|
APIXABAN 5 MG PO TABS
|
Facility
|
OP
|
$11.89
|
|
|
Service Code
|
NDC 0003089431
|
| Hospital Charge Code |
0003089431
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.16 |
| Max. Negotiated Rate |
$9.51 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.54
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.94
|
| Rate for Payer: Aetna Government |
$5.94
|
| Rate for Payer: Brighton Health Commercial |
$8.92
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$9.51
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$8.08
|
| Rate for Payer: EmblemHealth Commercial |
$5.94
|
| Rate for Payer: Group Health Inc Commercial |
$5.94
|
| Rate for Payer: Group Health Inc Medicare |
$4.16
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$7.73
|
|
|
Appendectomy
|
Facility
|
IP
|
$67,698.11
|
|
|
Service Code
|
APR-DRG 2253
|
| Min. Negotiated Rate |
$18,937.00 |
| Max. Negotiated Rate |
$67,698.11 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$67,698.11
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$67,698.11
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$30,088.05
|
| Rate for Payer: Amida Care Medicaid |
$30,088.05
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$67,698.11
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$30,088.05
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$30,088.05
|
| Rate for Payer: Fidelis Qualified Health Plan |
$36,105.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$30,088.05
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$30,088.05
|
| Rate for Payer: Healthfirst Commercial |
$32,838.00
|
| Rate for Payer: Healthfirst Essential Plan |
$67,698.11
|
| Rate for Payer: Healthfirst QHP |
$18,937.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$30,088.05
|
| Rate for Payer: SOMOS Essential |
$67,698.11
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$67,698.11
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$67,698.11
|
| Rate for Payer: United Healthcare Medicaid |
$30,088.05
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$30,088.05
|
|
|
Appendectomy
|
Facility
|
IP
|
$44,679.64
|
|
|
Service Code
|
APR-DRG 2251
|
| Min. Negotiated Rate |
$8,044.00 |
| Max. Negotiated Rate |
$44,679.64 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$44,679.64
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$44,679.64
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$19,857.62
|
| Rate for Payer: Amida Care Medicaid |
$19,857.62
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$44,679.64
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$19,857.62
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$19,857.62
|
| Rate for Payer: Fidelis Qualified Health Plan |
$23,829.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$19,857.62
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$19,857.62
|
| Rate for Payer: Healthfirst Commercial |
$13,544.00
|
| Rate for Payer: Healthfirst Essential Plan |
$44,679.64
|
| Rate for Payer: Healthfirst QHP |
$8,044.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$19,857.62
|
| Rate for Payer: SOMOS Essential |
$44,679.64
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$44,679.64
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$44,679.64
|
| Rate for Payer: United Healthcare Medicaid |
$19,857.62
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$19,857.62
|
|
|
Appendectomy
|
Facility
|
IP
|
$51,440.26
|
|
|
Service Code
|
APR-DRG 2252
|
| Min. Negotiated Rate |
$11,174.00 |
| Max. Negotiated Rate |
$51,440.26 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$51,440.26
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$51,440.26
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$22,862.34
|
| Rate for Payer: Amida Care Medicaid |
$22,862.34
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$51,440.26
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$22,862.34
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$22,862.34
|
| Rate for Payer: Fidelis Qualified Health Plan |
$27,434.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$22,862.34
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$22,862.34
|
| Rate for Payer: Healthfirst Commercial |
$19,202.00
|
| Rate for Payer: Healthfirst Essential Plan |
$51,440.26
|
| Rate for Payer: Healthfirst QHP |
$11,174.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$22,862.34
|
| Rate for Payer: SOMOS Essential |
$51,440.26
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$51,440.26
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$51,440.26
|
| Rate for Payer: United Healthcare Medicaid |
$22,862.34
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$22,862.34
|
|
|
Appendectomy
|
Facility
|
IP
|
$103,460.47
|
|
|
Service Code
|
APR-DRG 2254
|
| Min. Negotiated Rate |
$37,143.00 |
| Max. Negotiated Rate |
$103,460.47 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$103,460.47
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$103,460.47
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$45,982.43
|
| Rate for Payer: Amida Care Medicaid |
$45,982.43
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$103,460.47
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$45,982.43
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$45,982.43
|
| Rate for Payer: Fidelis Qualified Health Plan |
$55,178.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$45,982.43
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$45,982.43
|
| Rate for Payer: Healthfirst Commercial |
$71,681.00
|
| Rate for Payer: Healthfirst Essential Plan |
$103,460.47
|
| Rate for Payer: Healthfirst QHP |
$37,143.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$45,982.43
|
| Rate for Payer: SOMOS Essential |
$103,460.47
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$103,460.47
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$103,460.47
|
| Rate for Payer: United Healthcare Medicaid |
$45,982.43
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$45,982.43
|
|
|
APRACLONIDINE HCL 1 % OP SOLN
|
Facility
|
OP
|
$33.27
|
|
|
Service Code
|
NDC 8266720001
|
| Hospital Charge Code |
8266720001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.65 |
| Max. Negotiated Rate |
$26.62 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$18.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$16.64
|
| Rate for Payer: Aetna Government |
$16.64
|
| Rate for Payer: Brighton Health Commercial |
$24.95
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$26.62
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$22.63
|
| Rate for Payer: EmblemHealth Commercial |
$16.64
|
| Rate for Payer: Group Health Inc Commercial |
$16.64
|
| Rate for Payer: Group Health Inc Medicare |
$11.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$21.63
|
|
|
APRACLONIDINE HCL 1 % OP SOLN
|
Facility
|
IP
|
$33.27
|
|
|
Service Code
|
NDC 8266720001
|
| Hospital Charge Code |
8266720001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.64 |
| Max. Negotiated Rate |
$16.64 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.64
|
|
|
AQUACEL AG ADVANTAGE 4"X5" EX PADS
|
Facility
|
OP
|
$19.02
|
|
|
Service Code
|
NDC 6845512744
|
| Hospital Charge Code |
6845512744
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.66 |
| Max. Negotiated Rate |
$15.21 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$10.46
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$9.51
|
| Rate for Payer: Aetna Government |
$9.51
|
| Rate for Payer: Brighton Health Commercial |
$14.26
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$15.21
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$12.93
|
| Rate for Payer: EmblemHealth Commercial |
$9.51
|
| Rate for Payer: Group Health Inc Commercial |
$9.51
|
| Rate for Payer: Group Health Inc Medicare |
$6.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.51
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9.51
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12.36
|
|
|
AQUACEL AG ADVANTAGE 4"X5" EX PADS
|
Facility
|
IP
|
$19.02
|
|
|
Service Code
|
NDC 6845512744
|
| Hospital Charge Code |
6845512744
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.51 |
| Max. Negotiated Rate |
$9.51 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.51
|
|
|
AQUACEL AG ADVANTAGE 4"X5" EX PADS
|
Facility
|
IP
|
$19.02
|
|
|
Service Code
|
NDC 6845514564
|
| Hospital Charge Code |
6845514564
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.51 |
| Max. Negotiated Rate |
$9.51 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.51
|
|
|
AQUACEL AG ADVANTAGE 4"X5" EX PADS
|
Facility
|
OP
|
$19.02
|
|
|
Service Code
|
NDC 6845514564
|
| Hospital Charge Code |
6845514564
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.66 |
| Max. Negotiated Rate |
$15.21 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$10.46
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$9.51
|
| Rate for Payer: Aetna Government |
$9.51
|
| Rate for Payer: Brighton Health Commercial |
$14.26
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$15.21
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$12.93
|
| Rate for Payer: EmblemHealth Commercial |
$9.51
|
| Rate for Payer: Group Health Inc Commercial |
$9.51
|
| Rate for Payer: Group Health Inc Medicare |
$6.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.51
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9.51
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12.36
|
|
|
AQUACEL-AG EXTRA HYDROFIBER 2"X2" EX PADS
|
Facility
|
IP
|
$9.63
|
|
|
Service Code
|
NDC 6845512738
|
| Hospital Charge Code |
6845512738
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.81 |
| Max. Negotiated Rate |
$4.81 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.81
|
|
|
AQUACEL-AG EXTRA HYDROFIBER 2"X2" EX PADS
|
Facility
|
OP
|
$9.63
|
|
|
Service Code
|
NDC 6845512738
|
| Hospital Charge Code |
6845512738
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.37 |
| Max. Negotiated Rate |
$7.70 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.81
|
| Rate for Payer: Aetna Government |
$4.81
|
| Rate for Payer: Brighton Health Commercial |
$7.22
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7.70
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.55
|
| Rate for Payer: EmblemHealth Commercial |
$4.81
|
| Rate for Payer: Group Health Inc Commercial |
$4.81
|
| Rate for Payer: Group Health Inc Medicare |
$3.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.81
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.81
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6.26
|
|
|
AQUACEL-AG EXTRA HYDROFIBER 4"X5" EX PADS
|
Facility
|
OP
|
$19.02
|
|
|
Service Code
|
NDC 6845512744
|
| Hospital Charge Code |
6845512744
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.66 |
| Max. Negotiated Rate |
$15.21 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$10.46
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$9.51
|
| Rate for Payer: Aetna Government |
$9.51
|
| Rate for Payer: Brighton Health Commercial |
$14.26
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$15.21
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$12.93
|
| Rate for Payer: EmblemHealth Commercial |
$9.51
|
| Rate for Payer: Group Health Inc Commercial |
$9.51
|
| Rate for Payer: Group Health Inc Medicare |
$6.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.51
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9.51
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12.36
|
|
|
AQUACEL-AG EXTRA HYDROFIBER 4"X5" EX PADS
|
Facility
|
IP
|
$19.02
|
|
|
Service Code
|
NDC 6845512744
|
| Hospital Charge Code |
6845512744
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.51 |
| Max. Negotiated Rate |
$9.51 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.51
|
|
|
AQUACEL-AG EXTRA HYDROFIBER 4"X5" EX PADS
|
Facility
|
OP
|
$19.02
|
|
|
Service Code
|
NDC 6845514564
|
| Hospital Charge Code |
6845514564
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.66 |
| Max. Negotiated Rate |
$15.21 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$10.46
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$9.51
|
| Rate for Payer: Aetna Government |
$9.51
|
| Rate for Payer: Brighton Health Commercial |
$14.26
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$15.21
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$12.93
|
| Rate for Payer: EmblemHealth Commercial |
$9.51
|
| Rate for Payer: Group Health Inc Commercial |
$9.51
|
| Rate for Payer: Group Health Inc Medicare |
$6.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.51
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9.51
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12.36
|
|
|
AQUACEL-AG EXTRA HYDROFIBER 4"X5" EX PADS
|
Facility
|
IP
|
$19.02
|
|
|
Service Code
|
NDC 6845514564
|
| Hospital Charge Code |
6845514564
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.51 |
| Max. Negotiated Rate |
$9.51 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.51
|
|
|
AQUAPHOR EX OINT
|
Facility
|
IP
|
$0.17
|
|
|
Service Code
|
NDC 7214045231
|
| Hospital Charge Code |
7214045231
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.09 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.09
|
|
|
AQUAPHOR EX OINT
|
Facility
|
OP
|
$0.17
|
|
|
Service Code
|
NDC 7214045231
|
| Hospital Charge Code |
7214045231
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.14 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.09
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.09
|
| Rate for Payer: Aetna Government |
$0.09
|
| Rate for Payer: Brighton Health Commercial |
$0.13
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.14
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.12
|
| Rate for Payer: EmblemHealth Commercial |
$0.09
|
| Rate for Payer: Group Health Inc Commercial |
$0.09
|
| Rate for Payer: Group Health Inc Medicare |
$0.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.11
|
|
|
AQUAPHOR EX OINT
|
Facility
|
OP
|
$0.06
|
|
|
Service Code
|
NDC 7139951012
|
| Hospital Charge Code |
7139951012
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.03
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.03
|
| Rate for Payer: Aetna Government |
$0.03
|
| Rate for Payer: Brighton Health Commercial |
$0.05
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.05
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.04
|
| Rate for Payer: EmblemHealth Commercial |
$0.03
|
| Rate for Payer: Group Health Inc Commercial |
$0.03
|
| Rate for Payer: Group Health Inc Medicare |
$0.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.03
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.03
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.04
|
|
|
AQUAPHOR EX OINT
|
Facility
|
IP
|
$0.06
|
|
|
Service Code
|
NDC 7139951012
|
| Hospital Charge Code |
7139951012
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.03
|
|
|
ARGATROBAN 250 MG/2.5ML IV SOLN
|
Facility
|
OP
|
$244.80
|
|
|
Service Code
|
HCPCS J0883
|
| Hospital Charge Code |
6745721202
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.56 |
| Max. Negotiated Rate |
$195.84 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$134.64
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.80
|
| Rate for Payer: Aetna Government |
$0.80
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$0.56
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$0.56
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$0.56
|
| Rate for Payer: Brighton Health Commercial |
$183.60
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$0.80
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$195.84
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$166.46
|
| Rate for Payer: Elderplan Medicare Advantage |
$0.80
|
| Rate for Payer: EmblemHealth Commercial |
$0.80
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$0.72
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$0.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$0.71
|
| Rate for Payer: Fidelis Medicare Advantage |
$0.80
|
| Rate for Payer: Fidelis Qualified Health Plan |
$0.71
|
| Rate for Payer: Group Health Inc Commercial |
$0.80
|
| Rate for Payer: Group Health Inc Medicare |
$0.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.80
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.80
|
| Rate for Payer: Healthfirst Medicare Advantage |
$0.68
|
| Rate for Payer: Healthfirst QHP |
$0.80
|
| Rate for Payer: Humana Medicare |
$0.82
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$0.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.80
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$159.12
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$0.76
|
| Rate for Payer: Wellcare Medicare |
$0.76
|
|
|
ARGATROBAN 250 MG/2.5ML IV SOLN
|
Facility
|
IP
|
$244.80
|
|
|
Service Code
|
HCPCS J0883
|
| Hospital Charge Code |
4202318201
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$122.40 |
| Max. Negotiated Rate |
$122.40 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$122.40
|
|
|
ARGATROBAN 250 MG/2.5ML IV SOLN
|
Facility
|
OP
|
$244.80
|
|
|
Service Code
|
HCPCS J0883
|
| Hospital Charge Code |
4202318201
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.56 |
| Max. Negotiated Rate |
$195.84 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$134.64
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.80
|
| Rate for Payer: Aetna Government |
$0.80
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$0.56
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$0.56
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$0.56
|
| Rate for Payer: Brighton Health Commercial |
$183.60
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$0.80
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$195.84
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$166.46
|
| Rate for Payer: Elderplan Medicare Advantage |
$0.80
|
| Rate for Payer: EmblemHealth Commercial |
$0.80
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$0.72
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$0.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$0.71
|
| Rate for Payer: Fidelis Medicare Advantage |
$0.80
|
| Rate for Payer: Fidelis Qualified Health Plan |
$0.71
|
| Rate for Payer: Group Health Inc Commercial |
$0.80
|
| Rate for Payer: Group Health Inc Medicare |
$0.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.80
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.80
|
| Rate for Payer: Healthfirst Medicare Advantage |
$0.68
|
| Rate for Payer: Healthfirst QHP |
$0.80
|
| Rate for Payer: Humana Medicare |
$0.82
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$0.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.80
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$159.12
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$0.76
|
| Rate for Payer: Wellcare Medicare |
$0.76
|
|
|
ARGATROBAN 250 MG/2.5ML IV SOLN
|
Facility
|
IP
|
$244.80
|
|
|
Service Code
|
HCPCS J0883
|
| Hospital Charge Code |
6745721202
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$122.40 |
| Max. Negotiated Rate |
$122.40 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$122.40
|
|
