|
PIOGLITAZONE HCL 45 MG PO TABS [25530]
|
Facility
|
OP
|
$11.61
|
|
|
Service Code
|
NDC 57237022130
|
| Hospital Charge Code |
57237022130
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.06 |
| Max. Negotiated Rate |
$9.29 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.39
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.81
|
| Rate for Payer: Aetna Government |
$5.81
|
| Rate for Payer: Brighton Health Commercial |
$8.71
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$9.29
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7.90
|
| Rate for Payer: Group Health Inc Commercial |
$5.81
|
| Rate for Payer: Group Health Inc Medicare |
$4.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.81
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.81
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$7.55
|
|
|
PIOGLITAZONE HCL 45 MG PO TABS [25530]
|
Facility
|
OP
|
$11.61
|
|
|
Service Code
|
NDC 57237022190
|
| Hospital Charge Code |
57237022190
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.06 |
| Max. Negotiated Rate |
$9.29 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.39
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.81
|
| Rate for Payer: Aetna Government |
$5.81
|
| Rate for Payer: Brighton Health Commercial |
$8.71
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$9.29
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7.90
|
| Rate for Payer: Group Health Inc Commercial |
$5.81
|
| Rate for Payer: Group Health Inc Medicare |
$4.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.81
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.81
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$7.55
|
|
|
PIPE, LIGHT
|
Facility
|
OP
|
$927.00
|
|
| Hospital Charge Code |
64906066
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$324.45 |
| Max. Negotiated Rate |
$741.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$509.85
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$463.50
|
| Rate for Payer: Aetna Government |
$463.50
|
| Rate for Payer: Brighton Health Commercial |
$695.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$741.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$630.36
|
| Rate for Payer: Group Health Inc Commercial |
$463.50
|
| Rate for Payer: Group Health Inc Medicare |
$324.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$463.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$463.50
|
|
|
PIPERACILLIN SOD-TAZOBACTAM SO 2.25 (2-0.25) G IV SOLR [18304]
|
Facility
|
OP
|
$8.40
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
70594007802
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1.48 |
| Max. Negotiated Rate |
$8.82 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.62
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.48
|
| Rate for Payer: Aetna Government |
$1.48
|
| Rate for Payer: Brighton Health Commercial |
$5.04
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.83
|
| Rate for Payer: EmblemHealth Commercial |
$4.20
|
| Rate for Payer: Fidelis Medicare Advantage |
$8.82
|
| Rate for Payer: Group Health Inc Commercial |
$4.20
|
| Rate for Payer: Group Health Inc Medicare |
$2.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.46
|
|
|
PIPERACILLIN SOD-TAZOBACTAM SO 2.25 (2-0.25) G IV SOLR [18304]
|
Facility
|
IP
|
$11.45
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
60505615604
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5.72 |
| Max. Negotiated Rate |
$5.72 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.72
|
|
|
PIPERACILLIN SOD-TAZOBACTAM SO 2.25 (2-0.25) G IV SOLR [18304]
|
Facility
|
IP
|
$8.40
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
70594007802
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4.20 |
| Max. Negotiated Rate |
$4.20 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.20
|
|
|
PIPERACILLIN SOD-TAZOBACTAM SO 2.25 (2-0.25) G IV SOLR [18304]
|
Facility
|
OP
|
$11.45
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
60505615604
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1.48 |
| Max. Negotiated Rate |
$12.02 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.48
|
| Rate for Payer: Aetna Government |
$1.48
|
| Rate for Payer: Brighton Health Commercial |
$6.87
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5.72
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.58
|
| Rate for Payer: EmblemHealth Commercial |
$5.72
|
| Rate for Payer: Fidelis Medicare Advantage |
$12.02
|
| Rate for Payer: Group Health Inc Commercial |
$5.72
|
| Rate for Payer: Group Health Inc Medicare |
$4.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.72
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$7.44
|
|
|
PIPERACILLIN SOD-TAZOBACTAM SO 2.25 (2-0.25) G IV SOLR [18304]
|
Facility
|
IP
|
$3.59
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
44567080110
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1.79 |
| Max. Negotiated Rate |
$1.79 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.79
|
|
|
PIPERACILLIN SOD-TAZOBACTAM SO 2.25 (2-0.25) G IV SOLR [18304]
|
Facility
|
OP
|
$3.59
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
44567080110
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1.26 |
| Max. Negotiated Rate |
$3.77 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.97
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.48
|
| Rate for Payer: Aetna Government |
$1.48
|
| Rate for Payer: Brighton Health Commercial |
$2.15
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.79
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.06
|
| Rate for Payer: EmblemHealth Commercial |
$1.79
|
| Rate for Payer: Fidelis Medicare Advantage |
$3.77
|
| Rate for Payer: Group Health Inc Commercial |
$1.79
|
| Rate for Payer: Group Health Inc Medicare |
$1.26
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.79
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.33
|
|
|
PIPERACILLIN SOD-TAZOBACTAM SO 3.375 (3-0.375) G IV SOLR [18303]
|
Facility
|
OP
|
$3.60
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
63323098353
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1.26 |
| Max. Negotiated Rate |
$3.78 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.98
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.48
|
| Rate for Payer: Aetna Government |
$1.48
|
| Rate for Payer: Brighton Health Commercial |
$2.16
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.07
|
| Rate for Payer: EmblemHealth Commercial |
$1.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$3.78
|
| Rate for Payer: Group Health Inc Commercial |
$1.80
|
| Rate for Payer: Group Health Inc Medicare |
$1.26
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.80
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.34
|
|
|
PIPERACILLIN SOD-TAZOBACTAM SO 3.375 (3-0.375) G IV SOLR [18303]
|
Facility
|
OP
|
$17.18
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
60505615700
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1.48 |
| Max. Negotiated Rate |
$18.04 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$9.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.48
|
| Rate for Payer: Aetna Government |
$1.48
|
| Rate for Payer: Brighton Health Commercial |
$10.31
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.59
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$9.88
|
| Rate for Payer: EmblemHealth Commercial |
$8.59
|
| Rate for Payer: Fidelis Medicare Advantage |
$18.04
|
| Rate for Payer: Group Health Inc Commercial |
$8.59
|
| Rate for Payer: Group Health Inc Medicare |
$6.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.59
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$11.17
|
|
|
PIPERACILLIN SOD-TAZOBACTAM SO 3.375 (3-0.375) G IV SOLR [18303]
|
Facility
|
IP
|
$3.60
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
63323098353
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$1.80 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.80
|
|
|
PIPERACILLIN SOD-TAZOBACTAM SO 3.375 (3-0.375) G IV SOLR [18303]
|
Facility
|
IP
|
$16.64
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
63323098321
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8.32 |
| Max. Negotiated Rate |
$8.32 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.32
|
|
|
PIPERACILLIN SOD-TAZOBACTAM SO 3.375 (3-0.375) G IV SOLR [18303]
|
Facility
|
OP
|
$16.64
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
63323098321
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1.48 |
| Max. Negotiated Rate |
$17.48 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$9.15
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.48
|
| Rate for Payer: Aetna Government |
$1.48
|
| Rate for Payer: Brighton Health Commercial |
$9.99
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.32
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$9.57
|
| Rate for Payer: EmblemHealth Commercial |
$8.32
|
| Rate for Payer: Fidelis Medicare Advantage |
$17.48
|
| Rate for Payer: Group Health Inc Commercial |
$8.32
|
| Rate for Payer: Group Health Inc Medicare |
$5.83
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$10.82
|
|
|
PIPERACILLIN SOD-TAZOBACTAM SO 3.375 (3-0.375) G IV SOLR [18303]
|
Facility
|
IP
|
$13.20
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
70594007902
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.60 |
| Max. Negotiated Rate |
$6.60 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.60
|
|
|
PIPERACILLIN SOD-TAZOBACTAM SO 3.375 (3-0.375) G IV SOLR [18303]
|
Facility
|
IP
|
$17.18
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
60505615700
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8.59 |
| Max. Negotiated Rate |
$8.59 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.59
|
|
|
PIPERACILLIN SOD-TAZOBACTAM SO 3.375 (3-0.375) G IV SOLR [18303]
|
Facility
|
OP
|
$13.20
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
70594007902
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1.48 |
| Max. Negotiated Rate |
$13.86 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.26
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.48
|
| Rate for Payer: Aetna Government |
$1.48
|
| Rate for Payer: Brighton Health Commercial |
$7.92
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7.59
|
| Rate for Payer: EmblemHealth Commercial |
$6.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$13.86
|
| Rate for Payer: Group Health Inc Commercial |
$6.60
|
| Rate for Payer: Group Health Inc Medicare |
$4.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.60
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8.58
|
|
|
PIPERACILLIN SOD-TAZOBACTAM SO 3.375 (3-0.375) G IV SOLR [18303]
|
Facility
|
IP
|
$17.18
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
60505615704
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8.59 |
| Max. Negotiated Rate |
$8.59 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.59
|
|
|
PIPERACILLIN SOD-TAZOBACTAM SO 3.375 (3-0.375) G IV SOLR [18303]
|
Facility
|
OP
|
$17.18
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
60505615704
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1.48 |
| Max. Negotiated Rate |
$18.03 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$9.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.48
|
| Rate for Payer: Aetna Government |
$1.48
|
| Rate for Payer: Brighton Health Commercial |
$10.30
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.59
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$9.88
|
| Rate for Payer: EmblemHealth Commercial |
$8.59
|
| Rate for Payer: Fidelis Medicare Advantage |
$18.03
|
| Rate for Payer: Group Health Inc Commercial |
$8.59
|
| Rate for Payer: Group Health Inc Medicare |
$6.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.59
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$11.16
|
|
|
PIPERACILLIN SOD-TAZOBACTAM SO 4.5 (4-0.5) G IV SOLR [18302]
|
Facility
|
OP
|
$21.75
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
60505615900
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1.48 |
| Max. Negotiated Rate |
$22.84 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$11.96
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.48
|
| Rate for Payer: Aetna Government |
$1.48
|
| Rate for Payer: Brighton Health Commercial |
$13.05
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$10.88
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$12.51
|
| Rate for Payer: EmblemHealth Commercial |
$10.88
|
| Rate for Payer: Fidelis Medicare Advantage |
$22.84
|
| Rate for Payer: Group Health Inc Commercial |
$10.88
|
| Rate for Payer: Group Health Inc Medicare |
$7.61
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$10.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$14.14
|
|
|
PIPERACILLIN SOD-TAZOBACTAM SO 4.5 (4-0.5) G IV SOLR [18302]
|
Facility
|
IP
|
$21.75
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
60505615900
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10.88 |
| Max. Negotiated Rate |
$10.88 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$10.88
|
|
|
PIPERACILLIN SOD-TAZOBACTAM SO 4.5 (4-0.5) G IV SOLR [18302]
|
Facility
|
IP
|
$27.55
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
55150012150
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$13.78 |
| Max. Negotiated Rate |
$13.78 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$13.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.78
|
|
|
PIPERACILLIN SOD-TAZOBACTAM SO 4.5 (4-0.5) G IV SOLR [18302]
|
Facility
|
OP
|
$27.55
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
55150012150
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1.48 |
| Max. Negotiated Rate |
$28.93 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$15.15
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.48
|
| Rate for Payer: Aetna Government |
$1.48
|
| Rate for Payer: Brighton Health Commercial |
$16.53
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$13.78
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$15.84
|
| Rate for Payer: EmblemHealth Commercial |
$13.78
|
| Rate for Payer: Fidelis Medicare Advantage |
$28.93
|
| Rate for Payer: Group Health Inc Commercial |
$13.78
|
| Rate for Payer: Group Health Inc Medicare |
$9.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$13.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.78
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$17.91
|
|
|
PIPERACILLIN SOD-TAZOBACTAM SO 4.5 (4-0.5) G IV SOLR [18302]
|
Facility
|
IP
|
$21.75
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
60505615904
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10.88 |
| Max. Negotiated Rate |
$10.88 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$10.88
|
|
|
PIPERACILLIN SOD-TAZOBACTAM SO 4.5 (4-0.5) G IV SOLR [18302]
|
Facility
|
OP
|
$21.75
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
60505615904
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1.48 |
| Max. Negotiated Rate |
$22.84 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$11.96
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.48
|
| Rate for Payer: Aetna Government |
$1.48
|
| Rate for Payer: Brighton Health Commercial |
$13.05
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$10.88
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$12.51
|
| Rate for Payer: EmblemHealth Commercial |
$10.88
|
| Rate for Payer: Fidelis Medicare Advantage |
$22.84
|
| Rate for Payer: Group Health Inc Commercial |
$10.88
|
| Rate for Payer: Group Health Inc Medicare |
$7.61
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$10.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$14.14
|
|
