Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

FONDAPARINUX SODIUM 10 MG/0.8ML SC SOLN

Facility

OP

$108.94

Service Code	HCPCS J1652
Hospital Charge Code	5515023310
Hospital Revenue Code	250
Min. Negotiated Rate	$0.72
Max. Negotiated Rate	$87.15
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$59.92
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.43
Rate for Payer: Aetna Government	$1.43
Rate for Payer: Brighton Health Commercial	$81.70
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$87.15
Rate for Payer: Cigna LocalPlus Benefit Plan	$74.08
Rate for Payer: EmblemHealth Commercial	$54.47
Rate for Payer: Group Health Inc Commercial	$54.47
Rate for Payer: Group Health Inc Medicare	$38.13
Rate for Payer: Hamaspik Choice Inc Medicaid	$54.47
Rate for Payer: Hamaspik Choice Inc Medicare	$54.47
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.72
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$70.81

FONDAPARINUX SODIUM 10 MG/0.8ML SC SOLN

Facility

OP

$108.94

Service Code	HCPCS J1652
Hospital Charge Code	5515023300
Hospital Revenue Code	250
Min. Negotiated Rate	$0.72
Max. Negotiated Rate	$87.15
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$59.92
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.43
Rate for Payer: Aetna Government	$1.43
Rate for Payer: Brighton Health Commercial	$81.70
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$87.15
Rate for Payer: Cigna LocalPlus Benefit Plan	$74.08
Rate for Payer: EmblemHealth Commercial	$54.47
Rate for Payer: Group Health Inc Commercial	$54.47
Rate for Payer: Group Health Inc Medicare	$38.13
Rate for Payer: Hamaspik Choice Inc Medicaid	$54.47
Rate for Payer: Hamaspik Choice Inc Medicare	$54.47
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.72
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$70.81

FONDAPARINUX SODIUM 10 MG/0.8ML SC SOLN

Facility

IP

$108.94

Service Code	HCPCS J1652
Hospital Charge Code	5515023310
Hospital Revenue Code	250
Min. Negotiated Rate	$54.47
Max. Negotiated Rate	$54.47
Rate for Payer: Hamaspik Choice Inc Medicaid	$54.47

FONDAPARINUX SODIUM 2.5 MG/0.5ML SC SOLN

Facility

IP

$109.30

Service Code	HCPCS J1652
Hospital Charge Code	5511167810
Hospital Revenue Code	250
Min. Negotiated Rate	$54.65
Max. Negotiated Rate	$54.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$54.65

FONDAPARINUX SODIUM 2.5 MG/0.5ML SC SOLN

Facility

IP

$72.00

Service Code	HCPCS J1652
Hospital Charge Code	5515023000
Hospital Revenue Code	250
Min. Negotiated Rate	$36.00
Max. Negotiated Rate	$36.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$36.00

FONDAPARINUX SODIUM 2.5 MG/0.5ML SC SOLN

Facility

IP

$115.40

Service Code	HCPCS J1652
Hospital Charge Code	5511167802
Hospital Revenue Code	250
Min. Negotiated Rate	$57.70
Max. Negotiated Rate	$57.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$57.70

FONDAPARINUX SODIUM 2.5 MG/0.5ML SC SOLN

Facility

OP

$115.40

Service Code	HCPCS J1652
Hospital Charge Code	5511167802
Hospital Revenue Code	250
Min. Negotiated Rate	$0.72
Max. Negotiated Rate	$92.32
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$63.47
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.43
Rate for Payer: Aetna Government	$1.43
Rate for Payer: Brighton Health Commercial	$86.55
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$92.32
Rate for Payer: Cigna LocalPlus Benefit Plan	$78.47
Rate for Payer: EmblemHealth Commercial	$57.70
Rate for Payer: Group Health Inc Commercial	$57.70
Rate for Payer: Group Health Inc Medicare	$40.39
Rate for Payer: Hamaspik Choice Inc Medicaid	$57.70
Rate for Payer: Hamaspik Choice Inc Medicare	$57.70
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.72
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$75.01

FONDAPARINUX SODIUM 2.5 MG/0.5ML SC SOLN

Facility

OP

$72.00

Service Code	HCPCS J1652
Hospital Charge Code	5515023010
Hospital Revenue Code	250
Min. Negotiated Rate	$0.72
Max. Negotiated Rate	$57.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$39.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.43
Rate for Payer: Aetna Government	$1.43
Rate for Payer: Brighton Health Commercial	$54.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$57.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$48.96
Rate for Payer: EmblemHealth Commercial	$36.00
Rate for Payer: Group Health Inc Commercial	$36.00
Rate for Payer: Group Health Inc Medicare	$25.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$36.00
Rate for Payer: Hamaspik Choice Inc Medicare	$36.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.72
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$46.80

FONDAPARINUX SODIUM 2.5 MG/0.5ML SC SOLN

Facility

OP

$109.30

Service Code	HCPCS J1652
Hospital Charge Code	5511167810
Hospital Revenue Code	250
Min. Negotiated Rate	$0.72
Max. Negotiated Rate	$87.44
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$60.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.43
Rate for Payer: Aetna Government	$1.43
Rate for Payer: Brighton Health Commercial	$81.98
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$87.44
Rate for Payer: Cigna LocalPlus Benefit Plan	$74.33
Rate for Payer: EmblemHealth Commercial	$54.65
Rate for Payer: Group Health Inc Commercial	$54.65
Rate for Payer: Group Health Inc Medicare	$38.26
Rate for Payer: Hamaspik Choice Inc Medicaid	$54.65
Rate for Payer: Hamaspik Choice Inc Medicare	$54.65
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.72
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$71.05

FONDAPARINUX SODIUM 2.5 MG/0.5ML SC SOLN

Facility

IP

$72.00

Service Code	HCPCS J1652
Hospital Charge Code	5515023010
Hospital Revenue Code	250
Min. Negotiated Rate	$36.00
Max. Negotiated Rate	$36.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$36.00

FONDAPARINUX SODIUM 2.5 MG/0.5ML SC SOLN

Facility

OP

$72.00

Service Code	HCPCS J1652
Hospital Charge Code	5515023000
Hospital Revenue Code	250
Min. Negotiated Rate	$0.72
Max. Negotiated Rate	$57.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$39.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.43
Rate for Payer: Aetna Government	$1.43
Rate for Payer: Brighton Health Commercial	$54.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$57.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$48.96
Rate for Payer: EmblemHealth Commercial	$36.00
Rate for Payer: Group Health Inc Commercial	$36.00
Rate for Payer: Group Health Inc Medicare	$25.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$36.00
Rate for Payer: Hamaspik Choice Inc Medicare	$36.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.72
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$46.80

FONDAPARINUX SODIUM 5 MG/0.4ML SC SOLN

Facility

OP

$321.53

Service Code	HCPCS J1652
Hospital Charge Code	5511167910
Hospital Revenue Code	250
Min. Negotiated Rate	$0.72
Max. Negotiated Rate	$257.22
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$176.84
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.43
Rate for Payer: Aetna Government	$1.43
Rate for Payer: Brighton Health Commercial	$241.14
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$257.22
Rate for Payer: Cigna LocalPlus Benefit Plan	$218.64
Rate for Payer: EmblemHealth Commercial	$160.76
Rate for Payer: Group Health Inc Commercial	$160.76
Rate for Payer: Group Health Inc Medicare	$112.53
Rate for Payer: Hamaspik Choice Inc Medicaid	$160.76
Rate for Payer: Hamaspik Choice Inc Medicare	$160.76
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.72
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$208.99

FONDAPARINUX SODIUM 5 MG/0.4ML SC SOLN

Facility

IP

$217.88

Service Code	HCPCS J1652
Hospital Charge Code	5515023110
Hospital Revenue Code	250
Min. Negotiated Rate	$108.94
Max. Negotiated Rate	$108.94
Rate for Payer: Hamaspik Choice Inc Medicaid	$108.94

FONDAPARINUX SODIUM 5 MG/0.4ML SC SOLN

Facility

OP

$217.88

Service Code	HCPCS J1652
Hospital Charge Code	5515023100
Hospital Revenue Code	250
Min. Negotiated Rate	$0.72
Max. Negotiated Rate	$174.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$119.83
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.43
Rate for Payer: Aetna Government	$1.43
Rate for Payer: Brighton Health Commercial	$163.41
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$174.30
Rate for Payer: Cigna LocalPlus Benefit Plan	$148.16
Rate for Payer: EmblemHealth Commercial	$108.94
Rate for Payer: Group Health Inc Commercial	$108.94
Rate for Payer: Group Health Inc Medicare	$76.26
Rate for Payer: Hamaspik Choice Inc Medicaid	$108.94
Rate for Payer: Hamaspik Choice Inc Medicare	$108.94
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.72
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$141.62

FONDAPARINUX SODIUM 5 MG/0.4ML SC SOLN

Facility

IP

$217.88

Service Code	HCPCS J1652
Hospital Charge Code	5515023100
Hospital Revenue Code	250
Min. Negotiated Rate	$108.94
Max. Negotiated Rate	$108.94
Rate for Payer: Hamaspik Choice Inc Medicaid	$108.94

FONDAPARINUX SODIUM 5 MG/0.4ML SC SOLN

Facility

OP

$217.88

Service Code	HCPCS J1652
Hospital Charge Code	5515023110
Hospital Revenue Code	250
Min. Negotiated Rate	$0.72
Max. Negotiated Rate	$174.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$119.83
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.43
Rate for Payer: Aetna Government	$1.43
Rate for Payer: Brighton Health Commercial	$163.41
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$174.30
Rate for Payer: Cigna LocalPlus Benefit Plan	$148.16
Rate for Payer: EmblemHealth Commercial	$108.94
Rate for Payer: Group Health Inc Commercial	$108.94
Rate for Payer: Group Health Inc Medicare	$76.26
Rate for Payer: Hamaspik Choice Inc Medicaid	$108.94
Rate for Payer: Hamaspik Choice Inc Medicare	$108.94
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.72
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$141.62

FONDAPARINUX SODIUM 5 MG/0.4ML SC SOLN

Facility

IP

$321.53

Service Code	HCPCS J1652
Hospital Charge Code	5511167910
Hospital Revenue Code	250
Min. Negotiated Rate	$160.76
Max. Negotiated Rate	$160.76
Rate for Payer: Hamaspik Choice Inc Medicaid	$160.76

FONDAPARINUX SODIUM 7.5 MG/0.6ML SC SOLN

Facility

IP

$145.00

Service Code	HCPCS J1652
Hospital Charge Code	5515023210
Hospital Revenue Code	250
Min. Negotiated Rate	$72.50
Max. Negotiated Rate	$72.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$72.50

FONDAPARINUX SODIUM 7.5 MG/0.6ML SC SOLN

Facility

OP

$145.00

Service Code	HCPCS J1652
Hospital Charge Code	5515023200
Hospital Revenue Code	250
Min. Negotiated Rate	$0.72
Max. Negotiated Rate	$116.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$79.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.43
Rate for Payer: Aetna Government	$1.43
Rate for Payer: Brighton Health Commercial	$108.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$116.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$98.60
Rate for Payer: EmblemHealth Commercial	$72.50
Rate for Payer: Group Health Inc Commercial	$72.50
Rate for Payer: Group Health Inc Medicare	$50.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$72.50
Rate for Payer: Hamaspik Choice Inc Medicare	$72.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.72
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$94.25

FONDAPARINUX SODIUM 7.5 MG/0.6ML SC SOLN

Facility

OP

$145.00

Service Code	HCPCS J1652
Hospital Charge Code	5515023210
Hospital Revenue Code	250
Min. Negotiated Rate	$0.72
Max. Negotiated Rate	$116.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$79.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.43
Rate for Payer: Aetna Government	$1.43
Rate for Payer: Brighton Health Commercial	$108.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$116.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$98.60
Rate for Payer: EmblemHealth Commercial	$72.50
Rate for Payer: Group Health Inc Commercial	$72.50
Rate for Payer: Group Health Inc Medicare	$50.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$72.50
Rate for Payer: Hamaspik Choice Inc Medicare	$72.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.72
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$94.25

FONDAPARINUX SODIUM 7.5 MG/0.6ML SC SOLN

Facility

IP

$145.00

Service Code	HCPCS J1652
Hospital Charge Code	5515023200
Hospital Revenue Code	250
Min. Negotiated Rate	$72.50
Max. Negotiated Rate	$72.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$72.50

Foot & toe procedures

Facility

IP

$99,640.46

Service Code	APR-DRG 3144
Min. Negotiated Rate	$35,406.00
Max. Negotiated Rate	$99,640.46
Rate for Payer: Affinity Essential Plan 1&2	$99,640.46
Rate for Payer: Affinity Essential Plan 3&4	$99,640.46
Rate for Payer: Affinity Medicaid/CHP/HARP	$44,284.65
Rate for Payer: Amida Care Medicaid	$44,284.65
Rate for Payer: EmblemHealth Essential Plan 1&2	$99,640.46
Rate for Payer: EmblemHealth Essential Plan 3&4	$44,284.65
Rate for Payer: Fidelis CHP/HARP/Medicaid	$44,284.65
Rate for Payer: Fidelis Qualified Health Plan	$53,141.58
Rate for Payer: Hamaspik Choice Inc Medicaid	$44,284.65
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$44,284.65
Rate for Payer: Healthfirst Commercial	$70,274.00
Rate for Payer: Healthfirst Essential Plan	$99,640.46
Rate for Payer: Healthfirst QHP	$35,406.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$44,284.65
Rate for Payer: SOMOS Essential	$99,640.46
Rate for Payer: United Healthcare Essential Plan 1&2	$99,640.46
Rate for Payer: United Healthcare Essential Plan 3&4	$99,640.46
Rate for Payer: United Healthcare Medicaid	$44,284.65
Rate for Payer: Wellcare CHP/FHP/Medicaid	$44,284.65

Foot & toe procedures

Facility

IP

$67,764.94

Service Code	APR-DRG 3143
Min. Negotiated Rate	$18,873.00
Max. Negotiated Rate	$67,764.94
Rate for Payer: Affinity Essential Plan 1&2	$67,764.94
Rate for Payer: Affinity Essential Plan 3&4	$67,764.94
Rate for Payer: Affinity Medicaid/CHP/HARP	$30,117.75
Rate for Payer: Amida Care Medicaid	$30,117.75
Rate for Payer: EmblemHealth Essential Plan 1&2	$67,764.94
Rate for Payer: EmblemHealth Essential Plan 3&4	$30,117.75
Rate for Payer: Fidelis CHP/HARP/Medicaid	$30,117.75
Rate for Payer: Fidelis Qualified Health Plan	$36,141.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$30,117.75
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$30,117.75
Rate for Payer: Healthfirst Commercial	$33,308.00
Rate for Payer: Healthfirst Essential Plan	$67,764.94
Rate for Payer: Healthfirst QHP	$18,873.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$30,117.75
Rate for Payer: SOMOS Essential	$67,764.94
Rate for Payer: United Healthcare Essential Plan 1&2	$67,764.94
Rate for Payer: United Healthcare Essential Plan 3&4	$67,764.94
Rate for Payer: United Healthcare Medicaid	$30,117.75
Rate for Payer: Wellcare CHP/FHP/Medicaid	$30,117.75

Foot & toe procedures

Facility

IP

$50,631.23

Service Code	APR-DRG 3141
Min. Negotiated Rate	$10,515.00
Max. Negotiated Rate	$50,631.23
Rate for Payer: Affinity Essential Plan 1&2	$50,631.23
Rate for Payer: Affinity Essential Plan 3&4	$50,631.23
Rate for Payer: Affinity Medicaid/CHP/HARP	$22,502.77
Rate for Payer: Amida Care Medicaid	$22,502.77
Rate for Payer: EmblemHealth Essential Plan 1&2	$50,631.23
Rate for Payer: EmblemHealth Essential Plan 3&4	$22,502.77
Rate for Payer: Fidelis CHP/HARP/Medicaid	$22,502.77
Rate for Payer: Fidelis Qualified Health Plan	$27,003.32
Rate for Payer: Hamaspik Choice Inc Medicaid	$22,502.77
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$22,502.77
Rate for Payer: Healthfirst Commercial	$18,348.00
Rate for Payer: Healthfirst Essential Plan	$50,631.23
Rate for Payer: Healthfirst QHP	$10,515.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$22,502.77
Rate for Payer: SOMOS Essential	$50,631.23
Rate for Payer: United Healthcare Essential Plan 1&2	$50,631.23
Rate for Payer: United Healthcare Essential Plan 3&4	$50,631.23
Rate for Payer: United Healthcare Medicaid	$22,502.77
Rate for Payer: Wellcare CHP/FHP/Medicaid	$22,502.77

Foot & toe procedures

Facility

IP

$55,835.37

Service Code	APR-DRG 3142
Min. Negotiated Rate	$13,062.00
Max. Negotiated Rate	$55,835.37
Rate for Payer: Affinity Essential Plan 1&2	$55,835.37
Rate for Payer: Affinity Essential Plan 3&4	$55,835.37
Rate for Payer: Affinity Medicaid/CHP/HARP	$24,815.72
Rate for Payer: Amida Care Medicaid	$24,815.72
Rate for Payer: EmblemHealth Essential Plan 1&2	$55,835.37
Rate for Payer: EmblemHealth Essential Plan 3&4	$24,815.72
Rate for Payer: Fidelis CHP/HARP/Medicaid	$24,815.72
Rate for Payer: Fidelis Qualified Health Plan	$29,778.86
Rate for Payer: Hamaspik Choice Inc Medicaid	$24,815.72
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$24,815.72
Rate for Payer: Healthfirst Commercial	$23,317.00
Rate for Payer: Healthfirst Essential Plan	$55,835.37
Rate for Payer: Healthfirst QHP	$13,062.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$24,815.72
Rate for Payer: SOMOS Essential	$55,835.37
Rate for Payer: United Healthcare Essential Plan 1&2	$55,835.37
Rate for Payer: United Healthcare Essential Plan 3&4	$55,835.37
Rate for Payer: United Healthcare Medicaid	$24,815.72
Rate for Payer: Wellcare CHP/FHP/Medicaid	$24,815.72

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