|
AMPICILLIN-SULBACTAM SODIUM 3 (2-1) G IJ SOLR
|
Facility
|
OP
|
$14.60
|
|
|
Service Code
|
HCPCS J0295
|
| Hospital Charge Code |
5515011720
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.39 |
| Max. Negotiated Rate |
$11.68 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$8.03
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.21
|
| Rate for Payer: Aetna Government |
$2.21
|
| Rate for Payer: Brighton Health Commercial |
$10.95
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$11.68
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$9.93
|
| Rate for Payer: EmblemHealth Commercial |
$7.30
|
| Rate for Payer: Group Health Inc Commercial |
$7.30
|
| Rate for Payer: Group Health Inc Medicare |
$5.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.30
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$9.49
|
|
|
AMPICILLIN-SULBACTAM SODIUM 3 (2-1) G IJ SOLR
|
Facility
|
IP
|
$14.60
|
|
|
Service Code
|
HCPCS J0295
|
| Hospital Charge Code |
5515011710
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.30 |
| Max. Negotiated Rate |
$7.30 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.30
|
|
|
AMPICILLIN-SULBACTAM SODIUM 3 (2-1) G IJ SOLR
|
Facility
|
IP
|
$14.60
|
|
|
Service Code
|
HCPCS J0295
|
| Hospital Charge Code |
5515011720
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.30 |
| Max. Negotiated Rate |
$7.30 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.30
|
|
|
AMPICILLIN-SULBACTAM SODIUM 3 (2-1) G IJ SOLR
|
Facility
|
OP
|
$19.14
|
|
|
Service Code
|
HCPCS J0295
|
| Hospital Charge Code |
4456721110
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.39 |
| Max. Negotiated Rate |
$15.31 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$10.53
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.21
|
| Rate for Payer: Aetna Government |
$2.21
|
| Rate for Payer: Brighton Health Commercial |
$14.36
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$15.31
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$13.02
|
| Rate for Payer: EmblemHealth Commercial |
$9.57
|
| Rate for Payer: Group Health Inc Commercial |
$9.57
|
| Rate for Payer: Group Health Inc Medicare |
$6.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.57
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9.57
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12.44
|
|
|
AMPICILLIN-SULBACTAM SODIUM 3 (2-1) G IJ SOLR
|
Facility
|
IP
|
$6.36
|
|
|
Service Code
|
HCPCS J0295
|
| Hospital Charge Code |
7248541701
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.18 |
| Max. Negotiated Rate |
$3.18 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.18
|
|
|
AMPICILLIN-SULBACTAM SODIUM 3 (2-1) G IJ SOLR
|
Facility
|
IP
|
$17.47
|
|
|
Service Code
|
HCPCS J0295
|
| Hospital Charge Code |
0049001483
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.74 |
| Max. Negotiated Rate |
$8.74 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.74
|
|
|
Amputation of lower limb except toes
|
Facility
|
IP
|
$142,849.33
|
|
|
Service Code
|
APR-DRG 3054
|
| Min. Negotiated Rate |
$61,247.00 |
| Max. Negotiated Rate |
$142,849.33 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$142,849.33
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$142,849.33
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$63,488.59
|
| Rate for Payer: Amida Care Medicaid |
$63,488.59
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$142,849.33
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$63,488.59
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$63,488.59
|
| Rate for Payer: Fidelis Qualified Health Plan |
$76,186.31
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$63,488.59
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$63,488.59
|
| Rate for Payer: Healthfirst Commercial |
$125,142.00
|
| Rate for Payer: Healthfirst Essential Plan |
$142,849.33
|
| Rate for Payer: Healthfirst QHP |
$61,247.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$63,488.59
|
| Rate for Payer: SOMOS Essential |
$142,849.33
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$142,849.33
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$142,849.33
|
| Rate for Payer: United Healthcare Medicaid |
$63,488.59
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$63,488.59
|
|
|
Amputation of lower limb except toes
|
Facility
|
IP
|
$65,733.59
|
|
|
Service Code
|
APR-DRG 3052
|
| Min. Negotiated Rate |
$21,769.00 |
| Max. Negotiated Rate |
$65,733.59 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$65,733.59
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$65,733.59
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$29,214.93
|
| Rate for Payer: Amida Care Medicaid |
$29,214.93
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$65,733.59
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$29,214.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$29,214.93
|
| Rate for Payer: Fidelis Qualified Health Plan |
$35,057.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$29,214.93
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$29,214.93
|
| Rate for Payer: Healthfirst Commercial |
$38,655.00
|
| Rate for Payer: Healthfirst Essential Plan |
$65,733.59
|
| Rate for Payer: Healthfirst QHP |
$21,769.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$29,214.93
|
| Rate for Payer: SOMOS Essential |
$65,733.59
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$65,733.59
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$65,733.59
|
| Rate for Payer: United Healthcare Medicaid |
$29,214.93
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$29,214.93
|
|
|
Amputation of lower limb except toes
|
Facility
|
IP
|
$55,956.71
|
|
|
Service Code
|
APR-DRG 3051
|
| Min. Negotiated Rate |
$15,487.00 |
| Max. Negotiated Rate |
$55,956.71 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$55,956.71
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$55,956.71
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$24,869.65
|
| Rate for Payer: Amida Care Medicaid |
$24,869.65
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$55,956.71
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$24,869.65
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$24,869.65
|
| Rate for Payer: Fidelis Qualified Health Plan |
$29,843.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$24,869.65
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$24,869.65
|
| Rate for Payer: Healthfirst Commercial |
$29,901.00
|
| Rate for Payer: Healthfirst Essential Plan |
$55,956.71
|
| Rate for Payer: Healthfirst QHP |
$15,487.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$24,869.65
|
| Rate for Payer: SOMOS Essential |
$55,956.71
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$55,956.71
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$55,956.71
|
| Rate for Payer: United Healthcare Medicaid |
$24,869.65
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$24,869.65
|
|
|
Amputation of lower limb except toes
|
Facility
|
IP
|
$91,495.71
|
|
|
Service Code
|
APR-DRG 3053
|
| Min. Negotiated Rate |
$33,121.00 |
| Max. Negotiated Rate |
$91,495.71 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$91,495.71
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$91,495.71
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$40,664.76
|
| Rate for Payer: Amida Care Medicaid |
$40,664.76
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$91,495.71
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$40,664.76
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$40,664.76
|
| Rate for Payer: Fidelis Qualified Health Plan |
$48,797.71
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$40,664.76
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$40,664.76
|
| Rate for Payer: Healthfirst Commercial |
$57,153.00
|
| Rate for Payer: Healthfirst Essential Plan |
$91,495.71
|
| Rate for Payer: Healthfirst QHP |
$33,121.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$40,664.76
|
| Rate for Payer: SOMOS Essential |
$91,495.71
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$91,495.71
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$91,495.71
|
| Rate for Payer: United Healthcare Medicaid |
$40,664.76
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$40,664.76
|
|
|
Anal procedures
|
Facility
|
IP
|
$95,839.81
|
|
|
Service Code
|
APR-DRG 2264
|
| Min. Negotiated Rate |
$17,265.00 |
| Max. Negotiated Rate |
$95,839.81 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$95,839.81
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$95,839.81
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$42,595.47
|
| Rate for Payer: Amida Care Medicaid |
$42,595.47
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$95,839.81
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$42,595.47
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$42,595.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$51,114.56
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$42,595.47
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$42,595.47
|
| Rate for Payer: Healthfirst Commercial |
$36,064.00
|
| Rate for Payer: Healthfirst Essential Plan |
$95,839.81
|
| Rate for Payer: Healthfirst QHP |
$17,265.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$42,595.47
|
| Rate for Payer: SOMOS Essential |
$95,839.81
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$95,839.81
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$95,839.81
|
| Rate for Payer: United Healthcare Medicaid |
$42,595.47
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$42,595.47
|
|
|
Anal procedures
|
Facility
|
IP
|
$58,369.72
|
|
|
Service Code
|
APR-DRG 2263
|
| Min. Negotiated Rate |
$16,652.00 |
| Max. Negotiated Rate |
$58,369.72 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$58,369.72
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$58,369.72
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$25,942.10
|
| Rate for Payer: Amida Care Medicaid |
$25,942.10
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$58,369.72
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$25,942.10
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$25,942.10
|
| Rate for Payer: Fidelis Qualified Health Plan |
$31,130.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$25,942.10
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$25,942.10
|
| Rate for Payer: Healthfirst Commercial |
$29,389.00
|
| Rate for Payer: Healthfirst Essential Plan |
$58,369.72
|
| Rate for Payer: Healthfirst QHP |
$16,652.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$25,942.10
|
| Rate for Payer: SOMOS Essential |
$58,369.72
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$58,369.72
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$58,369.72
|
| Rate for Payer: United Healthcare Medicaid |
$25,942.10
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$25,942.10
|
|
|
Anal procedures
|
Facility
|
IP
|
$42,901.54
|
|
|
Service Code
|
APR-DRG 2261
|
| Min. Negotiated Rate |
$7,058.00 |
| Max. Negotiated Rate |
$42,901.54 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$42,901.54
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$42,901.54
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$19,067.35
|
| Rate for Payer: Amida Care Medicaid |
$19,067.35
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$42,901.54
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$19,067.35
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$19,067.35
|
| Rate for Payer: Fidelis Qualified Health Plan |
$22,880.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$19,067.35
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$19,067.35
|
| Rate for Payer: Healthfirst Commercial |
$12,262.00
|
| Rate for Payer: Healthfirst Essential Plan |
$42,901.54
|
| Rate for Payer: Healthfirst QHP |
$7,058.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$19,067.35
|
| Rate for Payer: SOMOS Essential |
$42,901.54
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$42,901.54
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$42,901.54
|
| Rate for Payer: United Healthcare Medicaid |
$19,067.35
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$19,067.35
|
|
|
Anal procedures
|
Facility
|
IP
|
$47,546.39
|
|
|
Service Code
|
APR-DRG 2262
|
| Min. Negotiated Rate |
$9,020.00 |
| Max. Negotiated Rate |
$47,546.39 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$47,546.39
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$47,546.39
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$21,131.73
|
| Rate for Payer: Amida Care Medicaid |
$21,131.73
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$47,546.39
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$21,131.73
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$21,131.73
|
| Rate for Payer: Fidelis Qualified Health Plan |
$25,358.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$21,131.73
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$21,131.73
|
| Rate for Payer: Healthfirst Commercial |
$16,654.00
|
| Rate for Payer: Healthfirst Essential Plan |
$47,546.39
|
| Rate for Payer: Healthfirst QHP |
$9,020.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$21,131.73
|
| Rate for Payer: SOMOS Essential |
$47,546.39
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$47,546.39
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$47,546.39
|
| Rate for Payer: United Healthcare Medicaid |
$21,131.73
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$21,131.73
|
|
|
ANASTROZOLE 1 MG PO TABS
|
Facility
|
OP
|
$13.50
|
|
|
Service Code
|
NDC 0093753656
|
| Hospital Charge Code |
0093753656
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.72 |
| Max. Negotiated Rate |
$10.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.42
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.75
|
| Rate for Payer: Aetna Government |
$6.75
|
| Rate for Payer: Brighton Health Commercial |
$10.12
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$10.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$9.18
|
| Rate for Payer: EmblemHealth Commercial |
$6.75
|
| Rate for Payer: Group Health Inc Commercial |
$6.75
|
| Rate for Payer: Group Health Inc Medicare |
$4.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.75
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8.77
|
|
|
ANASTROZOLE 1 MG PO TABS
|
Facility
|
OP
|
$2.07
|
|
|
Service Code
|
NDC 6068711211
|
| Hospital Charge Code |
6068711211
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.73 |
| Max. Negotiated Rate |
$1.66 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.14
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.04
|
| Rate for Payer: Aetna Government |
$1.04
|
| Rate for Payer: Brighton Health Commercial |
$1.55
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.66
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.41
|
| Rate for Payer: EmblemHealth Commercial |
$1.04
|
| Rate for Payer: Group Health Inc Commercial |
$1.04
|
| Rate for Payer: Group Health Inc Medicare |
$0.73
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.04
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.35
|
|
|
ANASTROZOLE 1 MG PO TABS
|
Facility
|
OP
|
$2.07
|
|
|
Service Code
|
NDC 5026807511
|
| Hospital Charge Code |
5026807511
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.73 |
| Max. Negotiated Rate |
$1.66 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.14
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.04
|
| Rate for Payer: Aetna Government |
$1.04
|
| Rate for Payer: Brighton Health Commercial |
$1.55
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.66
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.41
|
| Rate for Payer: EmblemHealth Commercial |
$1.04
|
| Rate for Payer: Group Health Inc Commercial |
$1.04
|
| Rate for Payer: Group Health Inc Medicare |
$0.73
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.04
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.35
|
|
|
ANASTROZOLE 1 MG PO TABS
|
Facility
|
IP
|
$2.07
|
|
|
Service Code
|
NDC 6068711211
|
| Hospital Charge Code |
6068711211
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.04 |
| Max. Negotiated Rate |
$1.04 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.04
|
|
|
ANASTROZOLE 1 MG PO TABS
|
Facility
|
IP
|
$13.48
|
|
|
Service Code
|
NDC 6838220906
|
| Hospital Charge Code |
6838220906
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.74 |
| Max. Negotiated Rate |
$6.74 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.74
|
|
|
ANASTROZOLE 1 MG PO TABS
|
Facility
|
IP
|
$2.07
|
|
|
Service Code
|
NDC 5026807515
|
| Hospital Charge Code |
5026807515
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.04 |
| Max. Negotiated Rate |
$1.04 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.04
|
|
|
ANASTROZOLE 1 MG PO TABS
|
Facility
|
OP
|
$2.07
|
|
|
Service Code
|
NDC 5026807515
|
| Hospital Charge Code |
5026807515
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.73 |
| Max. Negotiated Rate |
$1.66 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.14
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.04
|
| Rate for Payer: Aetna Government |
$1.04
|
| Rate for Payer: Brighton Health Commercial |
$1.55
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.66
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.41
|
| Rate for Payer: EmblemHealth Commercial |
$1.04
|
| Rate for Payer: Group Health Inc Commercial |
$1.04
|
| Rate for Payer: Group Health Inc Medicare |
$0.73
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.04
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.35
|
|
|
ANASTROZOLE 1 MG PO TABS
|
Facility
|
IP
|
$2.07
|
|
|
Service Code
|
NDC 5026807511
|
| Hospital Charge Code |
5026807511
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.04 |
| Max. Negotiated Rate |
$1.04 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.04
|
|
|
ANASTROZOLE 1 MG PO TABS
|
Facility
|
OP
|
$2.07
|
|
|
Service Code
|
NDC 6068711221
|
| Hospital Charge Code |
6068711221
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.73 |
| Max. Negotiated Rate |
$1.66 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.14
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.04
|
| Rate for Payer: Aetna Government |
$1.04
|
| Rate for Payer: Brighton Health Commercial |
$1.55
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.66
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.41
|
| Rate for Payer: EmblemHealth Commercial |
$1.04
|
| Rate for Payer: Group Health Inc Commercial |
$1.04
|
| Rate for Payer: Group Health Inc Medicare |
$0.73
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.04
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.35
|
|
|
ANASTROZOLE 1 MG PO TABS
|
Facility
|
IP
|
$2.07
|
|
|
Service Code
|
NDC 6068711221
|
| Hospital Charge Code |
6068711221
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.04 |
| Max. Negotiated Rate |
$1.04 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.04
|
|
|
ANASTROZOLE 1 MG PO TABS
|
Facility
|
IP
|
$13.50
|
|
|
Service Code
|
NDC 0093753656
|
| Hospital Charge Code |
0093753656
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.75 |
| Max. Negotiated Rate |
$6.75 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.75
|
|