|
EPHEDRINE SULFATE (PRESSORS) 50 MG/ML IV SOLN
|
Facility
|
OP
|
$29.52
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
5515037301
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$10.33 |
| Max. Negotiated Rate |
$23.62 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$16.24
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$14.76
|
| Rate for Payer: Aetna Government |
$14.76
|
| Rate for Payer: Brighton Health Commercial |
$22.14
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$23.62
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$20.07
|
| Rate for Payer: EmblemHealth Commercial |
$14.76
|
| Rate for Payer: Group Health Inc Commercial |
$14.76
|
| Rate for Payer: Group Health Inc Medicare |
$10.33
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.76
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$19.19
|
|
|
EPHEDRINE SULFATE (PRESSORS) 50 MG/ML IV SOLN
|
Facility
|
IP
|
$59.11
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
0781326971
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$29.56 |
| Max. Negotiated Rate |
$29.56 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$29.56
|
|
|
EPHEDRINE SULFATE (PRESSORS) 50 MG/ML IV SOLN
|
Facility
|
OP
|
$34.85
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
4202321625
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$12.20 |
| Max. Negotiated Rate |
$27.88 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$19.17
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$17.42
|
| Rate for Payer: Aetna Government |
$17.42
|
| Rate for Payer: Brighton Health Commercial |
$26.14
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$27.88
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$23.70
|
| Rate for Payer: EmblemHealth Commercial |
$17.42
|
| Rate for Payer: Group Health Inc Commercial |
$17.42
|
| Rate for Payer: Group Health Inc Medicare |
$12.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$17.42
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$22.65
|
|
|
EPHEDRINE SULFATE (PRESSORS) 50 MG/ML IV SOLN
|
Facility
|
OP
|
$29.52
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
5515037325
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$10.33 |
| Max. Negotiated Rate |
$23.62 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$16.24
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$14.76
|
| Rate for Payer: Aetna Government |
$14.76
|
| Rate for Payer: Brighton Health Commercial |
$22.14
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$23.62
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$20.07
|
| Rate for Payer: EmblemHealth Commercial |
$14.76
|
| Rate for Payer: Group Health Inc Commercial |
$14.76
|
| Rate for Payer: Group Health Inc Medicare |
$10.33
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.76
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$19.19
|
|
|
EPHEDRINE SULFATE (PRESSORS) 50 MG/ML IV SOLN
|
Facility
|
OP
|
$30.01
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
7075661125
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$10.50 |
| Max. Negotiated Rate |
$24.01 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$16.51
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$15.01
|
| Rate for Payer: Aetna Government |
$15.01
|
| Rate for Payer: Brighton Health Commercial |
$22.51
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$24.01
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$20.41
|
| Rate for Payer: EmblemHealth Commercial |
$15.01
|
| Rate for Payer: Group Health Inc Commercial |
$15.01
|
| Rate for Payer: Group Health Inc Medicare |
$10.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$15.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$19.51
|
|
|
EPHEDRINE SULFATE (PRESSORS) 50 MG/ML IV SOLN
|
Facility
|
OP
|
$34.85
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
4202321683
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$12.20 |
| Max. Negotiated Rate |
$27.88 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$19.17
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$17.42
|
| Rate for Payer: Aetna Government |
$17.42
|
| Rate for Payer: Brighton Health Commercial |
$26.14
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$27.88
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$23.70
|
| Rate for Payer: EmblemHealth Commercial |
$17.42
|
| Rate for Payer: Group Health Inc Commercial |
$17.42
|
| Rate for Payer: Group Health Inc Medicare |
$12.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$17.42
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$22.65
|
|
|
EPINASTINE HCL 0.05 % OP SOLN
|
Facility
|
IP
|
$20.52
|
|
|
Service Code
|
NDC 7006900801
|
| Hospital Charge Code |
7006900801
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.26 |
| Max. Negotiated Rate |
$10.26 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.26
|
|
|
EPINASTINE HCL 0.05 % OP SOLN
|
Facility
|
OP
|
$20.52
|
|
|
Service Code
|
NDC 7006900801
|
| Hospital Charge Code |
7006900801
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.18 |
| Max. Negotiated Rate |
$16.42 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$11.29
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$10.26
|
| Rate for Payer: Aetna Government |
$10.26
|
| Rate for Payer: Brighton Health Commercial |
$15.39
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$16.42
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$13.95
|
| Rate for Payer: EmblemHealth Commercial |
$10.26
|
| Rate for Payer: Group Health Inc Commercial |
$10.26
|
| Rate for Payer: Group Health Inc Medicare |
$7.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$10.26
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$13.34
|
|
|
EPINEPHRINE 0.15 MG/0.3ML IJ SOAJ
|
Facility
|
IP
|
$187.50
|
|
|
Service Code
|
HCPCS J0165
|
| Hospital Charge Code |
4950210102
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$93.75 |
| Max. Negotiated Rate |
$93.75 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$93.75
|
|
|
EPINEPHRINE 0.15 MG/0.3ML IJ SOAJ
|
Facility
|
OP
|
$187.50
|
|
|
Service Code
|
HCPCS J0165
|
| Hospital Charge Code |
4950210101
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.48 |
| Max. Negotiated Rate |
$150.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$103.12
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$93.75
|
| Rate for Payer: Aetna Government |
$93.75
|
| Rate for Payer: Brighton Health Commercial |
$140.62
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$150.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$127.50
|
| Rate for Payer: EmblemHealth Commercial |
$93.75
|
| Rate for Payer: Group Health Inc Commercial |
$93.75
|
| Rate for Payer: Group Health Inc Medicare |
$65.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$93.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$93.75
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.48
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$121.88
|
|
|
EPINEPHRINE 0.15 MG/0.3ML IJ SOAJ
|
Facility
|
OP
|
$187.50
|
|
|
Service Code
|
HCPCS J0165
|
| Hospital Charge Code |
4950210102
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.48 |
| Max. Negotiated Rate |
$150.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$103.12
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$93.75
|
| Rate for Payer: Aetna Government |
$93.75
|
| Rate for Payer: Brighton Health Commercial |
$140.62
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$150.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$127.50
|
| Rate for Payer: EmblemHealth Commercial |
$93.75
|
| Rate for Payer: Group Health Inc Commercial |
$93.75
|
| Rate for Payer: Group Health Inc Medicare |
$65.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$93.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$93.75
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.48
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$121.88
|
|
|
EPINEPHRINE 0.15 MG/0.3ML IJ SOAJ
|
Facility
|
IP
|
$187.50
|
|
|
Service Code
|
HCPCS J0165
|
| Hospital Charge Code |
4950210101
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$93.75 |
| Max. Negotiated Rate |
$93.75 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$93.75
|
|
|
EPINEPHRINE 0.3 MG/0.3ML IJ SOAJ
|
Facility
|
OP
|
$187.50
|
|
|
Service Code
|
HCPCS J0165
|
| Hospital Charge Code |
4950210201
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.48 |
| Max. Negotiated Rate |
$150.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$103.12
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$93.75
|
| Rate for Payer: Aetna Government |
$93.75
|
| Rate for Payer: Brighton Health Commercial |
$140.62
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$150.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$127.50
|
| Rate for Payer: EmblemHealth Commercial |
$93.75
|
| Rate for Payer: Group Health Inc Commercial |
$93.75
|
| Rate for Payer: Group Health Inc Medicare |
$65.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$93.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$93.75
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.48
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$121.88
|
|
|
EPINEPHRINE 0.3 MG/0.3ML IJ SOAJ
|
Facility
|
OP
|
$247.01
|
|
|
Service Code
|
HCPCS J0165
|
| Hospital Charge Code |
0115169449
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.48 |
| Max. Negotiated Rate |
$197.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$135.85
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$123.50
|
| Rate for Payer: Aetna Government |
$123.50
|
| Rate for Payer: Brighton Health Commercial |
$185.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$197.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$167.96
|
| Rate for Payer: EmblemHealth Commercial |
$123.50
|
| Rate for Payer: Group Health Inc Commercial |
$123.50
|
| Rate for Payer: Group Health Inc Medicare |
$86.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$123.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$123.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.48
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$160.55
|
|
|
EPINEPHRINE 0.3 MG/0.3ML IJ SOAJ
|
Facility
|
IP
|
$187.50
|
|
|
Service Code
|
HCPCS J0165
|
| Hospital Charge Code |
4950210201
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$93.75 |
| Max. Negotiated Rate |
$93.75 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$93.75
|
|
|
EPINEPHRINE 0.3 MG/0.3ML IJ SOAJ
|
Facility
|
IP
|
$187.50
|
|
|
Service Code
|
HCPCS J0165
|
| Hospital Charge Code |
4950210202
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$93.75 |
| Max. Negotiated Rate |
$93.75 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$93.75
|
|
|
EPINEPHRINE 0.3 MG/0.3ML IJ SOAJ
|
Facility
|
IP
|
$247.01
|
|
|
Service Code
|
HCPCS J0165
|
| Hospital Charge Code |
0115169449
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$123.50 |
| Max. Negotiated Rate |
$123.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$123.50
|
|
|
EPINEPHRINE 0.3 MG/0.3ML IJ SOAJ
|
Facility
|
OP
|
$187.50
|
|
|
Service Code
|
HCPCS J0165
|
| Hospital Charge Code |
4950210202
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.48 |
| Max. Negotiated Rate |
$150.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$103.12
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$93.75
|
| Rate for Payer: Aetna Government |
$93.75
|
| Rate for Payer: Brighton Health Commercial |
$140.62
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$150.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$127.50
|
| Rate for Payer: EmblemHealth Commercial |
$93.75
|
| Rate for Payer: Group Health Inc Commercial |
$93.75
|
| Rate for Payer: Group Health Inc Medicare |
$65.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$93.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$93.75
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.48
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$121.88
|
|
|
EPINEPHRINE 1 MG/10ML IJ SOSY
|
Facility
|
IP
|
$1.18
|
|
|
Service Code
|
HCPCS J0165
|
| Hospital Charge Code |
7632933161
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$0.59 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.59
|
|
|
EPINEPHRINE 1 MG/10ML IJ SOSY
|
Facility
|
OP
|
$1.18
|
|
|
Service Code
|
HCPCS J0165
|
| Hospital Charge Code |
7632933161
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.41 |
| Max. Negotiated Rate |
$0.95 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.65
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.59
|
| Rate for Payer: Aetna Government |
$0.59
|
| Rate for Payer: Brighton Health Commercial |
$0.89
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.95
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.80
|
| Rate for Payer: EmblemHealth Commercial |
$0.59
|
| Rate for Payer: Group Health Inc Commercial |
$0.59
|
| Rate for Payer: Group Health Inc Medicare |
$0.41
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.59
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.48
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.77
|
|
|
EPINEPHRINE 1 MG/10ML SOSY (WRAPPED)
|
Facility
|
OP
|
$1.18
|
|
|
Service Code
|
HCPCS J0165
|
| Hospital Charge Code |
7632933161
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.41 |
| Max. Negotiated Rate |
$0.95 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.65
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.59
|
| Rate for Payer: Aetna Government |
$0.59
|
| Rate for Payer: Brighton Health Commercial |
$0.89
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.95
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.80
|
| Rate for Payer: EmblemHealth Commercial |
$0.59
|
| Rate for Payer: Group Health Inc Commercial |
$0.59
|
| Rate for Payer: Group Health Inc Medicare |
$0.41
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.59
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.48
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.77
|
|
|
EPINEPHRINE 1 MG/10ML SOSY (WRAPPED)
|
Facility
|
OP
|
$1.01
|
|
|
Service Code
|
HCPCS J0165
|
| Hospital Charge Code |
0409493301
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$0.81 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.56
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.51
|
| Rate for Payer: Aetna Government |
$0.51
|
| Rate for Payer: Brighton Health Commercial |
$0.76
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.81
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.69
|
| Rate for Payer: EmblemHealth Commercial |
$0.51
|
| Rate for Payer: Group Health Inc Commercial |
$0.51
|
| Rate for Payer: Group Health Inc Medicare |
$0.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.51
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.51
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.48
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.66
|
|
|
EPINEPHRINE 1 MG/10ML SOSY (WRAPPED)
|
Facility
|
IP
|
$1.01
|
|
|
Service Code
|
HCPCS J0165
|
| Hospital Charge Code |
0409493301
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.51 |
| Max. Negotiated Rate |
$0.51 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.51
|
|
|
EPINEPHRINE 1 MG/10ML SOSY (WRAPPED)
|
Facility
|
IP
|
$1.18
|
|
|
Service Code
|
HCPCS J0165
|
| Hospital Charge Code |
7632933161
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$0.59 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.59
|
|
|
EPINEPHRINE (ANAPHYLAXIS) 30 MG/30ML IJ SOLN
|
Facility
|
OP
|
$9.00
|
|
|
Service Code
|
HCPCS J0171
|
| Hospital Charge Code |
7632990600
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.74 |
| Max. Negotiated Rate |
$7.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.74
|
| Rate for Payer: Aetna Government |
$0.74
|
| Rate for Payer: Brighton Health Commercial |
$6.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.12
|
| Rate for Payer: EmblemHealth Commercial |
$4.50
|
| Rate for Payer: Group Health Inc Commercial |
$4.50
|
| Rate for Payer: Group Health Inc Medicare |
$3.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.85
|
|
