|
DIGOXIN 125 MCG PO TABS
|
Facility
|
IP
|
$1.69
|
|
|
Service Code
|
NDC 0904592161
|
| Hospital Charge Code |
0904592161
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.84 |
| Max. Negotiated Rate |
$0.84 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.84
|
|
|
DIGOXIN 125 MCG PO TABS
|
Facility
|
OP
|
$2.30
|
|
|
Service Code
|
NDC 0143124001
|
| Hospital Charge Code |
0143124001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.81 |
| Max. Negotiated Rate |
$1.84 |
| 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 |
$1.73
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.84
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.56
|
| Rate for Payer: EmblemHealth Commercial |
$1.15
|
| 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
|
|
|
DIGOXIN 125 MCG PO TABS
|
Facility
|
OP
|
$1.69
|
|
|
Service Code
|
NDC 0904592161
|
| Hospital Charge Code |
0904592161
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$1.35 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.93
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.84
|
| Rate for Payer: Aetna Government |
$0.84
|
| Rate for Payer: Brighton Health Commercial |
$1.26
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.35
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.15
|
| Rate for Payer: EmblemHealth Commercial |
$0.84
|
| Rate for Payer: Group Health Inc Commercial |
$0.84
|
| Rate for Payer: Group Health Inc Medicare |
$0.59
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.84
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.10
|
|
|
DIGOXIN 250 MCG PO TABS
|
Facility
|
IP
|
$2.30
|
|
|
Service Code
|
NDC 0143124101
|
| Hospital Charge Code |
0143124101
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.15 |
| Max. Negotiated Rate |
$1.15 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.15
|
|
|
DIGOXIN 250 MCG PO TABS
|
Facility
|
OP
|
$1.69
|
|
|
Service Code
|
NDC 0904592261
|
| Hospital Charge Code |
0904592261
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$1.35 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.93
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.84
|
| Rate for Payer: Aetna Government |
$0.84
|
| Rate for Payer: Brighton Health Commercial |
$1.26
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.35
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.15
|
| Rate for Payer: EmblemHealth Commercial |
$0.84
|
| Rate for Payer: Group Health Inc Commercial |
$0.84
|
| Rate for Payer: Group Health Inc Medicare |
$0.59
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.84
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.10
|
|
|
DIGOXIN 250 MCG PO TABS
|
Facility
|
OP
|
$2.30
|
|
|
Service Code
|
NDC 0143124101
|
| Hospital Charge Code |
0143124101
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.81 |
| Max. Negotiated Rate |
$1.84 |
| 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 |
$1.73
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.84
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.56
|
| Rate for Payer: EmblemHealth Commercial |
$1.15
|
| 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
|
|
|
DIGOXIN 250 MCG PO TABS
|
Facility
|
IP
|
$1.69
|
|
|
Service Code
|
NDC 0904592261
|
| Hospital Charge Code |
0904592261
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.84 |
| Max. Negotiated Rate |
$0.84 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.84
|
|
|
DIGOXIN IMMUNE FAB 40 MG IV SOLR
|
Facility
|
OP
|
$5.00
|
|
|
Service Code
|
HCPCS J1162
|
| Hospital Charge Code |
5063312011
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$2.75 |
| Max. Negotiated Rate |
$5,271.59 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5,168.23
|
| Rate for Payer: Aetna Government |
$5,168.23
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$3,617.76
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$3,617.76
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$3,617.76
|
| Rate for Payer: Brighton Health Commercial |
$3.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$5,168.23
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.40
|
| Rate for Payer: Elderplan Medicare Advantage |
$5,168.23
|
| Rate for Payer: EmblemHealth Commercial |
$5,168.23
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$4,651.41
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4,393.00
|
| Rate for Payer: Fidelis Essential Plan QHP |
$4,599.72
|
| Rate for Payer: Fidelis Medicare Advantage |
$5,168.23
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4,599.72
|
| Rate for Payer: Group Health Inc Commercial |
$5,168.23
|
| Rate for Payer: Group Health Inc Medicare |
$5,168.23
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5,168.23
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5,168.23
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$5,168.23
|
| Rate for Payer: Healthfirst Medicare Advantage |
$4,393.00
|
| Rate for Payer: Healthfirst QHP |
$5,168.23
|
| Rate for Payer: Humana Medicare |
$5,271.59
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$5,168.23
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,168.23
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.25
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$4,909.82
|
| Rate for Payer: Wellcare Medicare |
$4,909.82
|
|
|
DIGOXIN IMMUNE FAB 40 MG IV SOLR
|
Facility
|
IP
|
$5.00
|
|
|
Service Code
|
HCPCS J1162
|
| Hospital Charge Code |
5063312011
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$2.50 |
| Max. Negotiated Rate |
$2.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.50
|
|
|
Dilation & curettage for non-obstetric diagnoses
|
Facility
|
IP
|
$48,452.15
|
|
|
Service Code
|
APR-DRG 5172
|
| Min. Negotiated Rate |
$8,729.00 |
| Max. Negotiated Rate |
$48,452.15 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$48,452.15
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$48,452.15
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$21,534.29
|
| Rate for Payer: Amida Care Medicaid |
$21,534.29
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$48,452.15
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$21,534.29
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$21,534.29
|
| Rate for Payer: Fidelis Qualified Health Plan |
$25,841.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$21,534.29
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$21,534.29
|
| Rate for Payer: Healthfirst Commercial |
$14,874.00
|
| Rate for Payer: Healthfirst Essential Plan |
$48,452.15
|
| Rate for Payer: Healthfirst QHP |
$8,729.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$21,534.29
|
| Rate for Payer: SOMOS Essential |
$48,452.15
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$48,452.15
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$48,452.15
|
| Rate for Payer: United Healthcare Medicaid |
$21,534.29
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$21,534.29
|
|
|
Dilation & curettage for non-obstetric diagnoses
|
Facility
|
IP
|
$67,822.99
|
|
|
Service Code
|
APR-DRG 5173
|
| Min. Negotiated Rate |
$16,571.00 |
| Max. Negotiated Rate |
$67,822.99 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$67,822.99
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$67,822.99
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$30,143.55
|
| Rate for Payer: Amida Care Medicaid |
$30,143.55
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$67,822.99
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$30,143.55
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$30,143.55
|
| Rate for Payer: Fidelis Qualified Health Plan |
$36,172.26
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$30,143.55
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$30,143.55
|
| Rate for Payer: Healthfirst Commercial |
$29,470.00
|
| Rate for Payer: Healthfirst Essential Plan |
$67,822.99
|
| Rate for Payer: Healthfirst QHP |
$16,571.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$30,143.55
|
| Rate for Payer: SOMOS Essential |
$67,822.99
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$67,822.99
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$67,822.99
|
| Rate for Payer: United Healthcare Medicaid |
$30,143.55
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$30,143.55
|
|
|
Dilation & curettage for non-obstetric diagnoses
|
Facility
|
IP
|
$43,759.82
|
|
|
Service Code
|
APR-DRG 5171
|
| Min. Negotiated Rate |
$6,815.00 |
| Max. Negotiated Rate |
$43,759.82 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$43,759.82
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$43,759.82
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$19,448.81
|
| Rate for Payer: Amida Care Medicaid |
$19,448.81
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$43,759.82
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$19,448.81
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$19,448.81
|
| Rate for Payer: Fidelis Qualified Health Plan |
$23,338.57
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$19,448.81
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$19,448.81
|
| Rate for Payer: Healthfirst Commercial |
$11,619.00
|
| Rate for Payer: Healthfirst Essential Plan |
$43,759.82
|
| Rate for Payer: Healthfirst QHP |
$6,815.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$19,448.81
|
| Rate for Payer: SOMOS Essential |
$43,759.82
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$43,759.82
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$43,759.82
|
| Rate for Payer: United Healthcare Medicaid |
$19,448.81
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$19,448.81
|
|
|
Dilation & curettage for non-obstetric diagnoses
|
Facility
|
IP
|
$69,827.96
|
|
|
Service Code
|
APR-DRG 5174
|
| Min. Negotiated Rate |
$17,405.00 |
| Max. Negotiated Rate |
$69,827.96 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$69,827.96
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$69,827.96
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$31,034.65
|
| Rate for Payer: Amida Care Medicaid |
$31,034.65
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$69,827.96
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$31,034.65
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$31,034.65
|
| Rate for Payer: Fidelis Qualified Health Plan |
$37,241.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$31,034.65
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$31,034.65
|
| Rate for Payer: Healthfirst Commercial |
$31,244.00
|
| Rate for Payer: Healthfirst Essential Plan |
$69,827.96
|
| Rate for Payer: Healthfirst QHP |
$17,405.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$31,034.65
|
| Rate for Payer: SOMOS Essential |
$69,827.96
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$69,827.96
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$69,827.96
|
| Rate for Payer: United Healthcare Medicaid |
$31,034.65
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$31,034.65
|
|
|
DILTIAZEM HCL 125 MG/25ML IV SOLN
|
Facility
|
IP
|
$0.36
|
|
|
Service Code
|
NDC 2502131925
|
| Hospital Charge Code |
2502131925
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$0.18 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.18
|
|
|
DILTIAZEM HCL 125 MG/25ML IV SOLN
|
Facility
|
IP
|
$0.44
|
|
|
Service Code
|
NDC 0641601501
|
| Hospital Charge Code |
0641601501
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$0.22 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.22
|
|
|
DILTIAZEM HCL 125 MG/25ML IV SOLN
|
Facility
|
OP
|
$0.36
|
|
|
Service Code
|
NDC 2502131925
|
| Hospital Charge Code |
2502131925
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.29 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.20
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.18
|
| Rate for Payer: Aetna Government |
$0.18
|
| Rate for Payer: Brighton Health Commercial |
$0.27
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.29
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.25
|
| Rate for Payer: EmblemHealth Commercial |
$0.18
|
| Rate for Payer: Group Health Inc Commercial |
$0.18
|
| Rate for Payer: Group Health Inc Medicare |
$0.13
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.18
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.24
|
|
|
DILTIAZEM HCL 125 MG/25ML IV SOLN
|
Facility
|
OP
|
$0.47
|
|
|
Service Code
|
NDC 7086030125
|
| Hospital Charge Code |
7086030125
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$0.37 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.26
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.23
|
| Rate for Payer: Aetna Government |
$0.23
|
| Rate for Payer: Brighton Health Commercial |
$0.35
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.37
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.32
|
| Rate for Payer: EmblemHealth Commercial |
$0.23
|
| Rate for Payer: Group Health Inc Commercial |
$0.23
|
| Rate for Payer: Group Health Inc Medicare |
$0.16
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.23
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.23
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.30
|
|
|
DILTIAZEM HCL 125 MG/25ML IV SOLN
|
Facility
|
IP
|
$0.47
|
|
|
Service Code
|
NDC 7086030125
|
| Hospital Charge Code |
7086030125
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.23 |
| Max. Negotiated Rate |
$0.23 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.23
|
|
|
DILTIAZEM HCL 125 MG/25ML IV SOLN
|
Facility
|
OP
|
$0.44
|
|
|
Service Code
|
NDC 0641601510
|
| Hospital Charge Code |
0641601510
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$0.35 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.24
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.22
|
| Rate for Payer: Aetna Government |
$0.22
|
| Rate for Payer: Brighton Health Commercial |
$0.33
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.35
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.30
|
| Rate for Payer: EmblemHealth Commercial |
$0.22
|
| Rate for Payer: Group Health Inc Commercial |
$0.22
|
| Rate for Payer: Group Health Inc Medicare |
$0.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.28
|
|
|
DILTIAZEM HCL 125 MG/25ML IV SOLN
|
Facility
|
IP
|
$0.44
|
|
|
Service Code
|
NDC 0641601510
|
| Hospital Charge Code |
0641601510
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$0.22 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.22
|
|
|
DILTIAZEM HCL 125 MG/25ML IV SOLN
|
Facility
|
OP
|
$0.44
|
|
|
Service Code
|
NDC 0641601501
|
| Hospital Charge Code |
0641601501
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$0.35 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.24
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.22
|
| Rate for Payer: Aetna Government |
$0.22
|
| Rate for Payer: Brighton Health Commercial |
$0.33
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.35
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.30
|
| Rate for Payer: EmblemHealth Commercial |
$0.22
|
| Rate for Payer: Group Health Inc Commercial |
$0.22
|
| Rate for Payer: Group Health Inc Medicare |
$0.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.28
|
|
|
DILTIAZEM HCL 25 MG/5ML IV SOLN
|
Facility
|
OP
|
$0.78
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
7086030141
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.27 |
| Max. Negotiated Rate |
$0.62 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.43
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.39
|
| Rate for Payer: Aetna Government |
$0.39
|
| Rate for Payer: Brighton Health Commercial |
$0.59
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.62
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.53
|
| Rate for Payer: EmblemHealth Commercial |
$0.39
|
| Rate for Payer: Group Health Inc Commercial |
$0.39
|
| Rate for Payer: Group Health Inc Medicare |
$0.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.51
|
|
|
DILTIAZEM HCL 25 MG/5ML IV SOLN
|
Facility
|
OP
|
$0.37
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
2502131905
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.30 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.21
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.19
|
| Rate for Payer: Aetna Government |
$0.19
|
| Rate for Payer: Brighton Health Commercial |
$0.28
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.30
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.25
|
| Rate for Payer: EmblemHealth Commercial |
$0.19
|
| Rate for Payer: Group Health Inc Commercial |
$0.19
|
| Rate for Payer: Group Health Inc Medicare |
$0.13
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.19
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.24
|
|
|
DILTIAZEM HCL 25 MG/5ML IV SOLN
|
Facility
|
IP
|
$0.78
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
7086030141
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.39 |
| Max. Negotiated Rate |
$0.39 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.39
|
|
|
DILTIAZEM HCL 25 MG/5ML IV SOLN
|
Facility
|
OP
|
$0.91
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
5515042501
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$0.73 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.46
|
| Rate for Payer: Aetna Government |
$0.46
|
| Rate for Payer: Brighton Health Commercial |
$0.68
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.73
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.62
|
| Rate for Payer: EmblemHealth Commercial |
$0.46
|
| Rate for Payer: Group Health Inc Commercial |
$0.46
|
| Rate for Payer: Group Health Inc Medicare |
$0.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.46
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.59
|
|
