|
LABETALOL HCL 200 MG PO TABS [10374]
|
Facility
|
OP
|
$1.14
|
|
|
Service Code
|
NDC 49884012305
|
| Hospital Charge Code |
49884012305
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$0.91 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.62
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.57
|
| Rate for Payer: Aetna Government |
$0.57
|
| Rate for Payer: Brighton Health Commercial |
$0.85
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.91
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.77
|
| Rate for Payer: Group Health Inc Commercial |
$0.57
|
| Rate for Payer: Group Health Inc Medicare |
$0.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.57
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.57
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.74
|
|
|
LABETALOL HCL 200 MG PO TABS [10374]
|
Facility
|
OP
|
$0.70
|
|
|
Service Code
|
NDC 60687045011
|
| Hospital Charge Code |
60687045011
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$0.56 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.38
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.35
|
| Rate for Payer: Aetna Government |
$0.35
|
| Rate for Payer: Brighton Health Commercial |
$0.52
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.56
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.48
|
| Rate for Payer: Group Health Inc Commercial |
$0.35
|
| Rate for Payer: Group Health Inc Medicare |
$0.24
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.35
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.45
|
|
|
LABETALOL HCL 200 MG PO TABS [10374]
|
Facility
|
OP
|
$0.53
|
|
|
Service Code
|
NDC 00904711061
|
| Hospital Charge Code |
00904711061
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.19 |
| Max. Negotiated Rate |
$0.43 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.29
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.27
|
| Rate for Payer: Aetna Government |
$0.27
|
| Rate for Payer: Brighton Health Commercial |
$0.40
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.43
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.36
|
| Rate for Payer: Group Health Inc Commercial |
$0.27
|
| Rate for Payer: Group Health Inc Medicare |
$0.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.27
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.35
|
|
|
LABETALOL HCL 200 MG PO TABS [10374]
|
Facility
|
OP
|
$0.70
|
|
|
Service Code
|
NDC 60687045001
|
| Hospital Charge Code |
60687045001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$0.56 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.38
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.35
|
| Rate for Payer: Aetna Government |
$0.35
|
| Rate for Payer: Brighton Health Commercial |
$0.52
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.56
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.48
|
| Rate for Payer: Group Health Inc Commercial |
$0.35
|
| Rate for Payer: Group Health Inc Medicare |
$0.24
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.35
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.45
|
|
|
LABETALOL HCL 300 MG PO TABS [10375]
|
Facility
|
OP
|
$0.95
|
|
|
Service Code
|
NDC 00591060701
|
| Hospital Charge Code |
00591060701
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.33 |
| Max. Negotiated Rate |
$0.76 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.52
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.47
|
| Rate for Payer: Aetna Government |
$0.47
|
| Rate for Payer: Brighton Health Commercial |
$0.71
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.76
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.65
|
| Rate for Payer: Group Health Inc Commercial |
$0.47
|
| Rate for Payer: Group Health Inc Medicare |
$0.33
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.47
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.62
|
|
|
LABETALOL HCL 300 MG PO TABS [10375]
|
Facility
|
OP
|
$1.04
|
|
|
Service Code
|
NDC 00904711161
|
| Hospital Charge Code |
00904711161
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$0.83 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.57
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.52
|
| Rate for Payer: Aetna Government |
$0.52
|
| Rate for Payer: Brighton Health Commercial |
$0.78
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.83
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.71
|
| Rate for Payer: Group Health Inc Commercial |
$0.52
|
| Rate for Payer: Group Health Inc Medicare |
$0.36
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.68
|
|
|
LABETALOL HCL 300 MG PO TABS [10375]
|
Facility
|
OP
|
$1.15
|
|
|
Service Code
|
NDC 70377006213
|
| Hospital Charge Code |
70377006213
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$0.92 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.63
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.58
|
| Rate for Payer: Aetna Government |
$0.58
|
| Rate for Payer: Brighton Health Commercial |
$0.86
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.92
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.78
|
| Rate for Payer: Group Health Inc Commercial |
$0.58
|
| Rate for Payer: Group Health Inc Medicare |
$0.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.58
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.75
|
|
|
LABETALOL HCL 300 MG PO TABS [10375]
|
Facility
|
OP
|
$1.09
|
|
|
Service Code
|
NDC 68382080005
|
| Hospital Charge Code |
68382080005
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.38 |
| Max. Negotiated Rate |
$0.87 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.55
|
| Rate for Payer: Aetna Government |
$0.55
|
| Rate for Payer: Brighton Health Commercial |
$0.82
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.87
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.74
|
| Rate for Payer: Group Health Inc Commercial |
$0.55
|
| Rate for Payer: Group Health Inc Medicare |
$0.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.55
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.55
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.71
|
|
|
LABETALOL HCL 5 MG/ML IV SOLN [10372]
|
Facility
|
IP
|
$2.73
|
|
|
Service Code
|
HCPCS J1920
|
| Hospital Charge Code |
00409233924
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1.36 |
| Max. Negotiated Rate |
$1.36 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.36
|
|
|
LABETALOL HCL 5 MG/ML IV SOLN [10372]
|
Facility
|
IP
|
$0.18
|
|
|
Service Code
|
HCPCS J1920
|
| Hospital Charge Code |
72266010301
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.09 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.09
|
|
|
LABETALOL HCL 5 MG/ML IV SOLN [10372]
|
Facility
|
OP
|
$0.18
|
|
|
Service Code
|
HCPCS J1920
|
| Hospital Charge Code |
00143932001
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.19 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.19
|
| Rate for Payer: Aetna Government |
$0.19
|
| Rate for Payer: Brighton Health Commercial |
$0.11
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$0.19
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.09
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.10
|
| Rate for Payer: Elderplan Medicare Advantage |
$0.19
|
| Rate for Payer: EmblemHealth Commercial |
$0.09
|
| Rate for Payer: Fidelis Medicare Advantage |
$0.19
|
| Rate for Payer: Group Health Inc Commercial |
$0.19
|
| Rate for Payer: Group Health Inc Medicare |
$0.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.09
|
| Rate for Payer: Healthfirst Medicare Advantage |
$0.16
|
| Rate for Payer: Healthfirst QHP |
$0.19
|
| Rate for Payer: Humana Medicare |
$0.19
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$0.19
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.12
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$0.15
|
|
|
LABETALOL HCL 5 MG/ML IV SOLN [10372]
|
Facility
|
OP
|
$2.73
|
|
|
Service Code
|
HCPCS J1920
|
| Hospital Charge Code |
00409233934
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$1.77 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.19
|
| Rate for Payer: Aetna Government |
$0.19
|
| Rate for Payer: Brighton Health Commercial |
$1.64
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$0.19
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.36
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.57
|
| Rate for Payer: Elderplan Medicare Advantage |
$0.19
|
| Rate for Payer: EmblemHealth Commercial |
$1.36
|
| Rate for Payer: Fidelis Medicare Advantage |
$0.19
|
| Rate for Payer: Group Health Inc Commercial |
$0.19
|
| Rate for Payer: Group Health Inc Medicare |
$0.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.36
|
| Rate for Payer: Healthfirst Medicare Advantage |
$0.16
|
| Rate for Payer: Healthfirst QHP |
$0.19
|
| Rate for Payer: Humana Medicare |
$0.19
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$0.19
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.77
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$0.15
|
|
|
LABETALOL HCL 5 MG/ML IV SOLN [10372]
|
Facility
|
IP
|
$0.69
|
|
|
Service Code
|
HCPCS J1920
|
| Hospital Charge Code |
47781058629
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.34 |
| Max. Negotiated Rate |
$0.34 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.34
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.34
|
|
|
LABETALOL HCL 5 MG/ML IV SOLN [10372]
|
Facility
|
IP
|
$0.69
|
|
|
Service Code
|
HCPCS J1920
|
| Hospital Charge Code |
72611073401
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.34 |
| Max. Negotiated Rate |
$0.34 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.34
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.34
|
|
|
LABETALOL HCL 5 MG/ML IV SOLN [10372]
|
Facility
|
OP
|
$1.27
|
|
|
Service Code
|
HCPCS J1920
|
| Hospital Charge Code |
36000032010
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$0.82 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.19
|
| Rate for Payer: Aetna Government |
$0.19
|
| Rate for Payer: Brighton Health Commercial |
$0.76
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$0.19
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.63
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.73
|
| Rate for Payer: Elderplan Medicare Advantage |
$0.19
|
| Rate for Payer: EmblemHealth Commercial |
$0.63
|
| Rate for Payer: Fidelis Medicare Advantage |
$0.19
|
| Rate for Payer: Group Health Inc Commercial |
$0.19
|
| Rate for Payer: Group Health Inc Medicare |
$0.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.63
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.63
|
| Rate for Payer: Healthfirst Medicare Advantage |
$0.16
|
| Rate for Payer: Healthfirst QHP |
$0.19
|
| Rate for Payer: Humana Medicare |
$0.19
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$0.19
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.82
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$0.15
|
|
|
LABETALOL HCL 5 MG/ML IV SOLN [10372]
|
Facility
|
OP
|
$0.69
|
|
|
Service Code
|
HCPCS J1920
|
| Hospital Charge Code |
47781058629
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$0.45 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.38
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.19
|
| Rate for Payer: Aetna Government |
$0.19
|
| Rate for Payer: Brighton Health Commercial |
$0.41
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$0.19
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.34
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.40
|
| Rate for Payer: Elderplan Medicare Advantage |
$0.19
|
| Rate for Payer: EmblemHealth Commercial |
$0.34
|
| Rate for Payer: Fidelis Medicare Advantage |
$0.19
|
| Rate for Payer: Group Health Inc Commercial |
$0.19
|
| Rate for Payer: Group Health Inc Medicare |
$0.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.34
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.34
|
| Rate for Payer: Healthfirst Medicare Advantage |
$0.16
|
| Rate for Payer: Healthfirst QHP |
$0.19
|
| Rate for Payer: Humana Medicare |
$0.19
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$0.19
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.45
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$0.15
|
|
|
LABETALOL HCL 5 MG/ML IV SOLN [10372]
|
Facility
|
OP
|
$0.18
|
|
|
Service Code
|
HCPCS J1920
|
| Hospital Charge Code |
72266010301
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.19 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.19
|
| Rate for Payer: Aetna Government |
$0.19
|
| Rate for Payer: Brighton Health Commercial |
$0.11
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$0.19
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.09
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.10
|
| Rate for Payer: Elderplan Medicare Advantage |
$0.19
|
| Rate for Payer: EmblemHealth Commercial |
$0.09
|
| Rate for Payer: Fidelis Medicare Advantage |
$0.19
|
| Rate for Payer: Group Health Inc Commercial |
$0.19
|
| Rate for Payer: Group Health Inc Medicare |
$0.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.09
|
| Rate for Payer: Healthfirst Medicare Advantage |
$0.16
|
| Rate for Payer: Healthfirst QHP |
$0.19
|
| Rate for Payer: Humana Medicare |
$0.19
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$0.19
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.12
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$0.15
|
|
|
LABETALOL HCL 5 MG/ML IV SOLN [10372]
|
Facility
|
OP
|
$0.69
|
|
|
Service Code
|
HCPCS J1920
|
| Hospital Charge Code |
72611073401
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$0.45 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.38
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.19
|
| Rate for Payer: Aetna Government |
$0.19
|
| Rate for Payer: Brighton Health Commercial |
$0.41
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$0.19
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.34
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.40
|
| Rate for Payer: Elderplan Medicare Advantage |
$0.19
|
| Rate for Payer: EmblemHealth Commercial |
$0.34
|
| Rate for Payer: Fidelis Medicare Advantage |
$0.19
|
| Rate for Payer: Group Health Inc Commercial |
$0.19
|
| Rate for Payer: Group Health Inc Medicare |
$0.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.34
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.34
|
| Rate for Payer: Healthfirst Medicare Advantage |
$0.16
|
| Rate for Payer: Healthfirst QHP |
$0.19
|
| Rate for Payer: Humana Medicare |
$0.19
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$0.19
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.45
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$0.15
|
|
|
LABETALOL HCL 5 MG/ML IV SOLN [10372]
|
Facility
|
IP
|
$1.27
|
|
|
Service Code
|
HCPCS J1920
|
| Hospital Charge Code |
36000032010
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.63 |
| Max. Negotiated Rate |
$0.63 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.63
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.63
|
|
|
LABETALOL HCL 5 MG/ML IV SOLN [10372]
|
Facility
|
OP
|
$0.24
|
|
|
Service Code
|
HCPCS J1920
|
| Hospital Charge Code |
00409226720
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.19 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.13
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.19
|
| Rate for Payer: Aetna Government |
$0.19
|
| Rate for Payer: Brighton Health Commercial |
$0.14
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$0.19
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.12
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.14
|
| Rate for Payer: Elderplan Medicare Advantage |
$0.19
|
| Rate for Payer: EmblemHealth Commercial |
$0.12
|
| Rate for Payer: Fidelis Medicare Advantage |
$0.19
|
| Rate for Payer: Group Health Inc Commercial |
$0.19
|
| Rate for Payer: Group Health Inc Medicare |
$0.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.12
|
| Rate for Payer: Healthfirst Medicare Advantage |
$0.16
|
| Rate for Payer: Healthfirst QHP |
$0.19
|
| Rate for Payer: Humana Medicare |
$0.19
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$0.19
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.15
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$0.15
|
|
|
LABETALOL HCL 5 MG/ML IV SOLN [10372]
|
Facility
|
IP
|
$2.73
|
|
|
Service Code
|
HCPCS J1920
|
| Hospital Charge Code |
00409233934
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1.36 |
| Max. Negotiated Rate |
$1.36 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.36
|
|
|
LABETALOL HCL 5 MG/ML IV SOLN [10372]
|
Facility
|
OP
|
$2.73
|
|
|
Service Code
|
HCPCS J1920
|
| Hospital Charge Code |
00409233924
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$1.77 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.19
|
| Rate for Payer: Aetna Government |
$0.19
|
| Rate for Payer: Brighton Health Commercial |
$1.64
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$0.19
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.36
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.57
|
| Rate for Payer: Elderplan Medicare Advantage |
$0.19
|
| Rate for Payer: EmblemHealth Commercial |
$1.36
|
| Rate for Payer: Fidelis Medicare Advantage |
$0.19
|
| Rate for Payer: Group Health Inc Commercial |
$0.19
|
| Rate for Payer: Group Health Inc Medicare |
$0.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.36
|
| Rate for Payer: Healthfirst Medicare Advantage |
$0.16
|
| Rate for Payer: Healthfirst QHP |
$0.19
|
| Rate for Payer: Humana Medicare |
$0.19
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$0.19
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.77
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$0.15
|
|
|
LABETALOL HCL 5 MG/ML IV SOLN [10372]
|
Facility
|
IP
|
$0.24
|
|
|
Service Code
|
HCPCS J1920
|
| Hospital Charge Code |
00409226720
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.12 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.12
|
|
|
LABETALOL HCL 5 MG/ML IV SOLN [10372]
|
Facility
|
IP
|
$0.18
|
|
|
Service Code
|
HCPCS J1920
|
| Hospital Charge Code |
00143932001
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.09 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.09
|
|
|
LABIAL VENEER (LAMINATE)-CHAIRSID
|
Facility
|
OP
|
$850.50
|
|
|
Service Code
|
HCPCS D2960
|
| Hospital Charge Code |
42300665
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$425.25 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$467.78
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,018.19
|
| Rate for Payer: Aetna Government |
$1,018.19
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$712.73
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$712.73
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$712.73
|
| Rate for Payer: Brighton Health Commercial |
$637.88
|
| Rate for Payer: Cash Price |
$1,018.19
|
| Rate for Payer: Cash Price |
$1,018.19
|
| Rate for Payer: Cash Price |
$1,018.19
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,018.19
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$1,018.19
|
| Rate for Payer: EmblemHealth Commercial |
$1,018.19
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$865.46
|
| Rate for Payer: Fidelis Essential Plan QHP |
$906.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,018.19
|
| Rate for Payer: Fidelis Qualified Health Plan |
$906.19
|
| Rate for Payer: Group Health Inc Commercial |
$1,018.19
|
| Rate for Payer: Group Health Inc Medicare |
$1,018.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$425.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,018.19
|
| Rate for Payer: Healthfirst Medicare Advantage |
$865.46
|
| Rate for Payer: Healthfirst QHP |
$1,018.19
|
| Rate for Payer: Humana Medicare |
$1,038.55
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,018.19
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,018.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,018.19
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$814.55
|
| Rate for Payer: Wellcare Medicare |
$967.28
|
|
