|
Craniotomy for trauma
|
Facility
|
IP
|
$71,683.43
|
|
|
Service Code
|
APR-DRG 0202
|
| Min. Negotiated Rate |
$26,448.00 |
| Max. Negotiated Rate |
$71,683.43 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$71,683.43
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$71,683.43
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$31,859.30
|
| Rate for Payer: Amida Care Medicaid |
$31,859.30
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$71,683.43
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$31,859.30
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$31,859.30
|
| Rate for Payer: Fidelis Qualified Health Plan |
$38,231.16
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$31,859.30
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$31,859.30
|
| Rate for Payer: Healthfirst Commercial |
$42,479.00
|
| Rate for Payer: Healthfirst Essential Plan |
$71,683.43
|
| Rate for Payer: Healthfirst QHP |
$26,448.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$31,859.30
|
| Rate for Payer: SOMOS Essential |
$71,683.43
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$71,683.43
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$71,683.43
|
| Rate for Payer: United Healthcare Medicaid |
$31,859.30
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$31,859.30
|
|
|
Craniotomy for trauma
|
Facility
|
IP
|
$94,318.49
|
|
|
Service Code
|
APR-DRG 0203
|
| Min. Negotiated Rate |
$41,919.33 |
| Max. Negotiated Rate |
$94,318.49 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$94,318.49
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$94,318.49
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$41,919.33
|
| Rate for Payer: Amida Care Medicaid |
$41,919.33
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$94,318.49
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$41,919.33
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$41,919.33
|
| Rate for Payer: Fidelis Qualified Health Plan |
$50,303.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$41,919.33
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$41,919.33
|
| Rate for Payer: Healthfirst Commercial |
$66,695.00
|
| Rate for Payer: Healthfirst Essential Plan |
$94,318.49
|
| Rate for Payer: Healthfirst QHP |
$43,250.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$41,919.33
|
| Rate for Payer: SOMOS Essential |
$94,318.49
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$94,318.49
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$94,318.49
|
| Rate for Payer: United Healthcare Medicaid |
$41,919.33
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$41,919.33
|
|
|
Craniotomy for trauma
|
Facility
|
IP
|
$149,676.80
|
|
|
Service Code
|
APR-DRG 0204
|
| Min. Negotiated Rate |
$66,523.02 |
| Max. Negotiated Rate |
$149,676.80 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$149,676.80
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$149,676.80
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$66,523.02
|
| Rate for Payer: Amida Care Medicaid |
$66,523.02
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$149,676.80
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$66,523.02
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$66,523.02
|
| Rate for Payer: Fidelis Qualified Health Plan |
$79,827.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$66,523.02
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$66,523.02
|
| Rate for Payer: Healthfirst Commercial |
$117,809.00
|
| Rate for Payer: Healthfirst Essential Plan |
$149,676.80
|
| Rate for Payer: Healthfirst QHP |
$74,119.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$66,523.02
|
| Rate for Payer: SOMOS Essential |
$149,676.80
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$149,676.80
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$149,676.80
|
| Rate for Payer: United Healthcare Medicaid |
$66,523.02
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$66,523.02
|
|
|
Craniotomy for trauma
|
Facility
|
IP
|
$63,420.84
|
|
|
Service Code
|
APR-DRG 0201
|
| Min. Negotiated Rate |
$21,375.00 |
| Max. Negotiated Rate |
$63,420.84 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$63,420.84
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$63,420.84
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$28,187.04
|
| Rate for Payer: Amida Care Medicaid |
$28,187.04
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$63,420.84
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$28,187.04
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$28,187.04
|
| Rate for Payer: Fidelis Qualified Health Plan |
$33,824.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$28,187.04
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$28,187.04
|
| Rate for Payer: Healthfirst Commercial |
$34,643.00
|
| Rate for Payer: Healthfirst Essential Plan |
$63,420.84
|
| Rate for Payer: Healthfirst QHP |
$21,375.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$28,187.04
|
| Rate for Payer: SOMOS Essential |
$63,420.84
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$63,420.84
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$63,420.84
|
| Rate for Payer: United Healthcare Medicaid |
$28,187.04
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$28,187.04
|
|
|
CRISIS INTERVENTION
|
Facility
|
OP
|
$263.83
|
|
|
Service Code
|
EAPG 00321
|
| Min. Negotiated Rate |
$192.09 |
| Max. Negotiated Rate |
$263.83 |
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$192.09
|
| Rate for Payer: Healthfirst Commercial |
$263.83
|
|
|
CRIZANLIZUMAB-TMCA 100 MG/10ML IV SOLN
|
Facility
|
IP
|
$294.35
|
|
|
Service Code
|
HCPCS J0791
|
| Hospital Charge Code |
0078088361
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$147.18 |
| Max. Negotiated Rate |
$147.18 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$147.18
|
|
|
CRIZANLIZUMAB-TMCA 100 MG/10ML IV SOLN
|
Facility
|
OP
|
$294.35
|
|
|
Service Code
|
HCPCS J0791
|
| Hospital Charge Code |
0078088361
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$90.64 |
| Max. Negotiated Rate |
$235.48 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$161.89
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$129.48
|
| Rate for Payer: Aetna Government |
$129.48
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$90.64
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$90.64
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$90.64
|
| Rate for Payer: Brighton Health Commercial |
$220.76
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$129.48
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$235.48
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$200.16
|
| Rate for Payer: Elderplan Medicare Advantage |
$129.48
|
| Rate for Payer: EmblemHealth Commercial |
$129.48
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$116.53
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$110.06
|
| Rate for Payer: Fidelis Essential Plan QHP |
$115.24
|
| Rate for Payer: Fidelis Medicare Advantage |
$129.48
|
| Rate for Payer: Fidelis Qualified Health Plan |
$115.24
|
| Rate for Payer: Group Health Inc Commercial |
$129.48
|
| Rate for Payer: Group Health Inc Medicare |
$129.48
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$129.48
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$129.48
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$129.48
|
| Rate for Payer: Healthfirst Medicare Advantage |
$110.06
|
| Rate for Payer: Healthfirst QHP |
$129.48
|
| Rate for Payer: Humana Medicare |
$132.07
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$129.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$129.48
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$191.33
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$123.01
|
| Rate for Payer: Wellcare Medicare |
$123.01
|
|
|
CT GUIDANCE
|
Facility
|
OP
|
$339.25
|
|
|
Service Code
|
EAPG 00473
|
| Min. Negotiated Rate |
$245.32 |
| Max. Negotiated Rate |
$339.25 |
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$245.32
|
| Rate for Payer: Healthfirst Commercial |
$339.25
|
|
|
CVA AND PRECEREBRAL OCCLUSION W INFARCT
|
Facility
|
OP
|
$217.21
|
|
|
Service Code
|
EAPG 00535
|
| Min. Negotiated Rate |
$157.37 |
| Max. Negotiated Rate |
$217.21 |
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$157.37
|
| Rate for Payer: Healthfirst Commercial |
$217.21
|
|
|
CVA & precerebral occlusion w infarct
|
Facility
|
IP
|
$46,039.16
|
|
|
Service Code
|
APR-DRG 0451
|
| Min. Negotiated Rate |
$8,961.00 |
| Max. Negotiated Rate |
$46,039.16 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$46,039.16
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$46,039.16
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$20,461.85
|
| Rate for Payer: Amida Care Medicaid |
$20,461.85
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$46,039.16
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$20,461.85
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$20,461.85
|
| Rate for Payer: Fidelis Qualified Health Plan |
$24,554.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$20,461.85
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$20,461.85
|
| Rate for Payer: Healthfirst Commercial |
$14,357.00
|
| Rate for Payer: Healthfirst Essential Plan |
$46,039.16
|
| Rate for Payer: Healthfirst QHP |
$8,961.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$20,461.85
|
| Rate for Payer: SOMOS Essential |
$46,039.16
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$46,039.16
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$46,039.16
|
| Rate for Payer: United Healthcare Medicaid |
$20,461.85
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$20,461.85
|
|
|
CVA & precerebral occlusion w infarct
|
Facility
|
IP
|
$92,169.32
|
|
|
Service Code
|
APR-DRG 0454
|
| Min. Negotiated Rate |
$33,987.00 |
| Max. Negotiated Rate |
$92,169.32 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$92,169.32
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$92,169.32
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$40,964.14
|
| Rate for Payer: Amida Care Medicaid |
$40,964.14
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$92,169.32
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$40,964.14
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$40,964.14
|
| Rate for Payer: Fidelis Qualified Health Plan |
$49,156.97
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$40,964.14
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$40,964.14
|
| Rate for Payer: Healthfirst Commercial |
$54,910.00
|
| Rate for Payer: Healthfirst Essential Plan |
$92,169.32
|
| Rate for Payer: Healthfirst QHP |
$33,987.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$40,964.14
|
| Rate for Payer: SOMOS Essential |
$92,169.32
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$92,169.32
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$92,169.32
|
| Rate for Payer: United Healthcare Medicaid |
$40,964.14
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$40,964.14
|
|
|
CVA & precerebral occlusion w infarct
|
Facility
|
IP
|
$51,561.61
|
|
|
Service Code
|
APR-DRG 0452
|
| Min. Negotiated Rate |
$10,999.00 |
| Max. Negotiated Rate |
$51,561.61 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$51,561.61
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$51,561.61
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$22,916.27
|
| Rate for Payer: Amida Care Medicaid |
$22,916.27
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$51,561.61
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$22,916.27
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$22,916.27
|
| Rate for Payer: Fidelis Qualified Health Plan |
$27,499.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$22,916.27
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$22,916.27
|
| Rate for Payer: Healthfirst Commercial |
$18,664.00
|
| Rate for Payer: Healthfirst Essential Plan |
$51,561.61
|
| Rate for Payer: Healthfirst QHP |
$10,999.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$22,916.27
|
| Rate for Payer: SOMOS Essential |
$51,561.61
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$51,561.61
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$51,561.61
|
| Rate for Payer: United Healthcare Medicaid |
$22,916.27
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$22,916.27
|
|
|
CVA & precerebral occlusion w infarct
|
Facility
|
IP
|
$62,289.97
|
|
|
Service Code
|
APR-DRG 0453
|
| Min. Negotiated Rate |
$16,333.00 |
| Max. Negotiated Rate |
$62,289.97 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$62,289.97
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$62,289.97
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$27,684.43
|
| Rate for Payer: Amida Care Medicaid |
$27,684.43
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$62,289.97
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$27,684.43
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$27,684.43
|
| Rate for Payer: Fidelis Qualified Health Plan |
$33,221.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$27,684.43
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$27,684.43
|
| Rate for Payer: Healthfirst Commercial |
$28,308.00
|
| Rate for Payer: Healthfirst Essential Plan |
$62,289.97
|
| Rate for Payer: Healthfirst QHP |
$16,333.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$27,684.43
|
| Rate for Payer: SOMOS Essential |
$62,289.97
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$62,289.97
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$62,289.97
|
| Rate for Payer: United Healthcare Medicaid |
$27,684.43
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$27,684.43
|
|
|
CYANOCOBALAMIN 1000 MCG/ML IJ SOLN
|
Facility
|
IP
|
$8.74
|
|
|
Service Code
|
HCPCS J3420
|
| Hospital Charge Code |
0517003125
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.37 |
| Max. Negotiated Rate |
$4.37 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.37
|
|
|
CYANOCOBALAMIN 1000 MCG/ML IJ SOLN
|
Facility
|
OP
|
$2.14
|
|
|
Service Code
|
HCPCS J3420
|
| Hospital Charge Code |
7128830301
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.75 |
| Max. Negotiated Rate |
$2.12 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.18
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.12
|
| Rate for Payer: Aetna Government |
$2.12
|
| Rate for Payer: Brighton Health Commercial |
$1.60
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.71
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.46
|
| Rate for Payer: EmblemHealth Commercial |
$1.07
|
| Rate for Payer: Group Health Inc Commercial |
$1.07
|
| Rate for Payer: Group Health Inc Medicare |
$0.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.07
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.07
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.39
|
|
|
CYANOCOBALAMIN 1000 MCG/ML IJ SOLN
|
Facility
|
IP
|
$4.45
|
|
|
Service Code
|
HCPCS J3420
|
| Hospital Charge Code |
7006900501
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.23 |
| Max. Negotiated Rate |
$2.23 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.23
|
|
|
CYANOCOBALAMIN 1000 MCG/ML IJ SOLN
|
Facility
|
OP
|
$8.29
|
|
|
Service Code
|
HCPCS J3420
|
| Hospital Charge Code |
6332304401
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.01 |
| Max. Negotiated Rate |
$6.63 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.56
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.12
|
| Rate for Payer: Aetna Government |
$2.12
|
| Rate for Payer: Brighton Health Commercial |
$6.22
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.63
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.64
|
| Rate for Payer: EmblemHealth Commercial |
$4.15
|
| Rate for Payer: Group Health Inc Commercial |
$4.15
|
| Rate for Payer: Group Health Inc Medicare |
$2.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.15
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.15
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.39
|
|
|
CYANOCOBALAMIN 1000 MCG/ML IJ SOLN
|
Facility
|
IP
|
$2.14
|
|
|
Service Code
|
HCPCS J3420
|
| Hospital Charge Code |
7128830301
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.07 |
| Max. Negotiated Rate |
$1.07 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.07
|
|
|
CYANOCOBALAMIN 1000 MCG/ML IJ SOLN
|
Facility
|
IP
|
$8.29
|
|
|
Service Code
|
HCPCS J3420
|
| Hospital Charge Code |
6332304400
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.15 |
| Max. Negotiated Rate |
$4.15 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.15
|
|
|
CYANOCOBALAMIN 1000 MCG/ML IJ SOLN
|
Facility
|
OP
|
$4.45
|
|
|
Service Code
|
HCPCS J3420
|
| Hospital Charge Code |
7006900501
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.01 |
| Max. Negotiated Rate |
$3.56 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.12
|
| Rate for Payer: Aetna Government |
$2.12
|
| Rate for Payer: Brighton Health Commercial |
$3.34
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.56
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.03
|
| Rate for Payer: EmblemHealth Commercial |
$2.23
|
| Rate for Payer: Group Health Inc Commercial |
$2.23
|
| Rate for Payer: Group Health Inc Medicare |
$1.56
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.23
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.23
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.89
|
|
|
CYANOCOBALAMIN 1000 MCG/ML IJ SOLN
|
Facility
|
IP
|
$8.74
|
|
|
Service Code
|
HCPCS J3420
|
| Hospital Charge Code |
0517003101
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.37 |
| Max. Negotiated Rate |
$4.37 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.37
|
|
|
CYANOCOBALAMIN 1000 MCG/ML IJ SOLN
|
Facility
|
IP
|
$8.29
|
|
|
Service Code
|
HCPCS J3420
|
| Hospital Charge Code |
6332304401
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.15 |
| Max. Negotiated Rate |
$4.15 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.15
|
|
|
CYANOCOBALAMIN 1000 MCG/ML IJ SOLN
|
Facility
|
IP
|
$4.08
|
|
|
Service Code
|
HCPCS J3420
|
| Hospital Charge Code |
5515036425
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.04 |
| Max. Negotiated Rate |
$2.04 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.04
|
|
|
CYANOCOBALAMIN 1000 MCG/ML IJ SOLN
|
Facility
|
IP
|
$3.86
|
|
|
Service Code
|
HCPCS J3420
|
| Hospital Charge Code |
6968011225
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.93 |
| Max. Negotiated Rate |
$1.93 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.93
|
|
|
CYANOCOBALAMIN 1000 MCG/ML IJ SOLN
|
Facility
|
OP
|
$8.29
|
|
|
Service Code
|
HCPCS J3420
|
| Hospital Charge Code |
6332304400
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.01 |
| Max. Negotiated Rate |
$6.63 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.56
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.12
|
| Rate for Payer: Aetna Government |
$2.12
|
| Rate for Payer: Brighton Health Commercial |
$6.22
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.63
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.64
|
| Rate for Payer: EmblemHealth Commercial |
$4.15
|
| Rate for Payer: Group Health Inc Commercial |
$4.15
|
| Rate for Payer: Group Health Inc Medicare |
$2.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.15
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.15
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.39
|
|
