|
AZITHROMYCIN 250 MG TAB
|
Facility
OP
|
$20.60
|
|
|
Service Code
|
HCPCS Q0144
|
| Hospital Charge Code |
41654340
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.21 |
| Max. Negotiated Rate |
$20.10 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$11.33
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$20.10
|
| Rate for Payer: Aetna Government |
$20.10
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$10.30
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$11.84
|
| Rate for Payer: Group Health Inc Commercial |
$10.30
|
| Rate for Payer: Group Health Inc Medicare |
$7.21
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$10.30
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$13.39
|
|
|
AZITHROMYCIN 500 MG INJ
|
Facility
OP
|
$7.91
|
|
|
Service Code
|
HCPCS J0456
|
| Hospital Charge Code |
41641724
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.49 |
| Max. Negotiated Rate |
$5.14 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.35
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.49
|
| Rate for Payer: Aetna Government |
$2.49
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.96
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.55
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2.50
|
| Rate for Payer: Group Health Inc Commercial |
$3.96
|
| Rate for Payer: Group Health Inc Medicare |
$2.77
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.96
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.96
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2.78
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2.55
|
| Rate for Payer: SOMOS Essential |
$2.55
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.14
|
|
|
AZITHROMYCIN 500 MG INJ
|
Facility
IP
|
$7.91
|
|
|
Service Code
|
HCPCS J0456
|
| Hospital Charge Code |
41651724
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.96 |
| Max. Negotiated Rate |
$3.96 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.96
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.96
|
|
|
AZITHROMYCIN 500 MG INJ
|
Facility
IP
|
$7.91
|
|
|
Service Code
|
HCPCS J0456
|
| Hospital Charge Code |
41641724
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.96 |
| Max. Negotiated Rate |
$3.96 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.96
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.96
|
|
|
AZITHROMYCIN 500 MG INJ
|
Facility
OP
|
$7.91
|
|
|
Service Code
|
HCPCS J0456
|
| Hospital Charge Code |
41651724
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.49 |
| Max. Negotiated Rate |
$5.14 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.35
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.49
|
| Rate for Payer: Aetna Government |
$2.49
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.96
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.55
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2.50
|
| Rate for Payer: Group Health Inc Commercial |
$3.96
|
| Rate for Payer: Group Health Inc Medicare |
$2.77
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.96
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.96
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2.78
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2.55
|
| Rate for Payer: SOMOS Essential |
$2.55
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.14
|
|
|
AZITHROMYCIN 500MG TAB
|
Facility
OP
|
$0.01
|
|
| Hospital Charge Code |
41650219
|
|
Hospital Revenue Code
|
250
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.01
|
| Rate for Payer: Aetna Government |
$0.01
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.01
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.01
|
| Rate for Payer: Group Health Inc Commercial |
$0.01
|
| Rate for Payer: Group Health Inc Medicare |
$0.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.01
|
|
|
AZITHROMYCIN 500MG TAB
|
Facility
OP
|
$0.01
|
|
| Hospital Charge Code |
41640219
|
|
Hospital Revenue Code
|
250
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.01
|
| Rate for Payer: Aetna Government |
$0.01
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.01
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.01
|
| Rate for Payer: Group Health Inc Commercial |
$0.01
|
| Rate for Payer: Group Health Inc Medicare |
$0.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.01
|
|
|
AZITHROMYCIN 600 MG TAB
|
Facility
OP
|
$8.01
|
|
|
Service Code
|
HCPCS Q0144
|
| Hospital Charge Code |
41650419
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$20.10 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.41
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$20.10
|
| Rate for Payer: Aetna Government |
$20.10
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.61
|
| 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 |
$5.21
|
|
|
AZITHROMYCIN 600 MG TAB
|
Facility
IP
|
$8.01
|
|
|
Service Code
|
HCPCS Q0144
|
| Hospital Charge Code |
41650419
|
|
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
|
|
|
AZITHROMYCIN 600 MG TAB
|
Facility
IP
|
$8.01
|
|
|
Service Code
|
HCPCS Q0144
|
| Hospital Charge Code |
41640419
|
|
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
|
|
|
AZITHROMYCIN 600 MG TAB
|
Facility
OP
|
$8.01
|
|
|
Service Code
|
HCPCS Q0144
|
| Hospital Charge Code |
41640419
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$20.10 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.41
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$20.10
|
| Rate for Payer: Aetna Government |
$20.10
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.61
|
| 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 |
$5.21
|
|
|
AZTREONAM 1000 MG INJ
|
Facility
OP
|
$50.58
|
|
| Hospital Charge Code |
41653098
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.70 |
| Max. Negotiated Rate |
$40.46 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$27.82
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$25.29
|
| Rate for Payer: Aetna Government |
$25.29
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$40.46
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$34.39
|
| Rate for Payer: Group Health Inc Commercial |
$25.29
|
| Rate for Payer: Group Health Inc Medicare |
$17.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$25.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$25.29
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$32.88
|
|
|
AZTREONAM 1000 MG INJ
|
Facility
OP
|
$50.58
|
|
| Hospital Charge Code |
41643098
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.70 |
| Max. Negotiated Rate |
$40.46 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$27.82
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$25.29
|
| Rate for Payer: Aetna Government |
$25.29
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$40.46
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$34.39
|
| Rate for Payer: Group Health Inc Commercial |
$25.29
|
| Rate for Payer: Group Health Inc Medicare |
$17.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$25.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$25.29
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$32.88
|
|
|
AZTREONAM 100 MG/ML INJ NEONATAL
|
Facility
OP
|
$6.00
|
|
| Hospital Charge Code |
41640395
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.10 |
| Max. Negotiated Rate |
$4.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.00
|
| Rate for Payer: Aetna Government |
$3.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.08
|
| Rate for Payer: Group Health Inc Commercial |
$3.00
|
| Rate for Payer: Group Health Inc Medicare |
$2.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.90
|
|
|
AZTREONAM 100 MG/ML INJ NEONATAL
|
Facility
OP
|
$6.00
|
|
| Hospital Charge Code |
41650395
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.10 |
| Max. Negotiated Rate |
$4.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.00
|
| Rate for Payer: Aetna Government |
$3.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.08
|
| Rate for Payer: Group Health Inc Commercial |
$3.00
|
| Rate for Payer: Group Health Inc Medicare |
$2.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.90
|
|
|
AZTREONAM 1G/D5W 50ML IVPB
|
Facility
OP
|
$28.00
|
|
| Hospital Charge Code |
41654303
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.80 |
| Max. Negotiated Rate |
$22.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$15.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$14.00
|
| Rate for Payer: Aetna Government |
$14.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$22.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$19.04
|
| Rate for Payer: Group Health Inc Commercial |
$14.00
|
| Rate for Payer: Group Health Inc Medicare |
$9.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$18.20
|
|
|
AZTREONAM 1G/D5W 50ML IVPB
|
Facility
OP
|
$28.00
|
|
| Hospital Charge Code |
41644303
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.80 |
| Max. Negotiated Rate |
$22.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$15.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$14.00
|
| Rate for Payer: Aetna Government |
$14.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$22.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$19.04
|
| Rate for Payer: Group Health Inc Commercial |
$14.00
|
| Rate for Payer: Group Health Inc Medicare |
$9.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$18.20
|
|
|
AZTREONAM 2000 MG INJ
|
Facility
OP
|
$101.01
|
|
| Hospital Charge Code |
41645545
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$35.35 |
| Max. Negotiated Rate |
$80.81 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$55.56
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$50.50
|
| Rate for Payer: Aetna Government |
$50.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$80.81
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$68.69
|
| Rate for Payer: Group Health Inc Commercial |
$50.50
|
| Rate for Payer: Group Health Inc Medicare |
$35.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$50.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$50.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$65.66
|
|
|
AZTREONAM 2000 MG INJ
|
Facility
OP
|
$101.01
|
|
| Hospital Charge Code |
41655545
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$35.35 |
| Max. Negotiated Rate |
$80.81 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$55.56
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$50.50
|
| Rate for Payer: Aetna Government |
$50.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$80.81
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$68.69
|
| Rate for Payer: Group Health Inc Commercial |
$50.50
|
| Rate for Payer: Group Health Inc Medicare |
$35.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$50.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$50.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$65.66
|
|
|
AZTREONAM 20MG/ML NS
|
Facility
IP
|
$2.16
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
41640284
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.08 |
| Max. Negotiated Rate |
$1.08 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.08
|
|
|
AZTREONAM 20MG/ML NS
|
Facility
IP
|
$2.16
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
41650284
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.08 |
| Max. Negotiated Rate |
$1.08 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.08
|
|
|
AZTREONAM 20MG/ML NS
|
Facility
OP
|
$2.16
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
41640284
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.76 |
| Max. Negotiated Rate |
$1.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.19
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.08
|
| Rate for Payer: Aetna Government |
$1.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.08
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.24
|
| Rate for Payer: Group Health Inc Commercial |
$1.08
|
| Rate for Payer: Group Health Inc Medicare |
$0.76
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.40
|
|
|
AZTREONAM 20MG/ML NS
|
Facility
OP
|
$2.16
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
41650284
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.76 |
| Max. Negotiated Rate |
$1.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.19
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.08
|
| Rate for Payer: Aetna Government |
$1.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.08
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.24
|
| Rate for Payer: Group Health Inc Commercial |
$1.08
|
| Rate for Payer: Group Health Inc Medicare |
$0.76
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.40
|
|
|
AZTREONAM 2G/D5W 50ML IVPB
|
Facility
OP
|
$48.00
|
|
| Hospital Charge Code |
41644304
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.80 |
| Max. Negotiated Rate |
$38.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$26.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$24.00
|
| Rate for Payer: Aetna Government |
$24.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$38.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$32.64
|
| Rate for Payer: Group Health Inc Commercial |
$24.00
|
| Rate for Payer: Group Health Inc Medicare |
$16.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$24.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$24.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$31.20
|
|
|
AZTREONAM 2G/D5W 50ML IVPB
|
Facility
OP
|
$48.00
|
|
| Hospital Charge Code |
41654304
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.80 |
| Max. Negotiated Rate |
$38.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$26.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$24.00
|
| Rate for Payer: Aetna Government |
$24.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$38.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$32.64
|
| Rate for Payer: Group Health Inc Commercial |
$24.00
|
| Rate for Payer: Group Health Inc Medicare |
$16.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$24.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$24.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$31.20
|
|
