|
OXYTOCIN 10 UNIT/ML IJ SOLN
|
Facility
|
IP
|
$1.89
|
|
|
Service Code
|
NDC 6332301202
|
| Hospital Charge Code |
6332301202
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.95 |
| Max. Negotiated Rate |
$0.95 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.95
|
|
|
OXYTOCIN-LACTATED RINGERS 30 UNIT/500ML IV SOLN
|
Facility
|
OP
|
$0.07
|
|
|
Service Code
|
NDC 70092107124
|
| Hospital Charge Code |
70092107124
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.04
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.03
|
| Rate for Payer: Aetna Government |
$0.03
|
| Rate for Payer: Brighton Health Commercial |
$0.05
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.05
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.04
|
| Rate for Payer: EmblemHealth Commercial |
$0.03
|
| Rate for Payer: Group Health Inc Commercial |
$0.03
|
| Rate for Payer: Group Health Inc Medicare |
$0.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.03
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.03
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.04
|
|
|
OXYTOCIN-LACTATED RINGERS 30 UNIT/500ML IV SOLN
|
Facility
|
IP
|
$0.07
|
|
|
Service Code
|
NDC 70092107124
|
| Hospital Charge Code |
70092107124
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.03
|
|
|
OYSTER SHELL CALCIUM 500 MG PO TABS
|
Facility
|
IP
|
$0.04
|
|
|
Service Code
|
NDC 8068100400
|
| Hospital Charge Code |
8068100400
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.02 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.02
|
|
|
OYSTER SHELL CALCIUM 500 MG PO TABS
|
Facility
|
OP
|
$0.04
|
|
|
Service Code
|
NDC 8068100400
|
| Hospital Charge Code |
8068100400
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.02
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.02
|
| Rate for Payer: Aetna Government |
$0.02
|
| Rate for Payer: Brighton Health Commercial |
$0.03
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.03
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.03
|
| Rate for Payer: EmblemHealth Commercial |
$0.02
|
| Rate for Payer: Group Health Inc Commercial |
$0.02
|
| Rate for Payer: Group Health Inc Medicare |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.03
|
|
|
OYSTER SHELL CALCIUM 500 MG PO TABS
|
Facility
|
OP
|
$0.11
|
|
|
Service Code
|
NDC 0904188361
|
| Hospital Charge Code |
0904188361
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.09 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.06
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.05
|
| Rate for Payer: Aetna Government |
$0.05
|
| Rate for Payer: Brighton Health Commercial |
$0.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.09
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.07
|
| Rate for Payer: EmblemHealth Commercial |
$0.05
|
| Rate for Payer: Group Health Inc Commercial |
$0.05
|
| Rate for Payer: Group Health Inc Medicare |
$0.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.07
|
|
|
OYSTER SHELL CALCIUM 500 MG PO TABS
|
Facility
|
OP
|
$0.02
|
|
|
Service Code
|
NDC 0904188372
|
| Hospital Charge Code |
0904188372
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.02 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.01
|
| Rate for Payer: Aetna Government |
$0.01
|
| Rate for Payer: Brighton Health Commercial |
$0.02
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.02
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.01
|
| Rate for Payer: EmblemHealth Commercial |
$0.01
|
| Rate for Payer: Group Health Inc Commercial |
$0.01
|
| Rate for Payer: Group Health Inc Medicare |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.01
|
|
|
OYSTER SHELL CALCIUM 500 MG PO TABS
|
Facility
|
IP
|
$0.02
|
|
|
Service Code
|
NDC 0904188372
|
| Hospital Charge Code |
0904188372
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
|
|
OYSTER SHELL CALCIUM 500 MG PO TABS
|
Facility
|
IP
|
$0.11
|
|
|
Service Code
|
NDC 0904188361
|
| Hospital Charge Code |
0904188361
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.05
|
|
|
PACEMAKER AND OTHER CARDIOVASCULAR DEVICE INSERTION AND REPLACEMENT
|
Facility
|
OP
|
$11,054.58
|
|
|
Service Code
|
EAPG 00086
|
| Min. Negotiated Rate |
$8,023.68 |
| Max. Negotiated Rate |
$11,054.58 |
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$8,023.68
|
| Rate for Payer: Healthfirst Commercial |
$11,054.58
|
|
|
PACLITAXEL 100 MG/16.7ML IV CONC
|
Facility
|
OP
|
$3.10
|
|
|
Service Code
|
HCPCS J9267
|
| Hospital Charge Code |
6332376316
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$2.48 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.71
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.13
|
| Rate for Payer: Aetna Government |
$0.13
|
| Rate for Payer: Brighton Health Commercial |
$2.33
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.48
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.11
|
| Rate for Payer: EmblemHealth Commercial |
$1.55
|
| Rate for Payer: Group Health Inc Commercial |
$1.55
|
| Rate for Payer: Group Health Inc Medicare |
$1.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.55
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.55
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.02
|
|
|
PACLITAXEL 100 MG/16.7ML IV CONC
|
Facility
|
IP
|
$2.84
|
|
|
Service Code
|
HCPCS J9267
|
| Hospital Charge Code |
7086020017
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$1.42 |
| Max. Negotiated Rate |
$1.42 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.42
|
|
|
PACLITAXEL 100 MG/16.7ML IV CONC
|
Facility
|
OP
|
$2.03
|
|
|
Service Code
|
HCPCS J9267
|
| Hospital Charge Code |
6170334222
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$1.62 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.11
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.13
|
| Rate for Payer: Aetna Government |
$0.13
|
| Rate for Payer: Brighton Health Commercial |
$1.52
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.62
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.38
|
| Rate for Payer: EmblemHealth Commercial |
$1.01
|
| Rate for Payer: Group Health Inc Commercial |
$1.01
|
| Rate for Payer: Group Health Inc Medicare |
$0.71
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.01
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.32
|
|
|
PACLITAXEL 100 MG/16.7ML IV CONC
|
Facility
|
OP
|
$2.84
|
|
|
Service Code
|
HCPCS J9267
|
| Hospital Charge Code |
7086020017
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$2.27 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.56
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.13
|
| Rate for Payer: Aetna Government |
$0.13
|
| Rate for Payer: Brighton Health Commercial |
$2.13
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.27
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.93
|
| Rate for Payer: EmblemHealth Commercial |
$1.42
|
| Rate for Payer: Group Health Inc Commercial |
$1.42
|
| Rate for Payer: Group Health Inc Medicare |
$0.99
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.42
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.84
|
|
|
PACLITAXEL 100 MG/16.7ML IV CONC
|
Facility
|
IP
|
$3.10
|
|
|
Service Code
|
HCPCS J9267
|
| Hospital Charge Code |
6332376316
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$1.55 |
| Max. Negotiated Rate |
$1.55 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.55
|
|
|
PACLITAXEL 100 MG/16.7ML IV CONC
|
Facility
|
IP
|
$2.03
|
|
|
Service Code
|
HCPCS J9267
|
| Hospital Charge Code |
6170334222
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$1.01 |
| Max. Negotiated Rate |
$1.01 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.01
|
|
|
PACLITAXEL 100 MG/16.7ML IV CONC
|
Facility
|
IP
|
$2.40
|
|
|
Service Code
|
HCPCS J9267
|
| Hospital Charge Code |
0703321601
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$1.20 |
| Max. Negotiated Rate |
$1.20 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.20
|
|
|
PACLITAXEL 100 MG/16.7ML IV CONC
|
Facility
|
OP
|
$2.40
|
|
|
Service Code
|
HCPCS J9267
|
| Hospital Charge Code |
0703321601
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$1.92 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.32
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.13
|
| Rate for Payer: Aetna Government |
$0.13
|
| Rate for Payer: Brighton Health Commercial |
$1.80
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.92
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.63
|
| Rate for Payer: EmblemHealth Commercial |
$1.20
|
| Rate for Payer: Group Health Inc Commercial |
$1.20
|
| Rate for Payer: Group Health Inc Medicare |
$0.84
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.20
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.56
|
|
|
PACLITAXEL 300 MG/50ML IV CONC
|
Facility
|
IP
|
$3.10
|
|
|
Service Code
|
HCPCS J9267
|
| Hospital Charge Code |
6332376350
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$1.55 |
| Max. Negotiated Rate |
$1.55 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.55
|
|
|
PACLITAXEL 300 MG/50ML IV CONC
|
Facility
|
IP
|
$2.40
|
|
|
Service Code
|
HCPCS J9267
|
| Hospital Charge Code |
0703321801
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$1.20 |
| Max. Negotiated Rate |
$1.20 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.20
|
|
|
PACLITAXEL 300 MG/50ML IV CONC
|
Facility
|
OP
|
$2.40
|
|
|
Service Code
|
HCPCS J9267
|
| Hospital Charge Code |
0703321801
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$1.92 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.32
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.13
|
| Rate for Payer: Aetna Government |
$0.13
|
| Rate for Payer: Brighton Health Commercial |
$1.80
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.92
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.63
|
| Rate for Payer: EmblemHealth Commercial |
$1.20
|
| Rate for Payer: Group Health Inc Commercial |
$1.20
|
| Rate for Payer: Group Health Inc Medicare |
$0.84
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.20
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.56
|
|
|
PACLITAXEL 300 MG/50ML IV CONC
|
Facility
|
OP
|
$3.10
|
|
|
Service Code
|
HCPCS J9267
|
| Hospital Charge Code |
6332376350
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$2.48 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.71
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.13
|
| Rate for Payer: Aetna Government |
$0.13
|
| Rate for Payer: Brighton Health Commercial |
$2.33
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.48
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.11
|
| Rate for Payer: EmblemHealth Commercial |
$1.55
|
| Rate for Payer: Group Health Inc Commercial |
$1.55
|
| Rate for Payer: Group Health Inc Medicare |
$1.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.55
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.55
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.02
|
|
|
PACLITAXEL 300 MG/50ML IV CONC
|
Facility
|
IP
|
$2.40
|
|
|
Service Code
|
HCPCS J9267
|
| Hospital Charge Code |
7220506301
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$1.20 |
| Max. Negotiated Rate |
$1.20 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.20
|
|
|
PACLITAXEL 300 MG/50ML IV CONC
|
Facility
|
OP
|
$2.40
|
|
|
Service Code
|
HCPCS J9267
|
| Hospital Charge Code |
7220506301
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$1.92 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.32
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.13
|
| Rate for Payer: Aetna Government |
$0.13
|
| Rate for Payer: Brighton Health Commercial |
$1.80
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.92
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.63
|
| Rate for Payer: EmblemHealth Commercial |
$1.20
|
| Rate for Payer: Group Health Inc Commercial |
$1.20
|
| Rate for Payer: Group Health Inc Medicare |
$0.84
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.20
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.56
|
|
|
PACLITAXEL 30 MG/5ML IV CONC
|
Facility
|
OP
|
$2.23
|
|
|
Service Code
|
HCPCS J9267
|
| Hospital Charge Code |
6170334209
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$1.79 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.23
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.13
|
| Rate for Payer: Aetna Government |
$0.13
|
| Rate for Payer: Brighton Health Commercial |
$1.68
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.79
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.52
|
| Rate for Payer: EmblemHealth Commercial |
$1.12
|
| Rate for Payer: Group Health Inc Commercial |
$1.12
|
| Rate for Payer: Group Health Inc Medicare |
$0.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.45
|
|
