|
PENICILLIN G BENZATHINE 1200000 UNIT/2ML IM SUSY [183757]
|
Facility
|
OP
|
$166.36
|
|
|
Service Code
|
HCPCS J0561
|
| Hospital Charge Code |
60793070102
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.21 |
| Max. Negotiated Rate |
$133.08 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$91.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$21.73
|
| Rate for Payer: Aetna Government |
$21.73
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$15.21
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$15.21
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$15.21
|
| Rate for Payer: Brighton Health Commercial |
$124.77
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$21.73
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$133.08
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$113.12
|
| Rate for Payer: Elderplan Medicare Advantage |
$21.73
|
| Rate for Payer: EmblemHealth Commercial |
$21.73
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$18.47
|
| Rate for Payer: Fidelis Essential Plan QHP |
$19.34
|
| Rate for Payer: Fidelis Medicare Advantage |
$21.73
|
| Rate for Payer: Fidelis Qualified Health Plan |
$19.34
|
| Rate for Payer: Group Health Inc Commercial |
$21.73
|
| Rate for Payer: Group Health Inc Medicare |
$21.73
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$83.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$21.73
|
| Rate for Payer: Healthfirst Medicare Advantage |
$18.47
|
| Rate for Payer: Healthfirst QHP |
$21.73
|
| Rate for Payer: Humana Medicare |
$22.16
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$22.00
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$23.32
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$23.32
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$23.32
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$21.73
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21.73
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$108.13
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$17.38
|
| Rate for Payer: Wellcare Medicare |
$20.64
|
|
|
PENICILLIN G BENZATHINE 1200000 UNIT/2ML IM SUSY [183757]
|
Facility
|
OP
|
$166.36
|
|
|
Service Code
|
HCPCS J0561
|
| Hospital Charge Code |
60793070110
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.21 |
| Max. Negotiated Rate |
$133.09 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$91.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$21.73
|
| Rate for Payer: Aetna Government |
$21.73
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$15.21
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$15.21
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$15.21
|
| Rate for Payer: Brighton Health Commercial |
$124.77
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$21.73
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$133.09
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$113.12
|
| Rate for Payer: Elderplan Medicare Advantage |
$21.73
|
| Rate for Payer: EmblemHealth Commercial |
$21.73
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$18.47
|
| Rate for Payer: Fidelis Essential Plan QHP |
$19.34
|
| Rate for Payer: Fidelis Medicare Advantage |
$21.73
|
| Rate for Payer: Fidelis Qualified Health Plan |
$19.34
|
| Rate for Payer: Group Health Inc Commercial |
$21.73
|
| Rate for Payer: Group Health Inc Medicare |
$21.73
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$83.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$21.73
|
| Rate for Payer: Healthfirst Medicare Advantage |
$18.47
|
| Rate for Payer: Healthfirst QHP |
$21.73
|
| Rate for Payer: Humana Medicare |
$22.16
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$22.00
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$23.32
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$23.32
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$23.32
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$21.73
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21.73
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$108.13
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$17.38
|
| Rate for Payer: Wellcare Medicare |
$20.64
|
|
|
PENICILLIN G BENZATHINE 1,200,000 UNITS/
|
Facility
|
OP
|
$30.22
|
|
|
Service Code
|
HCPCS J0561
|
| Hospital Charge Code |
41644650
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.11 |
| Max. Negotiated Rate |
$23.32 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$16.62
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$21.73
|
| Rate for Payer: Aetna Government |
$21.73
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$15.21
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$15.21
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$15.21
|
| Rate for Payer: Brighton Health Commercial |
$18.13
|
| Rate for Payer: Cash Price |
$21.73
|
| Rate for Payer: Cash Price |
$21.73
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$21.73
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$15.11
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$17.38
|
| Rate for Payer: Elderplan Medicare Advantage |
$21.73
|
| Rate for Payer: EmblemHealth Commercial |
$21.73
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$21.73
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$21.73
|
| Rate for Payer: Fidelis Essential Plan QHP |
$22.82
|
| Rate for Payer: Fidelis Medicare Advantage |
$21.73
|
| Rate for Payer: Fidelis Qualified Health Plan |
$22.82
|
| Rate for Payer: Group Health Inc Commercial |
$21.73
|
| Rate for Payer: Group Health Inc Medicare |
$21.73
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15.11
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$15.11
|
| Rate for Payer: Healthfirst Medicare Advantage |
$18.47
|
| Rate for Payer: Healthfirst QHP |
$21.73
|
| Rate for Payer: Humana Medicare |
$22.16
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$21.73
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$23.32
|
| Rate for Payer: SOMOS Essential |
$23.32
|
| Rate for Payer: United Healthcare Commercial |
$18.11
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21.73
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$19.64
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$17.38
|
| Rate for Payer: Wellcare Medicare |
$20.64
|
|
|
PENICILLIN G BENZATHINE 1,200,000 UNITS/
|
Facility
|
IP
|
$30.22
|
|
|
Service Code
|
HCPCS J0561
|
| Hospital Charge Code |
41644650
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.11 |
| Max. Negotiated Rate |
$15.11 |
| Rate for Payer: Cash Price |
$21.73
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15.11
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$15.11
|
|
|
PENICILLIN G BENZATHINE 1,200,000 UNITS/
|
Facility
|
OP
|
$30.22
|
|
|
Service Code
|
HCPCS J0561
|
| Hospital Charge Code |
41654650
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.11 |
| Max. Negotiated Rate |
$23.32 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$16.62
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$21.73
|
| Rate for Payer: Aetna Government |
$21.73
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$15.21
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$15.21
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$15.21
|
| Rate for Payer: Brighton Health Commercial |
$18.13
|
| Rate for Payer: Cash Price |
$21.73
|
| Rate for Payer: Cash Price |
$21.73
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$21.73
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$15.11
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$17.38
|
| Rate for Payer: Elderplan Medicare Advantage |
$21.73
|
| Rate for Payer: EmblemHealth Commercial |
$21.73
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$21.73
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$21.73
|
| Rate for Payer: Fidelis Essential Plan QHP |
$22.82
|
| Rate for Payer: Fidelis Medicare Advantage |
$21.73
|
| Rate for Payer: Fidelis Qualified Health Plan |
$22.82
|
| Rate for Payer: Group Health Inc Commercial |
$21.73
|
| Rate for Payer: Group Health Inc Medicare |
$21.73
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15.11
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$15.11
|
| Rate for Payer: Healthfirst Medicare Advantage |
$18.47
|
| Rate for Payer: Healthfirst QHP |
$21.73
|
| Rate for Payer: Humana Medicare |
$22.16
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$21.73
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$23.32
|
| Rate for Payer: SOMOS Essential |
$23.32
|
| Rate for Payer: United Healthcare Commercial |
$18.11
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21.73
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$19.64
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$17.38
|
| Rate for Payer: Wellcare Medicare |
$20.64
|
|
|
PENICILLIN G BENZATHINE 1,200,000 UNITS/
|
Facility
|
IP
|
$30.22
|
|
|
Service Code
|
HCPCS J0561
|
| Hospital Charge Code |
41654650
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.11 |
| Max. Negotiated Rate |
$15.11 |
| Rate for Payer: Cash Price |
$21.73
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15.11
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$15.11
|
|
|
PENICILLIN G BENZATHINE 2400000 UNIT/4ML IM SUSY [188816]
|
Facility
|
OP
|
$170.45
|
|
|
Service Code
|
HCPCS J0561
|
| Hospital Charge Code |
60793070210
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.21 |
| Max. Negotiated Rate |
$136.36 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$93.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$21.73
|
| Rate for Payer: Aetna Government |
$21.73
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$15.21
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$15.21
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$15.21
|
| Rate for Payer: Brighton Health Commercial |
$127.84
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$21.73
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$136.36
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$115.90
|
| Rate for Payer: Elderplan Medicare Advantage |
$21.73
|
| Rate for Payer: EmblemHealth Commercial |
$21.73
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$18.47
|
| Rate for Payer: Fidelis Essential Plan QHP |
$19.34
|
| Rate for Payer: Fidelis Medicare Advantage |
$21.73
|
| Rate for Payer: Fidelis Qualified Health Plan |
$19.34
|
| Rate for Payer: Group Health Inc Commercial |
$21.73
|
| Rate for Payer: Group Health Inc Medicare |
$21.73
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$85.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$21.73
|
| Rate for Payer: Healthfirst Medicare Advantage |
$18.47
|
| Rate for Payer: Healthfirst QHP |
$21.73
|
| Rate for Payer: Humana Medicare |
$22.16
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$22.00
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$23.32
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$23.32
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$23.32
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$21.73
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21.73
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$110.79
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$17.38
|
| Rate for Payer: Wellcare Medicare |
$20.64
|
|
|
PENICILLIN G BENZATHINE 2400000 UNIT/4ML IM SUSY [188816]
|
Facility
|
OP
|
$170.45
|
|
|
Service Code
|
HCPCS J0561
|
| Hospital Charge Code |
60793070204
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.21 |
| Max. Negotiated Rate |
$136.36 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$93.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$21.73
|
| Rate for Payer: Aetna Government |
$21.73
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$15.21
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$15.21
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$15.21
|
| Rate for Payer: Brighton Health Commercial |
$127.84
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$21.73
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$136.36
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$115.90
|
| Rate for Payer: Elderplan Medicare Advantage |
$21.73
|
| Rate for Payer: EmblemHealth Commercial |
$21.73
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$18.47
|
| Rate for Payer: Fidelis Essential Plan QHP |
$19.34
|
| Rate for Payer: Fidelis Medicare Advantage |
$21.73
|
| Rate for Payer: Fidelis Qualified Health Plan |
$19.34
|
| Rate for Payer: Group Health Inc Commercial |
$21.73
|
| Rate for Payer: Group Health Inc Medicare |
$21.73
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$85.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$21.73
|
| Rate for Payer: Healthfirst Medicare Advantage |
$18.47
|
| Rate for Payer: Healthfirst QHP |
$21.73
|
| Rate for Payer: Humana Medicare |
$22.16
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$22.00
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$23.32
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$23.32
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$23.32
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$21.73
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21.73
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$110.79
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$17.38
|
| Rate for Payer: Wellcare Medicare |
$20.64
|
|
|
PENICILLIN G BENZATHINE 2,400,000 UNITS/
|
Facility
|
OP
|
$28.50
|
|
|
Service Code
|
HCPCS J0561
|
| Hospital Charge Code |
41654651
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.25 |
| Max. Negotiated Rate |
$23.32 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$15.68
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$21.73
|
| Rate for Payer: Aetna Government |
$21.73
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$15.21
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$15.21
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$15.21
|
| Rate for Payer: Brighton Health Commercial |
$17.10
|
| Rate for Payer: Cash Price |
$21.73
|
| Rate for Payer: Cash Price |
$21.73
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$21.73
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$14.25
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$16.39
|
| Rate for Payer: Elderplan Medicare Advantage |
$21.73
|
| Rate for Payer: EmblemHealth Commercial |
$21.73
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$21.73
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$21.73
|
| Rate for Payer: Fidelis Essential Plan QHP |
$22.82
|
| Rate for Payer: Fidelis Medicare Advantage |
$21.73
|
| Rate for Payer: Fidelis Qualified Health Plan |
$22.82
|
| Rate for Payer: Group Health Inc Commercial |
$21.73
|
| Rate for Payer: Group Health Inc Medicare |
$21.73
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.25
|
| Rate for Payer: Healthfirst Medicare Advantage |
$18.47
|
| Rate for Payer: Healthfirst QHP |
$21.73
|
| Rate for Payer: Humana Medicare |
$22.16
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$21.73
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$23.32
|
| Rate for Payer: SOMOS Essential |
$23.32
|
| Rate for Payer: United Healthcare Commercial |
$18.11
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21.73
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$18.52
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$17.38
|
| Rate for Payer: Wellcare Medicare |
$20.64
|
|
|
PENICILLIN G BENZATHINE 2,400,000 UNITS/
|
Facility
|
IP
|
$28.50
|
|
|
Service Code
|
HCPCS J0561
|
| Hospital Charge Code |
41654651
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.25 |
| Max. Negotiated Rate |
$14.25 |
| Rate for Payer: Cash Price |
$21.73
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.25
|
|
|
PENICILLIN G BENZATHINE 2,400,000 UNITS/
|
Facility
|
OP
|
$28.50
|
|
|
Service Code
|
HCPCS J0561
|
| Hospital Charge Code |
41644651
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.25 |
| Max. Negotiated Rate |
$23.32 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$15.68
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$21.73
|
| Rate for Payer: Aetna Government |
$21.73
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$15.21
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$15.21
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$15.21
|
| Rate for Payer: Brighton Health Commercial |
$17.10
|
| Rate for Payer: Cash Price |
$21.73
|
| Rate for Payer: Cash Price |
$21.73
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$21.73
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$14.25
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$16.39
|
| Rate for Payer: Elderplan Medicare Advantage |
$21.73
|
| Rate for Payer: EmblemHealth Commercial |
$21.73
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$21.73
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$21.73
|
| Rate for Payer: Fidelis Essential Plan QHP |
$22.82
|
| Rate for Payer: Fidelis Medicare Advantage |
$21.73
|
| Rate for Payer: Fidelis Qualified Health Plan |
$22.82
|
| Rate for Payer: Group Health Inc Commercial |
$21.73
|
| Rate for Payer: Group Health Inc Medicare |
$21.73
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.25
|
| Rate for Payer: Healthfirst Medicare Advantage |
$18.47
|
| Rate for Payer: Healthfirst QHP |
$21.73
|
| Rate for Payer: Humana Medicare |
$22.16
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$21.73
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$23.32
|
| Rate for Payer: SOMOS Essential |
$23.32
|
| Rate for Payer: United Healthcare Commercial |
$18.11
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21.73
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$18.52
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$17.38
|
| Rate for Payer: Wellcare Medicare |
$20.64
|
|
|
PENICILLIN G BENZATHINE 2,400,000 UNITS/
|
Facility
|
IP
|
$28.50
|
|
|
Service Code
|
HCPCS J0561
|
| Hospital Charge Code |
41644651
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.25 |
| Max. Negotiated Rate |
$14.25 |
| Rate for Payer: Cash Price |
$21.73
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.25
|
|
|
PENICILLIN G BENZATHINE 600000 UNIT/ML IM SUSY [183756]
|
Facility
|
OP
|
$192.10
|
|
|
Service Code
|
HCPCS J0561
|
| Hospital Charge Code |
60793070010
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.21 |
| Max. Negotiated Rate |
$153.68 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$105.66
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$21.73
|
| Rate for Payer: Aetna Government |
$21.73
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$15.21
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$15.21
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$15.21
|
| Rate for Payer: Brighton Health Commercial |
$144.08
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$21.73
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$153.68
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$130.63
|
| Rate for Payer: Elderplan Medicare Advantage |
$21.73
|
| Rate for Payer: EmblemHealth Commercial |
$21.73
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$18.47
|
| Rate for Payer: Fidelis Essential Plan QHP |
$19.34
|
| Rate for Payer: Fidelis Medicare Advantage |
$21.73
|
| Rate for Payer: Fidelis Qualified Health Plan |
$19.34
|
| Rate for Payer: Group Health Inc Commercial |
$21.73
|
| Rate for Payer: Group Health Inc Medicare |
$21.73
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$96.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$21.73
|
| Rate for Payer: Healthfirst Medicare Advantage |
$18.47
|
| Rate for Payer: Healthfirst QHP |
$21.73
|
| Rate for Payer: Humana Medicare |
$22.16
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$22.00
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$23.32
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$23.32
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$23.32
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$21.73
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21.73
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$124.87
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$17.38
|
| Rate for Payer: Wellcare Medicare |
$20.64
|
|
|
PENICILLIN G BENZATHINE 600000 UNIT/ML IM SUSY [183756]
|
Facility
|
OP
|
$192.11
|
|
|
Service Code
|
HCPCS J0561
|
| Hospital Charge Code |
60793070001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.21 |
| Max. Negotiated Rate |
$153.69 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$105.66
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$21.73
|
| Rate for Payer: Aetna Government |
$21.73
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$15.21
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$15.21
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$15.21
|
| Rate for Payer: Brighton Health Commercial |
$144.08
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$21.73
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$153.69
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$130.63
|
| Rate for Payer: Elderplan Medicare Advantage |
$21.73
|
| Rate for Payer: EmblemHealth Commercial |
$21.73
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$18.47
|
| Rate for Payer: Fidelis Essential Plan QHP |
$19.34
|
| Rate for Payer: Fidelis Medicare Advantage |
$21.73
|
| Rate for Payer: Fidelis Qualified Health Plan |
$19.34
|
| Rate for Payer: Group Health Inc Commercial |
$21.73
|
| Rate for Payer: Group Health Inc Medicare |
$21.73
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$96.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$21.73
|
| Rate for Payer: Healthfirst Medicare Advantage |
$18.47
|
| Rate for Payer: Healthfirst QHP |
$21.73
|
| Rate for Payer: Humana Medicare |
$22.16
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$22.00
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$23.32
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$23.32
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$23.32
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$21.73
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21.73
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$124.87
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$17.38
|
| Rate for Payer: Wellcare Medicare |
$20.64
|
|
|
PENICILLIN G BENZATHINE PROCAINE 300,000
|
Facility
|
IP
|
$24.00
|
|
|
Service Code
|
HCPCS J0558
|
| Hospital Charge Code |
41653575
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$12.00 |
| Rate for Payer: Cash Price |
$17.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.00
|
|
|
PENICILLIN G BENZATHINE PROCAINE 300,000
|
Facility
|
OP
|
$24.00
|
|
|
Service Code
|
HCPCS J0558
|
| Hospital Charge Code |
41643575
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$18.46 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$13.20
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$17.58
|
| Rate for Payer: Aetna Government |
$17.58
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$12.30
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$12.30
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$12.30
|
| Rate for Payer: Brighton Health Commercial |
$14.40
|
| Rate for Payer: Cash Price |
$17.58
|
| Rate for Payer: Cash Price |
$17.58
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$17.58
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$12.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$13.80
|
| Rate for Payer: Elderplan Medicare Advantage |
$17.58
|
| Rate for Payer: EmblemHealth Commercial |
$17.58
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$17.58
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$17.58
|
| Rate for Payer: Fidelis Essential Plan QHP |
$18.46
|
| Rate for Payer: Fidelis Medicare Advantage |
$17.58
|
| Rate for Payer: Fidelis Qualified Health Plan |
$18.46
|
| Rate for Payer: Group Health Inc Commercial |
$17.58
|
| Rate for Payer: Group Health Inc Medicare |
$17.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$14.94
|
| Rate for Payer: Healthfirst QHP |
$17.58
|
| Rate for Payer: Humana Medicare |
$17.93
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$17.58
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$18.41
|
| Rate for Payer: SOMOS Essential |
$18.41
|
| Rate for Payer: United Healthcare Commercial |
$13.88
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.58
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$15.60
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$14.06
|
| Rate for Payer: Wellcare Medicare |
$16.70
|
|
|
PENICILLIN G BENZATHINE PROCAINE 300,000
|
Facility
|
OP
|
$24.00
|
|
|
Service Code
|
HCPCS J0558
|
| Hospital Charge Code |
41653575
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$18.46 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$13.20
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$17.58
|
| Rate for Payer: Aetna Government |
$17.58
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$12.30
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$12.30
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$12.30
|
| Rate for Payer: Brighton Health Commercial |
$14.40
|
| Rate for Payer: Cash Price |
$17.58
|
| Rate for Payer: Cash Price |
$17.58
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$17.58
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$12.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$13.80
|
| Rate for Payer: Elderplan Medicare Advantage |
$17.58
|
| Rate for Payer: EmblemHealth Commercial |
$17.58
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$17.58
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$17.58
|
| Rate for Payer: Fidelis Essential Plan QHP |
$18.46
|
| Rate for Payer: Fidelis Medicare Advantage |
$17.58
|
| Rate for Payer: Fidelis Qualified Health Plan |
$18.46
|
| Rate for Payer: Group Health Inc Commercial |
$17.58
|
| Rate for Payer: Group Health Inc Medicare |
$17.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$14.94
|
| Rate for Payer: Healthfirst QHP |
$17.58
|
| Rate for Payer: Humana Medicare |
$17.93
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$17.58
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$18.41
|
| Rate for Payer: SOMOS Essential |
$18.41
|
| Rate for Payer: United Healthcare Commercial |
$13.88
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.58
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$15.60
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$14.06
|
| Rate for Payer: Wellcare Medicare |
$16.70
|
|
|
PENICILLIN G BENZATHINE PROCAINE 300,000
|
Facility
|
IP
|
$24.00
|
|
|
Service Code
|
HCPCS J0558
|
| Hospital Charge Code |
41643575
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$12.00 |
| Rate for Payer: Cash Price |
$17.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.00
|
|
|
PENICILLIN-G POT 20MU - 600,000U
|
Facility
|
OP
|
$0.77
|
|
|
Service Code
|
HCPCS J2540
|
| Hospital Charge Code |
41648169
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.27 |
| Max. Negotiated Rate |
$0.92 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.42
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.92
|
| Rate for Payer: Aetna Government |
$0.92
|
| Rate for Payer: Brighton Health Commercial |
$0.46
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.39
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.44
|
| Rate for Payer: Group Health Inc Commercial |
$0.39
|
| Rate for Payer: Group Health Inc Medicare |
$0.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.39
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$0.88
|
| Rate for Payer: SOMOS Essential |
$0.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.50
|
|
|
PENICILLIN-G POT 20MU - 600,000U
|
Facility
|
IP
|
$0.77
|
|
|
Service Code
|
HCPCS J2540
|
| Hospital Charge Code |
41648169
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.39 |
| Max. Negotiated Rate |
$0.39 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.39
|
|
|
PENICILLIN-G POT 20MU-600,000U
|
Facility
|
IP
|
$0.77
|
|
|
Service Code
|
HCPCS J2540
|
| Hospital Charge Code |
41658169
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.39 |
| Max. Negotiated Rate |
$0.39 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.39
|
|
|
PENICILLIN-G POT 20MU-600,000U
|
Facility
|
OP
|
$0.77
|
|
|
Service Code
|
HCPCS J2540
|
| Hospital Charge Code |
41658169
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.27 |
| Max. Negotiated Rate |
$0.92 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.42
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.92
|
| Rate for Payer: Aetna Government |
$0.92
|
| Rate for Payer: Brighton Health Commercial |
$0.46
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.39
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.44
|
| Rate for Payer: Group Health Inc Commercial |
$0.39
|
| Rate for Payer: Group Health Inc Medicare |
$0.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.39
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$0.88
|
| Rate for Payer: SOMOS Essential |
$0.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.50
|
|
|
PENICILLIN G POT 5MU - 600,000U
|
Facility
|
OP
|
$0.74
|
|
|
Service Code
|
HCPCS J2540
|
| Hospital Charge Code |
41658171
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$0.92 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.41
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.92
|
| Rate for Payer: Aetna Government |
$0.92
|
| Rate for Payer: Brighton Health Commercial |
$0.44
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.37
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.43
|
| Rate for Payer: Group Health Inc Commercial |
$0.37
|
| Rate for Payer: Group Health Inc Medicare |
$0.26
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.37
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.37
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$0.88
|
| Rate for Payer: SOMOS Essential |
$0.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.48
|
|
|
PENICILLIN G POT 5MU - 600,000U
|
Facility
|
IP
|
$0.74
|
|
|
Service Code
|
HCPCS J2540
|
| Hospital Charge Code |
41658171
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.37 |
| Max. Negotiated Rate |
$0.37 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.37
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.37
|
|
|
PENICILLIN G POT 5MU -600,000U
|
Facility
|
OP
|
$0.74
|
|
|
Service Code
|
HCPCS J2540
|
| Hospital Charge Code |
41648171
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$0.92 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.41
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.92
|
| Rate for Payer: Aetna Government |
$0.92
|
| Rate for Payer: Brighton Health Commercial |
$0.44
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.37
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.43
|
| Rate for Payer: Group Health Inc Commercial |
$0.37
|
| Rate for Payer: Group Health Inc Medicare |
$0.26
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.37
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.37
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$0.88
|
| Rate for Payer: SOMOS Essential |
$0.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.48
|
|
