|
MENING ACY&W-135 TETANUS CONJ IM SOLN
|
Facility
|
OP
|
$400.46
|
|
|
Service Code
|
NDC 4928159005
|
| Hospital Charge Code |
4928159005
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$140.16 |
| Max. Negotiated Rate |
$320.37 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$220.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$200.23
|
| Rate for Payer: Aetna Government |
$200.23
|
| Rate for Payer: Brighton Health Commercial |
$300.35
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$320.37
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$272.31
|
| Rate for Payer: EmblemHealth Commercial |
$200.23
|
| Rate for Payer: Group Health Inc Commercial |
$200.23
|
| Rate for Payer: Group Health Inc Medicare |
$140.16
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$200.23
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$200.23
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$260.30
|
|
|
MENINGOCOCCAL A C Y&W-135 OLIG IM SOLR
|
Facility
|
OP
|
$188.67
|
|
|
Service Code
|
NDC 5816095509
|
| Hospital Charge Code |
5816095509
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$66.04 |
| Max. Negotiated Rate |
$150.94 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$103.77
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$94.34
|
| Rate for Payer: Aetna Government |
$94.34
|
| Rate for Payer: Brighton Health Commercial |
$141.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$150.94
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$128.30
|
| Rate for Payer: EmblemHealth Commercial |
$94.34
|
| Rate for Payer: Group Health Inc Commercial |
$94.34
|
| Rate for Payer: Group Health Inc Medicare |
$66.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$94.34
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$94.34
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$122.64
|
|
|
MENINGOCOCCAL A C Y&W-135 OLIG IM SOLR
|
Facility
|
IP
|
$188.67
|
|
|
Service Code
|
NDC 5816095509
|
| Hospital Charge Code |
5816095509
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$94.34 |
| Max. Negotiated Rate |
$94.34 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$94.34
|
|
|
MENINGOCOCCAL B RECOMB OMV ADJ IM SUSY
|
Facility
|
OP
|
$536.69
|
|
|
Service Code
|
NDC 5816097620
|
| Hospital Charge Code |
5816097620
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$187.84 |
| Max. Negotiated Rate |
$429.35 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$295.18
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$268.35
|
| Rate for Payer: Aetna Government |
$268.35
|
| Rate for Payer: Brighton Health Commercial |
$402.52
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$429.35
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$364.95
|
| Rate for Payer: EmblemHealth Commercial |
$268.35
|
| Rate for Payer: Group Health Inc Commercial |
$268.35
|
| Rate for Payer: Group Health Inc Medicare |
$187.84
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$268.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$268.35
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$348.85
|
|
|
MENINGOCOCCAL B RECOMB OMV ADJ IM SUSY
|
Facility
|
IP
|
$536.69
|
|
|
Service Code
|
NDC 5816097602
|
| Hospital Charge Code |
5816097602
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$268.35 |
| Max. Negotiated Rate |
$268.35 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$268.35
|
|
|
MENINGOCOCCAL B RECOMB OMV ADJ IM SUSY
|
Facility
|
IP
|
$536.69
|
|
|
Service Code
|
NDC 5816097620
|
| Hospital Charge Code |
5816097620
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$268.35 |
| Max. Negotiated Rate |
$268.35 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$268.35
|
|
|
MENINGOCOCCAL B RECOMB OMV ADJ IM SUSY
|
Facility
|
OP
|
$536.69
|
|
|
Service Code
|
NDC 5816097602
|
| Hospital Charge Code |
5816097602
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$187.84 |
| Max. Negotiated Rate |
$429.35 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$295.18
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$268.35
|
| Rate for Payer: Aetna Government |
$268.35
|
| Rate for Payer: Brighton Health Commercial |
$402.52
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$429.35
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$364.95
|
| Rate for Payer: EmblemHealth Commercial |
$268.35
|
| Rate for Payer: Group Health Inc Commercial |
$268.35
|
| Rate for Payer: Group Health Inc Medicare |
$187.84
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$268.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$268.35
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$348.85
|
|
|
MENINGOCOCCAL B VAC (RECOMB) IM SUSY
|
Facility
|
IP
|
$456.33
|
|
|
Service Code
|
NDC 0005010005
|
| Hospital Charge Code |
0005010005
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$228.16 |
| Max. Negotiated Rate |
$228.16 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$228.16
|
|
|
MENINGOCOCCAL B VAC (RECOMB) IM SUSY
|
Facility
|
OP
|
$456.33
|
|
|
Service Code
|
NDC 0005010005
|
| Hospital Charge Code |
0005010005
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$159.71 |
| Max. Negotiated Rate |
$365.06 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$250.98
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$228.16
|
| Rate for Payer: Aetna Government |
$228.16
|
| Rate for Payer: Brighton Health Commercial |
$342.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$365.06
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$310.30
|
| Rate for Payer: EmblemHealth Commercial |
$228.16
|
| Rate for Payer: Group Health Inc Commercial |
$228.16
|
| Rate for Payer: Group Health Inc Medicare |
$159.71
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$228.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$228.16
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$296.61
|
|
|
Menstrual & other female reproductive system disorders
|
Facility
|
IP
|
$39,116.72
|
|
|
Service Code
|
APR-DRG 5321
|
| Min. Negotiated Rate |
$5,374.00 |
| Max. Negotiated Rate |
$39,116.72 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$39,116.72
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$39,116.72
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$17,385.21
|
| Rate for Payer: Amida Care Medicaid |
$17,385.21
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$39,116.72
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$17,385.21
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$17,385.21
|
| Rate for Payer: Fidelis Qualified Health Plan |
$20,862.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17,385.21
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$17,385.21
|
| Rate for Payer: Healthfirst Commercial |
$9,010.00
|
| Rate for Payer: Healthfirst Essential Plan |
$39,116.72
|
| Rate for Payer: Healthfirst QHP |
$5,374.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$17,385.21
|
| Rate for Payer: SOMOS Essential |
$39,116.72
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$39,116.72
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$39,116.72
|
| Rate for Payer: United Healthcare Medicaid |
$17,385.21
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$17,385.21
|
|
|
Menstrual & other female reproductive system disorders
|
Facility
|
IP
|
$41,842.78
|
|
|
Service Code
|
APR-DRG 5322
|
| Min. Negotiated Rate |
$6,325.00 |
| Max. Negotiated Rate |
$41,842.78 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$41,842.78
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$41,842.78
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$18,596.79
|
| Rate for Payer: Amida Care Medicaid |
$18,596.79
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$41,842.78
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$18,596.79
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$18,596.79
|
| Rate for Payer: Fidelis Qualified Health Plan |
$22,316.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$18,596.79
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$18,596.79
|
| Rate for Payer: Healthfirst Commercial |
$10,544.00
|
| Rate for Payer: Healthfirst Essential Plan |
$41,842.78
|
| Rate for Payer: Healthfirst QHP |
$6,325.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$18,596.79
|
| Rate for Payer: SOMOS Essential |
$41,842.78
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$41,842.78
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$41,842.78
|
| Rate for Payer: United Healthcare Medicaid |
$18,596.79
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$18,596.79
|
|
|
Menstrual & other female reproductive system disorders
|
Facility
|
IP
|
$49,088.81
|
|
|
Service Code
|
APR-DRG 5323
|
| Min. Negotiated Rate |
$11,123.00 |
| Max. Negotiated Rate |
$49,088.81 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$49,088.81
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$49,088.81
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$21,817.25
|
| Rate for Payer: Amida Care Medicaid |
$21,817.25
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$49,088.81
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$21,817.25
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$21,817.25
|
| Rate for Payer: Fidelis Qualified Health Plan |
$26,180.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$21,817.25
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$21,817.25
|
| Rate for Payer: Healthfirst Commercial |
$19,456.00
|
| Rate for Payer: Healthfirst Essential Plan |
$49,088.81
|
| Rate for Payer: Healthfirst QHP |
$11,123.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$21,817.25
|
| Rate for Payer: SOMOS Essential |
$49,088.81
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$49,088.81
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$49,088.81
|
| Rate for Payer: United Healthcare Medicaid |
$21,817.25
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$21,817.25
|
|
|
Menstrual & other female reproductive system disorders
|
Facility
|
IP
|
$50,110.65
|
|
|
Service Code
|
APR-DRG 5324
|
| Min. Negotiated Rate |
$11,429.00 |
| Max. Negotiated Rate |
$50,110.65 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$50,110.65
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$50,110.65
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$22,271.40
|
| Rate for Payer: Amida Care Medicaid |
$22,271.40
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$50,110.65
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$22,271.40
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$22,271.40
|
| Rate for Payer: Fidelis Qualified Health Plan |
$26,725.68
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$22,271.40
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$22,271.40
|
| Rate for Payer: Healthfirst Commercial |
$19,725.00
|
| Rate for Payer: Healthfirst Essential Plan |
$50,110.65
|
| Rate for Payer: Healthfirst QHP |
$11,429.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$22,271.40
|
| Rate for Payer: SOMOS Essential |
$50,110.65
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$50,110.65
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$50,110.65
|
| Rate for Payer: United Healthcare Medicaid |
$22,271.40
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$22,271.40
|
|
|
Mental illness diagnosis w O.R. procedure
|
Facility
|
IP
|
$28,905.00
|
|
|
Service Code
|
APR-DRG 7404
|
| Min. Negotiated Rate |
$3,493.31 |
| Max. Negotiated Rate |
$28,905.00 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$3,493.31
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$3,493.31
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$3,493.31
|
| Rate for Payer: Carelon Behavioral Health HARP/QHP |
$3,493.31
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$7,859.95
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$3,493.31
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4,191.97
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,493.31
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3,493.31
|
| Rate for Payer: Healthfirst Commercial |
$28,905.00
|
| Rate for Payer: Healthfirst Essential Plan |
$7,859.95
|
| Rate for Payer: Healthfirst QHP |
$6,357.82
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$3,493.31
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$7,859.95
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$7,859.95
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$3,493.31
|
| Rate for Payer: SOMOS Essential |
$7,859.95
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$7,859.95
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$7,859.95
|
| Rate for Payer: United Healthcare Medicaid |
$3,493.31
|
|
|
Mental illness diagnosis w O.R. procedure
|
Facility
|
IP
|
$28,905.00
|
|
|
Service Code
|
APR-DRG 7403
|
| Min. Negotiated Rate |
$3,493.31 |
| Max. Negotiated Rate |
$28,905.00 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$3,493.31
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$3,493.31
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$3,493.31
|
| Rate for Payer: Carelon Behavioral Health HARP/QHP |
$3,493.31
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$7,859.95
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$3,493.31
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4,191.97
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,493.31
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3,493.31
|
| Rate for Payer: Healthfirst Commercial |
$28,905.00
|
| Rate for Payer: Healthfirst Essential Plan |
$7,859.95
|
| Rate for Payer: Healthfirst QHP |
$6,357.82
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$3,493.31
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$7,859.95
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$7,859.95
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$3,493.31
|
| Rate for Payer: SOMOS Essential |
$7,859.95
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$7,859.95
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$7,859.95
|
| Rate for Payer: United Healthcare Medicaid |
$3,493.31
|
|
|
Mental illness diagnosis w O.R. procedure
|
Facility
|
IP
|
$28,905.00
|
|
|
Service Code
|
APR-DRG 7402
|
| Min. Negotiated Rate |
$3,493.31 |
| Max. Negotiated Rate |
$28,905.00 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$3,493.31
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$3,493.31
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$3,493.31
|
| Rate for Payer: Carelon Behavioral Health HARP/QHP |
$3,493.31
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$7,859.95
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$3,493.31
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4,191.97
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,493.31
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3,493.31
|
| Rate for Payer: Healthfirst Commercial |
$28,905.00
|
| Rate for Payer: Healthfirst Essential Plan |
$7,859.95
|
| Rate for Payer: Healthfirst QHP |
$6,357.82
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$3,493.31
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$7,859.95
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$7,859.95
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$3,493.31
|
| Rate for Payer: SOMOS Essential |
$7,859.95
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$7,859.95
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$7,859.95
|
| Rate for Payer: United Healthcare Medicaid |
$3,493.31
|
|
|
Mental illness diagnosis w O.R. procedure
|
Facility
|
IP
|
$28,905.00
|
|
|
Service Code
|
APR-DRG 7401
|
| Min. Negotiated Rate |
$3,493.31 |
| Max. Negotiated Rate |
$28,905.00 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$3,493.31
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$3,493.31
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$3,493.31
|
| Rate for Payer: Carelon Behavioral Health HARP/QHP |
$3,493.31
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$7,859.95
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$3,493.31
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4,191.97
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,493.31
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3,493.31
|
| Rate for Payer: Healthfirst Commercial |
$28,905.00
|
| Rate for Payer: Healthfirst Essential Plan |
$7,859.95
|
| Rate for Payer: Healthfirst QHP |
$6,357.82
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$3,493.31
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$7,859.95
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$7,859.95
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$3,493.31
|
| Rate for Payer: SOMOS Essential |
$7,859.95
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$7,859.95
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$7,859.95
|
| Rate for Payer: United Healthcare Medicaid |
$3,493.31
|
|
|
MEPERIDINE HCL 100 MG/ML IJ SOLN
|
Facility
|
OP
|
$7.68
|
|
|
Service Code
|
HCPCS J2175
|
| Hospital Charge Code |
0409118069
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.69 |
| Max. Negotiated Rate |
$15.69 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.22
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.48
|
| Rate for Payer: Aetna Government |
$6.48
|
| Rate for Payer: Brighton Health Commercial |
$5.76
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.14
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.22
|
| Rate for Payer: EmblemHealth Commercial |
$3.84
|
| Rate for Payer: Group Health Inc Commercial |
$3.84
|
| Rate for Payer: Group Health Inc Medicare |
$2.69
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.84
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$15.69
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.99
|
|
|
MEPERIDINE HCL 100 MG/ML IJ SOLN
|
Facility
|
IP
|
$7.68
|
|
|
Service Code
|
HCPCS J2175
|
| Hospital Charge Code |
0409118069
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.84 |
| Max. Negotiated Rate |
$3.84 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.84
|
|
|
MEPERIDINE HCL 25 MG/ML IJ SOLN
|
Facility
|
IP
|
$3.05
|
|
|
Service Code
|
HCPCS J2175
|
| Hospital Charge Code |
0641605201
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.52 |
| Max. Negotiated Rate |
$1.52 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.52
|
|
|
MEPERIDINE HCL 25 MG/ML IJ SOLN
|
Facility
|
OP
|
$3.05
|
|
|
Service Code
|
HCPCS J2175
|
| Hospital Charge Code |
0641605201
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.07 |
| Max. Negotiated Rate |
$15.69 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.68
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.48
|
| Rate for Payer: Aetna Government |
$6.48
|
| Rate for Payer: Brighton Health Commercial |
$2.29
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.44
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.07
|
| Rate for Payer: EmblemHealth Commercial |
$1.52
|
| Rate for Payer: Group Health Inc Commercial |
$1.52
|
| Rate for Payer: Group Health Inc Medicare |
$1.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.52
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$15.69
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.98
|
|
|
MEPERIDINE HCL 25 MG/ML IJ SOLN
|
Facility
|
OP
|
$7.25
|
|
|
Service Code
|
HCPCS J2175
|
| Hospital Charge Code |
0409117630
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.54 |
| Max. Negotiated Rate |
$15.69 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.99
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.48
|
| Rate for Payer: Aetna Government |
$6.48
|
| Rate for Payer: Brighton Health Commercial |
$5.44
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.93
|
| Rate for Payer: EmblemHealth Commercial |
$3.62
|
| Rate for Payer: Group Health Inc Commercial |
$3.62
|
| Rate for Payer: Group Health Inc Medicare |
$2.54
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.62
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$15.69
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.71
|
|
|
MEPERIDINE HCL 25 MG/ML IJ SOLN
|
Facility
|
IP
|
$3.04
|
|
|
Service Code
|
HCPCS J2175
|
| Hospital Charge Code |
0641605225
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.52 |
| Max. Negotiated Rate |
$1.52 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.52
|
|
|
MEPERIDINE HCL 25 MG/ML IJ SOLN
|
Facility
|
IP
|
$7.25
|
|
|
Service Code
|
HCPCS J2175
|
| Hospital Charge Code |
0409117630
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.62 |
| Max. Negotiated Rate |
$3.62 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.62
|
|
|
MEPERIDINE HCL 25 MG/ML IJ SOLN
|
Facility
|
OP
|
$3.04
|
|
|
Service Code
|
HCPCS J2175
|
| Hospital Charge Code |
0641605225
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.07 |
| Max. Negotiated Rate |
$15.69 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.67
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.48
|
| Rate for Payer: Aetna Government |
$6.48
|
| Rate for Payer: Brighton Health Commercial |
$2.28
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.44
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.07
|
| Rate for Payer: EmblemHealth Commercial |
$1.52
|
| Rate for Payer: Group Health Inc Commercial |
$1.52
|
| Rate for Payer: Group Health Inc Medicare |
$1.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.52
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$15.69
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.98
|
|
