|
GLUCAGON HCL (DIAGNOSTIC) 1 MG IJ SOLR
|
Facility
|
OP
|
$194.40
|
|
|
Service Code
|
HCPCS J1610
|
| Hospital Charge Code |
6332359616
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$106.92 |
| Max. Negotiated Rate |
$186.10 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$106.92
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$182.45
|
| Rate for Payer: Aetna Government |
$182.45
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$127.72
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$127.72
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$127.72
|
| Rate for Payer: Brighton Health Commercial |
$145.80
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$182.45
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$155.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$132.19
|
| Rate for Payer: Elderplan Medicare Advantage |
$182.45
|
| Rate for Payer: EmblemHealth Commercial |
$182.45
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$164.21
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$155.08
|
| Rate for Payer: Fidelis Essential Plan QHP |
$162.38
|
| Rate for Payer: Fidelis Medicare Advantage |
$182.45
|
| Rate for Payer: Fidelis Qualified Health Plan |
$162.38
|
| Rate for Payer: Group Health Inc Commercial |
$182.45
|
| Rate for Payer: Group Health Inc Medicare |
$182.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$182.45
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$182.45
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$182.45
|
| Rate for Payer: Healthfirst Medicare Advantage |
$155.08
|
| Rate for Payer: Healthfirst QHP |
$182.45
|
| Rate for Payer: Humana Medicare |
$186.10
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$182.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$182.45
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$126.36
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$173.33
|
| Rate for Payer: Wellcare Medicare |
$173.33
|
|
|
GLUCAGON HCL (DIAGNOSTIC) 1 MG IJ SOLR
|
Facility
|
IP
|
$194.40
|
|
|
Service Code
|
HCPCS J1610
|
| Hospital Charge Code |
6332359616
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$97.20 |
| Max. Negotiated Rate |
$97.20 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$97.20
|
|
|
GLUCAGON HCL (DIAGNOSTIC) 1 MG IJ SOLR
|
Facility
|
OP
|
$194.40
|
|
|
Service Code
|
HCPCS J1610
|
| Hospital Charge Code |
6332359608
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$106.92 |
| Max. Negotiated Rate |
$186.10 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$106.92
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$182.45
|
| Rate for Payer: Aetna Government |
$182.45
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$127.72
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$127.72
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$127.72
|
| Rate for Payer: Brighton Health Commercial |
$145.80
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$182.45
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$155.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$132.19
|
| Rate for Payer: Elderplan Medicare Advantage |
$182.45
|
| Rate for Payer: EmblemHealth Commercial |
$182.45
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$164.21
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$155.08
|
| Rate for Payer: Fidelis Essential Plan QHP |
$162.38
|
| Rate for Payer: Fidelis Medicare Advantage |
$182.45
|
| Rate for Payer: Fidelis Qualified Health Plan |
$162.38
|
| Rate for Payer: Group Health Inc Commercial |
$182.45
|
| Rate for Payer: Group Health Inc Medicare |
$182.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$182.45
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$182.45
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$182.45
|
| Rate for Payer: Healthfirst Medicare Advantage |
$155.08
|
| Rate for Payer: Healthfirst QHP |
$182.45
|
| Rate for Payer: Humana Medicare |
$186.10
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$182.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$182.45
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$126.36
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$173.33
|
| Rate for Payer: Wellcare Medicare |
$173.33
|
|
|
GLUCAGON HCL (DIAGNOSTIC) 1 MG IJ SOLR
|
Facility
|
IP
|
$265.98
|
|
|
Service Code
|
HCPCS J1610
|
| Hospital Charge Code |
6332359613
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$132.99 |
| Max. Negotiated Rate |
$132.99 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$132.99
|
|
|
GLUCAGON HCL (DIAGNOSTIC) 1 MG IJ SOLR
|
Facility
|
OP
|
$194.40
|
|
|
Service Code
|
HCPCS J1610
|
| Hospital Charge Code |
6332359606
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$106.92 |
| Max. Negotiated Rate |
$186.10 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$106.92
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$182.45
|
| Rate for Payer: Aetna Government |
$182.45
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$127.72
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$127.72
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$127.72
|
| Rate for Payer: Brighton Health Commercial |
$145.80
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$182.45
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$155.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$132.19
|
| Rate for Payer: Elderplan Medicare Advantage |
$182.45
|
| Rate for Payer: EmblemHealth Commercial |
$182.45
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$164.21
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$155.08
|
| Rate for Payer: Fidelis Essential Plan QHP |
$162.38
|
| Rate for Payer: Fidelis Medicare Advantage |
$182.45
|
| Rate for Payer: Fidelis Qualified Health Plan |
$162.38
|
| Rate for Payer: Group Health Inc Commercial |
$182.45
|
| Rate for Payer: Group Health Inc Medicare |
$182.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$182.45
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$182.45
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$182.45
|
| Rate for Payer: Healthfirst Medicare Advantage |
$155.08
|
| Rate for Payer: Healthfirst QHP |
$182.45
|
| Rate for Payer: Humana Medicare |
$186.10
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$182.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$182.45
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$126.36
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$173.33
|
| Rate for Payer: Wellcare Medicare |
$173.33
|
|
|
GLUCAGON HCL (DIAGNOSTIC) 1 MG IJ SOLR
|
Facility
|
IP
|
$194.40
|
|
|
Service Code
|
HCPCS J1610
|
| Hospital Charge Code |
6332359608
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$97.20 |
| Max. Negotiated Rate |
$97.20 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$97.20
|
|
|
GLUCAGON HCL (DIAGNOSTIC) 1 MG IJ SOLR
|
Facility
|
OP
|
$265.98
|
|
|
Service Code
|
HCPCS J1610
|
| Hospital Charge Code |
6332359303
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$127.72 |
| Max. Negotiated Rate |
$212.78 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$146.29
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$182.45
|
| Rate for Payer: Aetna Government |
$182.45
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$127.72
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$127.72
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$127.72
|
| Rate for Payer: Brighton Health Commercial |
$199.49
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$182.45
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$212.78
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$180.87
|
| Rate for Payer: Elderplan Medicare Advantage |
$182.45
|
| Rate for Payer: EmblemHealth Commercial |
$182.45
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$164.21
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$155.08
|
| Rate for Payer: Fidelis Essential Plan QHP |
$162.38
|
| Rate for Payer: Fidelis Medicare Advantage |
$182.45
|
| Rate for Payer: Fidelis Qualified Health Plan |
$162.38
|
| Rate for Payer: Group Health Inc Commercial |
$182.45
|
| Rate for Payer: Group Health Inc Medicare |
$182.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$182.45
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$182.45
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$182.45
|
| Rate for Payer: Healthfirst Medicare Advantage |
$155.08
|
| Rate for Payer: Healthfirst QHP |
$182.45
|
| Rate for Payer: Humana Medicare |
$186.10
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$182.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$182.45
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$172.89
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$173.33
|
| Rate for Payer: Wellcare Medicare |
$173.33
|
|
|
GLUCAGON HCL (DIAGNOSTIC) 1 MG IJ SOLR
|
Facility
|
IP
|
$194.40
|
|
|
Service Code
|
HCPCS J1610
|
| Hospital Charge Code |
6332359606
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$97.20 |
| Max. Negotiated Rate |
$97.20 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$97.20
|
|
|
GLUCAGON HCL (DIAGNOSTIC) 1 MG IJ SOLR
|
Facility
|
IP
|
$194.40
|
|
|
Service Code
|
HCPCS J1610
|
| Hospital Charge Code |
6332359403
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$97.20 |
| Max. Negotiated Rate |
$97.20 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$97.20
|
|
|
GLUCAGON HCL (DIAGNOSTIC) 1 MG IJ SOLR
|
Facility
|
OP
|
$194.40
|
|
|
Service Code
|
HCPCS J1610
|
| Hospital Charge Code |
6332359403
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$106.92 |
| Max. Negotiated Rate |
$186.10 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$106.92
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$182.45
|
| Rate for Payer: Aetna Government |
$182.45
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$127.72
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$127.72
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$127.72
|
| Rate for Payer: Brighton Health Commercial |
$145.80
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$182.45
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$155.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$132.19
|
| Rate for Payer: Elderplan Medicare Advantage |
$182.45
|
| Rate for Payer: EmblemHealth Commercial |
$182.45
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$164.21
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$155.08
|
| Rate for Payer: Fidelis Essential Plan QHP |
$162.38
|
| Rate for Payer: Fidelis Medicare Advantage |
$182.45
|
| Rate for Payer: Fidelis Qualified Health Plan |
$162.38
|
| Rate for Payer: Group Health Inc Commercial |
$182.45
|
| Rate for Payer: Group Health Inc Medicare |
$182.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$182.45
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$182.45
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$182.45
|
| Rate for Payer: Healthfirst Medicare Advantage |
$155.08
|
| Rate for Payer: Healthfirst QHP |
$182.45
|
| Rate for Payer: Humana Medicare |
$186.10
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$182.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$182.45
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$126.36
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$173.33
|
| Rate for Payer: Wellcare Medicare |
$173.33
|
|
|
GLUCAGON HCL (DIAGNOSTIC) 1 MG IJ SOLR
|
Facility
|
IP
|
$265.98
|
|
|
Service Code
|
HCPCS J1610
|
| Hospital Charge Code |
6332359611
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$132.99 |
| Max. Negotiated Rate |
$132.99 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$132.99
|
|
|
GLUCAGON HCL (DIAGNOSTIC) 1 MG IJ SOLR
|
Facility
|
OP
|
$265.98
|
|
|
Service Code
|
HCPCS J1610
|
| Hospital Charge Code |
6332359613
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$127.72 |
| Max. Negotiated Rate |
$212.78 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$146.29
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$182.45
|
| Rate for Payer: Aetna Government |
$182.45
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$127.72
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$127.72
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$127.72
|
| Rate for Payer: Brighton Health Commercial |
$199.49
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$182.45
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$212.78
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$180.87
|
| Rate for Payer: Elderplan Medicare Advantage |
$182.45
|
| Rate for Payer: EmblemHealth Commercial |
$182.45
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$164.21
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$155.08
|
| Rate for Payer: Fidelis Essential Plan QHP |
$162.38
|
| Rate for Payer: Fidelis Medicare Advantage |
$182.45
|
| Rate for Payer: Fidelis Qualified Health Plan |
$162.38
|
| Rate for Payer: Group Health Inc Commercial |
$182.45
|
| Rate for Payer: Group Health Inc Medicare |
$182.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$182.45
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$182.45
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$182.45
|
| Rate for Payer: Healthfirst Medicare Advantage |
$155.08
|
| Rate for Payer: Healthfirst QHP |
$182.45
|
| Rate for Payer: Humana Medicare |
$186.10
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$182.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$182.45
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$172.89
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$173.33
|
| Rate for Payer: Wellcare Medicare |
$173.33
|
|
|
GLUCAGON HCL (DIAGNOSTIC) 1 MG IJ SOLR
|
Facility
|
IP
|
$265.98
|
|
|
Service Code
|
HCPCS J1610
|
| Hospital Charge Code |
6332359303
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$132.99 |
| Max. Negotiated Rate |
$132.99 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$132.99
|
|
|
GLUCAGON HCL RDNA (DIAGNOSTIC) 1 MG IJ SOLR
|
Facility
|
IP
|
$205.92
|
|
|
Service Code
|
HCPCS J1610
|
| Hospital Charge Code |
0597005345
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$102.96 |
| Max. Negotiated Rate |
$102.96 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$102.96
|
|
|
GLUCAGON HCL RDNA (DIAGNOSTIC) 1 MG IJ SOLR
|
Facility
|
OP
|
$205.92
|
|
|
Service Code
|
HCPCS J1610
|
| Hospital Charge Code |
0597005345
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$113.26 |
| Max. Negotiated Rate |
$186.10 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$113.26
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$182.45
|
| Rate for Payer: Aetna Government |
$182.45
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$127.72
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$127.72
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$127.72
|
| Rate for Payer: Brighton Health Commercial |
$154.44
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$182.45
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$164.74
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$140.03
|
| Rate for Payer: Elderplan Medicare Advantage |
$182.45
|
| Rate for Payer: EmblemHealth Commercial |
$182.45
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$164.21
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$155.08
|
| Rate for Payer: Fidelis Essential Plan QHP |
$162.38
|
| Rate for Payer: Fidelis Medicare Advantage |
$182.45
|
| Rate for Payer: Fidelis Qualified Health Plan |
$162.38
|
| Rate for Payer: Group Health Inc Commercial |
$182.45
|
| Rate for Payer: Group Health Inc Medicare |
$182.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$182.45
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$182.45
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$182.45
|
| Rate for Payer: Healthfirst Medicare Advantage |
$155.08
|
| Rate for Payer: Healthfirst QHP |
$182.45
|
| Rate for Payer: Humana Medicare |
$186.10
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$182.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$182.45
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$133.85
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$173.33
|
| Rate for Payer: Wellcare Medicare |
$173.33
|
|
|
GLUCAGON HCL RDNA (DIAGNOSTIC) 1 MG IJ SOLR
|
Facility
|
OP
|
$205.92
|
|
|
Service Code
|
HCPCS J1610
|
| Hospital Charge Code |
0597026010
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$113.26 |
| Max. Negotiated Rate |
$186.10 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$113.26
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$182.45
|
| Rate for Payer: Aetna Government |
$182.45
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$127.72
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$127.72
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$127.72
|
| Rate for Payer: Brighton Health Commercial |
$154.44
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$182.45
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$164.74
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$140.03
|
| Rate for Payer: Elderplan Medicare Advantage |
$182.45
|
| Rate for Payer: EmblemHealth Commercial |
$182.45
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$164.21
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$155.08
|
| Rate for Payer: Fidelis Essential Plan QHP |
$162.38
|
| Rate for Payer: Fidelis Medicare Advantage |
$182.45
|
| Rate for Payer: Fidelis Qualified Health Plan |
$162.38
|
| Rate for Payer: Group Health Inc Commercial |
$182.45
|
| Rate for Payer: Group Health Inc Medicare |
$182.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$182.45
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$182.45
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$182.45
|
| Rate for Payer: Healthfirst Medicare Advantage |
$155.08
|
| Rate for Payer: Healthfirst QHP |
$182.45
|
| Rate for Payer: Humana Medicare |
$186.10
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$182.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$182.45
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$133.85
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$173.33
|
| Rate for Payer: Wellcare Medicare |
$173.33
|
|
|
GLUCAGON HCL RDNA (DIAGNOSTIC) 1 MG IJ SOLR
|
Facility
|
IP
|
$205.92
|
|
|
Service Code
|
HCPCS J1610
|
| Hospital Charge Code |
0597026010
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$102.96 |
| Max. Negotiated Rate |
$102.96 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$102.96
|
|
|
GLUCOSE 40 % PO GEL
|
Facility
|
OP
|
$0.11
|
|
|
Service Code
|
NDC 0057406915
|
| Hospital Charge Code |
0057406915
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.08 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.06
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.05
|
| Rate for Payer: Aetna Government |
$0.05
|
| Rate for Payer: Brighton Health Commercial |
$0.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.08
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.07
|
| Rate for Payer: EmblemHealth Commercial |
$0.05
|
| Rate for Payer: Group Health Inc Commercial |
$0.05
|
| Rate for Payer: Group Health Inc Medicare |
$0.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.07
|
|
|
GLUCOSE 40 % PO GEL
|
Facility
|
OP
|
$0.11
|
|
|
Service Code
|
NDC 0057407030
|
| Hospital Charge Code |
0057407030
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.08 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.06
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.05
|
| Rate for Payer: Aetna Government |
$0.05
|
| Rate for Payer: Brighton Health Commercial |
$0.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.08
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.07
|
| Rate for Payer: EmblemHealth Commercial |
$0.05
|
| Rate for Payer: Group Health Inc Commercial |
$0.05
|
| Rate for Payer: Group Health Inc Medicare |
$0.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.07
|
|
|
GLUCOSE 40 % PO GEL
|
Facility
|
OP
|
$0.11
|
|
|
Service Code
|
NDC 0057406930
|
| Hospital Charge Code |
0057406930
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.08 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.06
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.05
|
| Rate for Payer: Aetna Government |
$0.05
|
| Rate for Payer: Brighton Health Commercial |
$0.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.08
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.07
|
| Rate for Payer: EmblemHealth Commercial |
$0.05
|
| Rate for Payer: Group Health Inc Commercial |
$0.05
|
| Rate for Payer: Group Health Inc Medicare |
$0.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.07
|
|
|
GLUCOSE 40 % PO GEL
|
Facility
|
IP
|
$0.11
|
|
|
Service Code
|
NDC 0057406930
|
| Hospital Charge Code |
0057406930
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.05
|
|
|
GLUCOSE 40 % PO GEL
|
Facility
|
IP
|
$0.11
|
|
|
Service Code
|
NDC 0057407030
|
| Hospital Charge Code |
0057407030
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.05
|
|
|
GLUCOSE 40 % PO GEL
|
Facility
|
IP
|
$0.11
|
|
|
Service Code
|
NDC 0057406915
|
| Hospital Charge Code |
0057406915
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.05
|
|
|
GLYBURIDE 2.5 MG PO TABS
|
Facility
|
IP
|
$0.46
|
|
|
Service Code
|
NDC 2315505701
|
| Hospital Charge Code |
2315505701
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.23 |
| Max. Negotiated Rate |
$0.23 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.23
|
|
|
GLYBURIDE 2.5 MG PO TABS
|
Facility
|
OP
|
$0.46
|
|
|
Service Code
|
NDC 0093834301
|
| Hospital Charge Code |
0093834301
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$0.37 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.23
|
| Rate for Payer: Aetna Government |
$0.23
|
| Rate for Payer: Brighton Health Commercial |
$0.34
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.37
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.31
|
| Rate for Payer: EmblemHealth Commercial |
$0.23
|
| Rate for Payer: Group Health Inc Commercial |
$0.23
|
| Rate for Payer: Group Health Inc Medicare |
$0.16
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.23
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.23
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.30
|
|
