|
CC WIRES STANDARD J-TIP .025 150C
|
Facility
OP
|
$35.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
66528802
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12.25 |
| Max. Negotiated Rate |
$44.85 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$19.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$44.85
|
| Rate for Payer: Aetna Government |
$44.85
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$17.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$20.12
|
| Rate for Payer: Fidelis Medicare Advantage |
$36.75
|
| Rate for Payer: Group Health Inc Commercial |
$17.50
|
| Rate for Payer: Group Health Inc Medicare |
$12.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$17.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$22.75
|
|
|
CC WIRES STANDARD J-TIP .025 150C
|
Facility
IP
|
$35.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
66528802
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$17.50 |
| Max. Negotiated Rate |
$17.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$17.50
|
|
|
CC WIRES STANDARD J-TIP.025 260C
|
Facility
IP
|
$35.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
66528801
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$17.50 |
| Max. Negotiated Rate |
$17.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$17.50
|
|
|
CC WIRES STANDARD J-TIP.025 260C
|
Facility
OP
|
$35.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
66528801
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12.25 |
| Max. Negotiated Rate |
$44.85 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$19.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$44.85
|
| Rate for Payer: Aetna Government |
$44.85
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$17.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$20.12
|
| Rate for Payer: Fidelis Medicare Advantage |
$36.75
|
| Rate for Payer: Group Health Inc Commercial |
$17.50
|
| Rate for Payer: Group Health Inc Medicare |
$12.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$17.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$22.75
|
|
|
CC XIENCE XPEDITION 33MM-38MM
|
Facility
OP
|
$2,900.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
66526893
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$265.52 |
| Max. Negotiated Rate |
$3,045.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,595.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$265.52
|
| Rate for Payer: Aetna Government |
$265.52
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,450.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,667.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,045.00
|
| Rate for Payer: Group Health Inc Commercial |
$1,450.00
|
| Rate for Payer: Group Health Inc Medicare |
$1,015.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,450.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,450.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,885.00
|
|
|
CC XIENCE XPEDITION 33MM-38MM
|
Facility
IP
|
$2,900.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
66526893
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,450.00 |
| Max. Negotiated Rate |
$1,450.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,450.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,450.00
|
|
|
CC XIENCE XPEDITION 8MM-28MM
|
Facility
IP
|
$2,850.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
66526892
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,425.00 |
| Max. Negotiated Rate |
$1,425.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,425.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,425.00
|
|
|
CC XIENCE XPEDITION 8MM-28MM
|
Facility
OP
|
$2,850.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
66526892
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$265.52 |
| Max. Negotiated Rate |
$2,992.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,567.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$265.52
|
| Rate for Payer: Aetna Government |
$265.52
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,425.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,638.75
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,992.50
|
| Rate for Payer: Group Health Inc Commercial |
$1,425.00
|
| Rate for Payer: Group Health Inc Medicare |
$997.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,425.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,425.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,852.50
|
|
|
CDFEPIME 40MG/ML INJ PED
|
Facility
IP
|
$7.21
|
|
|
Service Code
|
HCPCS J0692
|
| Hospital Charge Code |
41649543
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.60 |
| Max. Negotiated Rate |
$3.60 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.60
|
|
|
CDFEPIME 40MG/ML INJ PED
|
Facility
OP
|
$7.21
|
|
|
Service Code
|
HCPCS J0692
|
| Hospital Charge Code |
41649543
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.10 |
| Max. Negotiated Rate |
$4.69 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.97
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.85
|
| Rate for Payer: Aetna Government |
$1.85
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.15
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1.10
|
| Rate for Payer: Group Health Inc Commercial |
$3.60
|
| Rate for Payer: Group Health Inc Medicare |
$2.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.60
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1.23
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1.42
|
| Rate for Payer: SOMOS Essential |
$1.42
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.69
|
|
|
C. DIFFICILE, DNA
|
Facility
OP
|
$93.18
|
|
|
Service Code
|
HCPCS 87493
|
| Hospital Charge Code |
40614113
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$29.82 |
| Max. Negotiated Rate |
$55.78 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$51.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$37.27
|
| Rate for Payer: Aetna Government |
$37.27
|
| Rate for Payer: Cash Price |
$37.27
|
| Rate for Payer: Cash Price |
$37.27
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$37.27
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$55.78
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$47.20
|
| Rate for Payer: Elderplan Medicare Advantage |
$37.27
|
| Rate for Payer: EmblemHealth Commercial |
$37.27
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$33.54
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$31.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$33.17
|
| Rate for Payer: Fidelis Medicare Advantage |
$37.27
|
| Rate for Payer: Fidelis Qualified Health Plan |
$33.17
|
| Rate for Payer: Group Health Inc Commercial |
$37.27
|
| Rate for Payer: Group Health Inc Medicare |
$37.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$46.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$37.27
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$37.27
|
| Rate for Payer: Healthfirst Medicare Advantage |
$37.27
|
| Rate for Payer: Healthfirst QHP |
$37.27
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$37.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$37.27
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$29.82
|
| Rate for Payer: Wellcare Medicare |
$33.54
|
|
|
CEA
|
Facility
OP
|
$47.40
|
|
|
Service Code
|
HCPCS 82378
|
| Hospital Charge Code |
40609048
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.17 |
| Max. Negotiated Rate |
$30.16 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$26.07
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$18.96
|
| Rate for Payer: Aetna Government |
$18.96
|
| Rate for Payer: Cash Price |
$18.96
|
| Rate for Payer: Cash Price |
$18.96
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$18.96
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$30.16
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$25.52
|
| Rate for Payer: Elderplan Medicare Advantage |
$18.96
|
| Rate for Payer: EmblemHealth Commercial |
$18.96
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$17.06
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$16.12
|
| Rate for Payer: Fidelis Essential Plan QHP |
$16.87
|
| Rate for Payer: Fidelis Medicare Advantage |
$18.96
|
| Rate for Payer: Fidelis Qualified Health Plan |
$16.87
|
| Rate for Payer: Group Health Inc Commercial |
$18.96
|
| Rate for Payer: Group Health Inc Medicare |
$18.96
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$23.70
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$18.96
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$18.96
|
| Rate for Payer: Healthfirst Medicare Advantage |
$18.96
|
| Rate for Payer: Healthfirst QHP |
$18.96
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$18.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$18.96
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$15.17
|
| Rate for Payer: Wellcare Medicare |
$17.06
|
|
|
CEA FLUID
|
Facility
OP
|
$47.40
|
|
|
Service Code
|
HCPCS 82378
|
| Hospital Charge Code |
40609749
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.17 |
| Max. Negotiated Rate |
$30.16 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$26.07
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$18.96
|
| Rate for Payer: Aetna Government |
$18.96
|
| Rate for Payer: Cash Price |
$18.96
|
| Rate for Payer: Cash Price |
$18.96
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$18.96
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$30.16
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$25.52
|
| Rate for Payer: Elderplan Medicare Advantage |
$18.96
|
| Rate for Payer: EmblemHealth Commercial |
$18.96
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$17.06
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$16.12
|
| Rate for Payer: Fidelis Essential Plan QHP |
$16.87
|
| Rate for Payer: Fidelis Medicare Advantage |
$18.96
|
| Rate for Payer: Fidelis Qualified Health Plan |
$16.87
|
| Rate for Payer: Group Health Inc Commercial |
$18.96
|
| Rate for Payer: Group Health Inc Medicare |
$18.96
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$23.70
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$18.96
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$18.96
|
| Rate for Payer: Healthfirst Medicare Advantage |
$18.96
|
| Rate for Payer: Healthfirst QHP |
$18.96
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$18.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$18.96
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$15.17
|
| Rate for Payer: Wellcare Medicare |
$17.06
|
|
|
CEEPHALEXIN 250MG/5ML UD
|
Facility
OP
|
$1.52
|
|
| Hospital Charge Code |
41646556
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.53 |
| Max. Negotiated Rate |
$1.22 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.84
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.76
|
| Rate for Payer: Aetna Government |
$0.76
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.22
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.03
|
| Rate for Payer: Group Health Inc Commercial |
$0.76
|
| Rate for Payer: Group Health Inc Medicare |
$0.53
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.76
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.99
|
|
|
CEFAZOLIN 1000 MG INJ
|
Facility
OP
|
$7.00
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
41654843
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.75 |
| Max. Negotiated Rate |
$4.55 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.85
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.75
|
| Rate for Payer: Aetna Government |
$0.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.02
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$0.78
|
| Rate for Payer: Group Health Inc Commercial |
$3.50
|
| Rate for Payer: Group Health Inc Medicare |
$2.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.87
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$0.86
|
| Rate for Payer: SOMOS Essential |
$0.86
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.55
|
|
|
CEFAZOLIN 1000 MG INJ
|
Facility
IP
|
$7.00
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
41644843
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.50 |
| Max. Negotiated Rate |
$3.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.50
|
|
|
CEFAZOLIN 1000 MG INJ
|
Facility
IP
|
$7.00
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
41654843
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.50 |
| Max. Negotiated Rate |
$3.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.50
|
|
|
CEFAZOLIN 1000 MG INJ
|
Facility
OP
|
$7.00
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
41644843
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.75 |
| Max. Negotiated Rate |
$4.55 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.85
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.75
|
| Rate for Payer: Aetna Government |
$0.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.02
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$0.78
|
| Rate for Payer: Group Health Inc Commercial |
$3.50
|
| Rate for Payer: Group Health Inc Medicare |
$2.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.87
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$0.86
|
| Rate for Payer: SOMOS Essential |
$0.86
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.55
|
|
|
CEFAZOLIN 1G/D5W 50ML-500MG
|
Facility
OP
|
$3.00
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
41648856
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.75 |
| Max. Negotiated Rate |
$1.95 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.65
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.75
|
| Rate for Payer: Aetna Government |
$0.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.72
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$0.78
|
| Rate for Payer: Group Health Inc Commercial |
$1.50
|
| Rate for Payer: Group Health Inc Medicare |
$1.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.87
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$0.86
|
| Rate for Payer: SOMOS Essential |
$0.86
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.95
|
|
|
CEFAZOLIN 1G/D5W 50ML-500MG
|
Facility
IP
|
$3.00
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
41648856
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.50 |
| Max. Negotiated Rate |
$1.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.50
|
|
|
CEFAZOLIN 20 MG/ML INJ NEONATAL
|
Facility
OP
|
$2.00
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
41642846
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.70 |
| Max. Negotiated Rate |
$1.30 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.75
|
| Rate for Payer: Aetna Government |
$0.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.15
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$0.78
|
| Rate for Payer: Group Health Inc Commercial |
$1.00
|
| Rate for Payer: Group Health Inc Medicare |
$0.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.87
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$0.86
|
| Rate for Payer: SOMOS Essential |
$0.86
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.30
|
|
|
CEFAZOLIN 20 MG/ML INJ NEONATAL
|
Facility
IP
|
$2.00
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
41642846
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$1.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.00
|
|
|
CEFAZOLIN 20 MG/ML INJ NEONATAL
|
Facility
OP
|
$2.00
|
|
| Hospital Charge Code |
41652846
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.70 |
| Max. Negotiated Rate |
$1.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.00
|
| Rate for Payer: Aetna Government |
$1.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.36
|
| Rate for Payer: Group Health Inc Commercial |
$1.00
|
| Rate for Payer: Group Health Inc Medicare |
$0.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.30
|
|
|
CEFAZOLIN 225 MG/ML INJ PEDIATRIC
|
Facility
IP
|
$2.00
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
41640684
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$1.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.00
|
|
|
CEFAZOLIN 225 MG/ML INJ PEDIATRIC
|
Facility
OP
|
$2.00
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
41640684
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.70 |
| Max. Negotiated Rate |
$1.30 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.75
|
| Rate for Payer: Aetna Government |
$0.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.15
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$0.78
|
| Rate for Payer: Group Health Inc Commercial |
$1.00
|
| Rate for Payer: Group Health Inc Medicare |
$0.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.87
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$0.86
|
| Rate for Payer: SOMOS Essential |
$0.86
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.30
|
|
