|
CEFTRIAXONE 500MG/250MG 1%IM
|
Facility
|
IP
|
$2.61
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
41658408
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.30 |
| Max. Negotiated Rate |
$1.30 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.30
|
|
|
CEFTRIAXONE 500MG/250MG 1%IM
|
Facility
|
OP
|
$2.61
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
41648408
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.48 |
| Max. Negotiated Rate |
$1.70 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.44
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.50
|
| Rate for Payer: Aetna Government |
$0.50
|
| Rate for Payer: Brighton Health Commercial |
$1.57
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.30
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.50
|
| 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: SOMOS CHP/HARP/Medicaid |
$0.48
|
| Rate for Payer: SOMOS Essential |
$0.48
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.70
|
|
|
CEFTRIAXONE 500 MG INJ
|
Facility
|
OP
|
$0.89
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
41644197
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.31 |
| Max. Negotiated Rate |
$0.58 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.49
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.50
|
| Rate for Payer: Aetna Government |
$0.50
|
| Rate for Payer: Brighton Health Commercial |
$0.53
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.45
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.51
|
| Rate for Payer: Group Health Inc Commercial |
$0.45
|
| Rate for Payer: Group Health Inc Medicare |
$0.31
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.45
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.45
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$0.48
|
| Rate for Payer: SOMOS Essential |
$0.48
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.58
|
|
|
CEFTRIAXONE 500 MG INJ
|
Facility
|
IP
|
$0.89
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
41644197
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$0.45 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.45
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.45
|
|
|
CEFTRIAXONE 500 MG INJ
|
Facility
|
IP
|
$0.89
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
41654197
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$0.45 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.45
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.45
|
|
|
CEFTRIAXONE 500 MG INJ
|
Facility
|
OP
|
$0.89
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
41654197
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.31 |
| Max. Negotiated Rate |
$0.58 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.49
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.50
|
| Rate for Payer: Aetna Government |
$0.50
|
| Rate for Payer: Brighton Health Commercial |
$0.53
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.45
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.51
|
| Rate for Payer: Group Health Inc Commercial |
$0.45
|
| Rate for Payer: Group Health Inc Medicare |
$0.31
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.45
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.45
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$0.48
|
| Rate for Payer: SOMOS Essential |
$0.48
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.58
|
|
|
CEFTRIAXONE IM INJ 500 MG/2 ML - COMPOUNDED [401315]
|
Facility
|
OP
|
$2.99
|
|
|
Service Code
|
HCPCS J0696
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$2.39 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.64
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.50
|
| Rate for Payer: Aetna Government |
$0.50
|
| Rate for Payer: Brighton Health Commercial |
$2.24
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.39
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.03
|
| 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: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$0.45
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$0.48
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$0.48
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$0.48
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.94
|
|
|
CEFTRIAXONE SODIUM 1 G IJ SOLR [9487]
|
Facility
|
OP
|
$46.00
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
00781320885
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$36.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$25.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.50
|
| Rate for Payer: Aetna Government |
$0.50
|
| Rate for Payer: Brighton Health Commercial |
$34.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$36.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$31.28
|
| Rate for Payer: Group Health Inc Commercial |
$23.00
|
| Rate for Payer: Group Health Inc Medicare |
$16.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$23.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$23.00
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$0.45
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$0.48
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$0.48
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$0.48
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$29.90
|
|
|
CEFTRIAXONE SODIUM 1 G IJ SOLR [9487]
|
Facility
|
OP
|
$45.95
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
60505614804
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$36.76 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$25.27
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.50
|
| Rate for Payer: Aetna Government |
$0.50
|
| Rate for Payer: Brighton Health Commercial |
$34.46
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$36.76
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$31.25
|
| Rate for Payer: Group Health Inc Commercial |
$22.97
|
| Rate for Payer: Group Health Inc Medicare |
$16.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$22.97
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$22.97
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$0.45
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$0.48
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$0.48
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$0.48
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$29.87
|
|
|
CEFTRIAXONE SODIUM 1 G IJ SOLR [9487]
|
Facility
|
OP
|
$46.00
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
00781320895
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$36.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$25.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.50
|
| Rate for Payer: Aetna Government |
$0.50
|
| Rate for Payer: Brighton Health Commercial |
$34.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$36.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$31.28
|
| Rate for Payer: Group Health Inc Commercial |
$23.00
|
| Rate for Payer: Group Health Inc Medicare |
$16.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$23.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$23.00
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$0.45
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$0.48
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$0.48
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$0.48
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$29.90
|
|
|
CEFTRIAXONE SODIUM 1 G IJ SOLR [9487]
|
Facility
|
OP
|
$1.49
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
25021010667
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$1.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.82
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.50
|
| Rate for Payer: Aetna Government |
$0.50
|
| Rate for Payer: Brighton Health Commercial |
$1.12
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.02
|
| Rate for Payer: Group Health Inc Commercial |
$0.75
|
| Rate for Payer: Group Health Inc Medicare |
$0.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.75
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$0.45
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$0.48
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$0.48
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$0.48
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.97
|
|
|
CEFTRIAXONE SODIUM 1 G IJ SOLR [9487]
|
Facility
|
OP
|
$45.95
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
60505614800
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$36.76 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$25.27
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.50
|
| Rate for Payer: Aetna Government |
$0.50
|
| Rate for Payer: Brighton Health Commercial |
$34.46
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$36.76
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$31.25
|
| Rate for Payer: Group Health Inc Commercial |
$22.98
|
| Rate for Payer: Group Health Inc Medicare |
$16.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$22.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$22.98
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$0.45
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$0.48
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$0.48
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$0.48
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$29.87
|
|
|
CEFTRIAXONE SODIUM 1 G IJ SOLR [9487]
|
Facility
|
OP
|
$2.88
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
25021010610
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$2.30 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.58
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.50
|
| Rate for Payer: Aetna Government |
$0.50
|
| Rate for Payer: Brighton Health Commercial |
$2.16
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.30
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.96
|
| Rate for Payer: Group Health Inc Commercial |
$1.44
|
| Rate for Payer: Group Health Inc Medicare |
$1.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.44
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$0.45
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$0.48
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$0.48
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$0.48
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.87
|
|
|
CEFTRIAXONE SODIUM 1 G IJ SOLR [9487]
|
Facility
|
OP
|
$1.83
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
00409733201
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$1.46 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.50
|
| Rate for Payer: Aetna Government |
$0.50
|
| Rate for Payer: Brighton Health Commercial |
$1.37
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.46
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.24
|
| Rate for Payer: Group Health Inc Commercial |
$0.91
|
| Rate for Payer: Group Health Inc Medicare |
$0.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.91
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.91
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$0.45
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$0.48
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$0.48
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$0.48
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.19
|
|
|
CEFTRIAXONE SODIUM 250 MG IJ SOLR [9489]
|
Facility
|
OP
|
$0.91
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
00409733701
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$0.73 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.50
|
| Rate for Payer: Aetna Government |
$0.50
|
| Rate for Payer: Brighton Health Commercial |
$0.69
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.73
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.62
|
| Rate for Payer: Group Health Inc Commercial |
$0.46
|
| Rate for Payer: Group Health Inc Medicare |
$0.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.46
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$0.45
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$0.48
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$0.48
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$0.48
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.59
|
|
|
CEFTRIAXONE SODIUM 250 MG IJ SOLR [9489]
|
Facility
|
OP
|
$15.94
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
60505615104
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$12.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$8.77
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.50
|
| Rate for Payer: Aetna Government |
$0.50
|
| Rate for Payer: Brighton Health Commercial |
$11.96
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$12.75
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$10.84
|
| Rate for Payer: Group Health Inc Commercial |
$7.97
|
| Rate for Payer: Group Health Inc Medicare |
$5.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.97
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.97
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$0.45
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$0.48
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$0.48
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$0.48
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$10.36
|
|
|
CEFTRIAXONE SODIUM 250 MG IJ SOLR [9489]
|
Facility
|
OP
|
$14.82
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
60505615101
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$11.85 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$8.15
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.50
|
| Rate for Payer: Aetna Government |
$0.50
|
| Rate for Payer: Brighton Health Commercial |
$11.11
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$11.85
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$10.07
|
| Rate for Payer: Group Health Inc Commercial |
$7.41
|
| Rate for Payer: Group Health Inc Medicare |
$5.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.41
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.41
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$0.45
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$0.48
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$0.48
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$0.48
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$9.63
|
|
|
CEFTRIAXONE SODIUM 250 MG IJ SOLR [9489]
|
Facility
|
OP
|
$1.78
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
00781320685
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$1.42 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.98
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.50
|
| Rate for Payer: Aetna Government |
$0.50
|
| Rate for Payer: Brighton Health Commercial |
$1.34
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.42
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.21
|
| Rate for Payer: Group Health Inc Commercial |
$0.89
|
| Rate for Payer: Group Health Inc Medicare |
$0.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.89
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.89
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$0.45
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$0.48
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$0.48
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$0.48
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.16
|
|
|
CEFTRIAXONE SODIUM 250 MG IJ SOLR [9489]
|
Facility
|
OP
|
$14.83
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
00781320695
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$11.87 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$8.16
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.50
|
| Rate for Payer: Aetna Government |
$0.50
|
| Rate for Payer: Brighton Health Commercial |
$11.12
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$11.87
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$10.09
|
| Rate for Payer: Group Health Inc Commercial |
$7.42
|
| Rate for Payer: Group Health Inc Medicare |
$5.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.42
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$0.45
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$0.48
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$0.48
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$0.48
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$9.64
|
|
|
CEFTRIAXONE SODIUM 2 G IJ SOLR [9488]
|
Facility
|
OP
|
$91.31
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
60505614904
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$73.05 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$50.22
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.50
|
| Rate for Payer: Aetna Government |
$0.50
|
| Rate for Payer: Brighton Health Commercial |
$68.48
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$73.05
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$62.09
|
| Rate for Payer: Group Health Inc Commercial |
$45.65
|
| Rate for Payer: Group Health Inc Medicare |
$31.96
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$45.65
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$45.65
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$0.45
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$0.48
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$0.48
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$0.48
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$59.35
|
|
|
CEFTRIAXONE SODIUM 2 G IJ SOLR [9488]
|
Facility
|
OP
|
$91.41
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
00781320995
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$73.13 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$50.27
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.50
|
| Rate for Payer: Aetna Government |
$0.50
|
| Rate for Payer: Brighton Health Commercial |
$68.56
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$73.13
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$62.16
|
| Rate for Payer: Group Health Inc Commercial |
$45.70
|
| Rate for Payer: Group Health Inc Medicare |
$31.99
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$45.70
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$45.70
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$0.45
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$0.48
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$0.48
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$0.48
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$59.42
|
|
|
CEFTRIAXONE SODIUM 2 G IJ SOLR [9488]
|
Facility
|
OP
|
$5.28
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
25021010720
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$4.22 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.50
|
| Rate for Payer: Aetna Government |
$0.50
|
| Rate for Payer: Brighton Health Commercial |
$3.96
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.22
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.59
|
| Rate for Payer: Group Health Inc Commercial |
$2.64
|
| Rate for Payer: Group Health Inc Medicare |
$1.85
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.64
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$0.45
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$0.48
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$0.48
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$0.48
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.43
|
|
|
CEFTRIAXONE SODIUM 2 G IJ SOLR [9488]
|
Facility
|
OP
|
$7.20
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
44567070225
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$5.76 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.96
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.50
|
| Rate for Payer: Aetna Government |
$0.50
|
| 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 |
$0.45
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$0.48
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$0.48
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$0.48
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.68
|
|
|
CEFTRIAXONE SODIUM 2 G IJ SOLR [9488]
|
Facility
|
OP
|
$3.60
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
00143985601
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$2.88 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.98
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.50
|
| Rate for Payer: Aetna Government |
$0.50
|
| Rate for Payer: Brighton Health Commercial |
$2.70
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.88
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.45
|
| Rate for Payer: Group Health Inc Commercial |
$1.80
|
| Rate for Payer: Group Health Inc Medicare |
$1.26
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.80
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$0.45
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$0.48
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$0.48
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$0.48
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.34
|
|
|
CEFTRIAXONE SODIUM 500 MG IJ SOLR [9490]
|
Facility
|
OP
|
$26.88
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
00781320795
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$21.51 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$14.79
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.50
|
| Rate for Payer: Aetna Government |
$0.50
|
| Rate for Payer: Brighton Health Commercial |
$20.16
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$21.51
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$18.28
|
| Rate for Payer: Group Health Inc Commercial |
$13.44
|
| Rate for Payer: Group Health Inc Medicare |
$9.41
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$13.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.44
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$0.45
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$0.48
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$0.48
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$0.48
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$17.47
|
|
