|
CEFTAROLINE 300MG/NS 50ML
|
Facility
|
OP
|
$5.17
|
|
|
Service Code
|
HCPCS J0712
|
| Hospital Charge Code |
41655725
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.58 |
| Max. Negotiated Rate |
$4.09 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.84
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.84
|
| Rate for Payer: Aetna Government |
$3.84
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2.68
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2.68
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2.68
|
| Rate for Payer: Brighton Health Commercial |
$3.10
|
| Rate for Payer: Cash Price |
$3.84
|
| Rate for Payer: Cash Price |
$3.84
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3.84
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.58
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.97
|
| Rate for Payer: Elderplan Medicare Advantage |
$3.84
|
| Rate for Payer: EmblemHealth Commercial |
$3.84
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3.84
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3.84
|
| Rate for Payer: Fidelis Essential Plan QHP |
$4.03
|
| Rate for Payer: Fidelis Medicare Advantage |
$3.84
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4.03
|
| Rate for Payer: Group Health Inc Commercial |
$3.84
|
| Rate for Payer: Group Health Inc Medicare |
$3.84
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.58
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3.26
|
| Rate for Payer: Healthfirst QHP |
$3.84
|
| Rate for Payer: Humana Medicare |
$3.91
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3.84
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$4.09
|
| Rate for Payer: SOMOS Essential |
$4.09
|
| Rate for Payer: United Healthcare Commercial |
$3.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.84
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.36
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3.07
|
| Rate for Payer: Wellcare Medicare |
$3.64
|
|
|
CEFTAROLINE 300MG/NS 50ML
|
Facility
|
IP
|
$5.17
|
|
|
Service Code
|
HCPCS J0712
|
| Hospital Charge Code |
41655725
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.58 |
| Max. Negotiated Rate |
$2.58 |
| Rate for Payer: Cash Price |
$3.84
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.58
|
|
|
CEFTAROLINE 300MG/NS 50ML IVBP
|
Facility
|
OP
|
$5.17
|
|
|
Service Code
|
HCPCS J0712
|
| Hospital Charge Code |
41645725
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.58 |
| Max. Negotiated Rate |
$4.09 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.84
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.84
|
| Rate for Payer: Aetna Government |
$3.84
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2.68
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2.68
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2.68
|
| Rate for Payer: Brighton Health Commercial |
$3.10
|
| Rate for Payer: Cash Price |
$3.84
|
| Rate for Payer: Cash Price |
$3.84
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3.84
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.58
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.97
|
| Rate for Payer: Elderplan Medicare Advantage |
$3.84
|
| Rate for Payer: EmblemHealth Commercial |
$3.84
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3.84
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3.84
|
| Rate for Payer: Fidelis Essential Plan QHP |
$4.03
|
| Rate for Payer: Fidelis Medicare Advantage |
$3.84
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4.03
|
| Rate for Payer: Group Health Inc Commercial |
$3.84
|
| Rate for Payer: Group Health Inc Medicare |
$3.84
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.58
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3.26
|
| Rate for Payer: Healthfirst QHP |
$3.84
|
| Rate for Payer: Humana Medicare |
$3.91
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3.84
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$4.09
|
| Rate for Payer: SOMOS Essential |
$4.09
|
| Rate for Payer: United Healthcare Commercial |
$3.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.84
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.36
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3.07
|
| Rate for Payer: Wellcare Medicare |
$3.64
|
|
|
CEFTAROLINE 300MG/NS 50ML IVBP
|
Facility
|
IP
|
$5.17
|
|
|
Service Code
|
HCPCS J0712
|
| Hospital Charge Code |
41645725
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.58 |
| Max. Negotiated Rate |
$2.58 |
| Rate for Payer: Cash Price |
$3.84
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.58
|
|
|
CEFTAROLINE 400MG INJ - 10MG
|
Facility
|
IP
|
$7.00
|
|
|
Service Code
|
HCPCS J0712
|
| Hospital Charge Code |
41645634
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.50 |
| Max. Negotiated Rate |
$3.50 |
| Rate for Payer: Cash Price |
$3.84
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.50
|
|
|
CEFTAROLINE 400MG INJ - 10MG
|
Facility
|
OP
|
$7.00
|
|
|
Service Code
|
HCPCS J0712
|
| Hospital Charge Code |
41655634
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.68 |
| Max. Negotiated Rate |
$4.55 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.85
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.84
|
| Rate for Payer: Aetna Government |
$3.84
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2.68
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2.68
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2.68
|
| Rate for Payer: Brighton Health Commercial |
$4.20
|
| Rate for Payer: Cash Price |
$3.84
|
| Rate for Payer: Cash Price |
$3.84
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3.84
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.02
|
| Rate for Payer: Elderplan Medicare Advantage |
$3.84
|
| Rate for Payer: EmblemHealth Commercial |
$3.84
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3.84
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3.84
|
| Rate for Payer: Fidelis Essential Plan QHP |
$4.03
|
| Rate for Payer: Fidelis Medicare Advantage |
$3.84
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4.03
|
| Rate for Payer: Group Health Inc Commercial |
$3.84
|
| Rate for Payer: Group Health Inc Medicare |
$3.84
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.50
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3.26
|
| Rate for Payer: Healthfirst QHP |
$3.84
|
| Rate for Payer: Humana Medicare |
$3.91
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3.84
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$4.09
|
| Rate for Payer: SOMOS Essential |
$4.09
|
| Rate for Payer: United Healthcare Commercial |
$3.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.84
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.55
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3.07
|
| Rate for Payer: Wellcare Medicare |
$3.64
|
|
|
CEFTAROLINE 400MG INJ - 10MG
|
Facility
|
OP
|
$7.00
|
|
|
Service Code
|
HCPCS J0712
|
| Hospital Charge Code |
41645634
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.68 |
| Max. Negotiated Rate |
$4.55 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.85
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.84
|
| Rate for Payer: Aetna Government |
$3.84
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2.68
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2.68
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2.68
|
| Rate for Payer: Brighton Health Commercial |
$4.20
|
| Rate for Payer: Cash Price |
$3.84
|
| Rate for Payer: Cash Price |
$3.84
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3.84
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.02
|
| Rate for Payer: Elderplan Medicare Advantage |
$3.84
|
| Rate for Payer: EmblemHealth Commercial |
$3.84
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3.84
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3.84
|
| Rate for Payer: Fidelis Essential Plan QHP |
$4.03
|
| Rate for Payer: Fidelis Medicare Advantage |
$3.84
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4.03
|
| Rate for Payer: Group Health Inc Commercial |
$3.84
|
| Rate for Payer: Group Health Inc Medicare |
$3.84
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.50
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3.26
|
| Rate for Payer: Healthfirst QHP |
$3.84
|
| Rate for Payer: Humana Medicare |
$3.91
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3.84
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$4.09
|
| Rate for Payer: SOMOS Essential |
$4.09
|
| Rate for Payer: United Healthcare Commercial |
$3.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.84
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.55
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3.07
|
| Rate for Payer: Wellcare Medicare |
$3.64
|
|
|
CEFTAROLINE 400MG INJ - 10MG
|
Facility
|
IP
|
$7.00
|
|
|
Service Code
|
HCPCS J0712
|
| Hospital Charge Code |
41655634
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.50 |
| Max. Negotiated Rate |
$3.50 |
| Rate for Payer: Cash Price |
$3.84
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.50
|
|
|
CEFTAROLINE 600MG INJ-10MG
|
Facility
|
OP
|
$5.08
|
|
|
Service Code
|
HCPCS J0712
|
| Hospital Charge Code |
41655635
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.54 |
| Max. Negotiated Rate |
$4.09 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.79
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.84
|
| Rate for Payer: Aetna Government |
$3.84
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2.68
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2.68
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2.68
|
| Rate for Payer: Brighton Health Commercial |
$3.05
|
| Rate for Payer: Cash Price |
$3.84
|
| Rate for Payer: Cash Price |
$3.84
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3.84
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.54
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.92
|
| Rate for Payer: Elderplan Medicare Advantage |
$3.84
|
| Rate for Payer: EmblemHealth Commercial |
$3.84
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3.84
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3.84
|
| Rate for Payer: Fidelis Essential Plan QHP |
$4.03
|
| Rate for Payer: Fidelis Medicare Advantage |
$3.84
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4.03
|
| Rate for Payer: Group Health Inc Commercial |
$3.84
|
| Rate for Payer: Group Health Inc Medicare |
$3.84
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.54
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3.26
|
| Rate for Payer: Healthfirst QHP |
$3.84
|
| Rate for Payer: Humana Medicare |
$3.91
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3.84
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$4.09
|
| Rate for Payer: SOMOS Essential |
$4.09
|
| Rate for Payer: United Healthcare Commercial |
$3.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.84
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.30
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3.07
|
| Rate for Payer: Wellcare Medicare |
$3.64
|
|
|
CEFTAROLINE 600MG INJ-10MG
|
Facility
|
IP
|
$5.08
|
|
|
Service Code
|
HCPCS J0712
|
| Hospital Charge Code |
41645635
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.54 |
| Max. Negotiated Rate |
$2.54 |
| Rate for Payer: Cash Price |
$3.84
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.54
|
|
|
CEFTAROLINE 600MG INJ-10MG
|
Facility
|
OP
|
$5.08
|
|
|
Service Code
|
HCPCS J0712
|
| Hospital Charge Code |
41645635
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.54 |
| Max. Negotiated Rate |
$4.09 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.79
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.84
|
| Rate for Payer: Aetna Government |
$3.84
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2.68
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2.68
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2.68
|
| Rate for Payer: Brighton Health Commercial |
$3.05
|
| Rate for Payer: Cash Price |
$3.84
|
| Rate for Payer: Cash Price |
$3.84
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3.84
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.54
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.92
|
| Rate for Payer: Elderplan Medicare Advantage |
$3.84
|
| Rate for Payer: EmblemHealth Commercial |
$3.84
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3.84
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3.84
|
| Rate for Payer: Fidelis Essential Plan QHP |
$4.03
|
| Rate for Payer: Fidelis Medicare Advantage |
$3.84
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4.03
|
| Rate for Payer: Group Health Inc Commercial |
$3.84
|
| Rate for Payer: Group Health Inc Medicare |
$3.84
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.54
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3.26
|
| Rate for Payer: Healthfirst QHP |
$3.84
|
| Rate for Payer: Humana Medicare |
$3.91
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3.84
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$4.09
|
| Rate for Payer: SOMOS Essential |
$4.09
|
| Rate for Payer: United Healthcare Commercial |
$3.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.84
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.30
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3.07
|
| Rate for Payer: Wellcare Medicare |
$3.64
|
|
|
CEFTAROLINE 600MG INJ-10MG
|
Facility
|
IP
|
$5.08
|
|
|
Service Code
|
HCPCS J0712
|
| Hospital Charge Code |
41655635
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.54 |
| Max. Negotiated Rate |
$2.54 |
| Rate for Payer: Cash Price |
$3.84
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.54
|
|
|
CEFTAROLINE FOSAMIL 400 MG IV SOLR [107670]
|
Facility
|
OP
|
$294.24
|
|
|
Service Code
|
HCPCS J0712
|
| Hospital Charge Code |
00456040010
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3.07 |
| Max. Negotiated Rate |
$191.26 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$161.83
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.84
|
| Rate for Payer: Aetna Government |
$3.84
|
| Rate for Payer: Brighton Health Commercial |
$176.54
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3.84
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$147.12
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$169.19
|
| Rate for Payer: Elderplan Medicare Advantage |
$3.84
|
| Rate for Payer: EmblemHealth Commercial |
$147.12
|
| Rate for Payer: Fidelis Medicare Advantage |
$3.84
|
| Rate for Payer: Group Health Inc Commercial |
$3.84
|
| Rate for Payer: Group Health Inc Medicare |
$3.84
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$147.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$147.12
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3.26
|
| Rate for Payer: Healthfirst QHP |
$3.84
|
| Rate for Payer: Humana Medicare |
$3.91
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.84
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$191.26
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3.07
|
|
|
CEFTAROLINE FOSAMIL 400 MG IV SOLR [107670]
|
Facility
|
IP
|
$294.24
|
|
|
Service Code
|
HCPCS J0712
|
| Hospital Charge Code |
00456040010
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$147.12 |
| Max. Negotiated Rate |
$147.12 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$147.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$147.12
|
|
|
CEFTAROLINE FOSAMIL 600 MG IV SOLR [107671]
|
Facility
|
OP
|
$294.24
|
|
|
Service Code
|
HCPCS J0712
|
| Hospital Charge Code |
00456060010
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3.07 |
| Max. Negotiated Rate |
$191.26 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$161.83
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.84
|
| Rate for Payer: Aetna Government |
$3.84
|
| Rate for Payer: Brighton Health Commercial |
$176.54
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3.84
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$147.12
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$169.19
|
| Rate for Payer: Elderplan Medicare Advantage |
$3.84
|
| Rate for Payer: EmblemHealth Commercial |
$147.12
|
| Rate for Payer: Fidelis Medicare Advantage |
$3.84
|
| Rate for Payer: Group Health Inc Commercial |
$3.84
|
| Rate for Payer: Group Health Inc Medicare |
$3.84
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$147.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$147.12
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3.26
|
| Rate for Payer: Healthfirst QHP |
$3.84
|
| Rate for Payer: Humana Medicare |
$3.91
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.84
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$191.26
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3.07
|
|
|
CEFTAROLINE FOSAMIL 600 MG IV SOLR [107671]
|
Facility
|
IP
|
$280.22
|
|
|
Service Code
|
HCPCS J0712
|
| Hospital Charge Code |
00456060001
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$140.11 |
| Max. Negotiated Rate |
$140.11 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$140.11
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$140.11
|
|
|
CEFTAROLINE FOSAMIL 600 MG IV SOLR [107671]
|
Facility
|
IP
|
$294.24
|
|
|
Service Code
|
HCPCS J0712
|
| Hospital Charge Code |
00456060010
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$147.12 |
| Max. Negotiated Rate |
$147.12 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$147.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$147.12
|
|
|
CEFTAROLINE FOSAMIL 600 MG IV SOLR [107671]
|
Facility
|
OP
|
$280.22
|
|
|
Service Code
|
HCPCS J0712
|
| Hospital Charge Code |
00456060001
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3.07 |
| Max. Negotiated Rate |
$182.14 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$154.12
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.84
|
| Rate for Payer: Aetna Government |
$3.84
|
| Rate for Payer: Brighton Health Commercial |
$168.13
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3.84
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$140.11
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$161.13
|
| Rate for Payer: Elderplan Medicare Advantage |
$3.84
|
| Rate for Payer: EmblemHealth Commercial |
$140.11
|
| Rate for Payer: Fidelis Medicare Advantage |
$3.84
|
| Rate for Payer: Group Health Inc Commercial |
$3.84
|
| Rate for Payer: Group Health Inc Medicare |
$3.84
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$140.11
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$140.11
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3.26
|
| Rate for Payer: Healthfirst QHP |
$3.84
|
| Rate for Payer: Humana Medicare |
$3.91
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.84
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$182.14
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3.07
|
|
|
CEFTAZIDIME 1000 MG INJ
|
Facility
|
OP
|
$1.76
|
|
|
Service Code
|
HCPCS J0713
|
| Hospital Charge Code |
41644221
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$1.97 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.97
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.97
|
| Rate for Payer: Aetna Government |
$1.97
|
| Rate for Payer: Brighton Health Commercial |
$1.06
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.88
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.01
|
| Rate for Payer: Group Health Inc Commercial |
$0.88
|
| Rate for Payer: Group Health Inc Medicare |
$0.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.88
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1.76
|
| Rate for Payer: SOMOS Essential |
$1.76
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.14
|
|
|
CEFTAZIDIME 1000 MG INJ
|
Facility
|
IP
|
$1.76
|
|
|
Service Code
|
HCPCS J0713
|
| Hospital Charge Code |
41644221
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.88 |
| Max. Negotiated Rate |
$0.88 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.88
|
|
|
CEFTAZIDIME 1000 MG INJ
|
Facility
|
OP
|
$1.76
|
|
|
Service Code
|
HCPCS J0713
|
| Hospital Charge Code |
41654221
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$1.97 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.97
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.97
|
| Rate for Payer: Aetna Government |
$1.97
|
| Rate for Payer: Brighton Health Commercial |
$1.06
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.88
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.01
|
| Rate for Payer: Group Health Inc Commercial |
$0.88
|
| Rate for Payer: Group Health Inc Medicare |
$0.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.88
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1.76
|
| Rate for Payer: SOMOS Essential |
$1.76
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.14
|
|
|
CEFTAZIDIME 1000 MG INJ
|
Facility
|
IP
|
$1.76
|
|
|
Service Code
|
HCPCS J0713
|
| Hospital Charge Code |
41654221
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.88 |
| Max. Negotiated Rate |
$0.88 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.88
|
|
|
CEFTAZIDIME 10MG/ML NS
|
Facility
|
OP
|
$0.62
|
|
|
Service Code
|
HCPCS J0713
|
| Hospital Charge Code |
41650287
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$1.97 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.34
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.97
|
| Rate for Payer: Aetna Government |
$1.97
|
| Rate for Payer: Brighton Health Commercial |
$0.37
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.31
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.36
|
| Rate for Payer: Group Health Inc Commercial |
$0.31
|
| Rate for Payer: Group Health Inc Medicare |
$0.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.31
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.31
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1.76
|
| Rate for Payer: SOMOS Essential |
$1.76
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.40
|
|
|
CEFTAZIDIME 10MG/ML NS
|
Facility
|
IP
|
$0.62
|
|
|
Service Code
|
HCPCS J0713
|
| Hospital Charge Code |
41650287
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.31 |
| Max. Negotiated Rate |
$0.31 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.31
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.31
|
|
|
CEFTAZIDIME 10MG/ML NS
|
Facility
|
IP
|
$0.62
|
|
|
Service Code
|
HCPCS J0713
|
| Hospital Charge Code |
41640287
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.31 |
| Max. Negotiated Rate |
$0.31 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.31
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.31
|
|
