|
PHENYLEPHRINE HCL 1 % NA SOLN [6245]
|
Facility
|
OP
|
$0.21
|
|
|
Service Code
|
NDC 00067208601
|
| Hospital Charge Code |
00067208601
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.17 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.12
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.11
|
| Rate for Payer: Aetna Government |
$0.11
|
| Rate for Payer: Brighton Health Commercial |
$0.16
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.17
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.14
|
| Rate for Payer: Group Health Inc Commercial |
$0.11
|
| Rate for Payer: Group Health Inc Medicare |
$0.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.11
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.11
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.14
|
|
|
PHENYLEPHRINE HCL 2.5 % OP SOLN [6246]
|
Facility
|
OP
|
$20.32
|
|
|
Service Code
|
NDC 17478020102
|
| Hospital Charge Code |
17478020102
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.11 |
| Max. Negotiated Rate |
$16.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$11.17
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$10.16
|
| Rate for Payer: Aetna Government |
$10.16
|
| Rate for Payer: Brighton Health Commercial |
$15.24
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$16.25
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$13.81
|
| Rate for Payer: Group Health Inc Commercial |
$10.16
|
| Rate for Payer: Group Health Inc Medicare |
$7.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$10.16
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$13.20
|
|
|
PHENYLEPHRINE HCL 2.5 % OP SOLN [6246]
|
Facility
|
OP
|
$7.20
|
|
|
Service Code
|
NDC 42702010215
|
| Hospital Charge Code |
42702010215
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.52 |
| Max. Negotiated Rate |
$5.76 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.96
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.60
|
| Rate for Payer: Aetna Government |
$3.60
|
| Rate for Payer: Brighton Health Commercial |
$5.40
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5.76
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.90
|
| Rate for Payer: Group Health Inc Commercial |
$3.60
|
| Rate for Payer: Group Health Inc Medicare |
$2.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.60
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.68
|
|
|
PHENYLEPHRINE HCL 2.5 % OP SOLN [6246]
|
Facility
|
OP
|
$20.32
|
|
|
Service Code
|
NDC 70756062925
|
| Hospital Charge Code |
70756062925
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.11 |
| Max. Negotiated Rate |
$16.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$11.17
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$10.16
|
| Rate for Payer: Aetna Government |
$10.16
|
| Rate for Payer: Brighton Health Commercial |
$15.24
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$16.25
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$13.81
|
| Rate for Payer: Group Health Inc Commercial |
$10.16
|
| Rate for Payer: Group Health Inc Medicare |
$7.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$10.16
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$13.20
|
|
|
PHENYLEPHRINE HCL 2.5 % OP SOLN [6246]
|
Facility
|
OP
|
$7.50
|
|
|
Service Code
|
NDC 17478020115
|
| Hospital Charge Code |
17478020115
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.62 |
| Max. Negotiated Rate |
$6.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.12
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.75
|
| Rate for Payer: Aetna Government |
$3.75
|
| Rate for Payer: Brighton Health Commercial |
$5.62
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.10
|
| Rate for Payer: Group Health Inc Commercial |
$3.75
|
| Rate for Payer: Group Health Inc Medicare |
$2.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.75
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.88
|
|
|
PHENYLEPHRINE HCL 2.5 % OP SOLN [6246]
|
Facility
|
OP
|
$7.20
|
|
|
Service Code
|
NDC 42702010210
|
| Hospital Charge Code |
42702010210
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.52 |
| Max. Negotiated Rate |
$5.76 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.96
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.60
|
| Rate for Payer: Aetna Government |
$3.60
|
| Rate for Payer: Brighton Health Commercial |
$5.40
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5.76
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.90
|
| Rate for Payer: Group Health Inc Commercial |
$3.60
|
| Rate for Payer: Group Health Inc Medicare |
$2.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.60
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.68
|
|
|
PHENYLEPHRINE HCL (PRESSORS) 10 MG/ML IV SOLN [127358]
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
NDC 00781342292
|
| Hospital Charge Code |
00781342292
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1.40 |
| Max. Negotiated Rate |
$4.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.20
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.00
|
| Rate for Payer: Aetna Government |
$2.00
|
| Rate for Payer: Brighton Health Commercial |
$2.40
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.30
|
| Rate for Payer: EmblemHealth Commercial |
$2.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$4.20
|
| Rate for Payer: Group Health Inc Commercial |
$2.00
|
| Rate for Payer: Group Health Inc Medicare |
$1.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.60
|
|
|
PHENYLEPHRINE HCL (PRESSORS) 10 MG/ML IV SOLN [127358]
|
Facility
|
IP
|
$2.40
|
|
|
Service Code
|
NDC 71288080877
|
| Hospital Charge Code |
71288080877
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1.20 |
| Max. Negotiated Rate |
$1.20 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.20
|
|
|
PHENYLEPHRINE HCL (PRESSORS) 10 MG/ML IV SOLN [127358]
|
Facility
|
OP
|
$1.92
|
|
|
Service Code
|
NDC 81284021125
|
| Hospital Charge Code |
81284021125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.67 |
| Max. Negotiated Rate |
$2.02 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.06
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.96
|
| Rate for Payer: Aetna Government |
$0.96
|
| Rate for Payer: Brighton Health Commercial |
$1.15
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.96
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.10
|
| Rate for Payer: EmblemHealth Commercial |
$0.96
|
| Rate for Payer: Fidelis Medicare Advantage |
$2.02
|
| Rate for Payer: Group Health Inc Commercial |
$0.96
|
| Rate for Payer: Group Health Inc Medicare |
$0.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.96
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.25
|
|
|
PHENYLEPHRINE HCL (PRESSORS) 10 MG/ML IV SOLN [127358]
|
Facility
|
OP
|
$2.40
|
|
|
Service Code
|
NDC 71288080877
|
| Hospital Charge Code |
71288080877
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.84 |
| Max. Negotiated Rate |
$2.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.32
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.20
|
| Rate for Payer: Aetna Government |
$1.20
|
| Rate for Payer: Brighton Health Commercial |
$1.44
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.38
|
| Rate for Payer: EmblemHealth Commercial |
$1.20
|
| Rate for Payer: Fidelis Medicare Advantage |
$2.52
|
| Rate for Payer: Group Health Inc Commercial |
$1.20
|
| Rate for Payer: Group Health Inc Medicare |
$0.84
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.56
|
|
|
PHENYLEPHRINE HCL (PRESSORS) 10 MG/ML IV SOLN [127358]
|
Facility
|
OP
|
$3.84
|
|
|
Service Code
|
NDC 16729046408
|
| Hospital Charge Code |
16729046408
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1.34 |
| Max. Negotiated Rate |
$4.03 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.11
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.92
|
| Rate for Payer: Aetna Government |
$1.92
|
| Rate for Payer: Brighton Health Commercial |
$2.30
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.92
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.21
|
| Rate for Payer: EmblemHealth Commercial |
$1.92
|
| Rate for Payer: Fidelis Medicare Advantage |
$4.03
|
| Rate for Payer: Group Health Inc Commercial |
$1.92
|
| Rate for Payer: Group Health Inc Medicare |
$1.34
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.92
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.50
|
|
|
PHENYLEPHRINE HCL (PRESSORS) 10 MG/ML IV SOLN [127358]
|
Facility
|
IP
|
$1.92
|
|
|
Service Code
|
NDC 81284021100
|
| Hospital Charge Code |
81284021100
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.96 |
| Max. Negotiated Rate |
$0.96 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.96
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.96
|
|
|
PHENYLEPHRINE HCL (PRESSORS) 10 MG/ML IV SOLN [127358]
|
Facility
|
IP
|
$1.92
|
|
|
Service Code
|
NDC 81284021125
|
| Hospital Charge Code |
81284021125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.96 |
| Max. Negotiated Rate |
$0.96 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.96
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.96
|
|
|
PHENYLEPHRINE HCL (PRESSORS) 10 MG/ML IV SOLN [127358]
|
Facility
|
OP
|
$2.40
|
|
|
Service Code
|
NDC 71288080876
|
| Hospital Charge Code |
71288080876
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.84 |
| Max. Negotiated Rate |
$2.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.32
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.20
|
| Rate for Payer: Aetna Government |
$1.20
|
| Rate for Payer: Brighton Health Commercial |
$1.44
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.38
|
| Rate for Payer: EmblemHealth Commercial |
$1.20
|
| Rate for Payer: Fidelis Medicare Advantage |
$2.52
|
| Rate for Payer: Group Health Inc Commercial |
$1.20
|
| Rate for Payer: Group Health Inc Medicare |
$0.84
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.56
|
|
|
PHENYLEPHRINE HCL (PRESSORS) 10 MG/ML IV SOLN [127358]
|
Facility
|
IP
|
$4.86
|
|
|
Service Code
|
NDC 70121157807
|
| Hospital Charge Code |
70121157807
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.43 |
| Max. Negotiated Rate |
$2.43 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.43
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.43
|
|
|
PHENYLEPHRINE HCL (PRESSORS) 10 MG/ML IV SOLN [127358]
|
Facility
|
IP
|
$3.84
|
|
|
Service Code
|
NDC 55150030025
|
| Hospital Charge Code |
55150030025
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1.92 |
| Max. Negotiated Rate |
$1.92 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.92
|
|
|
PHENYLEPHRINE HCL (PRESSORS) 10 MG/ML IV SOLN [127358]
|
Facility
|
IP
|
$3.84
|
|
|
Service Code
|
NDC 16729046408
|
| Hospital Charge Code |
16729046408
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1.92 |
| Max. Negotiated Rate |
$1.92 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.92
|
|
|
PHENYLEPHRINE HCL (PRESSORS) 10 MG/ML IV SOLN [127358]
|
Facility
|
IP
|
$5.28
|
|
|
Service Code
|
NDC 70756062210
|
| Hospital Charge Code |
70756062210
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.64 |
| Max. Negotiated Rate |
$2.64 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.64
|
|
|
PHENYLEPHRINE HCL (PRESSORS) 10 MG/ML IV SOLN [127358]
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
NDC 00781342292
|
| Hospital Charge Code |
00781342292
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$2.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.00
|
|
|
PHENYLEPHRINE HCL (PRESSORS) 10 MG/ML IV SOLN [127358]
|
Facility
|
IP
|
$2.40
|
|
|
Service Code
|
NDC 71288080876
|
| Hospital Charge Code |
71288080876
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1.20 |
| Max. Negotiated Rate |
$1.20 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.20
|
|
|
PHENYLEPHRINE HCL (PRESSORS) 10 MG/ML IV SOLN [127358]
|
Facility
|
IP
|
$4.80
|
|
|
Service Code
|
NDC 55150030110
|
| Hospital Charge Code |
55150030110
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.40 |
| Max. Negotiated Rate |
$2.40 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.40
|
|
|
PHENYLEPHRINE HCL (PRESSORS) 10 MG/ML IV SOLN [127358]
|
Facility
|
IP
|
$4.80
|
|
|
Service Code
|
NDC 16729046503
|
| Hospital Charge Code |
16729046503
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.40 |
| Max. Negotiated Rate |
$2.40 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.40
|
|
|
PHENYLEPHRINE HCL (PRESSORS) 10 MG/ML IV SOLN [127358]
|
Facility
|
OP
|
$4.80
|
|
|
Service Code
|
NDC 55150030110
|
| Hospital Charge Code |
55150030110
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1.68 |
| Max. Negotiated Rate |
$5.04 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.64
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.40
|
| Rate for Payer: Aetna Government |
$2.40
|
| Rate for Payer: Brighton Health Commercial |
$2.88
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.76
|
| Rate for Payer: EmblemHealth Commercial |
$2.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$5.04
|
| Rate for Payer: Group Health Inc Commercial |
$2.40
|
| Rate for Payer: Group Health Inc Medicare |
$1.68
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.40
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.12
|
|
|
PHENYLEPHRINE HCL (PRESSORS) 10 MG/ML IV SOLN [127358]
|
Facility
|
OP
|
$5.28
|
|
|
Service Code
|
NDC 70756062210
|
| Hospital Charge Code |
70756062210
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1.85 |
| Max. Negotiated Rate |
$5.54 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.64
|
| Rate for Payer: Aetna Government |
$2.64
|
| Rate for Payer: Brighton Health Commercial |
$3.17
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.64
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.04
|
| Rate for Payer: EmblemHealth Commercial |
$2.64
|
| Rate for Payer: Fidelis Medicare Advantage |
$5.54
|
| Rate for Payer: Group Health Inc Commercial |
$2.64
|
| Rate for Payer: Group Health Inc Medicare |
$1.85
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.43
|
|
|
PHENYLEPHRINE HCL (PRESSORS) 10 MG/ML IV SOLN [127358]
|
Facility
|
OP
|
$5.28
|
|
|
Service Code
|
NDC 61990021202
|
| Hospital Charge Code |
61990021202
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1.85 |
| Max. Negotiated Rate |
$5.54 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.64
|
| Rate for Payer: Aetna Government |
$2.64
|
| Rate for Payer: Brighton Health Commercial |
$3.17
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.64
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.04
|
| Rate for Payer: EmblemHealth Commercial |
$2.64
|
| Rate for Payer: Fidelis Medicare Advantage |
$5.54
|
| Rate for Payer: Group Health Inc Commercial |
$2.64
|
| Rate for Payer: Group Health Inc Medicare |
$1.85
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.43
|
|
