|
BISMUTH SUBSALICYLATE 262 MG PO CHEW
|
Facility
|
IP
|
$0.19
|
|
|
Service Code
|
NDC 0149032040
|
| Hospital Charge Code |
0149032040
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.09 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.09
|
|
|
BISMUTH SUBSALICYLATE 262 MG PO CHEW
|
Facility
|
IP
|
$0.13
|
|
|
Service Code
|
NDC 0904131546
|
| Hospital Charge Code |
0904131546
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.06 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.06
|
|
|
BISMUTH SUBSALICYLATE 262 MG PO CHEW
|
Facility
|
OP
|
$0.09
|
|
|
Service Code
|
NDC 0904720546
|
| Hospital Charge Code |
0904720546
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.07 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.05
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.05
|
| Rate for Payer: Aetna Government |
$0.05
|
| Rate for Payer: Brighton Health Commercial |
$0.07
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.07
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.06
|
| Rate for Payer: EmblemHealth Commercial |
$0.05
|
| Rate for Payer: Group Health Inc Commercial |
$0.05
|
| Rate for Payer: Group Health Inc Medicare |
$0.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.06
|
|
|
BISMUTH SUBSALICYLATE 262 MG PO CHEW
|
Facility
|
OP
|
$0.19
|
|
|
Service Code
|
NDC 0149032040
|
| Hospital Charge Code |
0149032040
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.15 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.09
|
| Rate for Payer: Aetna Government |
$0.09
|
| Rate for Payer: Brighton Health Commercial |
$0.14
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.15
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.13
|
| Rate for Payer: EmblemHealth Commercial |
$0.09
|
| Rate for Payer: Group Health Inc Commercial |
$0.09
|
| Rate for Payer: Group Health Inc Medicare |
$0.07
|
| 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 |
$0.12
|
|
|
BIVALIRUDIN 250 MG/5ML IV (WET SOLR VIAL)
|
Facility
|
IP
|
$330.00
|
|
|
Service Code
|
HCPCS J0583
|
| Hospital Charge Code |
5511165207
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$165.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$165.00
|
|
|
BIVALIRUDIN 250 MG/5ML IV (WET SOLR VIAL)
|
Facility
|
IP
|
$84.00
|
|
|
Service Code
|
HCPCS J0583
|
| Hospital Charge Code |
7128842710
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$42.00 |
| Max. Negotiated Rate |
$42.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$42.00
|
|
|
BIVALIRUDIN 250 MG/5ML IV (WET SOLR VIAL)
|
Facility
|
OP
|
$84.00
|
|
|
Service Code
|
HCPCS J0583
|
| Hospital Charge Code |
7128842710
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$324.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$46.20
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.29
|
| Rate for Payer: Aetna Government |
$0.29
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$7.29
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$7.29
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$3.24
|
| Rate for Payer: Amida Care Medicaid |
$3.24
|
| Rate for Payer: Brighton Health Commercial |
$63.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$67.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$57.12
|
| Rate for Payer: EmblemHealth Commercial |
$42.00
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$7.29
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$3.24
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3.24
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$7.29
|
| Rate for Payer: Fidelis Essential Plan QHP |
$7.29
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3.40
|
| Rate for Payer: Group Health Inc Commercial |
$42.00
|
| Rate for Payer: Group Health Inc Medicare |
$29.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$42.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$324.00
|
| Rate for Payer: Healthfirst Essential Plan |
$7.29
|
| Rate for Payer: Healthfirst QHP |
$5.28
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$3.24
|
| Rate for Payer: SOMOS Essential |
$7.29
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$7.29
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$3.56
|
| Rate for Payer: United Healthcare Medicaid |
$3.24
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$54.60
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3.24
|
|
|
BIVALIRUDIN 250 MG/5ML IV (WET SOLR VIAL)
|
Facility
|
OP
|
$120.00
|
|
|
Service Code
|
HCPCS J0583
|
| Hospital Charge Code |
5515021010
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$324.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$66.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.29
|
| Rate for Payer: Aetna Government |
$0.29
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$7.29
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$7.29
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$3.24
|
| Rate for Payer: Amida Care Medicaid |
$3.24
|
| Rate for Payer: Brighton Health Commercial |
$90.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$96.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$81.60
|
| Rate for Payer: EmblemHealth Commercial |
$60.00
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$7.29
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$3.24
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3.24
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$7.29
|
| Rate for Payer: Fidelis Essential Plan QHP |
$7.29
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3.40
|
| Rate for Payer: Group Health Inc Commercial |
$60.00
|
| Rate for Payer: Group Health Inc Medicare |
$42.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$60.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$324.00
|
| Rate for Payer: Healthfirst Essential Plan |
$7.29
|
| Rate for Payer: Healthfirst QHP |
$5.28
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$3.24
|
| Rate for Payer: SOMOS Essential |
$7.29
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$7.29
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$3.56
|
| Rate for Payer: United Healthcare Medicaid |
$3.24
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$78.00
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3.24
|
|
|
BIVALIRUDIN 250 MG/5ML IV (WET SOLR VIAL)
|
Facility
|
OP
|
$330.00
|
|
|
Service Code
|
HCPCS J0583
|
| Hospital Charge Code |
5511165207
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$324.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$181.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.29
|
| Rate for Payer: Aetna Government |
$0.29
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$7.29
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$7.29
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$3.24
|
| Rate for Payer: Amida Care Medicaid |
$3.24
|
| Rate for Payer: Brighton Health Commercial |
$247.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$264.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$224.40
|
| Rate for Payer: EmblemHealth Commercial |
$165.00
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$7.29
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$3.24
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3.24
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$7.29
|
| Rate for Payer: Fidelis Essential Plan QHP |
$7.29
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3.40
|
| Rate for Payer: Group Health Inc Commercial |
$165.00
|
| Rate for Payer: Group Health Inc Medicare |
$115.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$165.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$324.00
|
| Rate for Payer: Healthfirst Essential Plan |
$7.29
|
| Rate for Payer: Healthfirst QHP |
$5.28
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$3.24
|
| Rate for Payer: SOMOS Essential |
$7.29
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$7.29
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$3.56
|
| Rate for Payer: United Healthcare Medicaid |
$3.24
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$214.50
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3.24
|
|
|
BIVALIRUDIN 250 MG/5ML IV (WET SOLR VIAL)
|
Facility
|
IP
|
$120.00
|
|
|
Service Code
|
HCPCS J0583
|
| Hospital Charge Code |
5515021010
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$60.00 |
| Max. Negotiated Rate |
$60.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$60.00
|
|
|
BIVALIRUDIN TRIFLUOROACETATE 250 MG IV SOLR
|
Facility
|
OP
|
$120.00
|
|
|
Service Code
|
HCPCS J0583
|
| Hospital Charge Code |
5515021010
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$324.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$66.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.29
|
| Rate for Payer: Aetna Government |
$0.29
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$7.29
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$7.29
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$3.24
|
| Rate for Payer: Amida Care Medicaid |
$3.24
|
| Rate for Payer: Brighton Health Commercial |
$90.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$96.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$81.60
|
| Rate for Payer: EmblemHealth Commercial |
$60.00
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$7.29
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$3.24
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3.24
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$7.29
|
| Rate for Payer: Fidelis Essential Plan QHP |
$7.29
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3.40
|
| Rate for Payer: Group Health Inc Commercial |
$60.00
|
| Rate for Payer: Group Health Inc Medicare |
$42.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$60.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$324.00
|
| Rate for Payer: Healthfirst Essential Plan |
$7.29
|
| Rate for Payer: Healthfirst QHP |
$5.28
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$3.24
|
| Rate for Payer: SOMOS Essential |
$7.29
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$7.29
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$3.56
|
| Rate for Payer: United Healthcare Medicaid |
$3.24
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$78.00
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3.24
|
|
|
BIVALIRUDIN TRIFLUOROACETATE 250 MG IV SOLR
|
Facility
|
IP
|
$108.00
|
|
|
Service Code
|
HCPCS J0583
|
| Hospital Charge Code |
8363440010
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$54.00 |
| Max. Negotiated Rate |
$54.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$54.00
|
|
|
BIVALIRUDIN TRIFLUOROACETATE 250 MG IV SOLR
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
HCPCS J0583
|
| Hospital Charge Code |
0781315894
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$324.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.29
|
| Rate for Payer: Aetna Government |
$0.29
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$7.29
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$7.29
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$3.24
|
| Rate for Payer: Amida Care Medicaid |
$3.24
|
| Rate for Payer: Brighton Health Commercial |
$0.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.68
|
| Rate for Payer: EmblemHealth Commercial |
$0.50
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$7.29
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$3.24
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3.24
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$7.29
|
| Rate for Payer: Fidelis Essential Plan QHP |
$7.29
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3.40
|
| Rate for Payer: Group Health Inc Commercial |
$0.50
|
| Rate for Payer: Group Health Inc Medicare |
$0.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$324.00
|
| Rate for Payer: Healthfirst Essential Plan |
$7.29
|
| Rate for Payer: Healthfirst QHP |
$5.28
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$3.24
|
| Rate for Payer: SOMOS Essential |
$7.29
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$7.29
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$3.56
|
| Rate for Payer: United Healthcare Medicaid |
$3.24
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.65
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3.24
|
|
|
BIVALIRUDIN TRIFLUOROACETATE 250 MG IV SOLR
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
HCPCS J0583
|
| Hospital Charge Code |
7043602582
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.50 |
| Max. Negotiated Rate |
$0.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.50
|
|
|
BIVALIRUDIN TRIFLUOROACETATE 250 MG IV SOLR
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
HCPCS J0583
|
| Hospital Charge Code |
1672927567
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.50 |
| Max. Negotiated Rate |
$0.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.50
|
|
|
BIVALIRUDIN TRIFLUOROACETATE 250 MG IV SOLR
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
HCPCS J0583
|
| Hospital Charge Code |
0781315894
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.50 |
| Max. Negotiated Rate |
$0.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.50
|
|
|
BIVALIRUDIN TRIFLUOROACETATE 250 MG IV SOLR
|
Facility
|
IP
|
$174.00
|
|
|
Service Code
|
HCPCS J0583
|
| Hospital Charge Code |
6332356210
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$87.00 |
| Max. Negotiated Rate |
$87.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$87.00
|
|
|
BIVALIRUDIN TRIFLUOROACETATE 250 MG IV SOLR
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
HCPCS J0583
|
| Hospital Charge Code |
1672927567
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$324.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.29
|
| Rate for Payer: Aetna Government |
$0.29
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$7.29
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$7.29
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$3.24
|
| Rate for Payer: Amida Care Medicaid |
$3.24
|
| Rate for Payer: Brighton Health Commercial |
$0.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.68
|
| Rate for Payer: EmblemHealth Commercial |
$0.50
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$7.29
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$3.24
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3.24
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$7.29
|
| Rate for Payer: Fidelis Essential Plan QHP |
$7.29
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3.40
|
| Rate for Payer: Group Health Inc Commercial |
$0.50
|
| Rate for Payer: Group Health Inc Medicare |
$0.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$324.00
|
| Rate for Payer: Healthfirst Essential Plan |
$7.29
|
| Rate for Payer: Healthfirst QHP |
$5.28
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$3.24
|
| Rate for Payer: SOMOS Essential |
$7.29
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$7.29
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$3.56
|
| Rate for Payer: United Healthcare Medicaid |
$3.24
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.65
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3.24
|
|
|
BIVALIRUDIN TRIFLUOROACETATE 250 MG IV SOLR
|
Facility
|
OP
|
$108.00
|
|
|
Service Code
|
HCPCS J0583
|
| Hospital Charge Code |
8363440010
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$324.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$59.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.29
|
| Rate for Payer: Aetna Government |
$0.29
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$7.29
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$7.29
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$3.24
|
| Rate for Payer: Amida Care Medicaid |
$3.24
|
| Rate for Payer: Brighton Health Commercial |
$81.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$86.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$73.44
|
| Rate for Payer: EmblemHealth Commercial |
$54.00
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$7.29
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$3.24
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3.24
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$7.29
|
| Rate for Payer: Fidelis Essential Plan QHP |
$7.29
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3.40
|
| Rate for Payer: Group Health Inc Commercial |
$54.00
|
| Rate for Payer: Group Health Inc Medicare |
$37.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$54.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$324.00
|
| Rate for Payer: Healthfirst Essential Plan |
$7.29
|
| Rate for Payer: Healthfirst QHP |
$5.28
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$3.24
|
| Rate for Payer: SOMOS Essential |
$7.29
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$7.29
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$3.56
|
| Rate for Payer: United Healthcare Medicaid |
$3.24
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$70.20
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3.24
|
|
|
BIVALIRUDIN TRIFLUOROACETATE 250 MG IV SOLR
|
Facility
|
OP
|
$174.00
|
|
|
Service Code
|
HCPCS J0583
|
| Hospital Charge Code |
6332356210
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$324.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$95.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.29
|
| Rate for Payer: Aetna Government |
$0.29
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$7.29
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$7.29
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$3.24
|
| Rate for Payer: Amida Care Medicaid |
$3.24
|
| Rate for Payer: Brighton Health Commercial |
$130.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$139.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$118.32
|
| Rate for Payer: EmblemHealth Commercial |
$87.00
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$7.29
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$3.24
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3.24
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$7.29
|
| Rate for Payer: Fidelis Essential Plan QHP |
$7.29
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3.40
|
| Rate for Payer: Group Health Inc Commercial |
$87.00
|
| Rate for Payer: Group Health Inc Medicare |
$60.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$87.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$324.00
|
| Rate for Payer: Healthfirst Essential Plan |
$7.29
|
| Rate for Payer: Healthfirst QHP |
$5.28
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$3.24
|
| Rate for Payer: SOMOS Essential |
$7.29
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$7.29
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$3.56
|
| Rate for Payer: United Healthcare Medicaid |
$3.24
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$113.10
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3.24
|
|
|
BIVALIRUDIN TRIFLUOROACETATE 250 MG IV SOLR
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
HCPCS J0583
|
| Hospital Charge Code |
7043602582
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$324.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.29
|
| Rate for Payer: Aetna Government |
$0.29
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$7.29
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$7.29
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$3.24
|
| Rate for Payer: Amida Care Medicaid |
$3.24
|
| Rate for Payer: Brighton Health Commercial |
$0.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.68
|
| Rate for Payer: EmblemHealth Commercial |
$0.50
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$7.29
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$3.24
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3.24
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$7.29
|
| Rate for Payer: Fidelis Essential Plan QHP |
$7.29
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3.40
|
| Rate for Payer: Group Health Inc Commercial |
$0.50
|
| Rate for Payer: Group Health Inc Medicare |
$0.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$324.00
|
| Rate for Payer: Healthfirst Essential Plan |
$7.29
|
| Rate for Payer: Healthfirst QHP |
$5.28
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$3.24
|
| Rate for Payer: SOMOS Essential |
$7.29
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$7.29
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$3.56
|
| Rate for Payer: United Healthcare Medicaid |
$3.24
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.65
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3.24
|
|
|
BIVALIRUDIN TRIFLUOROACETATE 250 MG IV SOLR
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
HCPCS J0583
|
| Hospital Charge Code |
0781315895
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$324.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.29
|
| Rate for Payer: Aetna Government |
$0.29
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$7.29
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$7.29
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$3.24
|
| Rate for Payer: Amida Care Medicaid |
$3.24
|
| Rate for Payer: Brighton Health Commercial |
$0.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.68
|
| Rate for Payer: EmblemHealth Commercial |
$0.50
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$7.29
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$3.24
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3.24
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$7.29
|
| Rate for Payer: Fidelis Essential Plan QHP |
$7.29
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3.40
|
| Rate for Payer: Group Health Inc Commercial |
$0.50
|
| Rate for Payer: Group Health Inc Medicare |
$0.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$324.00
|
| Rate for Payer: Healthfirst Essential Plan |
$7.29
|
| Rate for Payer: Healthfirst QHP |
$5.28
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$3.24
|
| Rate for Payer: SOMOS Essential |
$7.29
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$7.29
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$3.56
|
| Rate for Payer: United Healthcare Medicaid |
$3.24
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.65
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3.24
|
|
|
BIVALIRUDIN TRIFLUOROACETATE 250 MG IV SOLR
|
Facility
|
IP
|
$120.00
|
|
|
Service Code
|
HCPCS J0583
|
| Hospital Charge Code |
5515021010
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$60.00 |
| Max. Negotiated Rate |
$60.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$60.00
|
|
|
BIVALIRUDIN TRIFLUOROACETATE 250 MG IV SOLR
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
HCPCS J0583
|
| Hospital Charge Code |
0781315895
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.50 |
| Max. Negotiated Rate |
$0.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.50
|
|
|
BLEOMYCIN SULFATE 15 UNITS IJ SOLR
|
Facility
|
OP
|
$41.40
|
|
|
Service Code
|
HCPCS J9040
|
| Hospital Charge Code |
6332313610
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.49 |
| Max. Negotiated Rate |
$33.12 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$22.77
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$25.24
|
| Rate for Payer: Aetna Government |
$25.24
|
| Rate for Payer: Brighton Health Commercial |
$31.05
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$33.12
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$28.15
|
| Rate for Payer: EmblemHealth Commercial |
$20.70
|
| Rate for Payer: Group Health Inc Commercial |
$20.70
|
| Rate for Payer: Group Health Inc Medicare |
$14.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$20.70
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$20.70
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$21.53
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$26.91
|
|
