|
PROPOFOL 200 MG/20ML IV EMUL
|
Facility
|
OP
|
$0.14
|
|
|
Service Code
|
HCPCS J2704
|
| Hospital Charge Code |
6332326994
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.13 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.08
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.13
|
| Rate for Payer: Aetna Government |
$0.13
|
| Rate for Payer: Brighton Health Commercial |
$0.11
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.12
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.10
|
| Rate for Payer: EmblemHealth Commercial |
$0.07
|
| Rate for Payer: Group Health Inc Commercial |
$0.07
|
| Rate for Payer: Group Health Inc Medicare |
$0.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.07
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.07
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.09
|
|
|
PROPOFOL 200 MG/20ML IV EMUL
|
Facility
|
OP
|
$0.36
|
|
|
Service Code
|
HCPCS J2704
|
| Hospital Charge Code |
6332326922
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.29 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.20
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.13
|
| Rate for Payer: Aetna Government |
$0.13
|
| Rate for Payer: Brighton Health Commercial |
$0.27
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.29
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.24
|
| Rate for Payer: EmblemHealth Commercial |
$0.18
|
| Rate for Payer: Group Health Inc Commercial |
$0.18
|
| Rate for Payer: Group Health Inc Medicare |
$0.13
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.18
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.23
|
|
|
PROPOFOL 200 MG/20ML IV EMUL
|
Facility
|
IP
|
$0.09
|
|
|
Service Code
|
HCPCS J2704
|
| Hospital Charge Code |
8083011881
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.04 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.04
|
|
|
PROPOFOL 500 MG/50ML IV EMUL
|
Facility
|
IP
|
$0.36
|
|
|
Service Code
|
HCPCS J2704
|
| Hospital Charge Code |
6332326950
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$0.18 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.18
|
|
|
PROPOFOL 500 MG/50ML IV EMUL
|
Facility
|
OP
|
$0.36
|
|
|
Service Code
|
HCPCS J2704
|
| Hospital Charge Code |
6332326950
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.29 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.20
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.13
|
| Rate for Payer: Aetna Government |
$0.13
|
| Rate for Payer: Brighton Health Commercial |
$0.27
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.29
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.24
|
| Rate for Payer: EmblemHealth Commercial |
$0.18
|
| Rate for Payer: Group Health Inc Commercial |
$0.18
|
| Rate for Payer: Group Health Inc Medicare |
$0.13
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.18
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.23
|
|
|
PROPOFOL INFUSION 10 MG/ML (WRAPPED)
|
Facility
|
IP
|
$0.14
|
|
|
Service Code
|
HCPCS J2704
|
| Hospital Charge Code |
6332326959
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.07 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.07
|
|
|
PROPOFOL INFUSION 10 MG/ML (WRAPPED)
|
Facility
|
OP
|
$0.36
|
|
|
Service Code
|
NDC 6332326965
|
| Hospital Charge Code |
6332326965
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.29 |
| 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 |
$0.29
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.24
|
| Rate for Payer: EmblemHealth Commercial |
$0.18
|
| Rate for Payer: Group Health Inc Commercial |
$0.18
|
| Rate for Payer: Group Health Inc Medicare |
$0.13
|
| 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
|
|
|
PROPOFOL INFUSION 10 MG/ML (WRAPPED)
|
Facility
|
OP
|
$0.14
|
|
|
Service Code
|
HCPCS J2704
|
| Hospital Charge Code |
6332326959
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.13 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.08
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.13
|
| Rate for Payer: Aetna Government |
$0.13
|
| Rate for Payer: Brighton Health Commercial |
$0.11
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.12
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.10
|
| Rate for Payer: EmblemHealth Commercial |
$0.07
|
| Rate for Payer: Group Health Inc Commercial |
$0.07
|
| Rate for Payer: Group Health Inc Medicare |
$0.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.07
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.07
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.09
|
|
|
PROPOFOL INFUSION 10 MG/ML (WRAPPED)
|
Facility
|
IP
|
$0.14
|
|
|
Service Code
|
NDC 6332326969
|
| Hospital Charge Code |
6332326969
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.07 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.07
|
|
|
PROPOFOL INFUSION 10 MG/ML (WRAPPED)
|
Facility
|
IP
|
$0.36
|
|
|
Service Code
|
NDC 6332326965
|
| Hospital Charge Code |
6332326965
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$0.18 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.18
|
|
|
PROPOFOL INFUSION 10 MG/ML (WRAPPED)
|
Facility
|
OP
|
$0.14
|
|
|
Service Code
|
NDC 6332326969
|
| Hospital Charge Code |
6332326969
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.12 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.08
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.07
|
| Rate for Payer: Aetna Government |
$0.07
|
| Rate for Payer: Brighton Health Commercial |
$0.11
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.12
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.10
|
| Rate for Payer: EmblemHealth Commercial |
$0.07
|
| Rate for Payer: Group Health Inc Commercial |
$0.07
|
| Rate for Payer: Group Health Inc Medicare |
$0.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.07
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.07
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.09
|
|
|
PR OPPONENSPLASTY HYPOTHENAR MUSC TR
|
Professional
|
Both
|
$3,747.17
|
|
|
Service Code
|
HCPCS 26494
|
| Min. Negotiated Rate |
$696.40 |
| Max. Negotiated Rate |
$2,238.43 |
| Rate for Payer: Cash Price |
$1,009.06
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$994.86
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$895.37
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$895.37
|
| Rate for Payer: Fidelis Essential Plan QHP |
$945.12
|
| Rate for Payer: Fidelis Medicare Advantage |
$994.86
|
| Rate for Payer: Fidelis Qualified Health Plan |
$945.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$994.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$994.86
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$746.14
|
| Rate for Payer: Healthfirst Commercial |
$994.86
|
| Rate for Payer: Healthfirst Essential Plan |
$2,238.43
|
| Rate for Payer: Healthfirst Medicare Advantage |
$945.12
|
| Rate for Payer: Healthfirst QHP |
$994.86
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$696.40
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$994.86
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$845.63
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$696.40
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$994.86
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$746.14
|
| Rate for Payer: SOMOS Essential |
$746.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$994.86
|
|
|
PR OPPONENSPLASTY OTHER METHODS
|
Professional
|
Both
|
$4,035.19
|
|
|
Service Code
|
HCPCS 26496
|
| Min. Negotiated Rate |
$748.26 |
| Max. Negotiated Rate |
$2,405.11 |
| Rate for Payer: Cash Price |
$1,085.93
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,068.94
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$962.05
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$962.05
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,015.49
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,068.94
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,015.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,068.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,068.94
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$801.71
|
| Rate for Payer: Healthfirst Commercial |
$1,068.94
|
| Rate for Payer: Healthfirst Essential Plan |
$2,405.11
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,015.49
|
| Rate for Payer: Healthfirst QHP |
$1,068.94
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$748.26
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,068.94
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$908.60
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$748.26
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,068.94
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$801.71
|
| Rate for Payer: SOMOS Essential |
$801.71
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,068.94
|
|
|
PR OPPONENSPLASTY SUPFCIS TDN TR TYP EA TDN
|
Professional
|
Both
|
$3,732.61
|
|
|
Service Code
|
HCPCS 26490
|
| Min. Negotiated Rate |
$693.71 |
| Max. Negotiated Rate |
$2,229.77 |
| Rate for Payer: Cash Price |
$1,004.54
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$991.01
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$891.91
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$891.91
|
| Rate for Payer: Fidelis Essential Plan QHP |
$941.46
|
| Rate for Payer: Fidelis Medicare Advantage |
$991.01
|
| Rate for Payer: Fidelis Qualified Health Plan |
$941.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$991.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$991.01
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$743.26
|
| Rate for Payer: Healthfirst Commercial |
$991.01
|
| Rate for Payer: Healthfirst Essential Plan |
$2,229.77
|
| Rate for Payer: Healthfirst Medicare Advantage |
$941.46
|
| Rate for Payer: Healthfirst QHP |
$991.01
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$693.71
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$991.01
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$842.36
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$693.71
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$991.01
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$743.26
|
| Rate for Payer: SOMOS Essential |
$743.26
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$991.01
|
|
|
PR OPPONENSPLASTY TDN TR W/GRF EA TDN
|
Professional
|
Both
|
$4,127.24
|
|
|
Service Code
|
HCPCS 26492
|
| Min. Negotiated Rate |
$766.77 |
| Max. Negotiated Rate |
$2,464.61 |
| Rate for Payer: Cash Price |
$1,111.04
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,095.38
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$985.84
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$985.84
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,040.61
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,095.38
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,040.61
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,095.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,095.38
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$821.53
|
| Rate for Payer: Healthfirst Commercial |
$1,095.38
|
| Rate for Payer: Healthfirst Essential Plan |
$2,464.61
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,040.61
|
| Rate for Payer: Healthfirst QHP |
$1,095.38
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$766.77
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,095.38
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$931.07
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$766.77
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,095.38
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$821.53
|
| Rate for Payer: SOMOS Essential |
$821.53
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,095.38
|
|
|
PROPRANOLOL HCL 10 MG PO TABS
|
Facility
|
IP
|
$0.41
|
|
|
Service Code
|
NDC 6923820771
|
| Hospital Charge Code |
6923820771
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$0.20 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.20
|
|
|
PROPRANOLOL HCL 10 MG PO TABS
|
Facility
|
OP
|
$0.41
|
|
|
Service Code
|
NDC 0603548221
|
| Hospital Charge Code |
0603548221
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.33 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.22
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.20
|
| Rate for Payer: Aetna Government |
$0.20
|
| Rate for Payer: Brighton Health Commercial |
$0.31
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.33
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.28
|
| Rate for Payer: EmblemHealth Commercial |
$0.20
|
| Rate for Payer: Group Health Inc Commercial |
$0.20
|
| Rate for Payer: Group Health Inc Medicare |
$0.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.27
|
|
|
PROPRANOLOL HCL 10 MG PO TABS
|
Facility
|
OP
|
$0.30
|
|
|
Service Code
|
NDC 6068758711
|
| Hospital Charge Code |
6068758711
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.24 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.17
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.15
|
| Rate for Payer: Aetna Government |
$0.15
|
| Rate for Payer: Brighton Health Commercial |
$0.23
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.24
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.20
|
| Rate for Payer: EmblemHealth Commercial |
$0.15
|
| Rate for Payer: Group Health Inc Commercial |
$0.15
|
| Rate for Payer: Group Health Inc Medicare |
$0.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.15
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.20
|
|
|
PROPRANOLOL HCL 10 MG PO TABS
|
Facility
|
IP
|
$0.30
|
|
|
Service Code
|
NDC 6068758711
|
| Hospital Charge Code |
6068758711
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$0.15 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.15
|
|
|
PROPRANOLOL HCL 10 MG PO TABS
|
Facility
|
IP
|
$0.41
|
|
|
Service Code
|
NDC 0378018201
|
| Hospital Charge Code |
0378018201
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$0.20 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.20
|
|
|
PROPRANOLOL HCL 10 MG PO TABS
|
Facility
|
OP
|
$0.41
|
|
|
Service Code
|
NDC 0378018201
|
| Hospital Charge Code |
0378018201
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.33 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.22
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.20
|
| Rate for Payer: Aetna Government |
$0.20
|
| Rate for Payer: Brighton Health Commercial |
$0.31
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.33
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.28
|
| Rate for Payer: EmblemHealth Commercial |
$0.20
|
| Rate for Payer: Group Health Inc Commercial |
$0.20
|
| Rate for Payer: Group Health Inc Medicare |
$0.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.27
|
|
|
PROPRANOLOL HCL 10 MG PO TABS
|
Facility
|
OP
|
$0.41
|
|
|
Service Code
|
NDC 6923820771
|
| Hospital Charge Code |
6923820771
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.33 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.22
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.20
|
| Rate for Payer: Aetna Government |
$0.20
|
| Rate for Payer: Brighton Health Commercial |
$0.31
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.33
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.28
|
| Rate for Payer: EmblemHealth Commercial |
$0.20
|
| Rate for Payer: Group Health Inc Commercial |
$0.20
|
| Rate for Payer: Group Health Inc Medicare |
$0.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.27
|
|
|
PROPRANOLOL HCL 10 MG PO TABS
|
Facility
|
IP
|
$0.41
|
|
|
Service Code
|
NDC 0603548221
|
| Hospital Charge Code |
0603548221
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$0.20 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.20
|
|
|
PROPRANOLOL HCL 1 MG/ML IV SOLN
|
Facility
|
IP
|
$9.60
|
|
|
Service Code
|
HCPCS J1800
|
| Hospital Charge Code |
9999123473
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$4.80 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.80
|
|
|
PROPRANOLOL HCL 1 MG/ML IV SOLN
|
Facility
|
OP
|
$12.08
|
|
|
Service Code
|
HCPCS J1800
|
| Hospital Charge Code |
6332360401
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$4.23 |
| Max. Negotiated Rate |
$9.67 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.65
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.62
|
| Rate for Payer: Aetna Government |
$6.62
|
| Rate for Payer: Brighton Health Commercial |
$9.06
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$9.67
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$8.22
|
| Rate for Payer: EmblemHealth Commercial |
$6.04
|
| Rate for Payer: Group Health Inc Commercial |
$6.04
|
| Rate for Payer: Group Health Inc Medicare |
$4.23
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.04
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$7.85
|
|
