|
ATOVAQUONE-PROGUANIL HCL 250-100 MG PO TABS
|
Facility
|
OP
|
$8.24
|
|
|
Service Code
|
NDC 0173067502
|
| Hospital Charge Code |
0173067502
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.88 |
| Max. Negotiated Rate |
$6.59 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.53
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.12
|
| Rate for Payer: Aetna Government |
$4.12
|
| Rate for Payer: Brighton Health Commercial |
$6.18
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.59
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.60
|
| Rate for Payer: EmblemHealth Commercial |
$4.12
|
| Rate for Payer: Group Health Inc Commercial |
$4.12
|
| Rate for Payer: Group Health Inc Medicare |
$2.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.36
|
|
|
ATOVAQUONE-PROGUANIL HCL 250-100 MG PO TABS
|
Facility
|
OP
|
$7.15
|
|
|
Service Code
|
NDC 6846240401
|
| Hospital Charge Code |
6846240401
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.50 |
| Max. Negotiated Rate |
$5.72 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.93
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.57
|
| Rate for Payer: Aetna Government |
$3.57
|
| Rate for Payer: Brighton Health Commercial |
$5.36
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5.72
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.86
|
| Rate for Payer: EmblemHealth Commercial |
$3.57
|
| Rate for Payer: Group Health Inc Commercial |
$3.57
|
| Rate for Payer: Group Health Inc Medicare |
$2.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.57
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.57
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.65
|
|
|
ATOVAQUONE-PROGUANIL HCL 250-100 MG PO TABS
|
Facility
|
IP
|
$7.41
|
|
|
Service Code
|
NDC 6699306027
|
| Hospital Charge Code |
6699306027
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.70 |
| Max. Negotiated Rate |
$3.70 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.70
|
|
|
ATOVAQUONE-PROGUANIL HCL 250-100 MG PO TABS
|
Facility
|
IP
|
$8.24
|
|
|
Service Code
|
NDC 0173067502
|
| Hospital Charge Code |
0173067502
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.12 |
| Max. Negotiated Rate |
$4.12 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.12
|
|
|
ATOVAQUONE-PROGUANIL HCL 62.5-25 MG PO TABS
|
Facility
|
OP
|
$2.99
|
|
|
Service Code
|
NDC 0173067601
|
| Hospital Charge Code |
0173067601
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.05 |
| Max. Negotiated Rate |
$2.39 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.64
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.49
|
| Rate for Payer: Aetna Government |
$1.49
|
| Rate for Payer: Brighton Health Commercial |
$2.24
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.39
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.03
|
| Rate for Payer: EmblemHealth Commercial |
$1.49
|
| Rate for Payer: Group Health Inc Commercial |
$1.49
|
| Rate for Payer: Group Health Inc Medicare |
$1.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.49
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.94
|
|
|
ATOVAQUONE-PROGUANIL HCL 62.5-25 MG PO TABS
|
Facility
|
IP
|
$2.99
|
|
|
Service Code
|
NDC 0173067601
|
| Hospital Charge Code |
0173067601
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.49 |
| Max. Negotiated Rate |
$1.49 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.49
|
|
|
ATOVAQUONE-PROGUANIL HCL 62.5-25 MG PO TABS
|
Facility
|
IP
|
$2.69
|
|
|
Service Code
|
NDC 6846240201
|
| Hospital Charge Code |
6846240201
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.34 |
| Max. Negotiated Rate |
$1.34 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.34
|
|
|
ATOVAQUONE-PROGUANIL HCL 62.5-25 MG PO TABS
|
Facility
|
OP
|
$2.69
|
|
|
Service Code
|
NDC 6846240201
|
| Hospital Charge Code |
6846240201
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.94 |
| Max. Negotiated Rate |
$2.15 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.48
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.34
|
| Rate for Payer: Aetna Government |
$1.34
|
| Rate for Payer: Brighton Health Commercial |
$2.01
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.15
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.83
|
| Rate for Payer: EmblemHealth Commercial |
$1.34
|
| Rate for Payer: Group Health Inc Commercial |
$1.34
|
| Rate for Payer: Group Health Inc Medicare |
$0.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.34
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.34
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.75
|
|
|
ATRIAL AND VENTRICULAR RECORDING AND PACING
|
Facility
|
OP
|
$932.72
|
|
|
Service Code
|
EAPG 00096
|
| Min. Negotiated Rate |
$678.09 |
| Max. Negotiated Rate |
$932.72 |
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$678.09
|
| Rate for Payer: Healthfirst Commercial |
$932.72
|
|
|
ATRIAL FIBRILLATION
|
Facility
|
OP
|
$222.36
|
|
|
Service Code
|
EAPG 00602
|
| Min. Negotiated Rate |
$162.00 |
| Max. Negotiated Rate |
$222.36 |
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$162.00
|
| Rate for Payer: Healthfirst Commercial |
$222.36
|
|
|
ATROPINE SULFATE 0.4 MG/ML IV SOLN
|
Facility
|
IP
|
$14.50
|
|
|
Service Code
|
NDC 7006963125
|
| Hospital Charge Code |
7006963125
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$7.25 |
| Max. Negotiated Rate |
$7.25 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.25
|
|
|
ATROPINE SULFATE 0.4 MG/ML IV SOLN
|
Facility
|
OP
|
$14.50
|
|
|
Service Code
|
NDC 7006963125
|
| Hospital Charge Code |
7006963125
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$5.08 |
| Max. Negotiated Rate |
$11.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.98
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$7.25
|
| Rate for Payer: Aetna Government |
$7.25
|
| Rate for Payer: Brighton Health Commercial |
$10.88
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$11.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$9.86
|
| Rate for Payer: EmblemHealth Commercial |
$7.25
|
| Rate for Payer: Group Health Inc Commercial |
$7.25
|
| Rate for Payer: Group Health Inc Medicare |
$5.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$9.43
|
|
|
ATROPINE SULFATE 1 MG/10ML IJ SOSY
|
Facility
|
IP
|
$1.37
|
|
|
Service Code
|
HCPCS J0461
|
| Hospital Charge Code |
7632933401
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.69 |
| Max. Negotiated Rate |
$0.69 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.69
|
|
|
ATROPINE SULFATE 1 MG/10ML IJ SOSY
|
Facility
|
OP
|
$1.12
|
|
|
Service Code
|
HCPCS J0461
|
| Hospital Charge Code |
0409163010
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.90 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.62
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.08
|
| Rate for Payer: Aetna Government |
$0.08
|
| Rate for Payer: Brighton Health Commercial |
$0.84
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.90
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.76
|
| Rate for Payer: EmblemHealth Commercial |
$0.56
|
| Rate for Payer: Group Health Inc Commercial |
$0.56
|
| Rate for Payer: Group Health Inc Medicare |
$0.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.56
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.73
|
|
|
ATROPINE SULFATE 1 MG/10ML IJ SOSY
|
Facility
|
IP
|
$1.12
|
|
|
Service Code
|
HCPCS J0461
|
| Hospital Charge Code |
0409163010
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.56 |
| Max. Negotiated Rate |
$0.56 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.56
|
|
|
ATROPINE SULFATE 1 MG/10ML IJ SOSY
|
Facility
|
OP
|
$1.37
|
|
|
Service Code
|
HCPCS J0461
|
| Hospital Charge Code |
7632933401
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$1.10 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.76
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.08
|
| Rate for Payer: Aetna Government |
$0.08
|
| Rate for Payer: Brighton Health Commercial |
$1.03
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.10
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.93
|
| Rate for Payer: EmblemHealth Commercial |
$0.69
|
| Rate for Payer: Group Health Inc Commercial |
$0.69
|
| Rate for Payer: Group Health Inc Medicare |
$0.48
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.69
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.69
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.89
|
|
|
ATROPINE SULFATE 1 MG/ML IV SOLN
|
Facility
|
IP
|
$20.35
|
|
|
Service Code
|
HCPCS J0462
|
| Hospital Charge Code |
0517100125
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$10.18 |
| Max. Negotiated Rate |
$10.18 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.18
|
|
|
ATROPINE SULFATE 1 MG/ML IV SOLN
|
Facility
|
IP
|
$7.09
|
|
|
Service Code
|
HCPCS J0462
|
| Hospital Charge Code |
7006964125
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$3.54 |
| Max. Negotiated Rate |
$3.54 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.54
|
|
|
ATROPINE SULFATE 1 MG/ML IV SOLN
|
Facility
|
OP
|
$22.61
|
|
|
Service Code
|
HCPCS J0462
|
| Hospital Charge Code |
1672952663
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$18.09 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$12.43
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$11.30
|
| Rate for Payer: Aetna Government |
$11.30
|
| Rate for Payer: Brighton Health Commercial |
$16.96
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$18.09
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$15.37
|
| Rate for Payer: EmblemHealth Commercial |
$11.30
|
| Rate for Payer: Group Health Inc Commercial |
$11.30
|
| Rate for Payer: Group Health Inc Medicare |
$7.91
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$11.30
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$14.70
|
|
|
ATROPINE SULFATE 1 MG/ML IV SOLN
|
Facility
|
OP
|
$20.35
|
|
|
Service Code
|
HCPCS J0462
|
| Hospital Charge Code |
0517100125
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$16.28 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$11.19
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$10.18
|
| Rate for Payer: Aetna Government |
$10.18
|
| Rate for Payer: Brighton Health Commercial |
$15.26
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$16.28
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$13.84
|
| Rate for Payer: EmblemHealth Commercial |
$10.18
|
| Rate for Payer: Group Health Inc Commercial |
$10.18
|
| Rate for Payer: Group Health Inc Medicare |
$7.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$10.18
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$13.23
|
|
|
ATROPINE SULFATE 1 MG/ML IV SOLN
|
Facility
|
IP
|
$22.61
|
|
|
Service Code
|
HCPCS J0462
|
| Hospital Charge Code |
1672952663
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$11.30 |
| Max. Negotiated Rate |
$11.30 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11.30
|
|
|
ATROPINE SULFATE 1 MG/ML IV SOLN
|
Facility
|
OP
|
$7.09
|
|
|
Service Code
|
HCPCS J0462
|
| Hospital Charge Code |
7006964125
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$5.67 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.54
|
| Rate for Payer: Aetna Government |
$3.54
|
| Rate for Payer: Brighton Health Commercial |
$5.32
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5.67
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.82
|
| Rate for Payer: EmblemHealth Commercial |
$3.54
|
| Rate for Payer: Group Health Inc Commercial |
$3.54
|
| Rate for Payer: Group Health Inc Medicare |
$2.48
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.54
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.61
|
|
|
ATROPINE SULFATE 1 % OP SOLN
|
Facility
|
OP
|
$23.82
|
|
|
Service Code
|
NDC 0065081702
|
| Hospital Charge Code |
0065081702
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.34 |
| Max. Negotiated Rate |
$19.06 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$13.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$11.91
|
| Rate for Payer: Aetna Government |
$11.91
|
| Rate for Payer: Brighton Health Commercial |
$17.86
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$19.06
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$16.20
|
| Rate for Payer: EmblemHealth Commercial |
$11.91
|
| Rate for Payer: Group Health Inc Commercial |
$11.91
|
| Rate for Payer: Group Health Inc Medicare |
$8.34
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11.91
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$11.91
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$15.48
|
|
|
ATROPINE SULFATE 1 % OP SOLN
|
Facility
|
IP
|
$23.82
|
|
|
Service Code
|
NDC 0065081702
|
| Hospital Charge Code |
0065081702
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.91 |
| Max. Negotiated Rate |
$11.91 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11.91
|
|
|
ATROPINE SULFATE 1 % OP SOLN
|
Facility
|
IP
|
$23.93
|
|
|
Service Code
|
NDC 6021917482
|
| Hospital Charge Code |
6021917482
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.96 |
| Max. Negotiated Rate |
$11.96 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11.96
|
|
