|
ENFAMIL PREMATURE IRON FORTIFIED (24 CAL) PO LIQD
|
Facility
|
IP
|
$0.03
|
|
|
Service Code
|
NDC 0087511574
|
| Hospital Charge Code |
0087511574
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.02 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.02
|
|
|
ENFAMIL PREMATURE PO LIQD
|
Facility
|
OP
|
$0.03
|
|
|
Service Code
|
NDC 0087511569
|
| Hospital Charge Code |
0087511569
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.02
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.02
|
| Rate for Payer: Aetna Government |
$0.02
|
| Rate for Payer: Brighton Health Commercial |
$0.02
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.03
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.02
|
| Rate for Payer: EmblemHealth Commercial |
$0.02
|
| Rate for Payer: Group Health Inc Commercial |
$0.02
|
| Rate for Payer: Group Health Inc Medicare |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.02
|
|
|
ENFAMIL PREMATURE PO LIQD
|
Facility
|
OP
|
$0.03
|
|
|
Service Code
|
NDC 0087511568
|
| Hospital Charge Code |
0087511568
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.02
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.02
|
| Rate for Payer: Aetna Government |
$0.02
|
| Rate for Payer: Brighton Health Commercial |
$0.02
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.03
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.02
|
| Rate for Payer: EmblemHealth Commercial |
$0.02
|
| Rate for Payer: Group Health Inc Commercial |
$0.02
|
| Rate for Payer: Group Health Inc Medicare |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.02
|
|
|
ENFAMIL PREMATURE PO LIQD
|
Facility
|
IP
|
$0.03
|
|
|
Service Code
|
NDC 0087511571
|
| Hospital Charge Code |
0087511571
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.02 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.02
|
|
|
ENFAMIL PREMATURE PO LIQD
|
Facility
|
IP
|
$0.03
|
|
|
Service Code
|
NDC 0087511568
|
| Hospital Charge Code |
0087511568
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.02 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.02
|
|
|
ENFAMIL PREMATURE PO LIQD
|
Facility
|
OP
|
$0.03
|
|
|
Service Code
|
NDC 0087511571
|
| Hospital Charge Code |
0087511571
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.02
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.02
|
| Rate for Payer: Aetna Government |
$0.02
|
| Rate for Payer: Brighton Health Commercial |
$0.02
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.03
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.02
|
| Rate for Payer: EmblemHealth Commercial |
$0.02
|
| Rate for Payer: Group Health Inc Commercial |
$0.02
|
| Rate for Payer: Group Health Inc Medicare |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.02
|
|
|
ENFAMIL PREMATURE PO LIQD
|
Facility
|
IP
|
$0.03
|
|
|
Service Code
|
NDC 0087511569
|
| Hospital Charge Code |
0087511569
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.02 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.02
|
|
|
ENFORTUMAB VEDOTIN-EJFV 20 MG IV SOLR
|
Facility
|
OP
|
$3.00
|
|
|
Service Code
|
HCPCS J9177
|
| Hospital Charge Code |
5114402001
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$1.65 |
| Max. Negotiated Rate |
$37.47 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.65
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$36.74
|
| Rate for Payer: Aetna Government |
$36.74
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$25.72
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$25.72
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$25.72
|
| Rate for Payer: Brighton Health Commercial |
$2.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$36.74
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.04
|
| Rate for Payer: Elderplan Medicare Advantage |
$36.74
|
| Rate for Payer: EmblemHealth Commercial |
$36.74
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$33.07
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$31.23
|
| Rate for Payer: Fidelis Essential Plan QHP |
$32.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$36.74
|
| Rate for Payer: Fidelis Qualified Health Plan |
$32.70
|
| Rate for Payer: Group Health Inc Commercial |
$36.74
|
| Rate for Payer: Group Health Inc Medicare |
$36.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$36.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$36.74
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$36.74
|
| Rate for Payer: Healthfirst Medicare Advantage |
$31.23
|
| Rate for Payer: Healthfirst QHP |
$36.74
|
| Rate for Payer: Humana Medicare |
$37.47
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$36.74
|
| Rate for Payer: United Healthcare Medicare Advantage |
$36.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.95
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$34.90
|
| Rate for Payer: Wellcare Medicare |
$34.90
|
|
|
ENFORTUMAB VEDOTIN-EJFV 20 MG IV SOLR
|
Facility
|
IP
|
$3.00
|
|
|
Service Code
|
HCPCS J9177
|
| Hospital Charge Code |
5114402001
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$1.50 |
| Max. Negotiated Rate |
$1.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.50
|
|
|
ENFORTUMAB VEDOTIN-EJFV 30 MG IV SOLR
|
Facility
|
IP
|
$5.00
|
|
|
Service Code
|
HCPCS J9177
|
| Hospital Charge Code |
5114403001
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$2.50 |
| Max. Negotiated Rate |
$2.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.50
|
|
|
ENFORTUMAB VEDOTIN-EJFV 30 MG IV SOLR
|
Facility
|
OP
|
$5.00
|
|
|
Service Code
|
HCPCS J9177
|
| Hospital Charge Code |
5114403001
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$2.75 |
| Max. Negotiated Rate |
$37.47 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$36.74
|
| Rate for Payer: Aetna Government |
$36.74
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$25.72
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$25.72
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$25.72
|
| Rate for Payer: Brighton Health Commercial |
$3.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$36.74
|
| 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 |
$36.74
|
| Rate for Payer: EmblemHealth Commercial |
$36.74
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$33.07
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$31.23
|
| Rate for Payer: Fidelis Essential Plan QHP |
$32.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$36.74
|
| Rate for Payer: Fidelis Qualified Health Plan |
$32.70
|
| Rate for Payer: Group Health Inc Commercial |
$36.74
|
| Rate for Payer: Group Health Inc Medicare |
$36.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$36.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$36.74
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$36.74
|
| Rate for Payer: Healthfirst Medicare Advantage |
$31.23
|
| Rate for Payer: Healthfirst QHP |
$36.74
|
| Rate for Payer: Humana Medicare |
$37.47
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$36.74
|
| Rate for Payer: United Healthcare Medicare Advantage |
$36.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.25
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$34.90
|
| Rate for Payer: Wellcare Medicare |
$34.90
|
|
|
ENOXAPARIN SODIUM 100 MG/ML IJ SOSY
|
Facility
|
IP
|
$27.94
|
|
|
Service Code
|
HCPCS J1650
|
| Hospital Charge Code |
7183911310
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.97 |
| Max. Negotiated Rate |
$13.97 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$13.97
|
|
|
ENOXAPARIN SODIUM 100 MG/ML IJ SOSY
|
Facility
|
IP
|
$29.80
|
|
|
Service Code
|
HCPCS J1650
|
| Hospital Charge Code |
0075062300
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.90 |
| Max. Negotiated Rate |
$14.90 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.90
|
|
|
ENOXAPARIN SODIUM 100 MG/ML IJ SOSY
|
Facility
|
OP
|
$27.94
|
|
|
Service Code
|
HCPCS J1650
|
| Hospital Charge Code |
7183911310
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$22.35 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$15.37
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.76
|
| Rate for Payer: Aetna Government |
$0.76
|
| Rate for Payer: Brighton Health Commercial |
$20.96
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$22.35
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$19.00
|
| Rate for Payer: EmblemHealth Commercial |
$13.97
|
| Rate for Payer: Group Health Inc Commercial |
$13.97
|
| Rate for Payer: Group Health Inc Medicare |
$9.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$13.97
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.97
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.59
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$18.16
|
|
|
ENOXAPARIN SODIUM 100 MG/ML IJ SOSY
|
Facility
|
OP
|
$29.80
|
|
|
Service Code
|
HCPCS J1650
|
| Hospital Charge Code |
0075062300
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$23.84 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$16.39
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.76
|
| Rate for Payer: Aetna Government |
$0.76
|
| Rate for Payer: Brighton Health Commercial |
$22.35
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$23.84
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$20.27
|
| Rate for Payer: EmblemHealth Commercial |
$14.90
|
| Rate for Payer: Group Health Inc Commercial |
$14.90
|
| Rate for Payer: Group Health Inc Medicare |
$10.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.90
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.59
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$19.37
|
|
|
ENOXAPARIN SODIUM 100 MG/ML IJ SOSY
|
Facility
|
IP
|
$25.64
|
|
|
Service Code
|
HCPCS J1650
|
| Hospital Charge Code |
0955101010
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.82 |
| Max. Negotiated Rate |
$12.82 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.82
|
|
|
ENOXAPARIN SODIUM 100 MG/ML IJ SOSY
|
Facility
|
OP
|
$25.64
|
|
|
Service Code
|
HCPCS J1650
|
| Hospital Charge Code |
0955101010
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$20.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$14.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.76
|
| Rate for Payer: Aetna Government |
$0.76
|
| Rate for Payer: Brighton Health Commercial |
$19.23
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$20.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$17.44
|
| Rate for Payer: EmblemHealth Commercial |
$12.82
|
| Rate for Payer: Group Health Inc Commercial |
$12.82
|
| Rate for Payer: Group Health Inc Medicare |
$8.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.82
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.59
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$16.67
|
|
|
ENOXAPARIN SODIUM 120 MG/0.8ML IJ SOSY
|
Facility
|
OP
|
$41.93
|
|
|
Service Code
|
HCPCS J1650
|
| Hospital Charge Code |
7183911510
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$33.54 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$23.06
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.76
|
| Rate for Payer: Aetna Government |
$0.76
|
| Rate for Payer: Brighton Health Commercial |
$31.44
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$33.54
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$28.51
|
| Rate for Payer: EmblemHealth Commercial |
$20.96
|
| Rate for Payer: Group Health Inc Commercial |
$20.96
|
| Rate for Payer: Group Health Inc Medicare |
$14.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$20.96
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$20.96
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.59
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$27.25
|
|
|
ENOXAPARIN SODIUM 120 MG/0.8ML IJ SOSY
|
Facility
|
IP
|
$41.93
|
|
|
Service Code
|
HCPCS J1650
|
| Hospital Charge Code |
7183911510
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$20.96 |
| Max. Negotiated Rate |
$20.96 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$20.96
|
|
|
ENOXAPARIN SODIUM 120 MG/0.8ML IJ SOSY
|
Facility
|
OP
|
$44.72
|
|
|
Service Code
|
HCPCS J1650
|
| Hospital Charge Code |
0075291201
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$35.78 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$24.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.76
|
| Rate for Payer: Aetna Government |
$0.76
|
| Rate for Payer: Brighton Health Commercial |
$33.54
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$35.78
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$30.41
|
| Rate for Payer: EmblemHealth Commercial |
$22.36
|
| Rate for Payer: Group Health Inc Commercial |
$22.36
|
| Rate for Payer: Group Health Inc Medicare |
$15.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$22.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$22.36
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.59
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$29.07
|
|
|
ENOXAPARIN SODIUM 120 MG/0.8ML IJ SOSY
|
Facility
|
IP
|
$44.72
|
|
|
Service Code
|
HCPCS J1650
|
| Hospital Charge Code |
0075291201
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$22.36 |
| Max. Negotiated Rate |
$22.36 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$22.36
|
|
|
ENOXAPARIN SODIUM 150 MG/ML IJ SOSY
|
Facility
|
IP
|
$38.46
|
|
|
Service Code
|
HCPCS J1650
|
| Hospital Charge Code |
0075802510
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$19.23 |
| Max. Negotiated Rate |
$19.23 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$19.23
|
|
|
ENOXAPARIN SODIUM 150 MG/ML IJ SOSY
|
Facility
|
OP
|
$44.72
|
|
|
Service Code
|
HCPCS J1650
|
| Hospital Charge Code |
0075291501
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$35.78 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$24.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.76
|
| Rate for Payer: Aetna Government |
$0.76
|
| Rate for Payer: Brighton Health Commercial |
$33.54
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$35.78
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$30.41
|
| Rate for Payer: EmblemHealth Commercial |
$22.36
|
| Rate for Payer: Group Health Inc Commercial |
$22.36
|
| Rate for Payer: Group Health Inc Medicare |
$15.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$22.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$22.36
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.59
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$29.07
|
|
|
ENOXAPARIN SODIUM 150 MG/ML IJ SOSY
|
Facility
|
IP
|
$44.72
|
|
|
Service Code
|
HCPCS J1650
|
| Hospital Charge Code |
0075291501
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$22.36 |
| Max. Negotiated Rate |
$22.36 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$22.36
|
|
|
ENOXAPARIN SODIUM 150 MG/ML IJ SOSY
|
Facility
|
OP
|
$38.46
|
|
|
Service Code
|
HCPCS J1650
|
| Hospital Charge Code |
0075802510
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$30.77 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$21.15
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.76
|
| Rate for Payer: Aetna Government |
$0.76
|
| Rate for Payer: Brighton Health Commercial |
$28.84
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$30.77
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$26.15
|
| Rate for Payer: EmblemHealth Commercial |
$19.23
|
| Rate for Payer: Group Health Inc Commercial |
$19.23
|
| Rate for Payer: Group Health Inc Medicare |
$13.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$19.23
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$19.23
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.59
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$25.00
|
|
