|
ENOXAPARIN SODIUM 100 MG/ML IJ SOSY [183776]
|
Facility
|
OP
|
$29.80
|
|
|
Service Code
|
HCPCS J1650
|
| Hospital Charge Code |
00075062300
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$23.84 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$16.39
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.76
|
| Rate for Payer: Aetna Government |
$0.76
|
| Rate for Payer: Brighton Health Commercial |
$22.35
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$23.84
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$20.27
|
| Rate for Payer: Group Health Inc Commercial |
$14.90
|
| Rate for Payer: Group Health Inc Medicare |
$10.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.90
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$0.62
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$0.66
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$0.66
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$0.66
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$19.37
|
|
|
ENOXAPARIN SODIUM 100 MG/ML IJ SOSY [183776]
|
Facility
|
OP
|
$25.64
|
|
|
Service Code
|
HCPCS J1650
|
| Hospital Charge Code |
00955101010
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$20.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$14.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.76
|
| Rate for Payer: Aetna Government |
$0.76
|
| Rate for Payer: Brighton Health Commercial |
$19.23
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$20.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$17.44
|
| Rate for Payer: Group Health Inc Commercial |
$12.82
|
| Rate for Payer: Group Health Inc Medicare |
$8.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.82
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$0.62
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$0.66
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$0.66
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$0.66
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$16.67
|
|
|
ENOXAPARIN SODIUM 120 MG/0.8ML IJ SOSY [183777]
|
Facility
|
OP
|
$44.72
|
|
|
Service Code
|
HCPCS J1650
|
| Hospital Charge Code |
00075291201
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$35.78 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$24.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.76
|
| Rate for Payer: Aetna Government |
$0.76
|
| Rate for Payer: Brighton Health Commercial |
$33.54
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$35.78
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$30.41
|
| Rate for Payer: Group Health Inc Commercial |
$22.36
|
| Rate for Payer: Group Health Inc Medicare |
$15.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$22.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$22.36
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$0.62
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$0.66
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$0.66
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$0.66
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$29.07
|
|
|
ENOXAPARIN SODIUM 150 MG/ML IJ SOSY [183778]
|
Facility
|
OP
|
$38.46
|
|
|
Service Code
|
HCPCS J1650
|
| Hospital Charge Code |
00075802510
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$30.77 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$21.15
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.76
|
| Rate for Payer: Aetna Government |
$0.76
|
| Rate for Payer: Brighton Health Commercial |
$28.84
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$30.77
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$26.15
|
| Rate for Payer: Group Health Inc Commercial |
$19.23
|
| Rate for Payer: Group Health Inc Medicare |
$13.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$19.23
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$19.23
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$0.62
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$0.66
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$0.66
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$0.66
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$25.00
|
|
|
ENOXAPARIN SODIUM 150 MG/ML IJ SOSY [183778]
|
Facility
|
OP
|
$44.72
|
|
|
Service Code
|
HCPCS J1650
|
| Hospital Charge Code |
00075291501
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$35.78 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$24.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.76
|
| Rate for Payer: Aetna Government |
$0.76
|
| Rate for Payer: Brighton Health Commercial |
$33.54
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$35.78
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$30.41
|
| Rate for Payer: Group Health Inc Commercial |
$22.36
|
| Rate for Payer: Group Health Inc Medicare |
$15.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$22.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$22.36
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$0.62
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$0.66
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$0.66
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$0.66
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$29.07
|
|
|
ENOXAPARIN SODIUM 30 MG/0.3ML IJ SOSY [183772]
|
Facility
|
OP
|
$29.77
|
|
|
Service Code
|
HCPCS J1650
|
| Hospital Charge Code |
00075062430
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$23.81 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$16.37
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.76
|
| Rate for Payer: Aetna Government |
$0.76
|
| Rate for Payer: Brighton Health Commercial |
$22.33
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$23.81
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$20.24
|
| Rate for Payer: Group Health Inc Commercial |
$14.88
|
| Rate for Payer: Group Health Inc Medicare |
$10.42
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.88
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$0.62
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$0.66
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$0.66
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$0.66
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$19.35
|
|
|
ENOXAPARIN SODIUM 30 MG/0.3ML IJ SOSY [183772]
|
Facility
|
OP
|
$25.66
|
|
|
Service Code
|
HCPCS J1650
|
| Hospital Charge Code |
00955100310
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$20.53 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$14.11
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.76
|
| Rate for Payer: Aetna Government |
$0.76
|
| Rate for Payer: Brighton Health Commercial |
$19.24
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$20.53
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$17.45
|
| Rate for Payer: Group Health Inc Commercial |
$12.83
|
| Rate for Payer: Group Health Inc Medicare |
$8.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.83
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.83
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$0.62
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$0.66
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$0.66
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$0.66
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$16.68
|
|
|
ENOXAPARIN SODIUM 40 MG/0.4ML IJ SOSY [183773]
|
Facility
|
OP
|
$25.62
|
|
|
Service Code
|
HCPCS J1650
|
| Hospital Charge Code |
00955100410
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$20.49 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$14.09
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.76
|
| Rate for Payer: Aetna Government |
$0.76
|
| Rate for Payer: Brighton Health Commercial |
$19.21
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$20.49
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$17.42
|
| Rate for Payer: Group Health Inc Commercial |
$12.81
|
| Rate for Payer: Group Health Inc Medicare |
$8.97
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.81
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.81
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$0.62
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$0.66
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$0.66
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$0.66
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$16.65
|
|
|
ENOXAPARIN SODIUM 40 MG/0.4ML IJ SOSY [183773]
|
Facility
|
OP
|
$29.77
|
|
|
Service Code
|
HCPCS J1650
|
| Hospital Charge Code |
00075062040
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$23.82 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$16.37
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.76
|
| Rate for Payer: Aetna Government |
$0.76
|
| Rate for Payer: Brighton Health Commercial |
$22.33
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$23.82
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$20.24
|
| Rate for Payer: Group Health Inc Commercial |
$14.88
|
| Rate for Payer: Group Health Inc Medicare |
$10.42
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.88
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$0.62
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$0.66
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$0.66
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$0.66
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$19.35
|
|
|
ENOXAPARIN SODIUM 60 MG/0.6ML IJ SOSY [183774]
|
Facility
|
OP
|
$25.65
|
|
|
Service Code
|
HCPCS J1650
|
| Hospital Charge Code |
00955100610
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$20.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$14.11
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.76
|
| Rate for Payer: Aetna Government |
$0.76
|
| Rate for Payer: Brighton Health Commercial |
$19.24
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$20.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$17.44
|
| Rate for Payer: Group Health Inc Commercial |
$12.82
|
| Rate for Payer: Group Health Inc Medicare |
$8.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.82
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$0.62
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$0.66
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$0.66
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$0.66
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$16.67
|
|
|
ENOXAPARIN SODIUM 60 MG/0.6ML IJ SOSY [183774]
|
Facility
|
OP
|
$25.63
|
|
|
Service Code
|
HCPCS J1650
|
| Hospital Charge Code |
00075801601
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$20.51 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$14.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.76
|
| Rate for Payer: Aetna Government |
$0.76
|
| Rate for Payer: Brighton Health Commercial |
$19.22
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$20.51
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$17.43
|
| Rate for Payer: Group Health Inc Commercial |
$12.82
|
| Rate for Payer: Group Health Inc Medicare |
$8.97
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.82
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$0.62
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$0.66
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$0.66
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$0.66
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$16.66
|
|
|
ENOXAPARIN SODIUM 60 MG/0.6ML IJ SOSY [183774]
|
Facility
|
OP
|
$29.80
|
|
|
Service Code
|
HCPCS J1650
|
| Hospital Charge Code |
00075062160
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$23.84 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$16.39
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.76
|
| Rate for Payer: Aetna Government |
$0.76
|
| Rate for Payer: Brighton Health Commercial |
$22.35
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$23.84
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$20.27
|
| Rate for Payer: Group Health Inc Commercial |
$14.90
|
| Rate for Payer: Group Health Inc Medicare |
$10.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.90
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$0.62
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$0.66
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$0.66
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$0.66
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$19.37
|
|
|
ENOXAPARIN SODIUM 80 MG/0.8ML IJ SOSY [183775]
|
Facility
|
OP
|
$29.80
|
|
|
Service Code
|
HCPCS J1650
|
| Hospital Charge Code |
00075062280
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$23.84 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$16.39
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.76
|
| Rate for Payer: Aetna Government |
$0.76
|
| Rate for Payer: Brighton Health Commercial |
$22.35
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$23.84
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$20.27
|
| Rate for Payer: Group Health Inc Commercial |
$14.90
|
| Rate for Payer: Group Health Inc Medicare |
$10.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.90
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$0.62
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$0.66
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$0.66
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$0.66
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$19.37
|
|
|
ENOXAPARIN SODIUM 80 MG/0.8ML IJ SOSY [183775]
|
Facility
|
OP
|
$11.10
|
|
|
Service Code
|
HCPCS J1650
|
| Hospital Charge Code |
63323058499
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$8.88 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.76
|
| Rate for Payer: Aetna Government |
$0.76
|
| Rate for Payer: Brighton Health Commercial |
$8.32
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.88
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7.55
|
| Rate for Payer: Group Health Inc Commercial |
$5.55
|
| Rate for Payer: Group Health Inc Medicare |
$3.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.55
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.55
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$0.62
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$0.66
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$0.66
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$0.66
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$7.22
|
|
|
ENOXAPARIN SODIUM 80 MG/0.8ML IJ SOSY [183775]
|
Facility
|
OP
|
$23.85
|
|
|
Service Code
|
HCPCS J1650
|
| Hospital Charge Code |
63323053190
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$19.08 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$13.12
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.76
|
| Rate for Payer: Aetna Government |
$0.76
|
| Rate for Payer: Brighton Health Commercial |
$17.89
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$19.08
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$16.22
|
| Rate for Payer: Group Health Inc Commercial |
$11.92
|
| Rate for Payer: Group Health Inc Medicare |
$8.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$11.92
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$0.62
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$0.66
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$0.66
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$0.66
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$15.50
|
|
|
ENTECAVIR 0.5 MG PO TABS [41147]
|
Facility
|
OP
|
$44.44
|
|
|
Service Code
|
NDC 51991089533
|
| Hospital Charge Code |
51991089533
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.55 |
| Max. Negotiated Rate |
$35.55 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$24.44
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$22.22
|
| Rate for Payer: Aetna Government |
$22.22
|
| Rate for Payer: Brighton Health Commercial |
$33.33
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$35.55
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$30.22
|
| Rate for Payer: Group Health Inc Commercial |
$22.22
|
| Rate for Payer: Group Health Inc Medicare |
$15.55
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$22.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$22.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$28.88
|
|
|
ENTECAVIR 0.5 MG PO TABS [41147]
|
Facility
|
OP
|
$44.43
|
|
|
Service Code
|
NDC 31722083330
|
| Hospital Charge Code |
31722083330
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.55 |
| Max. Negotiated Rate |
$35.55 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$24.44
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$22.22
|
| Rate for Payer: Aetna Government |
$22.22
|
| Rate for Payer: Brighton Health Commercial |
$33.32
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$35.55
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$30.21
|
| Rate for Payer: Group Health Inc Commercial |
$22.22
|
| Rate for Payer: Group Health Inc Medicare |
$15.55
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$22.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$22.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$28.88
|
|
|
ENTECAVIR 0.5MG TABLET
|
Facility
|
OP
|
$4.05
|
|
| Hospital Charge Code |
41653893
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.42 |
| Max. Negotiated Rate |
$3.24 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.23
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.02
|
| Rate for Payer: Aetna Government |
$2.02
|
| Rate for Payer: Brighton Health Commercial |
$3.04
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.24
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.75
|
| Rate for Payer: Group Health Inc Commercial |
$2.02
|
| Rate for Payer: Group Health Inc Medicare |
$1.42
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.63
|
|
|
ENTECAVIR 0.5MG TABLET
|
Facility
|
OP
|
$4.05
|
|
| Hospital Charge Code |
41643893
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.42 |
| Max. Negotiated Rate |
$3.24 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.23
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.02
|
| Rate for Payer: Aetna Government |
$2.02
|
| Rate for Payer: Brighton Health Commercial |
$3.04
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.24
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.75
|
| Rate for Payer: Group Health Inc Commercial |
$2.02
|
| Rate for Payer: Group Health Inc Medicare |
$1.42
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.63
|
|
|
ENTEROVIRUS RT-PCR
|
Facility
|
OP
|
$87.73
|
|
|
Service Code
|
HCPCS 87498
|
| Hospital Charge Code |
40619200
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.56 |
| Max. Negotiated Rate |
$65.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$48.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$35.09
|
| Rate for Payer: Aetna Government |
$35.09
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$24.56
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$24.56
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$24.56
|
| Rate for Payer: Brighton Health Commercial |
$65.80
|
| Rate for Payer: Cash Price |
$35.09
|
| Rate for Payer: Cash Price |
$35.09
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$35.09
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$55.78
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$47.20
|
| Rate for Payer: Elderplan Medicare Advantage |
$35.09
|
| Rate for Payer: EmblemHealth Commercial |
$35.09
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$29.83
|
| Rate for Payer: Fidelis Essential Plan QHP |
$31.23
|
| Rate for Payer: Fidelis Medicare Advantage |
$35.09
|
| Rate for Payer: Fidelis Qualified Health Plan |
$31.23
|
| Rate for Payer: Group Health Inc Commercial |
$35.09
|
| Rate for Payer: Group Health Inc Medicare |
$35.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$43.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$35.09
|
| Rate for Payer: Healthfirst Medicare Advantage |
$35.09
|
| Rate for Payer: Healthfirst QHP |
$35.09
|
| Rate for Payer: Humana Medicare |
$35.79
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$35.09
|
| Rate for Payer: United Healthcare Commercial |
$44.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$35.09
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$28.07
|
| Rate for Payer: Wellcare Medicare |
$31.58
|
|
|
ENTEROVIRUS RT-PCR
|
Facility
|
IP
|
$87.73
|
|
|
Service Code
|
HCPCS 87498
|
| Hospital Charge Code |
40619200
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$35.09
|
|
|
ENTRY PORTAL
|
Facility
|
IP
|
$1,376.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40006118
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$688.00 |
| Max. Negotiated Rate |
$688.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$688.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$688.00
|
|
|
ENTRY PORTAL
|
Facility
|
OP
|
$1,376.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40006118
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$1,444.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$756.80
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Brighton Health Commercial |
$825.60
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$688.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$791.20
|
| Rate for Payer: EmblemHealth Commercial |
$688.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,444.80
|
| Rate for Payer: Group Health Inc Commercial |
$688.00
|
| Rate for Payer: Group Health Inc Medicare |
$481.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$688.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$688.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$894.40
|
|
|
ENTRY REAMER FLEXIBLE SHAFT
|
Facility
|
OP
|
$2,080.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40006117
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$2,184.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,144.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Brighton Health Commercial |
$1,248.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,040.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,196.00
|
| Rate for Payer: EmblemHealth Commercial |
$1,040.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,184.00
|
| Rate for Payer: Group Health Inc Commercial |
$1,040.00
|
| Rate for Payer: Group Health Inc Medicare |
$728.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,040.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,040.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,352.00
|
|
|
ENTRY REAMER FLEXIBLE SHAFT
|
Facility
|
IP
|
$2,080.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40006117
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,040.00 |
| Max. Negotiated Rate |
$1,040.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,040.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,040.00
|
|
