healthfirst Essential Plan |
$45.45
|
| Rate for Payer: Healthfirst QHP |
$20.20
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$8.06
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$8.54
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$8.54
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$8.54
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$20.20
|
| Rate for Payer: SOMOS Essential |
$20.20
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$45.45
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$22.22
|
| Rate for Payer: United Healthcare Medicaid |
$20.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.90
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$20.20
|
|
|
NALOXONE HCL 0.4 MG/ML IJ SOLN [5373]
|
Facility
|
OP
|
$19.00
|
|
|
Service Code
|
HCPCS J2310
|
| Hospital Charge Code |
17478004101
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.65 |
| Max. Negotiated Rate |
$2,020.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$10.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$10.93
|
| Rate for Payer: Aetna Government |
$10.93
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$45.45
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$45.45
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$20.20
|
| Rate for Payer: Amida Care Medicaid |
$20.20
|
| Rate for Payer: Brighton Health Commercial |
$14.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$15.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$12.92
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,020.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$20.20
|
| Rate for Payer: Fidelis Essential Plan QHP |
$20.20
|
| Rate for Payer: Fidelis Qualified Health Plan |
$21.21
|
| Rate for Payer: Group Health Inc Commercial |
$9.50
|
| Rate for Payer: Group Health Inc Medicare |
$6.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$20.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$20.20
|
| Rate for Payer: Healthfirst Essential Plan |
$45.45
|
| Rate for Payer: Healthfirst QHP |
$20.20
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$8.06
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$8.54
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$8.54
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$8.54
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$20.20
|
| Rate for Payer: SOMOS Essential |
$20.20
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$45.45
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$22.22
|
| Rate for Payer: United Healthcare Medicaid |
$20.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12.35
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$20.20
|
|
|
NALOXONE HCL 0.4 MG/ML IJ SOLN [5373]
|
Facility
|
OP
|
$23.72
|
|
|
Service Code
|
HCPCS J2310
|
| Hospital Charge Code |
67457059902
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.06 |
| Max. Negotiated Rate |
$2,020.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$13.05
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$10.93
|
| Rate for Payer: Aetna Government |
$10.93
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$45.45
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$45.45
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$20.20
|
| Rate for Payer: Amida Care Medicaid |
$20.20
|
| Rate for Payer: Brighton Health Commercial |
$17.79
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$18.98
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$16.13
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,020.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$20.20
|
| Rate for Payer: Fidelis Essential Plan QHP |
$20.20
|
| Rate for Payer: Fidelis Qualified Health Plan |
$21.21
|
| Rate for Payer: Group Health Inc Commercial |
$11.86
|
| Rate for Payer: Group Health Inc Medicare |
$8.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$20.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$11.86
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$20.20
|
| Rate for Payer: Healthfirst Essential Plan |
$45.45
|
| Rate for Payer: Healthfirst QHP |
$20.20
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$8.06
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$8.54
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$8.54
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$8.54
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$20.20
|
| Rate for Payer: SOMOS Essential |
$20.20
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$45.45
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$22.22
|
| Rate for Payer: United Healthcare Medicaid |
$20.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$15.42
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$20.20
|
|
|
NALOXONE HCL 0.4 MG/ML IJ SOLN [5373]
|
Facility
|
OP
|
$12.50
|
|
|
Service Code
|
HCPCS J2310
|
| Hospital Charge Code |
70069007110
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.38 |
| Max. Negotiated Rate |
$2,020.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.88
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$10.93
|
| Rate for Payer: Aetna Government |
$10.93
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$45.45
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$45.45
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$20.20
|
| Rate for Payer: Amida Care Medicaid |
$20.20
|
| Rate for Payer: Brighton Health Commercial |
$9.38
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$10.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$8.50
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,020.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$20.20
|
| Rate for Payer: Fidelis Essential Plan QHP |
$20.20
|
| Rate for Payer: Fidelis Qualified Health Plan |
$21.21
|
| Rate for Payer: Group Health Inc Commercial |
$6.25
|
| Rate for Payer: Group Health Inc Medicare |
$4.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$20.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.25
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$20.20
|
| Rate for Payer: Healthfirst Essential Plan |
$45.45
|
| Rate for Payer: Healthfirst QHP |
$20.20
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$8.06
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$8.54
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$8.54
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$8.54
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$20.20
|
| Rate for Payer: SOMOS Essential |
$20.20
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$45.45
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$22.22
|
| Rate for Payer: United Healthcare Medicaid |
$20.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8.12
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$20.20
|
|
|
NALOXONE HCL 0.4 MG/ML IJ SOLN [5373]
|
Facility
|
OP
|
$23.72
|
|
|
Service Code
|
HCPCS J2310
|
| Hospital Charge Code |
67457029202
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.06 |
| Max. Negotiated Rate |
$2,020.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$13.05
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$10.93
|
| Rate for Payer: Aetna Government |
$10.93
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$45.45
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$45.45
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$20.20
|
| Rate for Payer: Amida Care Medicaid |
$20.20
|
| Rate for Payer: Brighton Health Commercial |
$17.79
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$18.98
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$16.13
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,020.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$20.20
|
| Rate for Payer: Fidelis Essential Plan QHP |
$20.20
|
| Rate for Payer: Fidelis Qualified Health Plan |
$21.21
|
| Rate for Payer: Group Health Inc Commercial |
$11.86
|
| Rate for Payer: Group Health Inc Medicare |
$8.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$20.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$11.86
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$20.20
|
| Rate for Payer: Healthfirst Essential Plan |
$45.45
|
| Rate for Payer: Healthfirst QHP |
$20.20
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$8.06
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$8.54
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$8.54
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$8.54
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$20.20
|
| Rate for Payer: SOMOS Essential |
$20.20
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$45.45
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$22.22
|
| Rate for Payer: United Healthcare Medicaid |
$20.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$15.42
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$20.20
|
|
|
NALOXONE HCL 2 MG/2ML IJ SOSY [134075]
|
Facility
|
OP
|
$19.80
|
|
|
Service Code
|
HCPCS J2310
|
| Hospital Charge Code |
76329336901
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.93 |
| Max. Negotiated Rate |
$2,020.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$10.89
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$10.93
|
| Rate for Payer: Aetna Government |
$10.93
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$45.45
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$45.45
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$20.20
|
| Rate for Payer: Amida Care Medicaid |
$20.20
|
| Rate for Payer: Brighton Health Commercial |
$14.85
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$15.84
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$13.46
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,020.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$20.20
|
| Rate for Payer: Fidelis Essential Plan QHP |
$20.20
|
| Rate for Payer: Fidelis Qualified Health Plan |
$21.21
|
| Rate for Payer: Group Health Inc Commercial |
$9.90
|
| Rate for Payer: Group Health Inc Medicare |
$6.93
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$20.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9.90
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$20.20
|
| Rate for Payer: Healthfirst Essential Plan |
$45.45
|
| Rate for Payer: Healthfirst QHP |
$20.20
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$8.06
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$8.54
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$8.54
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$8.54
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$20.20
|
| Rate for Payer: SOMOS Essential |
$20.20
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$45.45
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$22.22
|
| Rate for Payer: United Healthcare Medicaid |
$20.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12.87
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$20.20
|
|
|
NALOXONE HCL 4 MG/10ML IJ SOLN [134074]
|
Facility
|
OP
|
$14.25
|
|
|
Service Code
|
HCPCS J2310
|
| Hospital Charge Code |
00409121901
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.99 |
| Max. Negotiated Rate |
$2,020.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.84
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$10.93
|
| Rate for Payer: Aetna Government |
$10.93
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$45.45
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$45.45
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$20.20
|
| Rate for Payer: Amida Care Medicaid |
$20.20
|
| Rate for Payer: Brighton Health Commercial |
$10.69
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$11.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$9.69
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,020.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$20.20
|
| Rate for Payer: Fidelis Essential Plan QHP |
$20.20
|
| Rate for Payer: Fidelis Qualified Health Plan |
$21.21
|
| Rate for Payer: Group Health Inc Commercial |
$7.12
|
| Rate for Payer: Group Health Inc Medicare |
$4.99
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$20.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$20.20
|
| Rate for Payer: Healthfirst Essential Plan |
$45.45
|
| Rate for Payer: Healthfirst QHP |
$20.20
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$8.06
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$8.54
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$8.54
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$8.54
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$20.20
|
| Rate for Payer: SOMOS Essential |
$20.20
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$45.45
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$22.22
|
| Rate for Payer: United Healthcare Medicaid |
$20.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$9.26
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$20.20
|
|
|
NALOXONE NYDOH KIT [401306]
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS J2310
|
|
Hospital Revenue Code
|
250
|
| Max. Negotiated Rate |
$2,020.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$10.93
|
| Rate for Payer: Aetna Government |
$10.93
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$45.45
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$45.45
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$20.20
|
| Rate for Payer: Amida Care Medicaid |
$20.20
|
| Rate for Payer: Brighton Health Commercial |
$0.01
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.01
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.01
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,020.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$20.20
|
| Rate for Payer: Fidelis Essential Plan QHP |
$20.20
|
| Rate for Payer: Fidelis Qualified Health Plan |
$21.21
|
| Rate for Payer: Group Health Inc Commercial |
$0.01
|
| Rate for Payer: Group Health Inc Medicare |
$0.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$20.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$20.20
|
| Rate for Payer: Healthfirst Essential Plan |
$45.45
|
| Rate for Payer: Healthfirst QHP |
$20.20
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$8.06
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$8.54
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$8.54
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$8.54
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$20.20
|
| Rate for Payer: SOMOS Essential |
$20.20
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$45.45
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$22.22
|
| Rate for Payer: United Healthcare Medicaid |
$20.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.01
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$20.20
|
|
