|
CEFAZOLIN IV SYRINGE 20 MG/ML IN D5W (NEO/PED) [400057]
|
Facility
|
IP
|
$3.28
|
|
|
Service Code
|
NDC 09999123460
|
| Hospital Charge Code |
00409258501
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1.64 |
| Max. Negotiated Rate |
$1.64 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.64
|
|
|
CEFAZOLIN SODIUM 10 G IJ SOLR [1446]
|
Facility
|
OP
|
$26.20
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
60505614300
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.75 |
| Max. Negotiated Rate |
$20.96 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$14.41
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.75
|
| Rate for Payer: Aetna Government |
$0.75
|
| Rate for Payer: Brighton Health Commercial |
$19.65
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$20.96
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$17.82
|
| Rate for Payer: Group Health Inc Commercial |
$13.10
|
| Rate for Payer: Group Health Inc Medicare |
$9.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$13.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.10
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$0.82
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$0.86
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$0.86
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$0.86
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$17.03
|
|
|
CEFAZOLIN SODIUM 1 G IJ SOLR [1445]
|
Facility
|
OP
|
$2.09
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
63323023710
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.73 |
| Max. Negotiated Rate |
$1.67 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.15
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.75
|
| Rate for Payer: Aetna Government |
$0.75
|
| Rate for Payer: Brighton Health Commercial |
$1.57
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.67
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.42
|
| Rate for Payer: Group Health Inc Commercial |
$1.04
|
| Rate for Payer: Group Health Inc Medicare |
$0.73
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.04
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$0.82
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$0.86
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$0.86
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$0.86
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.36
|
|
|
CEFAZOLIN SODIUM 1 G IJ SOLR [1445]
|
Facility
|
OP
|
$2.61
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
60505614205
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.75 |
| Max. Negotiated Rate |
$2.09 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.44
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.75
|
| Rate for Payer: Aetna Government |
$0.75
|
| Rate for Payer: Brighton Health Commercial |
$1.96
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.09
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.78
|
| Rate for Payer: Group Health Inc Commercial |
$1.31
|
| Rate for Payer: Group Health Inc Medicare |
$0.91
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.31
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.31
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$0.82
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$0.86
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$0.86
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$0.86
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.70
|
|
|
CEFAZOLIN SODIUM 1 G IJ SOLR [1445]
|
Facility
|
OP
|
$1.64
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
00143992490
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$1.31 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.75
|
| Rate for Payer: Aetna Government |
$0.75
|
| Rate for Payer: Brighton Health Commercial |
$1.23
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.31
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.12
|
| Rate for Payer: Group Health Inc Commercial |
$0.82
|
| Rate for Payer: Group Health Inc Medicare |
$0.57
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.82
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$0.82
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$0.86
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$0.86
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$0.86
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.07
|
|
|
CEFAZOLIN SODIUM 1 G IJ SOLR [1445]
|
Facility
|
OP
|
$2.61
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
60505614200
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.75 |
| Max. Negotiated Rate |
$2.09 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.44
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.75
|
| Rate for Payer: Aetna Government |
$0.75
|
| Rate for Payer: Brighton Health Commercial |
$1.96
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.09
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.77
|
| Rate for Payer: Group Health Inc Commercial |
$1.30
|
| Rate for Payer: Group Health Inc Medicare |
$0.91
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.30
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$0.82
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$0.86
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$0.86
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$0.86
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.70
|
|
|
CEFAZOLIN SODIUM 1 G IJ SOLR [1445]
|
Facility
|
OP
|
$7.50
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
00781345196
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.75 |
| Max. Negotiated Rate |
$6.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.12
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.75
|
| Rate for Payer: Aetna Government |
$0.75
|
| Rate for Payer: Brighton Health Commercial |
$5.62
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.10
|
| Rate for Payer: Group Health Inc Commercial |
$3.75
|
| Rate for Payer: Group Health Inc Medicare |
$2.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.75
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$0.82
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$0.86
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$0.86
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$0.86
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.88
|
|
|
CEFAZOLIN SODIUM 1 G IJ SOLR [1445]
|
Facility
|
OP
|
$1.92
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
25021010110
|
|
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 |
$0.75
|
| Rate for Payer: Aetna Government |
$0.75
|
| 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: 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: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$0.82
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$0.86
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$0.86
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$0.86
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.25
|
|
|
CEFAZOLIN SODIUM 2 G IJ SOLR (WRAPPED) [401338]
|
Facility
|
OP
|
$7.31
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
60505623105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.75 |
| Max. Negotiated Rate |
$5.85 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.02
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.75
|
| Rate for Payer: Aetna Government |
$0.75
|
| Rate for Payer: Brighton Health Commercial |
$5.48
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5.85
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.97
|
| Rate for Payer: Group Health Inc Commercial |
$3.66
|
| Rate for Payer: Group Health Inc Medicare |
$2.56
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.66
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.66
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$0.82
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$0.86
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$0.86
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$0.86
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.75
|
|
|
CEFAZOLIN SODIUM 2 G IJ SOLR (WRAPPED) [401338]
|
Facility
|
OP
|
$7.02
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
00143913925
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.75 |
| Max. Negotiated Rate |
$5.62 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.86
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.75
|
| Rate for Payer: Aetna Government |
$0.75
|
| Rate for Payer: Brighton Health Commercial |
$5.26
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5.62
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.77
|
| Rate for Payer: Group Health Inc Commercial |
$3.51
|
| Rate for Payer: Group Health Inc Medicare |
$2.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.51
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.51
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$0.82
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$0.86
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$0.86
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$0.86
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.56
|
|
|
CEFAZOLIN SODIUM 2 G IJ SOLR (WRAPPED) [401338]
|
Facility
|
OP
|
$7.02
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
00143913901
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.75 |
| Max. Negotiated Rate |
$5.62 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.86
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.75
|
| Rate for Payer: Aetna Government |
$0.75
|
| Rate for Payer: Brighton Health Commercial |
$5.26
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5.62
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.77
|
| Rate for Payer: Group Health Inc Commercial |
$3.51
|
| Rate for Payer: Group Health Inc Medicare |
$2.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.51
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.51
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$0.82
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$0.86
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$0.86
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$0.86
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.56
|
|
|
CEFAZOLIN SODIUM 500 MG IJ SOLR [1448]
|
Facility
|
OP
|
$1.92
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
44567070625
|
|
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 |
$0.75
|
| Rate for Payer: Aetna Government |
$0.75
|
| 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: 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: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$0.82
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$0.86
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$0.86
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$0.86
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.25
|
|
|
CEFAZOLIN SODIUM 500 MG IJ SOLR [1448]
|
Facility
|
OP
|
$9.74
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
00781345095
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.75 |
| Max. Negotiated Rate |
$7.79 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.35
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.75
|
| Rate for Payer: Aetna Government |
$0.75
|
| Rate for Payer: Brighton Health Commercial |
$7.30
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7.79
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.62
|
| Rate for Payer: Group Health Inc Commercial |
$4.87
|
| Rate for Payer: Group Health Inc Medicare |
$3.41
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.87
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.87
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$0.82
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$0.86
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$0.86
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$0.86
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6.33
|
|
|
CEFAZOLIN SODIUM 500 MG IJ SOLR [1448]
|
Facility
|
OP
|
$1.68
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
25021010010
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$1.34 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.92
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.75
|
| Rate for Payer: Aetna Government |
$0.75
|
| Rate for Payer: Brighton Health Commercial |
$1.26
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.34
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.14
|
| Rate for Payer: Group Health Inc Commercial |
$0.84
|
| Rate for Payer: Group Health Inc Medicare |
$0.59
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.84
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$0.82
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$0.86
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$0.86
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$0.86
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.09
|
|
|
CEFAZOLIN SODIUM-DEXTROSE 2-3 GM-%(50ML) IV SOLR [163119]
|
Facility
|
IP
|
$17.71
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
00264310511
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8.86 |
| Max. Negotiated Rate |
$8.86 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.86
|
|
|
CEFAZOLIN SODIUM-DEXTROSE 2-3 GM-%(50ML) IV SOLR [163119]
|
Facility
|
OP
|
$17.71
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
00264310511
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.75 |
| Max. Negotiated Rate |
$18.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$9.74
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.75
|
| Rate for Payer: Aetna Government |
$0.75
|
| Rate for Payer: Brighton Health Commercial |
$10.63
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.86
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$10.18
|
| Rate for Payer: EmblemHealth Commercial |
$8.86
|
| Rate for Payer: Fidelis Medicare Advantage |
$18.60
|
| Rate for Payer: Group Health Inc Commercial |
$8.86
|
| Rate for Payer: Group Health Inc Medicare |
$6.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.86
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$11.51
|
|
|
CEFDINIR 300 MG PO CAPS [22289]
|
Facility
|
OP
|
$5.11
|
|
|
Service Code
|
NDC 00093316006
|
| Hospital Charge Code |
00093316006
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.79 |
| Max. Negotiated Rate |
$4.09 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.81
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.56
|
| Rate for Payer: Aetna Government |
$2.56
|
| Rate for Payer: Brighton Health Commercial |
$3.84
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.09
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.48
|
| Rate for Payer: Group Health Inc Commercial |
$2.56
|
| Rate for Payer: Group Health Inc Medicare |
$1.79
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.56
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.32
|
|
|
CEFDINIR 300 MG PO CAPS [22289]
|
Facility
|
OP
|
$5.11
|
|
|
Service Code
|
NDC 65862017760
|
| Hospital Charge Code |
65862017760
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.79 |
| Max. Negotiated Rate |
$4.09 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.81
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.55
|
| Rate for Payer: Aetna Government |
$2.55
|
| Rate for Payer: Brighton Health Commercial |
$3.83
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.09
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.47
|
| Rate for Payer: Group Health Inc Commercial |
$2.55
|
| Rate for Payer: Group Health Inc Medicare |
$1.79
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.55
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.55
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.32
|
|
|
CEFDINIR CP 300MG TABLET
|
Facility
|
OP
|
$12.78
|
|
| Hospital Charge Code |
41650307
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.47 |
| Max. Negotiated Rate |
$10.22 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.03
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.39
|
| Rate for Payer: Aetna Government |
$6.39
|
| Rate for Payer: Brighton Health Commercial |
$9.58
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$10.22
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$8.69
|
| Rate for Payer: Group Health Inc Commercial |
$6.39
|
| Rate for Payer: Group Health Inc Medicare |
$4.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8.31
|
|
|
CEFDINIR CP 300MG TABLET
|
Facility
|
OP
|
$12.78
|
|
| Hospital Charge Code |
41640307
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.47 |
| Max. Negotiated Rate |
$10.22 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.03
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.39
|
| Rate for Payer: Aetna Government |
$6.39
|
| Rate for Payer: Brighton Health Commercial |
$9.58
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$10.22
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$8.69
|
| Rate for Payer: Group Health Inc Commercial |
$6.39
|
| Rate for Payer: Group Health Inc Medicare |
$4.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8.31
|
|
|
CEFEPIME 0.5 GRAMS INJ
|
Facility
|
IP
|
$10.26
|
|
|
Service Code
|
HCPCS J0692
|
| Hospital Charge Code |
41653344
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.13 |
| Max. Negotiated Rate |
$5.13 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.13
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.13
|
|
|
CEFEPIME 0.5 GRAMS INJ
|
Facility
|
OP
|
$10.26
|
|
|
Service Code
|
HCPCS J0692
|
| Hospital Charge Code |
41643344
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.42 |
| Max. Negotiated Rate |
$6.67 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.64
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.85
|
| Rate for Payer: Aetna Government |
$1.85
|
| Rate for Payer: Brighton Health Commercial |
$6.16
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5.13
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.90
|
| Rate for Payer: Group Health Inc Commercial |
$5.13
|
| Rate for Payer: Group Health Inc Medicare |
$3.59
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.13
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.13
|
| 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 |
$6.67
|
|
|
CEFEPIME 0.5 GRAMS INJ
|
Facility
|
OP
|
$10.26
|
|
|
Service Code
|
HCPCS J0692
|
| Hospital Charge Code |
41653344
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.42 |
| Max. Negotiated Rate |
$6.67 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.64
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.85
|
| Rate for Payer: Aetna Government |
$1.85
|
| Rate for Payer: Brighton Health Commercial |
$6.16
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5.13
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.90
|
| Rate for Payer: Group Health Inc Commercial |
$5.13
|
| Rate for Payer: Group Health Inc Medicare |
$3.59
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.13
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.13
|
| 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 |
$6.67
|
|
|
CEFEPIME 0.5 GRAMS INJ
|
Facility
|
IP
|
$10.26
|
|
|
Service Code
|
HCPCS J0692
|
| Hospital Charge Code |
41643344
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.13 |
| Max. Negotiated Rate |
$5.13 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.13
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.13
|
|
|
CEFEPIME 1 GRAM INJ
|
Facility
|
OP
|
$3.71
|
|
|
Service Code
|
HCPCS J0692
|
| Hospital Charge Code |
41653299
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.30 |
| Max. Negotiated Rate |
$2.41 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.04
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.85
|
| Rate for Payer: Aetna Government |
$1.85
|
| Rate for Payer: Brighton Health Commercial |
$2.23
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.86
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.13
|
| 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: 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 |
$2.41
|
|
