|
ESMOLOL HCL 100 MG/10ML IV SOLN
|
Facility
|
IP
|
$0.88
|
|
|
Service Code
|
HCPCS J1805
|
| Hospital Charge Code |
6745718210
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.44 |
| Max. Negotiated Rate |
$0.44 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.44
|
|
|
ESMOLOL HCL 100 MG/10ML IV SOLN
|
Facility
|
OP
|
$1.89
|
|
|
Service Code
|
HCPCS J1805
|
| Hospital Charge Code |
6332365210
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$1.51 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.04
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.95
|
| Rate for Payer: Aetna Government |
$0.95
|
| Rate for Payer: Brighton Health Commercial |
$1.42
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.51
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.29
|
| Rate for Payer: EmblemHealth Commercial |
$0.95
|
| Rate for Payer: Group Health Inc Commercial |
$0.95
|
| Rate for Payer: Group Health Inc Medicare |
$0.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.95
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.23
|
|
|
ESMOLOL HCL 2500 MG/250ML IV SOLN
|
Facility
|
IP
|
$0.57
|
|
|
Service Code
|
NDC 4456781110
|
| Hospital Charge Code |
4456781110
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$0.29 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.29
|
|
|
ESMOLOL HCL 2500 MG/250ML IV SOLN
|
Facility
|
OP
|
$0.57
|
|
|
Service Code
|
NDC 4456781110
|
| Hospital Charge Code |
4456781110
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$0.46 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.32
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.29
|
| Rate for Payer: Aetna Government |
$0.29
|
| Rate for Payer: Brighton Health Commercial |
$0.43
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.46
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.39
|
| Rate for Payer: EmblemHealth Commercial |
$0.29
|
| Rate for Payer: Group Health Inc Commercial |
$0.29
|
| Rate for Payer: Group Health Inc Medicare |
$0.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.29
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.37
|
|
|
ESMOLOL HCL-SODIUM CHLORIDE 2500 MG/250ML IV SOLN
|
Facility
|
OP
|
$2.02
|
|
|
Service Code
|
HCPCS J1805
|
| Hospital Charge Code |
6745765725
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$1.61 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.11
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.01
|
| Rate for Payer: Aetna Government |
$1.01
|
| Rate for Payer: Brighton Health Commercial |
$1.51
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.61
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.37
|
| Rate for Payer: EmblemHealth Commercial |
$1.01
|
| Rate for Payer: Group Health Inc Commercial |
$1.01
|
| Rate for Payer: Group Health Inc Medicare |
$0.71
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.01
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.31
|
|
|
ESMOLOL HCL-SODIUM CHLORIDE 2500 MG/250ML IV SOLN
|
Facility
|
OP
|
$2.25
|
|
|
Service Code
|
HCPCS J1805
|
| Hospital Charge Code |
1001905561
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$1.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.23
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.12
|
| Rate for Payer: Aetna Government |
$1.12
|
| Rate for Payer: Brighton Health Commercial |
$1.68
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.53
|
| Rate for Payer: EmblemHealth Commercial |
$1.12
|
| Rate for Payer: Group Health Inc Commercial |
$1.12
|
| Rate for Payer: Group Health Inc Medicare |
$0.79
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.46
|
|
|
ESMOLOL HCL-SODIUM CHLORIDE 2500 MG/250ML IV SOLN
|
Facility
|
IP
|
$0.45
|
|
|
Service Code
|
HCPCS J1805
|
| Hospital Charge Code |
4456745010
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$0.22 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.22
|
|
|
ESMOLOL HCL-SODIUM CHLORIDE 2500 MG/250ML IV SOLN
|
Facility
|
IP
|
$0.72
|
|
|
Service Code
|
HCPCS J1805
|
| Hospital Charge Code |
1001967010
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$0.36 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.36
|
|
|
ESMOLOL HCL-SODIUM CHLORIDE 2500 MG/250ML IV SOLN
|
Facility
|
IP
|
$2.02
|
|
|
Service Code
|
HCPCS J1805
|
| Hospital Charge Code |
6745765725
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$1.01 |
| Max. Negotiated Rate |
$1.01 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.01
|
|
|
ESMOLOL HCL-SODIUM CHLORIDE 2500 MG/250ML IV SOLN
|
Facility
|
IP
|
$2.25
|
|
|
Service Code
|
HCPCS J1805
|
| Hospital Charge Code |
1001905561
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$1.12 |
| Max. Negotiated Rate |
$1.12 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.12
|
|
|
ESMOLOL HCL-SODIUM CHLORIDE 2500 MG/250ML IV SOLN
|
Facility
|
OP
|
$0.72
|
|
|
Service Code
|
HCPCS J1805
|
| Hospital Charge Code |
1001967010
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$0.58 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.36
|
| Rate for Payer: Aetna Government |
$0.36
|
| Rate for Payer: Brighton Health Commercial |
$0.54
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.58
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.49
|
| Rate for Payer: EmblemHealth Commercial |
$0.36
|
| Rate for Payer: Group Health Inc Commercial |
$0.36
|
| Rate for Payer: Group Health Inc Medicare |
$0.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.36
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.47
|
|
|
ESMOLOL HCL-SODIUM CHLORIDE 2500 MG/250ML IV SOLN
|
Facility
|
OP
|
$0.45
|
|
|
Service Code
|
HCPCS J1805
|
| Hospital Charge Code |
4456745010
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$0.36 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.22
|
| Rate for Payer: Aetna Government |
$0.22
|
| Rate for Payer: Brighton Health Commercial |
$0.33
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.36
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.30
|
| Rate for Payer: EmblemHealth Commercial |
$0.22
|
| Rate for Payer: Group Health Inc Commercial |
$0.22
|
| Rate for Payer: Group Health Inc Medicare |
$0.16
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.22
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.29
|
|
|
ESOMEPRAZOLE MAGNESIUM 40 MG PO CPDR
|
Facility
|
IP
|
$9.02
|
|
|
Service Code
|
NDC 6846239130
|
| Hospital Charge Code |
6846239130
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.51 |
| Max. Negotiated Rate |
$4.51 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.51
|
|
|
ESOMEPRAZOLE MAGNESIUM 40 MG PO CPDR
|
Facility
|
IP
|
$8.83
|
|
|
Service Code
|
NDC 6787757290
|
| Hospital Charge Code |
6787757290
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.42 |
| Max. Negotiated Rate |
$4.42 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.42
|
|
|
ESOMEPRAZOLE MAGNESIUM 40 MG PO CPDR
|
Facility
|
IP
|
$9.02
|
|
|
Service Code
|
NDC 4359851030
|
| Hospital Charge Code |
4359851030
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.51 |
| Max. Negotiated Rate |
$4.51 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.51
|
|
|
ESOMEPRAZOLE MAGNESIUM 40 MG PO CPDR
|
Facility
|
IP
|
$8.52
|
|
|
Service Code
|
NDC 3172266530
|
| Hospital Charge Code |
3172266530
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.26 |
| Max. Negotiated Rate |
$4.26 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.26
|
|
|
ESOMEPRAZOLE MAGNESIUM 40 MG PO CPDR
|
Facility
|
OP
|
$9.02
|
|
|
Service Code
|
NDC 6330473530
|
| Hospital Charge Code |
6330473530
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.16 |
| Max. Negotiated Rate |
$7.22 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.96
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.51
|
| Rate for Payer: Aetna Government |
$4.51
|
| Rate for Payer: Brighton Health Commercial |
$6.77
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7.22
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.14
|
| Rate for Payer: EmblemHealth Commercial |
$4.51
|
| Rate for Payer: Group Health Inc Commercial |
$4.51
|
| Rate for Payer: Group Health Inc Medicare |
$3.16
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.51
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.51
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.87
|
|
|
ESOMEPRAZOLE MAGNESIUM 40 MG PO CPDR
|
Facility
|
IP
|
$8.52
|
|
|
Service Code
|
NDC 0093645156
|
| Hospital Charge Code |
0093645156
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.26 |
| Max. Negotiated Rate |
$4.26 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.26
|
|
|
ESOMEPRAZOLE MAGNESIUM 40 MG PO CPDR
|
Facility
|
IP
|
$9.02
|
|
|
Service Code
|
NDC 6330473530
|
| Hospital Charge Code |
6330473530
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.51 |
| Max. Negotiated Rate |
$4.51 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.51
|
|
|
ESOMEPRAZOLE MAGNESIUM 40 MG PO CPDR
|
Facility
|
OP
|
$9.02
|
|
|
Service Code
|
NDC 6846239130
|
| Hospital Charge Code |
6846239130
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.16 |
| Max. Negotiated Rate |
$7.22 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.96
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.51
|
| Rate for Payer: Aetna Government |
$4.51
|
| Rate for Payer: Brighton Health Commercial |
$6.77
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7.22
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.14
|
| Rate for Payer: EmblemHealth Commercial |
$4.51
|
| Rate for Payer: Group Health Inc Commercial |
$4.51
|
| Rate for Payer: Group Health Inc Medicare |
$3.16
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.51
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.51
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.87
|
|
|
ESOMEPRAZOLE MAGNESIUM 40 MG PO CPDR
|
Facility
|
OP
|
$8.52
|
|
|
Service Code
|
NDC 3172266530
|
| Hospital Charge Code |
3172266530
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.98 |
| Max. Negotiated Rate |
$6.82 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.69
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.26
|
| Rate for Payer: Aetna Government |
$4.26
|
| Rate for Payer: Brighton Health Commercial |
$6.39
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.82
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.80
|
| Rate for Payer: EmblemHealth Commercial |
$4.26
|
| Rate for Payer: Group Health Inc Commercial |
$4.26
|
| Rate for Payer: Group Health Inc Medicare |
$2.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.26
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.54
|
|
|
ESOMEPRAZOLE MAGNESIUM 40 MG PO CPDR
|
Facility
|
OP
|
$9.02
|
|
|
Service Code
|
NDC 4359851030
|
| Hospital Charge Code |
4359851030
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.16 |
| Max. Negotiated Rate |
$7.22 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.96
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.51
|
| Rate for Payer: Aetna Government |
$4.51
|
| Rate for Payer: Brighton Health Commercial |
$6.77
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7.22
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.14
|
| Rate for Payer: EmblemHealth Commercial |
$4.51
|
| Rate for Payer: Group Health Inc Commercial |
$4.51
|
| Rate for Payer: Group Health Inc Medicare |
$3.16
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.51
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.51
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.87
|
|
|
ESOMEPRAZOLE MAGNESIUM 40 MG PO CPDR
|
Facility
|
OP
|
$8.83
|
|
|
Service Code
|
NDC 6787757290
|
| Hospital Charge Code |
6787757290
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.09 |
| Max. Negotiated Rate |
$7.07 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.86
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.42
|
| Rate for Payer: Aetna Government |
$4.42
|
| Rate for Payer: Brighton Health Commercial |
$6.62
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7.07
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.01
|
| Rate for Payer: EmblemHealth Commercial |
$4.42
|
| Rate for Payer: Group Health Inc Commercial |
$4.42
|
| Rate for Payer: Group Health Inc Medicare |
$3.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.42
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.74
|
|
|
ESOMEPRAZOLE MAGNESIUM 40 MG PO CPDR
|
Facility
|
IP
|
$8.52
|
|
|
Service Code
|
NDC 0093645198
|
| Hospital Charge Code |
0093645198
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.26 |
| Max. Negotiated Rate |
$4.26 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.26
|
|
|
ESOMEPRAZOLE MAGNESIUM 40 MG PO CPDR
|
Facility
|
OP
|
$8.52
|
|
|
Service Code
|
NDC 0093645156
|
| Hospital Charge Code |
0093645156
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.98 |
| Max. Negotiated Rate |
$6.82 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.69
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.26
|
| Rate for Payer: Aetna Government |
$4.26
|
| Rate for Payer: Brighton Health Commercial |
$6.39
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.82
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.80
|
| Rate for Payer: EmblemHealth Commercial |
$4.26
|
| Rate for Payer: Group Health Inc Commercial |
$4.26
|
| Rate for Payer: Group Health Inc Medicare |
$2.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.26
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.54
|
|
