CEFOTAXIME 1000 MG INJ
|
Facility
IP
|
$3.21
|
|
Service Code
|
HCPCS J0698
|
Hospital Charge Code |
41651782
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$1.60 |
Max. Negotiated Rate |
$1.60 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.60
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1.60
|
|
CEFOTAXIME 1000 MG INJ
|
Facility
OP
|
$3.21
|
|
Service Code
|
HCPCS J0698
|
Hospital Charge Code |
41651782
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$1.12 |
Max. Negotiated Rate |
$8.11 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.77
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8.11
|
Rate for Payer: Aetna Government |
$8.11
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.60
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.85
|
Rate for Payer: Group Health Inc Commercial |
$1.60
|
Rate for Payer: Group Health Inc Medicare |
$1.12
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.60
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1.60
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.09
|
|
CEFOTAXIME 2000 MG INJ
|
Facility
IP
|
$3.72
|
|
Service Code
|
HCPCS J0698
|
Hospital Charge Code |
41641790
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$1.86 |
Max. Negotiated Rate |
$1.86 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.86
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1.86
|
|
CEFOTAXIME 2000 MG INJ
|
Facility
IP
|
$3.72
|
|
Service Code
|
HCPCS J0698
|
Hospital Charge Code |
41651790
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$1.86 |
Max. Negotiated Rate |
$1.86 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.86
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1.86
|
|
CEFOTAXIME 2000 MG INJ
|
Facility
OP
|
$3.72
|
|
Service Code
|
HCPCS J0698
|
Hospital Charge Code |
41651790
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$1.30 |
Max. Negotiated Rate |
$8.11 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.05
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8.11
|
Rate for Payer: Aetna Government |
$8.11
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.86
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.14
|
Rate for Payer: Group Health Inc Commercial |
$1.86
|
Rate for Payer: Group Health Inc Medicare |
$1.30
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.86
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1.86
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.42
|
|
CEFOTAXIME 2000 MG INJ
|
Facility
OP
|
$3.72
|
|
Service Code
|
HCPCS J0698
|
Hospital Charge Code |
41641790
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$1.30 |
Max. Negotiated Rate |
$8.11 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.05
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8.11
|
Rate for Payer: Aetna Government |
$8.11
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.86
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.14
|
Rate for Payer: Group Health Inc Commercial |
$1.86
|
Rate for Payer: Group Health Inc Medicare |
$1.30
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.86
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1.86
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.42
|
|
CEFOTAXIME 230 MG/ML INJ PEDIATRIC (IM)
|
Facility
OP
|
$2.00
|
|
Service Code
|
HCPCS J0698
|
Hospital Charge Code |
41641778
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$0.70 |
Max. Negotiated Rate |
$8.11 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.10
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8.11
|
Rate for Payer: Aetna Government |
$8.11
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.15
|
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
|
|
CEFOTAXIME 230 MG/ML INJ PEDIATRIC (IM)
|
Facility
IP
|
$2.00
|
|
Service Code
|
HCPCS J0698
|
Hospital Charge Code |
41651778
|
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
|
|
CEFOTAXIME 230 MG/ML INJ PEDIATRIC (IM)
|
Facility
OP
|
$2.00
|
|
Service Code
|
HCPCS J0698
|
Hospital Charge Code |
41651778
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$0.70 |
Max. Negotiated Rate |
$8.11 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.10
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8.11
|
Rate for Payer: Aetna Government |
$8.11
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.15
|
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
|
|
CEFOTAXIME 230 MG/ML INJ PEDIATRIC (IM)
|
Facility
IP
|
$2.00
|
|
Service Code
|
HCPCS J0698
|
Hospital Charge Code |
41641778
|
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
|
|
CEFOTAXIME 300 MG/ML INJ PEDIATRIC (IM)
|
Facility
IP
|
$1.00
|
|
Service Code
|
HCPCS J0698
|
Hospital Charge Code |
41651771
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$0.50 |
Max. Negotiated Rate |
$0.50 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$0.50
|
|
CEFOTAXIME 300 MG/ML INJ PEDIATRIC (IM)
|
Facility
IP
|
$1.00
|
|
Service Code
|
HCPCS J0698
|
Hospital Charge Code |
41641771
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$0.50 |
Max. Negotiated Rate |
$0.50 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$0.50
|
|
CEFOTAXIME 300 MG/ML INJ PEDIATRIC (IM)
|
Facility
OP
|
$1.00
|
|
Service Code
|
HCPCS J0698
|
Hospital Charge Code |
41651771
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$0.35 |
Max. Negotiated Rate |
$8.11 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.55
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8.11
|
Rate for Payer: Aetna Government |
$8.11
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.50
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.58
|
Rate for Payer: Group Health Inc Commercial |
$0.50
|
Rate for Payer: Group Health Inc Medicare |
$0.35
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$0.50
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.65
|
|
CEFOTAXIME 300 MG/ML INJ PEDIATRIC (IM)
|
Facility
OP
|
$1.00
|
|
Service Code
|
HCPCS J0698
|
Hospital Charge Code |
41641771
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$0.35 |
Max. Negotiated Rate |
$8.11 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.55
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8.11
|
Rate for Payer: Aetna Government |
$8.11
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.50
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.58
|
Rate for Payer: Group Health Inc Commercial |
$0.50
|
Rate for Payer: Group Health Inc Medicare |
$0.35
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$0.50
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.65
|
|
CEFOTAXIME 500 MG INJ
|
Facility
IP
|
$1.35
|
|
Service Code
|
HCPCS J0698
|
Hospital Charge Code |
41641053
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$0.68 |
Max. Negotiated Rate |
$0.68 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.68
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$0.68
|
|
CEFOTAXIME 500 MG INJ
|
Facility
OP
|
$1.35
|
|
Service Code
|
HCPCS J0698
|
Hospital Charge Code |
41651053
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$0.47 |
Max. Negotiated Rate |
$8.11 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.74
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8.11
|
Rate for Payer: Aetna Government |
$8.11
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.68
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.78
|
Rate for Payer: Group Health Inc Commercial |
$0.68
|
Rate for Payer: Group Health Inc Medicare |
$0.47
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.68
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$0.68
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.88
|
|
CEFOTAXIME 500 MG INJ
|
Facility
IP
|
$1.35
|
|
Service Code
|
HCPCS J0698
|
Hospital Charge Code |
41651053
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$0.68 |
Max. Negotiated Rate |
$0.68 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.68
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$0.68
|
|
CEFOTAXIME 500 MG INJ
|
Facility
OP
|
$1.35
|
|
Service Code
|
HCPCS J0698
|
Hospital Charge Code |
41641053
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$0.47 |
Max. Negotiated Rate |
$8.11 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.74
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8.11
|
Rate for Payer: Aetna Government |
$8.11
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.68
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.78
|
Rate for Payer: Group Health Inc Commercial |
$0.68
|
Rate for Payer: Group Health Inc Medicare |
$0.47
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.68
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$0.68
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.88
|
|
CEFOTAXIME 50 MG/ML INJ PEDIATRIC (IV)
|
Facility
IP
|
$2.00
|
|
Service Code
|
HCPCS J0698
|
Hospital Charge Code |
41651788
|
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
|
|
CEFOTAXIME 50 MG/ML INJ PEDIATRIC (IV)
|
Facility
IP
|
$2.00
|
|
Service Code
|
HCPCS J0698
|
Hospital Charge Code |
41641788
|
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
|
|
CEFOTAXIME 50 MG/ML INJ PEDIATRIC (IV)
|
Facility
OP
|
$2.00
|
|
Service Code
|
HCPCS J0698
|
Hospital Charge Code |
41641788
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$0.70 |
Max. Negotiated Rate |
$8.11 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.10
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8.11
|
Rate for Payer: Aetna Government |
$8.11
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.15
|
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
|
|
CEFOTAXIME 50 MG/ML INJ PEDIATRIC (IV)
|
Facility
OP
|
$2.00
|
|
Service Code
|
HCPCS J0698
|
Hospital Charge Code |
41651788
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$0.70 |
Max. Negotiated Rate |
$8.11 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.10
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8.11
|
Rate for Payer: Aetna Government |
$8.11
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.15
|
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
|
|
CEFOTAXIME 95 MG/ML INJ PEDIATRIC (IV)
|
Facility
OP
|
$3.00
|
|
Service Code
|
HCPCS J0698
|
Hospital Charge Code |
41651789
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$1.05 |
Max. Negotiated Rate |
$8.11 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.65
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8.11
|
Rate for Payer: Aetna Government |
$8.11
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.50
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.72
|
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: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.95
|
|
CEFOTAXIME 95 MG/ML INJ PEDIATRIC (IV)
|
Facility
IP
|
$3.00
|
|
Service Code
|
HCPCS J0698
|
Hospital Charge Code |
41641789
|
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
|
|
CEFOTAXIME 95 MG/ML INJ PEDIATRIC (IV)
|
Facility
OP
|
$3.00
|
|
Service Code
|
HCPCS J0698
|
Hospital Charge Code |
41641789
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$1.05 |
Max. Negotiated Rate |
$8.11 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.65
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8.11
|
Rate for Payer: Aetna Government |
$8.11
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.50
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.72
|
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: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.95
|
|