|
EPOETIN ALFA-EPBX 4000 UNIT/ML IJ SOLN
|
Facility
|
IP
|
$52.94
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
0069130701
|
|
Hospital Revenue Code
|
635
|
| Min. Negotiated Rate |
$26.47 |
| Max. Negotiated Rate |
$26.47 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$26.47
|
|
|
EPTIFIBATIDE 20 MG/10ML IV SOLN
|
Facility
|
OP
|
$1.67
|
|
|
Service Code
|
NDC 7128841210
|
| Hospital Charge Code |
7128841210
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$1.34 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.92
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.84
|
| Rate for Payer: Aetna Government |
$0.84
|
| Rate for Payer: Brighton Health Commercial |
$1.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.34
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.14
|
| Rate for Payer: EmblemHealth Commercial |
$0.84
|
| Rate for Payer: Group Health Inc Commercial |
$0.84
|
| Rate for Payer: Group Health Inc Medicare |
$0.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.84
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.09
|
|
|
EPTIFIBATIDE 20 MG/10ML IV SOLN
|
Facility
|
IP
|
$1.67
|
|
|
Service Code
|
NDC 7128841210
|
| Hospital Charge Code |
7128841210
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.84 |
| Max. Negotiated Rate |
$0.84 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.84
|
|
|
EPTIFIBATIDE 20 MG/10ML IV SOLN
|
Facility
|
OP
|
$4.51
|
|
|
Service Code
|
NDC 7086030310
|
| Hospital Charge Code |
7086030310
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$1.58 |
| Max. Negotiated Rate |
$3.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.48
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.25
|
| Rate for Payer: Aetna Government |
$2.25
|
| Rate for Payer: Brighton Health Commercial |
$3.38
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.06
|
| Rate for Payer: EmblemHealth Commercial |
$2.25
|
| Rate for Payer: Group Health Inc Commercial |
$2.25
|
| Rate for Payer: Group Health Inc Medicare |
$1.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.93
|
|
|
EPTIFIBATIDE 20 MG/10ML IV SOLN
|
Facility
|
IP
|
$4.51
|
|
|
Service Code
|
NDC 7086030310
|
| Hospital Charge Code |
7086030310
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$2.25 |
| Max. Negotiated Rate |
$2.25 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.25
|
|
|
EPTIFIBATIDE 20 MG/10ML IV SOLN
|
Facility
|
IP
|
$15.22
|
|
|
Service Code
|
NDC 7043602680
|
| Hospital Charge Code |
7043602680
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$7.61 |
| Max. Negotiated Rate |
$7.61 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.61
|
|
|
EPTIFIBATIDE 20 MG/10ML IV SOLN
|
Facility
|
OP
|
$15.22
|
|
|
Service Code
|
NDC 7043602680
|
| Hospital Charge Code |
7043602680
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$5.33 |
| Max. Negotiated Rate |
$12.18 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$8.37
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$7.61
|
| Rate for Payer: Aetna Government |
$7.61
|
| Rate for Payer: Brighton Health Commercial |
$11.42
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$12.18
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$10.35
|
| Rate for Payer: EmblemHealth Commercial |
$7.61
|
| Rate for Payer: Group Health Inc Commercial |
$7.61
|
| Rate for Payer: Group Health Inc Medicare |
$5.33
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.61
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.61
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$9.90
|
|
|
EPTIFIBATIDE 75 MG/100ML IV SOLN
|
Facility
|
IP
|
$4.69
|
|
|
Service Code
|
NDC 7043616380
|
| Hospital Charge Code |
7043616380
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$2.34 |
| Max. Negotiated Rate |
$2.34 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.34
|
|
|
EPTIFIBATIDE 75 MG/100ML IV SOLN
|
Facility
|
OP
|
$4.69
|
|
|
Service Code
|
NDC 7043616380
|
| Hospital Charge Code |
7043616380
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$1.64 |
| Max. Negotiated Rate |
$3.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.58
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.34
|
| Rate for Payer: Aetna Government |
$2.34
|
| Rate for Payer: Brighton Health Commercial |
$3.52
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.75
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.19
|
| Rate for Payer: EmblemHealth Commercial |
$2.34
|
| Rate for Payer: Group Health Inc Commercial |
$2.34
|
| Rate for Payer: Group Health Inc Medicare |
$1.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.34
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.34
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.05
|
|
|
EPTIFIBATIDE 75 MG/100ML IV SOLN
|
Facility
|
IP
|
$4.69
|
|
|
Service Code
|
NDC 7043602780
|
| Hospital Charge Code |
7043602780
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$2.34 |
| Max. Negotiated Rate |
$2.34 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.34
|
|
|
EPTIFIBATIDE 75 MG/100ML IV SOLN
|
Facility
|
OP
|
$4.69
|
|
|
Service Code
|
NDC 7043602780
|
| Hospital Charge Code |
7043602780
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$1.64 |
| Max. Negotiated Rate |
$3.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.58
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.34
|
| Rate for Payer: Aetna Government |
$2.34
|
| Rate for Payer: Brighton Health Commercial |
$3.52
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.75
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.19
|
| Rate for Payer: EmblemHealth Commercial |
$2.34
|
| Rate for Payer: Group Health Inc Commercial |
$2.34
|
| Rate for Payer: Group Health Inc Medicare |
$1.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.34
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.34
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.05
|
|
|
EPTIFIBATIDE 75 MG/100ML IV SOLN
|
Facility
|
IP
|
$1.20
|
|
|
Service Code
|
NDC 7128841351
|
| Hospital Charge Code |
7128841351
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$0.60 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.60
|
|
|
EPTIFIBATIDE 75 MG/100ML IV SOLN
|
Facility
|
IP
|
$1.80
|
|
|
Service Code
|
NDC 5515021899
|
| Hospital Charge Code |
5515021899
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$0.90 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.90
|
|
|
EPTIFIBATIDE 75 MG/100ML IV SOLN
|
Facility
|
OP
|
$1.80
|
|
|
Service Code
|
NDC 5515021899
|
| Hospital Charge Code |
5515021899
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.63 |
| Max. Negotiated Rate |
$1.44 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.99
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.90
|
| Rate for Payer: Aetna Government |
$0.90
|
| Rate for Payer: Brighton Health Commercial |
$1.35
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.44
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.22
|
| Rate for Payer: EmblemHealth Commercial |
$0.90
|
| Rate for Payer: Group Health Inc Commercial |
$0.90
|
| Rate for Payer: Group Health Inc Medicare |
$0.63
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.90
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.17
|
|
|
EPTIFIBATIDE 75 MG/100ML IV SOLN
|
Facility
|
OP
|
$1.20
|
|
|
Service Code
|
NDC 7128841351
|
| Hospital Charge Code |
7128841351
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.42 |
| Max. Negotiated Rate |
$0.96 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.66
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.60
|
| Rate for Payer: Aetna Government |
$0.60
|
| Rate for Payer: Brighton Health Commercial |
$0.90
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.96
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.82
|
| Rate for Payer: EmblemHealth Commercial |
$0.60
|
| Rate for Payer: Group Health Inc Commercial |
$0.60
|
| Rate for Payer: Group Health Inc Medicare |
$0.42
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.60
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.78
|
|
|
ERAVACYCLINE DIHYDROCHLORIDE 50 MG IV SOLR
|
Facility
|
OP
|
$73.80
|
|
|
Service Code
|
HCPCS J0122
|
| Hospital Charge Code |
7177305012
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$1.02 |
| Max. Negotiated Rate |
$59.04 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$40.59
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.02
|
| Rate for Payer: Aetna Government |
$1.02
|
| Rate for Payer: Brighton Health Commercial |
$55.35
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$59.04
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$50.18
|
| Rate for Payer: EmblemHealth Commercial |
$36.90
|
| Rate for Payer: Group Health Inc Commercial |
$36.90
|
| Rate for Payer: Group Health Inc Medicare |
$25.83
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$36.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$36.90
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1.30
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$47.97
|
|
|
ERAVACYCLINE DIHYDROCHLORIDE 50 MG IV SOLR
|
Facility
|
IP
|
$73.80
|
|
|
Service Code
|
HCPCS J0122
|
| Hospital Charge Code |
7177305012
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$36.90 |
| Max. Negotiated Rate |
$36.90 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$36.90
|
|
|
ERGOCALCIFEROL 1.25 MG (50000 UT) PO CAPS
|
Facility
|
IP
|
$1.92
|
|
|
Service Code
|
NDC 5026829711
|
| Hospital Charge Code |
5026829711
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.96 |
| Max. Negotiated Rate |
$0.96 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.96
|
|
|
ERGOCALCIFEROL 1.25 MG (50000 UT) PO CAPS
|
Facility
|
IP
|
$1.97
|
|
|
Service Code
|
NDC 6438073706
|
| Hospital Charge Code |
6438073706
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.99 |
| Max. Negotiated Rate |
$0.99 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.99
|
|
|
ERGOCALCIFEROL 1.25 MG (50000 UT) PO CAPS
|
Facility
|
OP
|
$1.97
|
|
|
Service Code
|
NDC 6438073706
|
| Hospital Charge Code |
6438073706
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.69 |
| Max. Negotiated Rate |
$1.58 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.08
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.99
|
| Rate for Payer: Aetna Government |
$0.99
|
| Rate for Payer: Brighton Health Commercial |
$1.48
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.58
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.34
|
| Rate for Payer: EmblemHealth Commercial |
$0.99
|
| Rate for Payer: Group Health Inc Commercial |
$0.99
|
| Rate for Payer: Group Health Inc Medicare |
$0.69
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.99
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.28
|
|
|
ERGOCALCIFEROL 1.25 MG (50000 UT) PO CAPS
|
Facility
|
OP
|
$1.92
|
|
|
Service Code
|
NDC 5026829711
|
| Hospital Charge Code |
5026829711
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.67 |
| Max. Negotiated Rate |
$1.54 |
| 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 |
$1.44
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.54
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.31
|
| Rate for Payer: EmblemHealth Commercial |
$0.96
|
| 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
|
|
|
ERGOCALCIFEROL 200 MCG/ML PO SOLN
|
Facility
|
OP
|
$1.67
|
|
|
Service Code
|
NDC 4778164726
|
| Hospital Charge Code |
4778164726
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$1.34 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.92
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.84
|
| Rate for Payer: Aetna Government |
$0.84
|
| Rate for Payer: Brighton Health Commercial |
$1.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.34
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.14
|
| Rate for Payer: EmblemHealth Commercial |
$0.84
|
| Rate for Payer: Group Health Inc Commercial |
$0.84
|
| Rate for Payer: Group Health Inc Medicare |
$0.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.84
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.09
|
|
|
ERGOCALCIFEROL 200 MCG/ML PO SOLN
|
Facility
|
IP
|
$1.66
|
|
|
Service Code
|
NDC 3932835760
|
| Hospital Charge Code |
3932835760
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.83 |
| Max. Negotiated Rate |
$0.83 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.83
|
|
|
ERGOCALCIFEROL 200 MCG/ML PO SOLN
|
Facility
|
OP
|
$1.66
|
|
|
Service Code
|
NDC 3932835760
|
| Hospital Charge Code |
3932835760
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$1.33 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.91
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.83
|
| Rate for Payer: Aetna Government |
$0.83
|
| Rate for Payer: Brighton Health Commercial |
$1.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.33
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.13
|
| Rate for Payer: EmblemHealth Commercial |
$0.83
|
| Rate for Payer: Group Health Inc Commercial |
$0.83
|
| Rate for Payer: Group Health Inc Medicare |
$0.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.83
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.83
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.08
|
|
|
ERGOCALCIFEROL 200 MCG/ML PO SOLN
|
Facility
|
IP
|
$1.67
|
|
|
Service Code
|
NDC 4778164726
|
| Hospital Charge Code |
4778164726
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.84 |
| Max. Negotiated Rate |
$0.84 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.84
|
|
