|
Neonate, transferred <5 days old, not born here
|
Facility
|
IP
|
$41,545.55
|
|
|
Service Code
|
APR-DRG 5803
|
| Min. Negotiated Rate |
$7,343.00 |
| Max. Negotiated Rate |
$41,545.55 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$41,545.55
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$41,545.55
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$18,464.69
|
| Rate for Payer: Amida Care Medicaid |
$18,464.69
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$41,545.55
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$18,464.69
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$18,464.69
|
| Rate for Payer: Fidelis Qualified Health Plan |
$22,157.63
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$18,464.69
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$18,464.69
|
| Rate for Payer: Healthfirst Commercial |
$11,809.00
|
| Rate for Payer: Healthfirst Essential Plan |
$41,545.55
|
| Rate for Payer: Healthfirst QHP |
$7,343.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$18,464.69
|
| Rate for Payer: SOMOS Essential |
$41,545.55
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$41,545.55
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$41,545.55
|
| Rate for Payer: United Healthcare Medicaid |
$18,464.69
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$18,464.69
|
|
|
Neonate, transferred <5 days old, not born here
|
Facility
|
IP
|
$51,595.02
|
|
|
Service Code
|
APR-DRG 5804
|
| Min. Negotiated Rate |
$9,115.00 |
| Max. Negotiated Rate |
$51,595.02 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$51,595.02
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$51,595.02
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$22,931.12
|
| Rate for Payer: Amida Care Medicaid |
$22,931.12
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$51,595.02
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$22,931.12
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$22,931.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$27,517.34
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$22,931.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$22,931.12
|
| Rate for Payer: Healthfirst Commercial |
$19,435.00
|
| Rate for Payer: Healthfirst Essential Plan |
$51,595.02
|
| Rate for Payer: Healthfirst QHP |
$9,115.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$22,931.12
|
| Rate for Payer: SOMOS Essential |
$51,595.02
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$51,595.02
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$51,595.02
|
| Rate for Payer: United Healthcare Medicaid |
$22,931.12
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$22,931.12
|
|
|
Neonate, transferred <5 days old, not born here
|
Facility
|
IP
|
$37,379.09
|
|
|
Service Code
|
APR-DRG 5801
|
| Min. Negotiated Rate |
$4,513.00 |
| Max. Negotiated Rate |
$37,379.09 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$37,379.09
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$37,379.09
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$16,612.93
|
| Rate for Payer: Amida Care Medicaid |
$16,612.93
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$37,379.09
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$16,612.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$16,612.93
|
| Rate for Payer: Fidelis Qualified Health Plan |
$19,935.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16,612.93
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$16,612.93
|
| Rate for Payer: Healthfirst Commercial |
$8,469.00
|
| Rate for Payer: Healthfirst Essential Plan |
$37,379.09
|
| Rate for Payer: Healthfirst QHP |
$4,513.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$16,612.93
|
| Rate for Payer: SOMOS Essential |
$37,379.09
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$37,379.09
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$37,379.09
|
| Rate for Payer: United Healthcare Medicaid |
$16,612.93
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$16,612.93
|
|
|
Neonate w ECMO
|
Facility
|
IP
|
$283,860.34
|
|
|
Service Code
|
APR-DRG 5831
|
| Min. Negotiated Rate |
$126,160.15 |
| Max. Negotiated Rate |
$283,860.34 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$283,860.34
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$283,860.34
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$126,160.15
|
| Rate for Payer: Amida Care Medicaid |
$126,160.15
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$283,860.34
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$126,160.15
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$126,160.15
|
| Rate for Payer: Fidelis Qualified Health Plan |
$151,392.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$126,160.15
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$126,160.15
|
| Rate for Payer: Healthfirst Commercial |
$239,949.00
|
| Rate for Payer: Healthfirst Essential Plan |
$283,860.34
|
| Rate for Payer: Healthfirst QHP |
$178,464.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$126,160.15
|
| Rate for Payer: SOMOS Essential |
$283,860.34
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$283,860.34
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$283,860.34
|
| Rate for Payer: United Healthcare Medicaid |
$126,160.15
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$126,160.15
|
|
|
Neonate w ECMO
|
Facility
|
IP
|
$283,860.34
|
|
|
Service Code
|
APR-DRG 5832
|
| Min. Negotiated Rate |
$126,160.15 |
| Max. Negotiated Rate |
$283,860.34 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$283,860.34
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$283,860.34
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$126,160.15
|
| Rate for Payer: Amida Care Medicaid |
$126,160.15
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$283,860.34
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$126,160.15
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$126,160.15
|
| Rate for Payer: Fidelis Qualified Health Plan |
$151,392.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$126,160.15
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$126,160.15
|
| Rate for Payer: Healthfirst Commercial |
$239,949.00
|
| Rate for Payer: Healthfirst Essential Plan |
$283,860.34
|
| Rate for Payer: Healthfirst QHP |
$178,464.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$126,160.15
|
| Rate for Payer: SOMOS Essential |
$283,860.34
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$283,860.34
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$283,860.34
|
| Rate for Payer: United Healthcare Medicaid |
$126,160.15
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$126,160.15
|
|
|
Neonate w ECMO
|
Facility
|
IP
|
$288,659.95
|
|
|
Service Code
|
APR-DRG 5833
|
| Min. Negotiated Rate |
$128,293.31 |
| Max. Negotiated Rate |
$288,659.95 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$288,659.95
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$288,659.95
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$128,293.31
|
| Rate for Payer: Amida Care Medicaid |
$128,293.31
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$288,659.95
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$128,293.31
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$128,293.31
|
| Rate for Payer: Fidelis Qualified Health Plan |
$153,951.97
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$128,293.31
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$128,293.31
|
| Rate for Payer: Healthfirst Commercial |
$240,996.00
|
| Rate for Payer: Healthfirst Essential Plan |
$288,659.95
|
| Rate for Payer: Healthfirst QHP |
$178,464.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$128,293.31
|
| Rate for Payer: SOMOS Essential |
$288,659.95
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$288,659.95
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$288,659.95
|
| Rate for Payer: United Healthcare Medicaid |
$128,293.31
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$128,293.31
|
|
|
Neonate w ECMO
|
Facility
|
IP
|
$483,762.96
|
|
|
Service Code
|
APR-DRG 5834
|
| Min. Negotiated Rate |
$215,005.76 |
| Max. Negotiated Rate |
$483,762.96 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$483,762.96
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$483,762.96
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$215,005.76
|
| Rate for Payer: Amida Care Medicaid |
$215,005.76
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$483,762.96
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$215,005.76
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$215,005.76
|
| Rate for Payer: Fidelis Qualified Health Plan |
$258,006.91
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$215,005.76
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$215,005.76
|
| Rate for Payer: Healthfirst Commercial |
$337,304.00
|
| Rate for Payer: Healthfirst Essential Plan |
$483,762.96
|
| Rate for Payer: Healthfirst QHP |
$245,415.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$215,005.76
|
| Rate for Payer: SOMOS Essential |
$483,762.96
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$483,762.96
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$483,762.96
|
| Rate for Payer: United Healthcare Medicaid |
$215,005.76
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$215,005.76
|
|
|
NEOSTIGMINE-GLYCOPYRROLATE 3-0.6 MG/3ML IV SOSY
|
Facility
|
OP
|
$8.50
|
|
|
Service Code
|
NDC 4202326905
|
| Hospital Charge Code |
4202326905
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$2.98 |
| Max. Negotiated Rate |
$6.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.67
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.25
|
| Rate for Payer: Aetna Government |
$4.25
|
| Rate for Payer: Brighton Health Commercial |
$6.38
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.78
|
| Rate for Payer: EmblemHealth Commercial |
$4.25
|
| Rate for Payer: Group Health Inc Commercial |
$4.25
|
| Rate for Payer: Group Health Inc Medicare |
$2.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.53
|
|
|
NEOSTIGMINE-GLYCOPYRROLATE 3-0.6 MG/3ML IV SOSY
|
Facility
|
IP
|
$8.50
|
|
|
Service Code
|
NDC 4202326905
|
| Hospital Charge Code |
4202326905
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$4.25 |
| Max. Negotiated Rate |
$4.25 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.25
|
|
|
NEOSTIGMINE METHYLSULFATE 10 MG/10ML IV SOLN
|
Facility
|
IP
|
$3.12
|
|
|
Service Code
|
NDC 3172299531
|
| Hospital Charge Code |
3172299531
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$1.56 |
| Max. Negotiated Rate |
$1.56 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.56
|
|
|
NEOSTIGMINE METHYLSULFATE 10 MG/10ML IV SOLN
|
Facility
|
IP
|
$2.16
|
|
|
Service Code
|
NDC 4359852911
|
| Hospital Charge Code |
4359852911
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$1.08 |
| Max. Negotiated Rate |
$1.08 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.08
|
|
|
NEOSTIGMINE METHYLSULFATE 10 MG/10ML IV SOLN
|
Facility
|
OP
|
$3.12
|
|
|
Service Code
|
NDC 3172299531
|
| Hospital Charge Code |
3172299531
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$1.09 |
| Max. Negotiated Rate |
$2.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.72
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.56
|
| Rate for Payer: Aetna Government |
$1.56
|
| Rate for Payer: Brighton Health Commercial |
$2.34
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.12
|
| Rate for Payer: EmblemHealth Commercial |
$1.56
|
| Rate for Payer: Group Health Inc Commercial |
$1.56
|
| Rate for Payer: Group Health Inc Medicare |
$1.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.56
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.03
|
|
|
NEOSTIGMINE METHYLSULFATE 10 MG/10ML IV SOLN
|
Facility
|
IP
|
$3.36
|
|
|
Service Code
|
NDC 6332341510
|
| Hospital Charge Code |
6332341510
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$1.68 |
| Max. Negotiated Rate |
$1.68 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.68
|
|
|
NEOSTIGMINE METHYLSULFATE 10 MG/10ML IV SOLN
|
Facility
|
IP
|
$3.12
|
|
|
Service Code
|
NDC 7012114797
|
| Hospital Charge Code |
7012114797
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$1.56 |
| Max. Negotiated Rate |
$1.56 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.56
|
|
|
NEOSTIGMINE METHYLSULFATE 10 MG/10ML IV SOLN
|
Facility
|
OP
|
$3.36
|
|
|
Service Code
|
NDC 6332341510
|
| Hospital Charge Code |
6332341510
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$1.18 |
| Max. Negotiated Rate |
$2.69 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.85
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.68
|
| Rate for Payer: Aetna Government |
$1.68
|
| Rate for Payer: Brighton Health Commercial |
$2.52
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.69
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.28
|
| Rate for Payer: EmblemHealth Commercial |
$1.68
|
| Rate for Payer: Group Health Inc Commercial |
$1.68
|
| Rate for Payer: Group Health Inc Medicare |
$1.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.68
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.18
|
|
|
NEOSTIGMINE METHYLSULFATE 10 MG/10ML IV SOLN
|
Facility
|
OP
|
$3.12
|
|
|
Service Code
|
NDC 7012114797
|
| Hospital Charge Code |
7012114797
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$1.09 |
| Max. Negotiated Rate |
$2.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.72
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.56
|
| Rate for Payer: Aetna Government |
$1.56
|
| Rate for Payer: Brighton Health Commercial |
$2.34
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.12
|
| Rate for Payer: EmblemHealth Commercial |
$1.56
|
| Rate for Payer: Group Health Inc Commercial |
$1.56
|
| Rate for Payer: Group Health Inc Medicare |
$1.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.56
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.03
|
|
|
NEOSTIGMINE METHYLSULFATE 10 MG/10ML IV SOLN
|
Facility
|
OP
|
$0.99
|
|
|
Service Code
|
NDC 7128850111
|
| Hospital Charge Code |
7128850111
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$0.79 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.54
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.50
|
| Rate for Payer: Aetna Government |
$0.50
|
| Rate for Payer: Brighton Health Commercial |
$0.74
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.79
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.67
|
| Rate for Payer: EmblemHealth Commercial |
$0.50
|
| 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 |
$0.64
|
|
|
NEOSTIGMINE METHYLSULFATE 10 MG/10ML IV SOLN
|
Facility
|
IP
|
$0.99
|
|
|
Service Code
|
NDC 7128850111
|
| Hospital Charge Code |
7128850111
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.50 |
| Max. Negotiated Rate |
$0.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.50
|
|
|
NEOSTIGMINE METHYLSULFATE 10 MG/10ML IV SOLN
|
Facility
|
IP
|
$0.72
|
|
|
Service Code
|
NDC 4202318910
|
| Hospital Charge Code |
4202318910
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$0.36 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.36
|
|
|
NEOSTIGMINE METHYLSULFATE 10 MG/10ML IV SOLN
|
Facility
|
OP
|
$2.25
|
|
|
Service Code
|
NDC 7070017223
|
| Hospital Charge Code |
7070017223
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.79 |
| Max. Negotiated Rate |
$1.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.24
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.12
|
| Rate for Payer: Aetna Government |
$1.12
|
| Rate for Payer: Brighton Health Commercial |
$1.69
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.53
|
| Rate for Payer: EmblemHealth Commercial |
$1.12
|
| Rate for Payer: Group Health Inc Commercial |
$1.12
|
| Rate for Payer: Group Health Inc Medicare |
$0.79
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.46
|
|
|
NEOSTIGMINE METHYLSULFATE 10 MG/10ML IV SOLN
|
Facility
|
IP
|
$2.25
|
|
|
Service Code
|
NDC 7070017223
|
| Hospital Charge Code |
7070017223
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$1.12 |
| Max. Negotiated Rate |
$1.12 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.12
|
|
|
NEOSTIGMINE METHYLSULFATE 10 MG/10ML IV SOLN
|
Facility
|
OP
|
$0.72
|
|
|
Service Code
|
NDC 4202318910
|
| Hospital Charge Code |
4202318910
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.25 |
| Max. Negotiated Rate |
$0.58 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.36
|
| Rate for Payer: Aetna Government |
$0.36
|
| Rate for Payer: Brighton Health Commercial |
$0.54
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.58
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.49
|
| Rate for Payer: EmblemHealth Commercial |
$0.36
|
| Rate for Payer: Group Health Inc Commercial |
$0.36
|
| Rate for Payer: Group Health Inc Medicare |
$0.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.36
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.47
|
|
|
NEOSTIGMINE METHYLSULFATE 10 MG/10ML IV SOLN
|
Facility
|
OP
|
$1.08
|
|
|
Service Code
|
NDC 0641614910
|
| Hospital Charge Code |
0641614910
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.38 |
| Max. Negotiated Rate |
$0.86 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.59
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.54
|
| Rate for Payer: Aetna Government |
$0.54
|
| Rate for Payer: Brighton Health Commercial |
$0.81
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.86
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.73
|
| Rate for Payer: EmblemHealth Commercial |
$0.54
|
| Rate for Payer: Group Health Inc Commercial |
$0.54
|
| Rate for Payer: Group Health Inc Medicare |
$0.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.54
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.70
|
|
|
NEOSTIGMINE METHYLSULFATE 10 MG/10ML IV SOLN
|
Facility
|
IP
|
$1.08
|
|
|
Service Code
|
NDC 0641614910
|
| Hospital Charge Code |
0641614910
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.54 |
| Max. Negotiated Rate |
$0.54 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.54
|
|
|
NEOSTIGMINE METHYLSULFATE 10 MG/10ML IV SOLN
|
Facility
|
OP
|
$2.16
|
|
|
Service Code
|
NDC 4359852936
|
| Hospital Charge Code |
4359852936
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.76 |
| Max. Negotiated Rate |
$1.73 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.19
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.08
|
| Rate for Payer: Aetna Government |
$1.08
|
| Rate for Payer: Brighton Health Commercial |
$1.62
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.73
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.47
|
| Rate for Payer: EmblemHealth Commercial |
$1.08
|
| Rate for Payer: Group Health Inc Commercial |
$1.08
|
| Rate for Payer: Group Health Inc Medicare |
$0.76
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.40
|
|
