|
Other stomach, esophageal & duodenal procedures
|
Facility
|
IP
|
$68,030.51
|
|
|
Service Code
|
APR-DRG 2223
|
| Min. Negotiated Rate |
$27,581.00 |
| Max. Negotiated Rate |
$68,030.51 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$68,030.51
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$68,030.51
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$30,235.78
|
| Rate for Payer: Amida Care Medicaid |
$30,235.78
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$68,030.51
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$30,235.78
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$30,235.78
|
| Rate for Payer: Fidelis Qualified Health Plan |
$36,282.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$30,235.78
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$30,235.78
|
| Rate for Payer: Healthfirst Commercial |
$44,742.00
|
| Rate for Payer: Healthfirst Essential Plan |
$68,030.51
|
| Rate for Payer: Healthfirst QHP |
$27,581.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$30,235.78
|
| Rate for Payer: SOMOS Essential |
$68,030.51
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$68,030.51
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$68,030.51
|
| Rate for Payer: United Healthcare Medicaid |
$30,235.78
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$30,235.78
|
|
|
Other stomach, esophageal & duodenal procedures
|
Facility
|
IP
|
$129,345.68
|
|
|
Service Code
|
APR-DRG 2224
|
| Min. Negotiated Rate |
$57,486.97 |
| Max. Negotiated Rate |
$129,345.68 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$129,345.68
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$129,345.68
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$57,486.97
|
| Rate for Payer: Amida Care Medicaid |
$57,486.97
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$129,345.68
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$57,486.97
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$57,486.97
|
| Rate for Payer: Fidelis Qualified Health Plan |
$68,984.36
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$57,486.97
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$57,486.97
|
| Rate for Payer: Healthfirst Commercial |
$88,879.00
|
| Rate for Payer: Healthfirst Essential Plan |
$129,345.68
|
| Rate for Payer: Healthfirst QHP |
$68,392.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$57,486.97
|
| Rate for Payer: SOMOS Essential |
$129,345.68
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$129,345.68
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$129,345.68
|
| Rate for Payer: United Healthcare Medicaid |
$57,486.97
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$57,486.97
|
|
|
Other stomach, esophageal & duodenal procedures
|
Facility
|
IP
|
$46,489.39
|
|
|
Service Code
|
APR-DRG 2221
|
| Min. Negotiated Rate |
$10,256.00 |
| Max. Negotiated Rate |
$46,489.39 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$46,489.39
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$46,489.39
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$20,661.95
|
| Rate for Payer: Amida Care Medicaid |
$20,661.95
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$46,489.39
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$20,661.95
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$20,661.95
|
| Rate for Payer: Fidelis Qualified Health Plan |
$24,794.34
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$20,661.95
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$20,661.95
|
| Rate for Payer: Healthfirst Commercial |
$17,248.00
|
| Rate for Payer: Healthfirst Essential Plan |
$46,489.39
|
| Rate for Payer: Healthfirst QHP |
$10,256.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$20,661.95
|
| Rate for Payer: SOMOS Essential |
$46,489.39
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$46,489.39
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$46,489.39
|
| Rate for Payer: United Healthcare Medicaid |
$20,661.95
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$20,661.95
|
|
|
Other stomach, esophageal & duodenal procedures
|
Facility
|
IP
|
$51,959.09
|
|
|
Service Code
|
APR-DRG 2222
|
| Min. Negotiated Rate |
$13,513.00 |
| Max. Negotiated Rate |
$51,959.09 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$51,959.09
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$51,959.09
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$23,092.93
|
| Rate for Payer: Amida Care Medicaid |
$23,092.93
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$51,959.09
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$23,092.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$23,092.93
|
| Rate for Payer: Fidelis Qualified Health Plan |
$27,711.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$23,092.93
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$23,092.93
|
| Rate for Payer: Healthfirst Commercial |
$22,137.00
|
| Rate for Payer: Healthfirst Essential Plan |
$51,959.09
|
| Rate for Payer: Healthfirst QHP |
$13,513.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$23,092.93
|
| Rate for Payer: SOMOS Essential |
$51,959.09
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$51,959.09
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$51,959.09
|
| Rate for Payer: United Healthcare Medicaid |
$23,092.93
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$23,092.93
|
|
|
Other & unspecified gastrointestinal hemorrhage
|
Facility
|
IP
|
$46,355.71
|
|
|
Service Code
|
APR-DRG 2532
|
| Min. Negotiated Rate |
$8,594.00 |
| Max. Negotiated Rate |
$46,355.71 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$46,355.71
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$46,355.71
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$20,602.54
|
| Rate for Payer: Amida Care Medicaid |
$20,602.54
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$46,355.71
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$20,602.54
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$20,602.54
|
| Rate for Payer: Fidelis Qualified Health Plan |
$24,723.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$20,602.54
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$20,602.54
|
| Rate for Payer: Healthfirst Commercial |
$14,923.00
|
| Rate for Payer: Healthfirst Essential Plan |
$46,355.71
|
| Rate for Payer: Healthfirst QHP |
$8,594.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$20,602.54
|
| Rate for Payer: SOMOS Essential |
$46,355.71
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$46,355.71
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$46,355.71
|
| Rate for Payer: United Healthcare Medicaid |
$20,602.54
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$20,602.54
|
|
|
Other & unspecified gastrointestinal hemorrhage
|
Facility
|
IP
|
$42,752.05
|
|
|
Service Code
|
APR-DRG 2531
|
| Min. Negotiated Rate |
$6,607.00 |
| Max. Negotiated Rate |
$42,752.05 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$42,752.05
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$42,752.05
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$19,000.91
|
| Rate for Payer: Amida Care Medicaid |
$19,000.91
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$42,752.05
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$19,000.91
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$19,000.91
|
| Rate for Payer: Fidelis Qualified Health Plan |
$22,801.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$19,000.91
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$19,000.91
|
| Rate for Payer: Healthfirst Commercial |
$11,341.00
|
| Rate for Payer: Healthfirst Essential Plan |
$42,752.05
|
| Rate for Payer: Healthfirst QHP |
$6,607.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$19,000.91
|
| Rate for Payer: SOMOS Essential |
$42,752.05
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$42,752.05
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$42,752.05
|
| Rate for Payer: United Healthcare Medicaid |
$19,000.91
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$19,000.91
|
|
|
Other & unspecified gastrointestinal hemorrhage
|
Facility
|
IP
|
$55,525.84
|
|
|
Service Code
|
APR-DRG 2533
|
| Min. Negotiated Rate |
$12,697.00 |
| Max. Negotiated Rate |
$55,525.84 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$55,525.84
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$55,525.84
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$24,678.15
|
| Rate for Payer: Amida Care Medicaid |
$24,678.15
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$55,525.84
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$24,678.15
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$24,678.15
|
| Rate for Payer: Fidelis Qualified Health Plan |
$29,613.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$24,678.15
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$24,678.15
|
| Rate for Payer: Healthfirst Commercial |
$22,554.00
|
| Rate for Payer: Healthfirst Essential Plan |
$55,525.84
|
| Rate for Payer: Healthfirst QHP |
$12,697.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$24,678.15
|
| Rate for Payer: SOMOS Essential |
$55,525.84
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$55,525.84
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$55,525.84
|
| Rate for Payer: United Healthcare Medicaid |
$24,678.15
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$24,678.15
|
|
|
Other & unspecified gastrointestinal hemorrhage
|
Facility
|
IP
|
$73,626.84
|
|
|
Service Code
|
APR-DRG 2534
|
| Min. Negotiated Rate |
$23,695.00 |
| Max. Negotiated Rate |
$73,626.84 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$73,626.84
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$73,626.84
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$32,723.04
|
| Rate for Payer: Amida Care Medicaid |
$32,723.04
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$73,626.84
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$32,723.04
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$32,723.04
|
| Rate for Payer: Fidelis Qualified Health Plan |
$39,267.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$32,723.04
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$32,723.04
|
| Rate for Payer: Healthfirst Commercial |
$45,126.00
|
| Rate for Payer: Healthfirst Essential Plan |
$73,626.84
|
| Rate for Payer: Healthfirst QHP |
$23,695.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$32,723.04
|
| Rate for Payer: SOMOS Essential |
$73,626.84
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$73,626.84
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$73,626.84
|
| Rate for Payer: United Healthcare Medicaid |
$32,723.04
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$32,723.04
|
|
|
OTORHINOLARYNGOLOGIC FUNCTION TESTS
|
Facility
|
OP
|
$235.27
|
|
|
Service Code
|
EAPG 00251
|
| Min. Negotiated Rate |
$171.26 |
| Max. Negotiated Rate |
$235.27 |
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$171.26
|
| Rate for Payer: Healthfirst Commercial |
$235.27
|
|
|
OXACILLIN SODIUM 1 G IJ SOLR
|
Facility
|
OP
|
$14.50
|
|
|
Service Code
|
HCPCS J2700
|
| Hospital Charge Code |
6467969801
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.79 |
| Max. Negotiated Rate |
$11.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.97
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.28
|
| Rate for Payer: Aetna Government |
$1.28
|
| Rate for Payer: Brighton Health Commercial |
$10.88
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$11.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$9.86
|
| Rate for Payer: EmblemHealth Commercial |
$7.25
|
| Rate for Payer: Group Health Inc Commercial |
$7.25
|
| Rate for Payer: Group Health Inc Medicare |
$5.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.25
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.79
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$9.43
|
|
|
OXACILLIN SODIUM 1 G IJ SOLR
|
Facility
|
IP
|
$14.50
|
|
|
Service Code
|
HCPCS J2700
|
| Hospital Charge Code |
6467969801
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.25 |
| Max. Negotiated Rate |
$7.25 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.25
|
|
|
OXACILLIN SODIUM 2 G IJ SOLR
|
Facility
|
OP
|
$28.28
|
|
|
Service Code
|
HCPCS J2700
|
| Hospital Charge Code |
5515012824
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.79 |
| Max. Negotiated Rate |
$22.62 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$15.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.28
|
| Rate for Payer: Aetna Government |
$1.28
|
| Rate for Payer: Brighton Health Commercial |
$21.21
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$22.62
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$19.23
|
| Rate for Payer: EmblemHealth Commercial |
$14.14
|
| Rate for Payer: Group Health Inc Commercial |
$14.14
|
| Rate for Payer: Group Health Inc Medicare |
$9.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.14
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.79
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$18.38
|
|
|
OXACILLIN SODIUM 2 G IJ SOLR
|
Facility
|
IP
|
$28.28
|
|
|
Service Code
|
HCPCS J2700
|
| Hospital Charge Code |
5515012824
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.14 |
| Max. Negotiated Rate |
$14.14 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.14
|
|
|
OXALIPLATIN 100 MG/20ML IV SOLN
|
Facility
|
OP
|
$12.00
|
|
|
Service Code
|
HCPCS J9263
|
| Hospital Charge Code |
6745744220
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$9.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.11
|
| Rate for Payer: Aetna Government |
$0.11
|
| Rate for Payer: Brighton Health Commercial |
$9.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$9.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$8.16
|
| Rate for Payer: EmblemHealth Commercial |
$6.00
|
| Rate for Payer: Group Health Inc Commercial |
$6.00
|
| Rate for Payer: Group Health Inc Medicare |
$4.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$7.80
|
|
|
OXALIPLATIN 100 MG/20ML IV SOLN
|
Facility
|
OP
|
$1.50
|
|
|
Service Code
|
HCPCS J9263
|
| Hospital Charge Code |
7226616201
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$1.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.83
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.11
|
| Rate for Payer: Aetna Government |
$0.11
|
| Rate for Payer: Brighton Health Commercial |
$1.12
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.02
|
| Rate for Payer: EmblemHealth Commercial |
$0.75
|
| Rate for Payer: Group Health Inc Commercial |
$0.75
|
| Rate for Payer: Group Health Inc Medicare |
$0.53
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.75
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.98
|
|
|
OXALIPLATIN 100 MG/20ML IV SOLN
|
Facility
|
IP
|
$6.00
|
|
|
Service Code
|
HCPCS J9263
|
| Hospital Charge Code |
0703398601
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$3.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.00
|
|
|
OXALIPLATIN 100 MG/20ML IV SOLN
|
Facility
|
OP
|
$6.00
|
|
|
Service Code
|
HCPCS J9263
|
| Hospital Charge Code |
0703398601
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$4.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.11
|
| Rate for Payer: Aetna Government |
$0.11
|
| Rate for Payer: Brighton Health Commercial |
$4.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.08
|
| Rate for Payer: EmblemHealth Commercial |
$3.00
|
| Rate for Payer: Group Health Inc Commercial |
$3.00
|
| Rate for Payer: Group Health Inc Medicare |
$2.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.90
|
|
|
OXALIPLATIN 100 MG/20ML IV SOLN
|
Facility
|
IP
|
$1.50
|
|
|
Service Code
|
HCPCS J9263
|
| Hospital Charge Code |
7226616201
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.75 |
| Max. Negotiated Rate |
$0.75 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.75
|
|
|
OXALIPLATIN 100 MG/20ML IV SOLN
|
Facility
|
IP
|
$12.00
|
|
|
Service Code
|
HCPCS J9263
|
| Hospital Charge Code |
6745744220
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$6.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.00
|
|
|
OXALIPLATIN 100 MG/20ML IV SOLN
|
Facility
|
IP
|
$5.76
|
|
|
Service Code
|
HCPCS J9263
|
| Hospital Charge Code |
6170336322
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$2.88 |
| Max. Negotiated Rate |
$2.88 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.88
|
|
|
OXALIPLATIN 100 MG/20ML IV SOLN
|
Facility
|
IP
|
$21.22
|
|
|
Service Code
|
HCPCS J9263
|
| Hospital Charge Code |
0781331780
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$10.61 |
| Max. Negotiated Rate |
$10.61 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.61
|
|
|
OXALIPLATIN 100 MG/20ML IV SOLN
|
Facility
|
OP
|
$5.76
|
|
|
Service Code
|
HCPCS J9263
|
| Hospital Charge Code |
6170336322
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$4.61 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.17
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.11
|
| Rate for Payer: Aetna Government |
$0.11
|
| Rate for Payer: Brighton Health Commercial |
$4.32
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.61
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.92
|
| Rate for Payer: EmblemHealth Commercial |
$2.88
|
| Rate for Payer: Group Health Inc Commercial |
$2.88
|
| Rate for Payer: Group Health Inc Medicare |
$2.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.88
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.74
|
|
|
OXALIPLATIN 100 MG/20ML IV SOLN
|
Facility
|
OP
|
$21.22
|
|
|
Service Code
|
HCPCS J9263
|
| Hospital Charge Code |
0781331780
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$16.98 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$11.67
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.11
|
| Rate for Payer: Aetna Government |
$0.11
|
| Rate for Payer: Brighton Health Commercial |
$15.91
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$16.98
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$14.43
|
| Rate for Payer: EmblemHealth Commercial |
$10.61
|
| Rate for Payer: Group Health Inc Commercial |
$10.61
|
| Rate for Payer: Group Health Inc Medicare |
$7.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.61
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$10.61
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$13.79
|
|
|
OXALIPLATIN 50 MG/10ML IV SOLN
|
Facility
|
IP
|
$21.22
|
|
|
Service Code
|
HCPCS J9263
|
| Hospital Charge Code |
5074240510
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$10.61 |
| Max. Negotiated Rate |
$10.61 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.61
|
|
|
OXALIPLATIN 50 MG/10ML IV SOLN
|
Facility
|
IP
|
$3.00
|
|
|
Service Code
|
HCPCS J9263
|
| Hospital Charge Code |
2502123310
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$1.50 |
| Max. Negotiated Rate |
$1.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.50
|
|
