|
MECLIZINE HCL 25 MG PO TABS
|
Facility
|
OP
|
$0.40
|
|
|
Service Code
|
NDC 7071011621
|
| Hospital Charge Code |
7071011621
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.32 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.22
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.20
|
| Rate for Payer: Aetna Government |
$0.20
|
| Rate for Payer: Brighton Health Commercial |
$0.30
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.32
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.27
|
| Rate for Payer: EmblemHealth Commercial |
$0.20
|
| Rate for Payer: Group Health Inc Commercial |
$0.20
|
| Rate for Payer: Group Health Inc Medicare |
$0.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.26
|
|
|
MEDICATION ADMINISTRATION & OBSERVATION
|
Facility
|
OP
|
$42.56
|
|
|
Service Code
|
EAPG 00322
|
| Min. Negotiated Rate |
$27.77 |
| Max. Negotiated Rate |
$42.56 |
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$27.77
|
| Rate for Payer: Healthfirst Commercial |
$42.56
|
|
|
MEDIHONEY CA ALGINATE 2"X2" EX PADS
|
Facility
|
OP
|
$13.99
|
|
|
Service Code
|
NDC 0995803131
|
| Hospital Charge Code |
0995803131
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.90 |
| Max. Negotiated Rate |
$11.19 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$7.00
|
| Rate for Payer: Aetna Government |
$7.00
|
| Rate for Payer: Brighton Health Commercial |
$10.49
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$11.19
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$9.51
|
| Rate for Payer: EmblemHealth Commercial |
$7.00
|
| Rate for Payer: Group Health Inc Commercial |
$7.00
|
| Rate for Payer: Group Health Inc Medicare |
$4.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$9.09
|
|
|
MEDIHONEY CA ALGINATE 2"X2" EX PADS
|
Facility
|
IP
|
$13.99
|
|
|
Service Code
|
NDC 0995803131
|
| Hospital Charge Code |
0995803131
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.00 |
| Max. Negotiated Rate |
$7.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.00
|
|
|
MEDIHONEY CA ALGINATE 4"X5" EX PADS
|
Facility
|
IP
|
$31.78
|
|
|
Service Code
|
NDC 0995803141
|
| Hospital Charge Code |
0995803141
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.89 |
| Max. Negotiated Rate |
$15.89 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15.89
|
|
|
MEDIHONEY CA ALGINATE 4"X5" EX PADS
|
Facility
|
OP
|
$31.78
|
|
|
Service Code
|
NDC 0995803141
|
| Hospital Charge Code |
0995803141
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.12 |
| Max. Negotiated Rate |
$25.42 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$17.48
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$15.89
|
| Rate for Payer: Aetna Government |
$15.89
|
| Rate for Payer: Brighton Health Commercial |
$23.83
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$25.42
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$21.61
|
| Rate for Payer: EmblemHealth Commercial |
$15.89
|
| Rate for Payer: Group Health Inc Commercial |
$15.89
|
| Rate for Payer: Group Health Inc Medicare |
$11.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15.89
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$15.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$20.65
|
|
|
MEDIHONEY WOUND/BURN DRESSING EX GEL
|
Facility
|
OP
|
$0.96
|
|
|
Service Code
|
NDC 0995803471
|
| Hospital Charge Code |
0995803471
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.34 |
| Max. Negotiated Rate |
$0.77 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.53
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.48
|
| Rate for Payer: Aetna Government |
$0.48
|
| Rate for Payer: Brighton Health Commercial |
$0.72
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.77
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.66
|
| Rate for Payer: EmblemHealth Commercial |
$0.48
|
| Rate for Payer: Group Health Inc Commercial |
$0.48
|
| Rate for Payer: Group Health Inc Medicare |
$0.34
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.48
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.48
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.63
|
|
|
MEDIHONEY WOUND/BURN DRESSING EX GEL
|
Facility
|
IP
|
$1.02
|
|
|
Service Code
|
NDC 0995803461
|
| Hospital Charge Code |
0995803461
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.51 |
| Max. Negotiated Rate |
$0.51 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.51
|
|
|
MEDIHONEY WOUND/BURN DRESSING EX GEL
|
Facility
|
IP
|
$0.96
|
|
|
Service Code
|
NDC 0995803471
|
| Hospital Charge Code |
0995803471
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.48 |
| Max. Negotiated Rate |
$0.48 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.48
|
|
|
MEDIHONEY WOUND/BURN DRESSING EX GEL
|
Facility
|
OP
|
$1.02
|
|
|
Service Code
|
NDC 0995803461
|
| Hospital Charge Code |
0995803461
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$0.82 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.56
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.51
|
| Rate for Payer: Aetna Government |
$0.51
|
| Rate for Payer: Brighton Health Commercial |
$0.77
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.82
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.69
|
| Rate for Payer: EmblemHealth Commercial |
$0.51
|
| Rate for Payer: Group Health Inc Commercial |
$0.51
|
| Rate for Payer: Group Health Inc Medicare |
$0.36
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.51
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.51
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.66
|
|
|
MEDROXYPROGESTERONE ACETATE 10 MG PO TABS
|
Facility
|
OP
|
$1.68
|
|
|
Service Code
|
NDC 6068710521
|
| Hospital Charge Code |
6068710521
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$1.34 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.92
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.84
|
| Rate for Payer: Aetna Government |
$0.84
|
| Rate for Payer: Brighton Health Commercial |
$1.26
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.34
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.14
|
| Rate for Payer: EmblemHealth Commercial |
$0.84
|
| Rate for Payer: Group Health Inc Commercial |
$0.84
|
| Rate for Payer: Group Health Inc Medicare |
$0.59
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.84
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.09
|
|
|
MEDROXYPROGESTERONE ACETATE 10 MG PO TABS
|
Facility
|
OP
|
$0.49
|
|
|
Service Code
|
NDC 5976200561
|
| Hospital Charge Code |
5976200561
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.17 |
| Max. Negotiated Rate |
$0.39 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.27
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.25
|
| Rate for Payer: Aetna Government |
$0.25
|
| Rate for Payer: Brighton Health Commercial |
$0.37
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.39
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.33
|
| Rate for Payer: EmblemHealth Commercial |
$0.25
|
| Rate for Payer: Group Health Inc Commercial |
$0.25
|
| Rate for Payer: Group Health Inc Medicare |
$0.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.32
|
|
|
MEDROXYPROGESTERONE ACETATE 10 MG PO TABS
|
Facility
|
IP
|
$0.49
|
|
|
Service Code
|
NDC 0555077902
|
| Hospital Charge Code |
0555077902
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.25 |
| Max. Negotiated Rate |
$0.25 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.25
|
|
|
MEDROXYPROGESTERONE ACETATE 10 MG PO TABS
|
Facility
|
IP
|
$1.68
|
|
|
Service Code
|
NDC 6068710521
|
| Hospital Charge Code |
6068710521
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.84 |
| Max. Negotiated Rate |
$0.84 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.84
|
|
|
MEDROXYPROGESTERONE ACETATE 10 MG PO TABS
|
Facility
|
OP
|
$0.49
|
|
|
Service Code
|
NDC 0555077902
|
| Hospital Charge Code |
0555077902
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.17 |
| Max. Negotiated Rate |
$0.39 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.27
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.25
|
| Rate for Payer: Aetna Government |
$0.25
|
| Rate for Payer: Brighton Health Commercial |
$0.37
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.39
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.33
|
| Rate for Payer: EmblemHealth Commercial |
$0.25
|
| Rate for Payer: Group Health Inc Commercial |
$0.25
|
| Rate for Payer: Group Health Inc Medicare |
$0.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.32
|
|
|
MEDROXYPROGESTERONE ACETATE 10 MG PO TABS
|
Facility
|
IP
|
$0.49
|
|
|
Service Code
|
NDC 5976200561
|
| Hospital Charge Code |
5976200561
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.25 |
| Max. Negotiated Rate |
$0.25 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.25
|
|
|
MEDROXYPROGESTERONE ACETATE 150 MG/ML IM SUSP
|
Facility
|
IP
|
$54.00
|
|
|
Service Code
|
HCPCS J1050
|
| Hospital Charge Code |
0548540000
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$27.00 |
| Max. Negotiated Rate |
$27.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$27.00
|
|
|
MEDROXYPROGESTERONE ACETATE 150 MG/ML IM SUSP
|
Facility
|
IP
|
$41.27
|
|
|
Service Code
|
HCPCS J1050
|
| Hospital Charge Code |
6745788799
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$20.64 |
| Max. Negotiated Rate |
$20.64 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$20.64
|
|
|
MEDROXYPROGESTERONE ACETATE 150 MG/ML IM SUSP
|
Facility
|
OP
|
$97.75
|
|
|
Service Code
|
HCPCS J1050
|
| Hospital Charge Code |
6275609045
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$78.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$53.76
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.57
|
| Rate for Payer: Aetna Government |
$0.57
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$0.72
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$0.72
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$0.32
|
| Rate for Payer: Amida Care Medicaid |
$0.32
|
| Rate for Payer: Brighton Health Commercial |
$73.31
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$78.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$66.47
|
| Rate for Payer: EmblemHealth Commercial |
$48.87
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$0.72
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$0.32
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$0.32
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$0.72
|
| Rate for Payer: Fidelis Essential Plan QHP |
$0.72
|
| Rate for Payer: Fidelis Qualified Health Plan |
$0.34
|
| Rate for Payer: Group Health Inc Commercial |
$48.87
|
| Rate for Payer: Group Health Inc Medicare |
$34.21
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$48.87
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$32.00
|
| Rate for Payer: Healthfirst Essential Plan |
$0.72
|
| Rate for Payer: Healthfirst QHP |
$0.52
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$0.32
|
| Rate for Payer: SOMOS Essential |
$0.72
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$0.72
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$0.35
|
| Rate for Payer: United Healthcare Medicaid |
$0.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$63.53
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$0.32
|
|
|
MEDROXYPROGESTERONE ACETATE 150 MG/ML IM SUSP
|
Facility
|
IP
|
$97.75
|
|
|
Service Code
|
HCPCS J1050
|
| Hospital Charge Code |
6275609045
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$48.87 |
| Max. Negotiated Rate |
$48.87 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$48.87
|
|
|
MEDROXYPROGESTERONE ACETATE 150 MG/ML IM SUSP
|
Facility
|
OP
|
$97.85
|
|
|
Service Code
|
HCPCS J1050
|
| Hospital Charge Code |
6275609040
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$78.28 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$53.82
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.57
|
| Rate for Payer: Aetna Government |
$0.57
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$0.72
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$0.72
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$0.32
|
| Rate for Payer: Amida Care Medicaid |
$0.32
|
| Rate for Payer: Brighton Health Commercial |
$73.39
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$78.28
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$66.54
|
| Rate for Payer: EmblemHealth Commercial |
$48.92
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$0.72
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$0.32
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$0.32
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$0.72
|
| Rate for Payer: Fidelis Essential Plan QHP |
$0.72
|
| Rate for Payer: Fidelis Qualified Health Plan |
$0.34
|
| Rate for Payer: Group Health Inc Commercial |
$48.92
|
| Rate for Payer: Group Health Inc Medicare |
$34.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$48.92
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$32.00
|
| Rate for Payer: Healthfirst Essential Plan |
$0.72
|
| Rate for Payer: Healthfirst QHP |
$0.52
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$0.32
|
| Rate for Payer: SOMOS Essential |
$0.72
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$0.72
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$0.35
|
| Rate for Payer: United Healthcare Medicaid |
$0.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$63.60
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$0.32
|
|
|
MEDROXYPROGESTERONE ACETATE 150 MG/ML IM SUSP
|
Facility
|
IP
|
$97.85
|
|
|
Service Code
|
HCPCS J1050
|
| Hospital Charge Code |
6699337083
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$48.92 |
| Max. Negotiated Rate |
$48.92 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$48.92
|
|
|
MEDROXYPROGESTERONE ACETATE 150 MG/ML IM SUSP
|
Facility
|
IP
|
$54.00
|
|
|
Service Code
|
HCPCS J1050
|
| Hospital Charge Code |
0548540025
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$27.00 |
| Max. Negotiated Rate |
$27.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$27.00
|
|
|
MEDROXYPROGESTERONE ACETATE 150 MG/ML IM SUSP
|
Facility
|
OP
|
$54.00
|
|
|
Service Code
|
HCPCS J1050
|
| Hospital Charge Code |
0548540025
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$43.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$29.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.57
|
| Rate for Payer: Aetna Government |
$0.57
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$0.72
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$0.72
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$0.32
|
| Rate for Payer: Amida Care Medicaid |
$0.32
|
| Rate for Payer: Brighton Health Commercial |
$40.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$43.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$36.72
|
| Rate for Payer: EmblemHealth Commercial |
$27.00
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$0.72
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$0.32
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$0.32
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$0.72
|
| Rate for Payer: Fidelis Essential Plan QHP |
$0.72
|
| Rate for Payer: Fidelis Qualified Health Plan |
$0.34
|
| Rate for Payer: Group Health Inc Commercial |
$27.00
|
| Rate for Payer: Group Health Inc Medicare |
$18.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$27.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$32.00
|
| Rate for Payer: Healthfirst Essential Plan |
$0.72
|
| Rate for Payer: Healthfirst QHP |
$0.52
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$0.32
|
| Rate for Payer: SOMOS Essential |
$0.72
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$0.72
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$0.35
|
| Rate for Payer: United Healthcare Medicaid |
$0.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$35.10
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$0.32
|
|
|
MEDROXYPROGESTERONE ACETATE 150 MG/ML IM SUSP
|
Facility
|
OP
|
$54.00
|
|
|
Service Code
|
HCPCS J1050
|
| Hospital Charge Code |
0548540000
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$43.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$29.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.57
|
| Rate for Payer: Aetna Government |
$0.57
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$0.72
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$0.72
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$0.32
|
| Rate for Payer: Amida Care Medicaid |
$0.32
|
| Rate for Payer: Brighton Health Commercial |
$40.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$43.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$36.72
|
| Rate for Payer: EmblemHealth Commercial |
$27.00
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$0.72
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$0.32
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$0.32
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$0.72
|
| Rate for Payer: Fidelis Essential Plan QHP |
$0.72
|
| Rate for Payer: Fidelis Qualified Health Plan |
$0.34
|
| Rate for Payer: Group Health Inc Commercial |
$27.00
|
| Rate for Payer: Group Health Inc Medicare |
$18.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$27.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$32.00
|
| Rate for Payer: Healthfirst Essential Plan |
$0.72
|
| Rate for Payer: Healthfirst QHP |
$0.52
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$0.32
|
| Rate for Payer: SOMOS Essential |
$0.72
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$0.72
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$0.35
|
| Rate for Payer: United Healthcare Medicaid |
$0.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$35.10
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$0.32
|
|
