|
AMIODARONE 360MG/200ML IVPB
|
Facility
|
OP
|
$3.92
|
|
|
Service Code
|
HCPCS J0282
|
| Hospital Charge Code |
41656602
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$2.55 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.16
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.35
|
| Rate for Payer: Aetna Government |
$0.35
|
| Rate for Payer: Brighton Health Commercial |
$2.35
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.96
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.25
|
| Rate for Payer: Group Health Inc Commercial |
$1.96
|
| Rate for Payer: Group Health Inc Medicare |
$1.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.96
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.55
|
|
|
AMIODARONE 360MG/200ML IVPB
|
Facility
|
IP
|
$3.92
|
|
|
Service Code
|
HCPCS J0282
|
| Hospital Charge Code |
41646602
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.96 |
| Max. Negotiated Rate |
$1.96 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.96
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.96
|
|
|
AMIODARONE 360MG/200ML IVPB
|
Facility
|
IP
|
$3.92
|
|
|
Service Code
|
HCPCS J0282
|
| Hospital Charge Code |
41656602
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.96 |
| Max. Negotiated Rate |
$1.96 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.96
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.96
|
|
|
AMIODARONE 50 MG/ML INJ 18 ML
|
Facility
|
IP
|
$0.49
|
|
|
Service Code
|
HCPCS J0282
|
| Hospital Charge Code |
41653305
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.25 |
| Max. Negotiated Rate |
$0.25 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.25
|
|
|
AMIODARONE 50 MG/ML INJ 18 ML
|
Facility
|
OP
|
$0.49
|
|
|
Service Code
|
HCPCS J0282
|
| Hospital Charge Code |
41643305
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.17 |
| Max. Negotiated Rate |
$0.35 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.27
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.35
|
| Rate for Payer: Aetna Government |
$0.35
|
| Rate for Payer: Brighton Health Commercial |
$0.29
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.25
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.28
|
| 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
|
|
|
AMIODARONE 50 MG/ML INJ 18 ML
|
Facility
|
OP
|
$0.49
|
|
|
Service Code
|
HCPCS J0282
|
| Hospital Charge Code |
41653305
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.17 |
| Max. Negotiated Rate |
$0.35 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.27
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.35
|
| Rate for Payer: Aetna Government |
$0.35
|
| Rate for Payer: Brighton Health Commercial |
$0.29
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.25
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.28
|
| 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
|
|
|
AMIODARONE 50 MG/ML INJ 18 ML
|
Facility
|
IP
|
$0.49
|
|
|
Service Code
|
HCPCS J0282
|
| Hospital Charge Code |
41643305
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.25 |
| Max. Negotiated Rate |
$0.25 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.25
|
|
|
AMIODARONE 50 MG/ML INJ 3 ML
|
Facility
|
IP
|
$0.98
|
|
|
Service Code
|
HCPCS J0282
|
| Hospital Charge Code |
41651300
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.49 |
| Max. Negotiated Rate |
$0.49 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.49
|
|
|
AMIODARONE 50 MG/ML INJ 3 ML
|
Facility
|
OP
|
$0.98
|
|
|
Service Code
|
HCPCS J0282
|
| Hospital Charge Code |
41641300
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.34 |
| Max. Negotiated Rate |
$0.64 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.54
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.35
|
| Rate for Payer: Aetna Government |
$0.35
|
| Rate for Payer: Brighton Health Commercial |
$0.59
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.49
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.56
|
| Rate for Payer: Group Health Inc Commercial |
$0.49
|
| Rate for Payer: Group Health Inc Medicare |
$0.34
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.49
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.64
|
|
|
AMIODARONE 50 MG/ML INJ 3 ML
|
Facility
|
OP
|
$0.98
|
|
|
Service Code
|
HCPCS J0282
|
| Hospital Charge Code |
41651300
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.34 |
| Max. Negotiated Rate |
$0.64 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.54
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.35
|
| Rate for Payer: Aetna Government |
$0.35
|
| Rate for Payer: Brighton Health Commercial |
$0.59
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.49
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.56
|
| Rate for Payer: Group Health Inc Commercial |
$0.49
|
| Rate for Payer: Group Health Inc Medicare |
$0.34
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.49
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.64
|
|
|
AMIODARONE 50 MG/ML INJ 3 ML
|
Facility
|
IP
|
$0.98
|
|
|
Service Code
|
HCPCS J0282
|
| Hospital Charge Code |
41641300
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.49 |
| Max. Negotiated Rate |
$0.49 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.49
|
|
|
AMIODARONE HCL 100 MG PO TABS [36959]
|
Facility
|
OP
|
$7.43
|
|
|
Service Code
|
NDC 00245014401
|
| Hospital Charge Code |
00245014401
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.60 |
| Max. Negotiated Rate |
$5.94 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.09
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.72
|
| Rate for Payer: Aetna Government |
$3.72
|
| Rate for Payer: Brighton Health Commercial |
$5.57
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5.94
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.05
|
| Rate for Payer: Group Health Inc Commercial |
$3.72
|
| Rate for Payer: Group Health Inc Medicare |
$2.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.72
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.83
|
|
|
AMIODARONE HCL 150 MG/3ML IV SOLN [93084]
|
Facility
|
IP
|
$1.53
|
|
|
Service Code
|
NDC 67457015303
|
| Hospital Charge Code |
67457015303
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.77 |
| Max. Negotiated Rate |
$0.77 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.77
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.77
|
|
|
AMIODARONE HCL 150 MG/3ML IV SOLN [93084]
|
Facility
|
IP
|
$0.83
|
|
|
Service Code
|
NDC 00143987501
|
| Hospital Charge Code |
00143987501
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.42 |
| Max. Negotiated Rate |
$0.42 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.42
|
|
|
AMIODARONE HCL 150 MG/3ML IV SOLN [93084]
|
Facility
|
OP
|
$0.83
|
|
|
Service Code
|
NDC 00143987501
|
| Hospital Charge Code |
00143987501
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$0.87 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.46
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.42
|
| Rate for Payer: Aetna Government |
$0.42
|
| Rate for Payer: Brighton Health Commercial |
$0.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.42
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.48
|
| Rate for Payer: EmblemHealth Commercial |
$0.42
|
| Rate for Payer: Fidelis Medicare Advantage |
$0.87
|
| Rate for Payer: Group Health Inc Commercial |
$0.42
|
| Rate for Payer: Group Health Inc Medicare |
$0.29
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.42
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.54
|
|
|
AMIODARONE HCL 150 MG/3ML IV SOLN [93084]
|
Facility
|
IP
|
$0.80
|
|
|
Service Code
|
NDC 00143987525
|
| Hospital Charge Code |
00143987525
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$0.40 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.40
|
|
|
AMIODARONE HCL 150 MG/3ML IV SOLN [93084]
|
Facility
|
OP
|
$0.80
|
|
|
Service Code
|
NDC 00143987525
|
| Hospital Charge Code |
00143987525
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.28 |
| Max. Negotiated Rate |
$0.84 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.44
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.40
|
| Rate for Payer: Aetna Government |
$0.40
|
| Rate for Payer: Brighton Health Commercial |
$0.48
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.46
|
| Rate for Payer: EmblemHealth Commercial |
$0.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$0.84
|
| Rate for Payer: Group Health Inc Commercial |
$0.40
|
| Rate for Payer: Group Health Inc Medicare |
$0.28
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.40
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.52
|
|
|
AMIODARONE HCL 150 MG/3ML IV SOLN [93084]
|
Facility
|
OP
|
$1.53
|
|
|
Service Code
|
NDC 67457015303
|
| Hospital Charge Code |
67457015303
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.54 |
| Max. Negotiated Rate |
$1.61 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.84
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.77
|
| Rate for Payer: Aetna Government |
$0.77
|
| Rate for Payer: Brighton Health Commercial |
$0.92
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.77
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.88
|
| Rate for Payer: EmblemHealth Commercial |
$0.77
|
| Rate for Payer: Fidelis Medicare Advantage |
$1.61
|
| Rate for Payer: Group Health Inc Commercial |
$0.77
|
| Rate for Payer: Group Health Inc Medicare |
$0.54
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.77
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.77
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.00
|
|
|
AMIODARONE HCL 200 MG PO TABS [9066]
|
Facility
|
OP
|
$0.36
|
|
|
Service Code
|
NDC 00904699361
|
| Hospital Charge Code |
00904699361
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.28 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.20
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.18
|
| Rate for Payer: Aetna Government |
$0.18
|
| Rate for Payer: Brighton Health Commercial |
$0.27
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.28
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.24
|
| Rate for Payer: Group Health Inc Commercial |
$0.18
|
| Rate for Payer: Group Health Inc Medicare |
$0.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.18
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.23
|
|
|
AMIODARONE HCL 200 MG PO TABS [9066]
|
Facility
|
OP
|
$3.30
|
|
|
Service Code
|
NDC 51672402504
|
| Hospital Charge Code |
51672402504
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.16 |
| Max. Negotiated Rate |
$2.64 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.82
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.65
|
| Rate for Payer: Aetna Government |
$1.65
|
| Rate for Payer: Brighton Health Commercial |
$2.48
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.64
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.25
|
| Rate for Payer: Group Health Inc Commercial |
$1.65
|
| Rate for Payer: Group Health Inc Medicare |
$1.16
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.65
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.65
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.15
|
|
|
AMIODARONE HCL 200 MG PO TABS [9066]
|
Facility
|
OP
|
$3.38
|
|
|
Service Code
|
NDC 65862073260
|
| Hospital Charge Code |
65862073260
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.18 |
| Max. Negotiated Rate |
$2.71 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.86
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.69
|
| Rate for Payer: Aetna Government |
$1.69
|
| Rate for Payer: Brighton Health Commercial |
$2.54
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.71
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.30
|
| Rate for Payer: Group Health Inc Commercial |
$1.69
|
| Rate for Payer: Group Health Inc Medicare |
$1.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.69
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.69
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.20
|
|
|
AMIODARONE HCL 900 MG/18ML IV SOLN [97694]
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
NDC 67457015318
|
| Hospital Charge Code |
67457015318
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.50 |
| Max. Negotiated Rate |
$0.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.50
|
|
|
AMIODARONE HCL 900 MG/18ML IV SOLN [97694]
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
NDC 67457015318
|
| Hospital Charge Code |
67457015318
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$1.05 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.50
|
| Rate for Payer: Aetna Government |
$0.50
|
| Rate for Payer: Brighton Health Commercial |
$0.60
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.57
|
| Rate for Payer: EmblemHealth Commercial |
$0.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$1.05
|
| 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 |
$0.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.65
|
|
|
AMIODARONE HCL IN DEXTROSE 150-4.21 MG/100ML-% IV SOLN [110257]
|
Facility
|
OP
|
$0.42
|
|
|
Service Code
|
NDC 43066015010
|
| Hospital Charge Code |
43066015010
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$0.44 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.23
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.21
|
| Rate for Payer: Aetna Government |
$0.21
|
| Rate for Payer: Brighton Health Commercial |
$0.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.21
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.24
|
| Rate for Payer: EmblemHealth Commercial |
$0.21
|
| Rate for Payer: Fidelis Medicare Advantage |
$0.44
|
| Rate for Payer: Group Health Inc Commercial |
$0.21
|
| Rate for Payer: Group Health Inc Medicare |
$0.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.21
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.27
|
|
|
AMIODARONE HCL IN DEXTROSE 150-4.21 MG/100ML-% IV SOLN [110257]
|
Facility
|
IP
|
$0.42
|
|
|
Service Code
|
NDC 43066015010
|
| Hospital Charge Code |
43066015010
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.21 |
| Max. Negotiated Rate |
$0.21 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.21
|
|
