|
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
|
|
|
PENICILLIN G POTASSIUM 100,000 UNITS/ML
|
Facility
|
OP
|
$8.00
|
|
| Hospital Charge Code |
41644811
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$6.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.00
|
| Rate for Payer: Aetna Government |
$4.00
|
| Rate for Payer: Brighton Health Commercial |
$6.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.44
|
| Rate for Payer: Group Health Inc Commercial |
$4.00
|
| Rate for Payer: Group Health Inc Medicare |
$2.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.20
|
|
|
PENICILLIN G POTASSIUM 100,000 UNITS/ML
|
Facility
|
OP
|
$8.00
|
|
| Hospital Charge Code |
41654811
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$6.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.00
|
| Rate for Payer: Aetna Government |
$4.00
|
| Rate for Payer: Brighton Health Commercial |
$6.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.44
|
| Rate for Payer: Group Health Inc Commercial |
$4.00
|
| Rate for Payer: Group Health Inc Medicare |
$2.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.20
|
|
|
PENICILLIN G POTASSIUM 20000000 UNITS IJ SOLR [6085]
|
Facility
|
OP
|
$61.06
|
|
|
Service Code
|
HCPCS J2540
|
| Hospital Charge Code |
00049053028
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.83 |
| Max. Negotiated Rate |
$48.85 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$33.58
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.92
|
| Rate for Payer: Aetna Government |
$0.92
|
| Rate for Payer: Brighton Health Commercial |
$45.80
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$48.85
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$41.52
|
| Rate for Payer: Group Health Inc Commercial |
$30.53
|
| Rate for Payer: Group Health Inc Medicare |
$21.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$30.53
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$30.53
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$0.83
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$0.88
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$0.88
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$0.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$39.69
|
|
|
PENICILLIN G POTASSIUM 5,000,000 UNITS I
|
Facility
|
OP
|
$8.00
|
|
|
Service Code
|
HCPCS J2540
|
| Hospital Charge Code |
41652512
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.88 |
| Max. Negotiated Rate |
$5.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.92
|
| Rate for Payer: Aetna Government |
$0.92
|
| Rate for Payer: Brighton Health Commercial |
$4.80
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.60
|
| Rate for Payer: Group Health Inc Commercial |
$4.00
|
| Rate for Payer: Group Health Inc Medicare |
$2.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.00
|
| 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 |
$5.20
|
|
|
PENICILLIN G POTASSIUM 5,000,000 UNITS I
|
Facility
|
IP
|
$8.00
|
|
|
Service Code
|
HCPCS J2540
|
| Hospital Charge Code |
41652512
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$4.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.00
|
|
|
PENICILLIN G POTASSIUM 5,000,000 UNITS I
|
Facility
|
OP
|
$8.00
|
|
|
Service Code
|
HCPCS J2540
|
| Hospital Charge Code |
41642512
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.88 |
| Max. Negotiated Rate |
$5.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.92
|
| Rate for Payer: Aetna Government |
$0.92
|
| Rate for Payer: Brighton Health Commercial |
$4.80
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.60
|
| Rate for Payer: Group Health Inc Commercial |
$4.00
|
| Rate for Payer: Group Health Inc Medicare |
$2.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.00
|
| 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 |
$5.20
|
|
|
PENICILLIN G POTASSIUM 5,000,000 UNITS I
|
Facility
|
IP
|
$8.00
|
|
|
Service Code
|
HCPCS J2540
|
| Hospital Charge Code |
41642512
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$4.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.00
|
|
|
PENICILLIN G POTASSIUM 5000000 UNITS IJ SOLR [6086]
|
Facility
|
OP
|
$15.27
|
|
|
Service Code
|
HCPCS J2540
|
| Hospital Charge Code |
00049052083
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.83 |
| Max. Negotiated Rate |
$12.21 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$8.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.92
|
| Rate for Payer: Aetna Government |
$0.92
|
| Rate for Payer: Brighton Health Commercial |
$11.45
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$12.21
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$10.38
|
| Rate for Payer: Group Health Inc Commercial |
$7.63
|
| Rate for Payer: Group Health Inc Medicare |
$5.34
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.63
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.63
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$0.83
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$0.88
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$0.88
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$0.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$9.92
|
|
|
PENICILLIN G POTASSIUM 5000000 UNITS IJ SOLR [6086]
|
Facility
|
OP
|
$15.26
|
|
|
Service Code
|
HCPCS J2540
|
| Hospital Charge Code |
00049052084
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.83 |
| Max. Negotiated Rate |
$12.21 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$8.39
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.92
|
| Rate for Payer: Aetna Government |
$0.92
|
| Rate for Payer: Brighton Health Commercial |
$11.44
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$12.21
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$10.38
|
| Rate for Payer: Group Health Inc Commercial |
$7.63
|
| Rate for Payer: Group Health Inc Medicare |
$5.34
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.63
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.63
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$0.83
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$0.88
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$0.88
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$0.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$9.92
|
|
|
PENICILLIN G POTASSIUM 5000000 UNITS IJ SOLR [6086]
|
Facility
|
OP
|
$15.27
|
|
|
Service Code
|
HCPCS J2540
|
| Hospital Charge Code |
00049042010
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.83 |
| Max. Negotiated Rate |
$12.21 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$8.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.92
|
| Rate for Payer: Aetna Government |
$0.92
|
| Rate for Payer: Brighton Health Commercial |
$11.45
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$12.21
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$10.38
|
| Rate for Payer: Group Health Inc Commercial |
$7.63
|
| Rate for Payer: Group Health Inc Medicare |
$5.34
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.63
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.63
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$0.83
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$0.88
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$0.88
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$0.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$9.92
|
|
|
PENICILLIN G PROCAINE 1,200,000 UNITS/2
|
Facility
|
IP
|
$70.00
|
|
|
Service Code
|
HCPCS J2510
|
| Hospital Charge Code |
41644806
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$35.00 |
| Max. Negotiated Rate |
$35.00 |
| Rate for Payer: Cash Price |
$40.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$35.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$35.00
|
|
|
PENICILLIN G PROCAINE 1,200,000 UNITS/2
|
Facility
|
OP
|
$70.00
|
|
|
Service Code
|
HCPCS J2510
|
| Hospital Charge Code |
41654806
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$28.66 |
| Max. Negotiated Rate |
$45.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$38.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$40.94
|
| Rate for Payer: Aetna Government |
$40.94
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$28.66
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$28.66
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$28.66
|
| Rate for Payer: Brighton Health Commercial |
$42.00
|
| Rate for Payer: Cash Price |
$40.94
|
| Rate for Payer: Cash Price |
$40.94
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$40.94
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$35.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$40.25
|
| Rate for Payer: Elderplan Medicare Advantage |
$40.94
|
| Rate for Payer: EmblemHealth Commercial |
$40.94
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$40.94
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$40.94
|
| Rate for Payer: Fidelis Essential Plan QHP |
$42.99
|
| Rate for Payer: Fidelis Medicare Advantage |
$40.94
|
| Rate for Payer: Fidelis Qualified Health Plan |
$42.99
|
| Rate for Payer: Group Health Inc Commercial |
$40.94
|
| Rate for Payer: Group Health Inc Medicare |
$40.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$35.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$35.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$34.80
|
| Rate for Payer: Healthfirst QHP |
$40.94
|
| Rate for Payer: Humana Medicare |
$41.76
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$40.94
|
| Rate for Payer: United Healthcare Commercial |
$38.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$40.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$45.50
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$32.75
|
| Rate for Payer: Wellcare Medicare |
$38.89
|
|
|
PENICILLIN G PROCAINE 1,200,000 UNITS/2
|
Facility
|
IP
|
$70.00
|
|
|
Service Code
|
HCPCS J2510
|
| Hospital Charge Code |
41654806
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$35.00 |
| Max. Negotiated Rate |
$35.00 |
| Rate for Payer: Cash Price |
$40.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$35.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$35.00
|
|
|
PENICILLIN G PROCAINE 1,200,000 UNITS/2
|
Facility
|
OP
|
$70.00
|
|
|
Service Code
|
HCPCS J2510
|
| Hospital Charge Code |
41644806
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$28.66 |
| Max. Negotiated Rate |
$45.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$38.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$40.94
|
| Rate for Payer: Aetna Government |
$40.94
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$28.66
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$28.66
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$28.66
|
| Rate for Payer: Brighton Health Commercial |
$42.00
|
| Rate for Payer: Cash Price |
$40.94
|
| Rate for Payer: Cash Price |
$40.94
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$40.94
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$35.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$40.25
|
| Rate for Payer: Elderplan Medicare Advantage |
$40.94
|
| Rate for Payer: EmblemHealth Commercial |
$40.94
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$40.94
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$40.94
|
| Rate for Payer: Fidelis Essential Plan QHP |
$42.99
|
| Rate for Payer: Fidelis Medicare Advantage |
$40.94
|
| Rate for Payer: Fidelis Qualified Health Plan |
$42.99
|
| Rate for Payer: Group Health Inc Commercial |
$40.94
|
| Rate for Payer: Group Health Inc Medicare |
$40.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$35.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$35.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$34.80
|
| Rate for Payer: Healthfirst QHP |
$40.94
|
| Rate for Payer: Humana Medicare |
$41.76
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$40.94
|
| Rate for Payer: United Healthcare Commercial |
$38.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$40.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$45.50
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$32.75
|
| Rate for Payer: Wellcare Medicare |
$38.89
|
|
|
PENICILLIN G PROCAINE 600,000 UNITS/ML
|
Facility
|
IP
|
$21.00
|
|
|
Service Code
|
HCPCS J2510
|
| Hospital Charge Code |
41654805
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.50 |
| Max. Negotiated Rate |
$10.50 |
| Rate for Payer: Cash Price |
$40.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$10.50
|
|
|
PENICILLIN G PROCAINE 600,000 UNITS/ML
|
Facility
|
IP
|
$21.00
|
|
|
Service Code
|
HCPCS J2510
|
| Hospital Charge Code |
41644805
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.50 |
| Max. Negotiated Rate |
$10.50 |
| Rate for Payer: Cash Price |
$40.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$10.50
|
|
|
PENICILLIN G PROCAINE 600,000 UNITS/ML
|
Facility
|
OP
|
$21.00
|
|
|
Service Code
|
HCPCS J2510
|
| Hospital Charge Code |
41654805
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.50 |
| Max. Negotiated Rate |
$42.99 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$11.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$40.94
|
| Rate for Payer: Aetna Government |
$40.94
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$28.66
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$28.66
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$28.66
|
| Rate for Payer: Brighton Health Commercial |
$12.60
|
| Rate for Payer: Cash Price |
$40.94
|
| Rate for Payer: Cash Price |
$40.94
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$40.94
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$10.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$12.08
|
| Rate for Payer: Elderplan Medicare Advantage |
$40.94
|
| Rate for Payer: EmblemHealth Commercial |
$40.94
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$40.94
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$40.94
|
| Rate for Payer: Fidelis Essential Plan QHP |
$42.99
|
| Rate for Payer: Fidelis Medicare Advantage |
$40.94
|
| Rate for Payer: Fidelis Qualified Health Plan |
$42.99
|
| Rate for Payer: Group Health Inc Commercial |
$40.94
|
| Rate for Payer: Group Health Inc Medicare |
$40.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$10.50
|
| Rate for Payer: Healthfirst Medicare Advantage |
$34.80
|
| Rate for Payer: Healthfirst QHP |
$40.94
|
| Rate for Payer: Humana Medicare |
$41.76
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$40.94
|
| Rate for Payer: United Healthcare Commercial |
$38.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$40.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$13.65
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$32.75
|
| Rate for Payer: Wellcare Medicare |
$38.89
|
|
|
PENICILLIN G PROCAINE 600,000 UNITS/ML
|
Facility
|
OP
|
$21.00
|
|
|
Service Code
|
HCPCS J2510
|
| Hospital Charge Code |
41644805
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.50 |
| Max. Negotiated Rate |
$42.99 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$11.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$40.94
|
| Rate for Payer: Aetna Government |
$40.94
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$28.66
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$28.66
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$28.66
|
| Rate for Payer: Brighton Health Commercial |
$12.60
|
| Rate for Payer: Cash Price |
$40.94
|
| Rate for Payer: Cash Price |
$40.94
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$40.94
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$10.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$12.08
|
| Rate for Payer: Elderplan Medicare Advantage |
$40.94
|
| Rate for Payer: EmblemHealth Commercial |
$40.94
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$40.94
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$40.94
|
| Rate for Payer: Fidelis Essential Plan QHP |
$42.99
|
| Rate for Payer: Fidelis Medicare Advantage |
$40.94
|
| Rate for Payer: Fidelis Qualified Health Plan |
$42.99
|
| Rate for Payer: Group Health Inc Commercial |
$40.94
|
| Rate for Payer: Group Health Inc Medicare |
$40.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$10.50
|
| Rate for Payer: Healthfirst Medicare Advantage |
$34.80
|
| Rate for Payer: Healthfirst QHP |
$40.94
|
| Rate for Payer: Humana Medicare |
$41.76
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$40.94
|
| Rate for Payer: United Healthcare Commercial |
$38.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$40.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$13.65
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$32.75
|
| Rate for Payer: Wellcare Medicare |
$38.89
|
|
|
PENICILLIN V POTASSIUM 125 MG/5ML PO SOLR [6090]
|
Facility
|
OP
|
$0.10
|
|
|
Service Code
|
NDC 00093412573
|
| Hospital Charge Code |
00093412573
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.08 |
| 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 |
$0.08
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.07
|
| 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
|
|
|
PENICILLIN V POTASSIUM 125 MG/5 ML SUSP
|
Facility
|
OP
|
$0.05
|
|
| Hospital Charge Code |
41642774
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.04 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.03
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.03
|
| Rate for Payer: Aetna Government |
$0.03
|
| Rate for Payer: Brighton Health Commercial |
$0.04
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.04
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$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 |
$0.03
|
|
|
PENICILLIN V POTASSIUM 125 MG/5 ML SUSP
|
Facility
|
OP
|
$0.05
|
|
| Hospital Charge Code |
41652774
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.04 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.03
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.03
|
| Rate for Payer: Aetna Government |
$0.03
|
| Rate for Payer: Brighton Health Commercial |
$0.04
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.04
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$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 |
$0.03
|
|
|
PENICILLIN V POTASSIUM 250 MG/5ML PO SOLR [6091]
|
Facility
|
OP
|
$0.08
|
|
|
Service Code
|
NDC 00093412774
|
| Hospital Charge Code |
00093412774
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.06 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.04
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.04
|
| Rate for Payer: Aetna Government |
$0.04
|
| Rate for Payer: Brighton Health Commercial |
$0.06
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.06
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.06
|
| Rate for Payer: Group Health Inc Commercial |
$0.04
|
| Rate for Payer: Group Health Inc Medicare |
$0.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.04
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.05
|
|
|
PENICILLIN V POTASSIUM 250 MG/5ML PO SOLR [6091]
|
Facility
|
OP
|
$0.11
|
|
|
Service Code
|
NDC 00093412773
|
| Hospital Charge Code |
00093412773
|
|
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 |
$0.06
|
| Rate for Payer: Aetna Government |
$0.06
|
| 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 |
$0.08
|
| Rate for Payer: Group Health Inc Commercial |
$0.06
|
| Rate for Payer: Group Health Inc Medicare |
$0.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.07
|
|
|
PENICILLIN V POTASSIUM 250 MG/5 ML SUSP
|
Facility
|
OP
|
$0.05
|
|
| Hospital Charge Code |
41653399
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.04 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.03
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.03
|
| Rate for Payer: Aetna Government |
$0.03
|
| Rate for Payer: Brighton Health Commercial |
$0.04
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.04
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$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 |
$0.03
|
|
