|
CEFEPIME 1 GRAM INJ
|
Facility
|
OP
|
$3.71
|
|
|
Service Code
|
HCPCS J0692
|
| Hospital Charge Code |
41643299
|
|
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
|
|
|
CEFEPIME 1 GRAM INJ
|
Facility
|
IP
|
$3.71
|
|
|
Service Code
|
HCPCS J0692
|
| Hospital Charge Code |
41653299
|
|
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
|
|
|
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
|
|
|
CEFEPIME 2 GRAMS INJ
|
Facility
|
OP
|
$3.00
|
|
|
Service Code
|
HCPCS J0692
|
| Hospital Charge Code |
41653345
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.05 |
| Max. Negotiated Rate |
$1.95 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.65
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.85
|
| Rate for Payer: Aetna Government |
$1.85
|
| Rate for Payer: Brighton Health Commercial |
$1.80
|
| 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: 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 |
$1.95
|
|
|
CEFEPIME 2 GRAMS INJ
|
Facility
|
OP
|
$3.00
|
|
|
Service Code
|
HCPCS J0692
|
| Hospital Charge Code |
41643345
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.05 |
| Max. Negotiated Rate |
$1.95 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.65
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.85
|
| Rate for Payer: Aetna Government |
$1.85
|
| Rate for Payer: Brighton Health Commercial |
$1.80
|
| 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: 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 |
$1.95
|
|
|
CEFEPIME 2 GRAMS INJ
|
Facility
|
IP
|
$3.00
|
|
|
Service Code
|
HCPCS J0692
|
| Hospital Charge Code |
41643345
|
|
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
|
|
|
CEFEPIME 2 GRAMS INJ
|
Facility
|
IP
|
$3.00
|
|
|
Service Code
|
HCPCS J0692
|
| Hospital Charge Code |
41653345
|
|
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
|
|
|
CEFEPIME 40MG/ML INJ PED
|
Facility
|
IP
|
$7.21
|
|
|
Service Code
|
HCPCS J0692
|
| Hospital Charge Code |
41659543
|
|
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
|
|
|
CEFEPIME 40MG/ML INJ PED
|
Facility
|
OP
|
$7.21
|
|
|
Service Code
|
HCPCS J0692
|
| Hospital Charge Code |
41659543
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.42 |
| 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: Brighton Health Commercial |
$4.33
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.15
|
| 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: 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
|
|
|
CEFEPIME 500MG IM
|
Facility
|
OP
|
$8.00
|
|
|
Service Code
|
HCPCS J0692
|
| Hospital Charge Code |
41645917
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.42 |
| Max. Negotiated Rate |
$5.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.85
|
| Rate for Payer: Aetna Government |
$1.85
|
| Rate for Payer: Brighton Health Commercial |
$4.80
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.60
|
| Rate for Payer: Group Health Inc Commercial |
$4.00
|
| Rate for Payer: Group Health Inc Medicare |
$2.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.00
|
| 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 |
$5.20
|
|
|
CEFEPIME 500MG IM
|
Facility
|
IP
|
$8.00
|
|
|
Service Code
|
HCPCS J0692
|
| Hospital Charge Code |
41645917
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$4.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.00
|
|
|
CEFEPIME HCL 1 G IJ SOLR [16369]
|
Facility
|
OP
|
$6.84
|
|
|
Service Code
|
HCPCS J0692
|
| Hospital Charge Code |
44567024010
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.34 |
| Max. Negotiated Rate |
$5.47 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.76
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.85
|
| Rate for Payer: Aetna Government |
$1.85
|
| Rate for Payer: Brighton Health Commercial |
$5.13
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5.47
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.65
|
| Rate for Payer: Group Health Inc Commercial |
$3.42
|
| Rate for Payer: Group Health Inc Medicare |
$2.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.42
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1.34
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1.42
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1.42
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1.42
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.45
|
|
|
CEFEPIME HCL 1 G IJ SOLR [16369]
|
Facility
|
OP
|
$6.90
|
|
|
Service Code
|
HCPCS J0692
|
| Hospital Charge Code |
70594008902
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.34 |
| Max. Negotiated Rate |
$5.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.80
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.85
|
| Rate for Payer: Aetna Government |
$1.85
|
| Rate for Payer: Brighton Health Commercial |
$5.18
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.69
|
| Rate for Payer: Group Health Inc Commercial |
$3.45
|
| Rate for Payer: Group Health Inc Medicare |
$2.42
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.45
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.45
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1.34
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1.42
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1.42
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1.42
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.48
|
|
|
CEFEPIME HCL 1 G IJ SOLR [16369]
|
Facility
|
OP
|
$7.20
|
|
|
Service Code
|
HCPCS J0692
|
| Hospital Charge Code |
25021012120
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.34 |
| Max. Negotiated Rate |
$5.76 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.96
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.85
|
| Rate for Payer: Aetna Government |
$1.85
|
| Rate for Payer: Brighton Health Commercial |
$5.40
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5.76
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.90
|
| 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: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1.34
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1.42
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1.42
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1.42
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.68
|
|
|
CEFEPIME HCL 1 G IJ SOLR [16369]
|
Facility
|
OP
|
$20.33
|
|
|
Service Code
|
HCPCS J0692
|
| Hospital Charge Code |
60505614600
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.34 |
| Max. Negotiated Rate |
$16.26 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$11.18
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.85
|
| Rate for Payer: Aetna Government |
$1.85
|
| Rate for Payer: Brighton Health Commercial |
$15.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$16.26
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$13.82
|
| Rate for Payer: Group Health Inc Commercial |
$10.16
|
| Rate for Payer: Group Health Inc Medicare |
$7.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$10.16
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1.34
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1.42
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1.42
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1.42
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$13.21
|
|
|
CEFEPIME HCL 2 G SOLR (WRAPPED) [401294]
|
Facility
|
OP
|
$11.76
|
|
|
Service Code
|
HCPCS J0692
|
| Hospital Charge Code |
70594009002
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.34 |
| Max. Negotiated Rate |
$9.41 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.47
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.85
|
| Rate for Payer: Aetna Government |
$1.85
|
| Rate for Payer: Brighton Health Commercial |
$8.82
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$9.41
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$8.00
|
| Rate for Payer: Group Health Inc Commercial |
$5.88
|
| Rate for Payer: Group Health Inc Medicare |
$4.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.88
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1.34
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1.42
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1.42
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1.42
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$7.64
|
|
|
CEFEPIME HCL 2 G SOLR (WRAPPED) [401294]
|
Facility
|
OP
|
$12.06
|
|
|
Service Code
|
HCPCS J0692
|
| Hospital Charge Code |
00409973501
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.34 |
| Max. Negotiated Rate |
$9.65 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.63
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.85
|
| Rate for Payer: Aetna Government |
$1.85
|
| Rate for Payer: Brighton Health Commercial |
$9.04
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$9.65
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$8.20
|
| Rate for Payer: Group Health Inc Commercial |
$6.03
|
| Rate for Payer: Group Health Inc Medicare |
$4.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.03
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.03
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1.34
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1.42
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1.42
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1.42
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$7.84
|
|
|
CEFEPIME HCL 2 G SOLR (WRAPPED) [401294]
|
Facility
|
OP
|
$11.64
|
|
|
Service Code
|
HCPCS J0692
|
| Hospital Charge Code |
71288000920
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.34 |
| Max. Negotiated Rate |
$9.31 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.85
|
| Rate for Payer: Aetna Government |
$1.85
|
| Rate for Payer: Brighton Health Commercial |
$8.73
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$9.31
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7.92
|
| Rate for Payer: Group Health Inc Commercial |
$5.82
|
| Rate for Payer: Group Health Inc Medicare |
$4.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.82
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1.34
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1.42
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1.42
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1.42
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$7.57
|
|
|
CEFEPIME HCL 2 G SOLR (WRAPPED) [401294]
|
Facility
|
OP
|
$40.36
|
|
|
Service Code
|
HCPCS J0692
|
| Hospital Charge Code |
60505614704
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.34 |
| Max. Negotiated Rate |
$32.28 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$22.20
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.85
|
| Rate for Payer: Aetna Government |
$1.85
|
| Rate for Payer: Brighton Health Commercial |
$30.27
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$32.28
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$27.44
|
| Rate for Payer: Group Health Inc Commercial |
$20.18
|
| Rate for Payer: Group Health Inc Medicare |
$14.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$20.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$20.18
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1.34
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1.42
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1.42
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1.42
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$26.23
|
|
|
CEFEPIME HCL 2 G SOLR (WRAPPED) [401294]
|
Facility
|
OP
|
$40.36
|
|
|
Service Code
|
HCPCS J0692
|
| Hospital Charge Code |
60505614700
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.34 |
| Max. Negotiated Rate |
$32.29 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$22.20
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.85
|
| Rate for Payer: Aetna Government |
$1.85
|
| Rate for Payer: Brighton Health Commercial |
$30.27
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$32.29
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$27.44
|
| Rate for Payer: Group Health Inc Commercial |
$20.18
|
| Rate for Payer: Group Health Inc Medicare |
$14.13
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$20.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$20.18
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1.34
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1.42
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1.42
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1.42
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$26.23
|
|
|
CEFEPIME HCL 2 G SOLR (WRAPPED) [401294]
|
Facility
|
OP
|
$12.00
|
|
|
Service Code
|
HCPCS J0692
|
| Hospital Charge Code |
25021012250
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.34 |
| Max. Negotiated Rate |
$9.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.85
|
| Rate for Payer: Aetna Government |
$1.85
|
| Rate for Payer: Brighton Health Commercial |
$9.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$9.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$8.16
|
| Rate for Payer: Group Health Inc Commercial |
$6.00
|
| Rate for Payer: Group Health Inc Medicare |
$4.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.00
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1.34
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1.42
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1.42
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1.42
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$7.80
|
|
|
CEFIDEROCOL
|
Facility
|
OP
|
$4.73
|
|
|
Service Code
|
HCPCS J0699
|
| Hospital Charge Code |
41640343
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.52 |
| Max. Negotiated Rate |
$3.07 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.17
|
| Rate for Payer: Aetna Government |
$2.17
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1.52
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1.52
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1.52
|
| Rate for Payer: Brighton Health Commercial |
$2.84
|
| Rate for Payer: Cash Price |
$2.17
|
| Rate for Payer: Cash Price |
$2.17
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2.17
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.36
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.72
|
| Rate for Payer: Elderplan Medicare Advantage |
$2.17
|
| Rate for Payer: EmblemHealth Commercial |
$2.17
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2.17
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2.17
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2.28
|
| Rate for Payer: Fidelis Medicare Advantage |
$2.17
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2.28
|
| Rate for Payer: Group Health Inc Commercial |
$2.17
|
| Rate for Payer: Group Health Inc Medicare |
$2.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.36
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1.85
|
| Rate for Payer: Healthfirst QHP |
$2.17
|
| Rate for Payer: Humana Medicare |
$2.22
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2.17
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2.30
|
| Rate for Payer: SOMOS Essential |
$2.30
|
| Rate for Payer: United Healthcare Commercial |
$2.11
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2.17
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.07
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1.74
|
| Rate for Payer: Wellcare Medicare |
$2.06
|
|
|
CEFIDEROCOL
|
Facility
|
IP
|
$4.73
|
|
|
Service Code
|
HCPCS J0699
|
| Hospital Charge Code |
41640343
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.36 |
| Max. Negotiated Rate |
$2.36 |
| Rate for Payer: Cash Price |
$2.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.36
|
|
|
CEFIDEROCOL
|
Facility
|
OP
|
$4.73
|
|
|
Service Code
|
HCPCS J0699
|
| Hospital Charge Code |
41650343
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.52 |
| Max. Negotiated Rate |
$3.07 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.17
|
| Rate for Payer: Aetna Government |
$2.17
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1.52
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1.52
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1.52
|
| Rate for Payer: Brighton Health Commercial |
$2.84
|
| Rate for Payer: Cash Price |
$2.17
|
| Rate for Payer: Cash Price |
$2.17
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2.17
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.36
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.72
|
| Rate for Payer: Elderplan Medicare Advantage |
$2.17
|
| Rate for Payer: EmblemHealth Commercial |
$2.17
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2.17
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2.17
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2.28
|
| Rate for Payer: Fidelis Medicare Advantage |
$2.17
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2.28
|
| Rate for Payer: Group Health Inc Commercial |
$2.17
|
| Rate for Payer: Group Health Inc Medicare |
$2.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.36
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1.85
|
| Rate for Payer: Healthfirst QHP |
$2.17
|
| Rate for Payer: Humana Medicare |
$2.22
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2.17
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2.30
|
| Rate for Payer: SOMOS Essential |
$2.30
|
| Rate for Payer: United Healthcare Commercial |
$2.11
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2.17
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.07
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1.74
|
| Rate for Payer: Wellcare Medicare |
$2.06
|
|
|
CEFIDEROCOL
|
Facility
|
IP
|
$4.73
|
|
|
Service Code
|
HCPCS J0699
|
| Hospital Charge Code |
41650343
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.36 |
| Max. Negotiated Rate |
$2.36 |
| Rate for Payer: Cash Price |
$2.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.36
|
|
