|
NIFEDIPINE ER OSMOTIC RELEASE 60 MG PO TB24 [27659]
|
Facility
|
OP
|
$2.25
|
|
|
Service Code
|
NDC 50268059815
|
| Hospital Charge Code |
50268059815
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.79 |
| Max. Negotiated Rate |
$1.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.24
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.13
|
| Rate for Payer: Aetna Government |
$1.13
|
| Rate for Payer: Brighton Health Commercial |
$1.69
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.53
|
| Rate for Payer: Group Health Inc Commercial |
$1.13
|
| Rate for Payer: Group Health Inc Medicare |
$0.79
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.13
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.13
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.47
|
|
|
NIFEDIPINE ER OSMOTIC RELEASE 60 MG PO TB24 [27659]
|
Facility
|
OP
|
$2.27
|
|
|
Service Code
|
NDC 50742026103
|
| Hospital Charge Code |
50742026103
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.79 |
| Max. Negotiated Rate |
$1.81 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.13
|
| Rate for Payer: Aetna Government |
$1.13
|
| Rate for Payer: Brighton Health Commercial |
$1.70
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.81
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.54
|
| Rate for Payer: Group Health Inc Commercial |
$1.13
|
| Rate for Payer: Group Health Inc Medicare |
$0.79
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.13
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.13
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.47
|
|
|
NIFEDIPINE ER OSMOTIC RELEASE 60 MG PO TB24 [27659]
|
Facility
|
OP
|
$2.01
|
|
|
Service Code
|
NDC 00904708106
|
| Hospital Charge Code |
00904708106
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.70 |
| Max. Negotiated Rate |
$1.61 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.11
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.01
|
| Rate for Payer: Aetna Government |
$1.01
|
| Rate for Payer: Brighton Health Commercial |
$1.51
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.61
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.37
|
| Rate for Payer: Group Health Inc Commercial |
$1.01
|
| Rate for Payer: Group Health Inc Medicare |
$0.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.31
|
|
|
NIFEDIPINE ER OSMOTIC RELEASE 60 MG PO TB24 [27659]
|
Facility
|
OP
|
$2.29
|
|
|
Service Code
|
NDC 50742026101
|
| Hospital Charge Code |
50742026101
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.80 |
| Max. Negotiated Rate |
$1.83 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.26
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.15
|
| Rate for Payer: Aetna Government |
$1.15
|
| Rate for Payer: Brighton Health Commercial |
$1.72
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.83
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.56
|
| Rate for Payer: Group Health Inc Commercial |
$1.15
|
| Rate for Payer: Group Health Inc Medicare |
$0.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.15
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.49
|
|
|
NIFEDIPINE ER OSMOTIC RELEASE 60 MG PO TB24 [27659]
|
Facility
|
OP
|
$2.25
|
|
|
Service Code
|
NDC 50268059811
|
| Hospital Charge Code |
50268059811
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.79 |
| Max. Negotiated Rate |
$1.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.24
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.13
|
| Rate for Payer: Aetna Government |
$1.13
|
| Rate for Payer: Brighton Health Commercial |
$1.69
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.53
|
| Rate for Payer: Group Health Inc Commercial |
$1.13
|
| Rate for Payer: Group Health Inc Medicare |
$0.79
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.13
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.13
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.47
|
|
|
NIFEDIPINE ER OSMOTIC RELEASE 90 MG PO TB24 [27660]
|
Facility
|
OP
|
$2.49
|
|
|
Service Code
|
NDC 50268059915
|
| Hospital Charge Code |
50268059915
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.87 |
| Max. Negotiated Rate |
$1.99 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.37
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.25
|
| Rate for Payer: Aetna Government |
$1.25
|
| Rate for Payer: Brighton Health Commercial |
$1.87
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.99
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.70
|
| Rate for Payer: Group Health Inc Commercial |
$1.25
|
| Rate for Payer: Group Health Inc Medicare |
$0.87
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.62
|
|
|
NIFEDIPINE ER OSMOTIC RELEASE 90 MG PO TB24 [27660]
|
Facility
|
OP
|
$2.56
|
|
|
Service Code
|
NDC 50742026201
|
| Hospital Charge Code |
50742026201
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$2.05 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.41
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.28
|
| Rate for Payer: Aetna Government |
$1.28
|
| Rate for Payer: Brighton Health Commercial |
$1.92
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.05
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.74
|
| Rate for Payer: Group Health Inc Commercial |
$1.28
|
| Rate for Payer: Group Health Inc Medicare |
$0.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.28
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.28
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.67
|
|
|
NIFEDIPINE ER OSMOTIC RELEASE 90 MG PO TB24 [27660]
|
Facility
|
OP
|
$3.75
|
|
|
Service Code
|
NDC 68084060321
|
| Hospital Charge Code |
68084060321
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.31 |
| Max. Negotiated Rate |
$3.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.06
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.87
|
| Rate for Payer: Aetna Government |
$1.87
|
| Rate for Payer: Brighton Health Commercial |
$2.81
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.55
|
| Rate for Payer: Group Health Inc Commercial |
$1.87
|
| Rate for Payer: Group Health Inc Medicare |
$1.31
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.87
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.87
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.43
|
|
|
NIFEDIPINE ER OSMOTIC RELEASE 90 MG PO TB24 [27660]
|
Facility
|
OP
|
$2.49
|
|
|
Service Code
|
NDC 50268059911
|
| Hospital Charge Code |
50268059911
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.87 |
| Max. Negotiated Rate |
$1.99 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.37
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.25
|
| Rate for Payer: Aetna Government |
$1.25
|
| Rate for Payer: Brighton Health Commercial |
$1.87
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.99
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.70
|
| Rate for Payer: Group Health Inc Commercial |
$1.25
|
| Rate for Payer: Group Health Inc Medicare |
$0.87
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.62
|
|
|
NIFEDIPINE ER OSMOTIC RELEASE 90 MG PO TB24 [27660]
|
Facility
|
OP
|
$2.31
|
|
|
Service Code
|
NDC 24979000901
|
| Hospital Charge Code |
24979000901
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.81 |
| Max. Negotiated Rate |
$1.85 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.27
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.15
|
| Rate for Payer: Aetna Government |
$1.15
|
| Rate for Payer: Brighton Health Commercial |
$1.73
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.85
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.57
|
| Rate for Payer: Group Health Inc Commercial |
$1.15
|
| Rate for Payer: Group Health Inc Medicare |
$0.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.15
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.50
|
|
|
NIFEDIPINE ER OSMOTIC RELEASE 90 MG PO TB24 [27660]
|
Facility
|
OP
|
$1.04
|
|
|
Service Code
|
NDC 00904708206
|
| Hospital Charge Code |
00904708206
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$0.83 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.57
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.52
|
| Rate for Payer: Aetna Government |
$0.52
|
| Rate for Payer: Brighton Health Commercial |
$0.78
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.83
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.71
|
| Rate for Payer: Group Health Inc Commercial |
$0.52
|
| Rate for Payer: Group Health Inc Medicare |
$0.36
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.67
|
|
|
NI FT TP 102MM 4FLG 89MM 3-1/2
|
Facility
|
OP
|
$28.76
|
|
|
Service Code
|
HCPCS A4410
|
| Hospital Charge Code |
40005178
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.50 |
| Max. Negotiated Rate |
$23.01 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$15.82
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.50
|
| Rate for Payer: Aetna Government |
$5.50
|
| Rate for Payer: Brighton Health Commercial |
$21.57
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$23.01
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$19.56
|
| Rate for Payer: Group Health Inc Commercial |
$14.38
|
| Rate for Payer: Group Health Inc Medicare |
$10.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.38
|
|
|
NI HIOPTPCH UCLR SFTAP 57MM 2-1/4
|
Facility
|
OP
|
$28.46
|
|
|
Service Code
|
HCPCS A4412
|
| Hospital Charge Code |
40005164
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.64 |
| Max. Negotiated Rate |
$22.77 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$15.65
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.64
|
| Rate for Payer: Aetna Government |
$1.64
|
| Rate for Payer: Brighton Health Commercial |
$21.34
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$22.77
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$19.35
|
| Rate for Payer: Group Health Inc Commercial |
$14.23
|
| Rate for Payer: Group Health Inc Medicare |
$9.96
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.23
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.23
|
|
|
NI HIOPTPCH UCLR SFTAP 70MM 2-3/4
|
Facility
|
OP
|
$28.46
|
|
|
Service Code
|
HCPCS A4412
|
| Hospital Charge Code |
40005165
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.64 |
| Max. Negotiated Rate |
$22.77 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$15.65
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.64
|
| Rate for Payer: Aetna Government |
$1.64
|
| Rate for Payer: Brighton Health Commercial |
$21.34
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$22.77
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$19.35
|
| Rate for Payer: Group Health Inc Commercial |
$14.23
|
| Rate for Payer: Group Health Inc Medicare |
$9.96
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.23
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.23
|
|
|
NIMODIPINE 30 MG CAP
|
Facility
|
OP
|
$4.00
|
|
| Hospital Charge Code |
41651208
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.40 |
| Max. Negotiated Rate |
$3.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.20
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.00
|
| Rate for Payer: Aetna Government |
$2.00
|
| Rate for Payer: Brighton Health Commercial |
$3.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.72
|
| Rate for Payer: Group Health Inc Commercial |
$2.00
|
| Rate for Payer: Group Health Inc Medicare |
$1.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.60
|
|
|
NIMODIPINE 30 MG CAP
|
Facility
|
OP
|
$4.00
|
|
| Hospital Charge Code |
41641208
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.40 |
| Max. Negotiated Rate |
$3.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.20
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.00
|
| Rate for Payer: Aetna Government |
$2.00
|
| Rate for Payer: Brighton Health Commercial |
$3.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.72
|
| Rate for Payer: Group Health Inc Commercial |
$2.00
|
| Rate for Payer: Group Health Inc Medicare |
$1.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.60
|
|
|
NIMODIPINE 30 MG PO CAPS [10722]
|
Facility
|
OP
|
$19.23
|
|
|
Service Code
|
NDC 69452020913
|
| Hospital Charge Code |
69452020913
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.73 |
| Max. Negotiated Rate |
$15.39 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$10.58
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$9.62
|
| Rate for Payer: Aetna Government |
$9.62
|
| Rate for Payer: Brighton Health Commercial |
$14.42
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$15.39
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$13.08
|
| Rate for Payer: Group Health Inc Commercial |
$9.62
|
| Rate for Payer: Group Health Inc Medicare |
$6.73
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12.50
|
|
|
NIMODIPINE 30 MG PO CAPS [10722]
|
Facility
|
OP
|
$18.41
|
|
|
Service Code
|
NDC 23155051200
|
| Hospital Charge Code |
23155051200
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.44 |
| Max. Negotiated Rate |
$14.73 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$10.13
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$9.20
|
| Rate for Payer: Aetna Government |
$9.20
|
| Rate for Payer: Brighton Health Commercial |
$13.81
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$14.73
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$12.52
|
| Rate for Payer: Group Health Inc Commercial |
$9.20
|
| Rate for Payer: Group Health Inc Medicare |
$6.44
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$11.97
|
|
|
NIMODIPINE 30 MG PO CAPS [10722]
|
Facility
|
OP
|
$18.41
|
|
|
Service Code
|
NDC 69452020920
|
| Hospital Charge Code |
69452020920
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.44 |
| Max. Negotiated Rate |
$14.73 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$10.13
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$9.20
|
| Rate for Payer: Aetna Government |
$9.20
|
| Rate for Payer: Brighton Health Commercial |
$13.81
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$14.73
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$12.52
|
| Rate for Payer: Group Health Inc Commercial |
$9.20
|
| Rate for Payer: Group Health Inc Medicare |
$6.44
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$11.97
|
|
|
NIMODIPINE 60 MG/20ML PO SOLN [122038]
|
Facility
|
OP
|
$3.35
|
|
|
Service Code
|
NDC 09999123441
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.17 |
| Max. Negotiated Rate |
$2.68 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.84
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.68
|
| Rate for Payer: Aetna Government |
$1.68
|
| Rate for Payer: Brighton Health Commercial |
$2.51
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.68
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.28
|
| Rate for Payer: Group Health Inc Commercial |
$1.68
|
| Rate for Payer: Group Health Inc Medicare |
$1.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.68
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.18
|
|
|
NIPPLE/AREOLA RECONSTRUCTION
|
Facility
|
IP
|
$9,720.15
|
|
|
Service Code
|
HCPCS 19350
|
| Hospital Charge Code |
30302528
|
|
Hospital Revenue Code
|
510
|
| Rate for Payer: Cash Price |
$4,407.98
|
|
|
NIPPLE/AREOLA RECONSTRUCTION
|
Facility
|
OP
|
$9,720.15
|
|
|
Service Code
|
HCPCS 19350
|
| Hospital Charge Code |
30302528
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$222.00 |
| Max. Negotiated Rate |
$4,860.08 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,485.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4,407.98
|
| Rate for Payer: Aetna Government |
$4,407.98
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$3,085.59
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$3,085.59
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$3,085.59
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$4,407.98
|
| Rate for Payer: Cash Price |
$4,407.98
|
| Rate for Payer: Cash Price |
$4,407.98
|
| Rate for Payer: Cash Price |
$4,407.98
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$4,407.98
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$4,407.98
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,746.78
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,923.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$4,407.98
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,923.10
|
| Rate for Payer: Group Health Inc Commercial |
$250.00
|
| Rate for Payer: Group Health Inc Medicare |
$250.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,860.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,407.98
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,746.78
|
| Rate for Payer: Healthfirst QHP |
$4,407.98
|
| Rate for Payer: Humana Medicare |
$4,496.14
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$4,407.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4,407.98
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4,407.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4,407.98
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3,526.38
|
| Rate for Payer: Wellcare Medicare |
$4,187.58
|
|
|
NIPPLE EXPLORATION
|
Facility
|
OP
|
$9,175.75
|
|
|
Service Code
|
HCPCS 19110
|
| Hospital Charge Code |
40019932
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,468.00 |
| Max. Negotiated Rate |
$6,881.81 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4,407.98
|
| Rate for Payer: Aetna Government |
$4,407.98
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$3,085.59
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$3,085.59
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$3,085.59
|
| Rate for Payer: Brighton Health Commercial |
$6,881.81
|
| Rate for Payer: Cash Price |
$4,407.98
|
| Rate for Payer: Cash Price |
$4,407.98
|
| Rate for Payer: Cash Price |
$4,407.98
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$4,407.98
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$4,407.98
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,746.78
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,923.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$4,407.98
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,923.10
|
| Rate for Payer: Group Health Inc Commercial |
$4,407.98
|
| Rate for Payer: Group Health Inc Medicare |
$4,407.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,587.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,407.98
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,746.78
|
| Rate for Payer: Healthfirst QHP |
$4,407.98
|
| Rate for Payer: Humana Medicare |
$4,496.14
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4,407.98
|
| Rate for Payer: United Healthcare Commercial |
$1,468.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4,407.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4,407.98
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3,526.38
|
| Rate for Payer: Wellcare Medicare |
$4,187.58
|
|
|
NIPPLE EXPLORATION
|
Facility
|
IP
|
$9,175.75
|
|
|
Service Code
|
HCPCS 19110
|
| Hospital Charge Code |
40019932
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$4,407.98
|
|
|
NIPPLE NEWBORN ORTHO.
|
Facility
|
OP
|
$0.32
|
|
| Hospital Charge Code |
64902360
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.26 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.18
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.16
|
| Rate for Payer: Aetna Government |
$0.16
|
| Rate for Payer: Brighton Health Commercial |
$0.24
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.26
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.22
|
| Rate for Payer: Group Health Inc Commercial |
$0.16
|
| Rate for Payer: Group Health Inc Medicare |
$0.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.16
|
|
