|
CESAREAN DELIV AFTER ATTEMP VAG D
|
Facility
|
OP
|
$2,774.75
|
|
|
Service Code
|
HCPCS 59620
|
| Hospital Charge Code |
40052242
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$971.16 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,526.11
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,137.59
|
| Rate for Payer: Aetna Government |
$1,137.59
|
| Rate for Payer: Brighton Health Commercial |
$2,081.06
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Group Health Inc Commercial |
$1,387.38
|
| Rate for Payer: Group Health Inc Medicare |
$971.16
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,387.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,387.38
|
|
|
CESAREAN DELIVERY ONLY
|
Facility
|
OP
|
$9,079.36
|
|
|
Service Code
|
HCPCS 59514
|
| Hospital Charge Code |
40052238
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,111.54 |
| Max. Negotiated Rate |
$6,809.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4,993.65
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,111.54
|
| Rate for Payer: Aetna Government |
$1,111.54
|
| Rate for Payer: Brighton Health Commercial |
$6,809.52
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Group Health Inc Commercial |
$4,539.68
|
| Rate for Payer: Group Health Inc Medicare |
$3,177.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,539.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,539.68
|
|
|
CESAREAN DELIVRY INCLD ANTE/POSTP
|
Facility
|
OP
|
$10,441.26
|
|
|
Service Code
|
HCPCS 59510
|
| Hospital Charge Code |
40002232
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,505.00 |
| Max. Negotiated Rate |
$7,830.94 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5,742.69
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,295.00
|
| Rate for Payer: Aetna Government |
$2,295.00
|
| Rate for Payer: Brighton Health Commercial |
$7,830.94
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Group Health Inc Commercial |
$5,220.63
|
| Rate for Payer: Group Health Inc Medicare |
$3,654.44
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5,220.63
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5,220.63
|
|
|
CESAREAN SECTION WITHOUT STERILIZATION WITH CC
|
Facility
|
IP
|
$30,117.78
|
|
|
Service Code
|
MSDRG 787
|
| Min. Negotiated Rate |
$9,013.18 |
| Max. Negotiated Rate |
$30,117.78 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$15,498.47
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$21,903.84
|
| Rate for Payer: Aetna Government |
$21,903.84
|
| Rate for Payer: Brighton Health Commercial |
$15,240.95
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$22,341.92
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$18,151.45
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$14,979.35
|
| Rate for Payer: Elderplan Medicare Advantage |
$20,808.65
|
| Rate for Payer: EmblemHealth Commercial |
$9,013.18
|
| Rate for Payer: Fidelis Medicare Advantage |
$21,903.84
|
| Rate for Payer: Group Health Inc Commercial |
$21,903.84
|
| Rate for Payer: Group Health Inc Medicare |
$21,903.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$21,903.84
|
| Rate for Payer: Healthfirst Medicare Advantage |
$10,185.29
|
| Rate for Payer: Humana Medicare |
$30,117.78
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$21,903.84
|
| Rate for Payer: United Healthcare Commercial |
$20,903.23
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21,903.84
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$21,903.84
|
| Rate for Payer: Wellcare Medicare |
$20,808.65
|
|
|
CESAREAN SECTION WITHOUT STERILIZATION WITH MCC
|
Facility
|
IP
|
$43,434.63
|
|
|
Service Code
|
MSDRG 786
|
| Min. Negotiated Rate |
$14,688.80 |
| Max. Negotiated Rate |
$43,434.63 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$25,796.38
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$31,588.82
|
| Rate for Payer: Aetna Government |
$31,588.82
|
| Rate for Payer: Brighton Health Commercial |
$25,367.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$32,220.60
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$30,212.12
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$24,932.33
|
| Rate for Payer: Elderplan Medicare Advantage |
$30,009.38
|
| Rate for Payer: EmblemHealth Commercial |
$15,002.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$31,588.82
|
| Rate for Payer: Group Health Inc Commercial |
$31,588.82
|
| Rate for Payer: Group Health Inc Medicare |
$31,588.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$31,588.82
|
| Rate for Payer: Healthfirst Medicare Advantage |
$14,688.80
|
| Rate for Payer: Humana Medicare |
$43,434.63
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$31,588.82
|
| Rate for Payer: United Healthcare Commercial |
$34,792.31
|
| Rate for Payer: United Healthcare Medicare Advantage |
$31,588.82
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$31,588.82
|
| Rate for Payer: Wellcare Medicare |
$30,009.38
|
|
|
CESAREAN SECTION WITHOUT STERILIZATION WITHOUT CC/MCC
|
Facility
|
IP
|
$26,378.63
|
|
|
Service Code
|
MSDRG 788
|
| Min. Negotiated Rate |
$7,331.63 |
| Max. Negotiated Rate |
$26,378.63 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$12,606.98
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$19,184.46
|
| Rate for Payer: Aetna Government |
$19,184.46
|
| Rate for Payer: Brighton Health Commercial |
$12,397.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$19,568.15
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$14,765.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$12,184.71
|
| Rate for Payer: Elderplan Medicare Advantage |
$18,225.24
|
| Rate for Payer: EmblemHealth Commercial |
$7,331.63
|
| Rate for Payer: Fidelis Medicare Advantage |
$19,184.46
|
| Rate for Payer: Group Health Inc Commercial |
$19,184.46
|
| Rate for Payer: Group Health Inc Medicare |
$19,184.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$19,184.46
|
| Rate for Payer: Healthfirst Medicare Advantage |
$8,920.77
|
| Rate for Payer: Humana Medicare |
$26,378.63
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$19,184.46
|
| Rate for Payer: United Healthcare Commercial |
$17,003.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19,184.46
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$19,184.46
|
| Rate for Payer: Wellcare Medicare |
$18,225.24
|
|
|
CESAREAN SECTION WITH STERILIZATION WITH CC
|
Facility
|
IP
|
$29,602.97
|
|
|
Service Code
|
MSDRG 784
|
| Min. Negotiated Rate |
$8,781.66 |
| Max. Negotiated Rate |
$29,602.97 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$15,100.35
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$21,529.43
|
| Rate for Payer: Aetna Government |
$21,529.43
|
| Rate for Payer: Brighton Health Commercial |
$14,849.45
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$21,960.02
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$17,685.18
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$14,594.57
|
| Rate for Payer: Elderplan Medicare Advantage |
$20,452.96
|
| Rate for Payer: EmblemHealth Commercial |
$8,781.66
|
| Rate for Payer: Fidelis Medicare Advantage |
$21,529.43
|
| Rate for Payer: Group Health Inc Commercial |
$21,529.43
|
| Rate for Payer: Group Health Inc Medicare |
$21,529.43
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$21,529.43
|
| Rate for Payer: Healthfirst Medicare Advantage |
$10,011.18
|
| Rate for Payer: Humana Medicare |
$29,602.97
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$21,529.43
|
| Rate for Payer: United Healthcare Commercial |
$20,366.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21,529.43
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$21,529.43
|
| Rate for Payer: Wellcare Medicare |
$20,452.96
|
|
|
CESAREAN SECTION WITH STERILIZATION WITH MCC
|
Facility
|
IP
|
$43,859.87
|
|
|
Service Code
|
MSDRG 783
|
| Min. Negotiated Rate |
$14,832.61 |
| Max. Negotiated Rate |
$43,859.87 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$26,125.19
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$31,898.09
|
| Rate for Payer: Aetna Government |
$31,898.09
|
| Rate for Payer: Brighton Health Commercial |
$25,691.10
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$32,536.05
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$30,597.21
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$25,250.13
|
| Rate for Payer: Elderplan Medicare Advantage |
$30,303.19
|
| Rate for Payer: EmblemHealth Commercial |
$15,193.20
|
| Rate for Payer: Fidelis Medicare Advantage |
$31,898.09
|
| Rate for Payer: Group Health Inc Commercial |
$31,898.09
|
| Rate for Payer: Group Health Inc Medicare |
$31,898.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$31,898.09
|
| Rate for Payer: Healthfirst Medicare Advantage |
$14,832.61
|
| Rate for Payer: Humana Medicare |
$43,859.87
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$31,898.09
|
| Rate for Payer: United Healthcare Commercial |
$35,235.79
|
| Rate for Payer: United Healthcare Medicare Advantage |
$31,898.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$31,898.09
|
| Rate for Payer: Wellcare Medicare |
$30,303.19
|
|
|
CESAREAN SECTION WITH STERILIZATION WITHOUT CC/MCC
|
Facility
|
IP
|
$26,594.10
|
|
|
Service Code
|
MSDRG 785
|
| Min. Negotiated Rate |
$7,428.52 |
| Max. Negotiated Rate |
$26,594.10 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$12,773.59
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$19,341.16
|
| Rate for Payer: Aetna Government |
$19,341.16
|
| Rate for Payer: Brighton Health Commercial |
$12,561.35
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$19,727.98
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$14,960.13
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$12,345.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$18,374.10
|
| Rate for Payer: EmblemHealth Commercial |
$7,428.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$19,341.16
|
| Rate for Payer: Group Health Inc Commercial |
$19,341.16
|
| Rate for Payer: Group Health Inc Medicare |
$19,341.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$19,341.16
|
| Rate for Payer: Healthfirst Medicare Advantage |
$8,993.64
|
| Rate for Payer: Humana Medicare |
$26,594.10
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$19,341.16
|
| Rate for Payer: United Healthcare Commercial |
$17,228.11
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19,341.16
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$19,341.16
|
| Rate for Payer: Wellcare Medicare |
$18,374.10
|
|
|
CESSJ THERAPY CATH REMOVAL
|
Facility
|
IP
|
$4,940.28
|
|
|
Service Code
|
HCPCS 37214
|
| Hospital Charge Code |
41102604
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$3,686.08
|
|
|
CESSJ THERAPY CATH REMOVAL
|
Facility
|
OP
|
$4,940.28
|
|
|
Service Code
|
HCPCS 37214
|
| Hospital Charge Code |
41102604
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,188.00 |
| Max. Negotiated Rate |
$3,759.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,686.08
|
| Rate for Payer: Aetna Government |
$3,686.08
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2,580.26
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2,580.26
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2,580.26
|
| Rate for Payer: Brighton Health Commercial |
$3,705.21
|
| Rate for Payer: Cash Price |
$3,686.08
|
| Rate for Payer: Cash Price |
$3,686.08
|
| Rate for Payer: Cash Price |
$3,686.08
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,686.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$3,686.08
|
| Rate for Payer: EmblemHealth Commercial |
$3,686.08
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,133.17
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,280.61
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,686.08
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,280.61
|
| Rate for Payer: Group Health Inc Commercial |
$3,686.08
|
| Rate for Payer: Group Health Inc Medicare |
$3,686.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,470.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,686.08
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,133.17
|
| Rate for Payer: Healthfirst QHP |
$3,686.08
|
| Rate for Payer: Humana Medicare |
$3,759.80
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,686.08
|
| Rate for Payer: United Healthcare Commercial |
$1,188.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,686.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,686.08
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,948.86
|
| Rate for Payer: Wellcare Medicare |
$3,501.78
|
|
|
CETIRIIZINE 10 MG TABLET
|
Facility
|
OP
|
$0.10
|
|
| Hospital Charge Code |
41646085
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.08 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.06
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.05
|
| Rate for Payer: Aetna Government |
$0.05
|
| Rate for Payer: Brighton Health Commercial |
$0.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.08
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.07
|
| Rate for Payer: Group Health Inc Commercial |
$0.05
|
| Rate for Payer: Group Health Inc Medicare |
$0.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.07
|
|
|
CETIRIIZINE 1 MG/1ML SYRUP
|
Facility
|
OP
|
$0.04
|
|
| Hospital Charge Code |
41656083
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.02
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.02
|
| Rate for Payer: Aetna Government |
$0.02
|
| Rate for Payer: Brighton Health Commercial |
$0.03
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.03
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.03
|
| Rate for Payer: Group Health Inc Commercial |
$0.02
|
| Rate for Payer: Group Health Inc Medicare |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.03
|
|
|
CETIRIIZINE 1MG/1ML SYRUP
|
Facility
|
OP
|
$0.04
|
|
| Hospital Charge Code |
41646083
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.02
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.02
|
| Rate for Payer: Aetna Government |
$0.02
|
| Rate for Payer: Brighton Health Commercial |
$0.03
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.03
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.03
|
| Rate for Payer: Group Health Inc Commercial |
$0.02
|
| Rate for Payer: Group Health Inc Medicare |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.03
|
|
|
CETIRIIZINE 5 MG TABLET
|
Facility
|
OP
|
$0.13
|
|
| Hospital Charge Code |
41646084
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.10 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.07
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.07
|
| Rate for Payer: Aetna Government |
$0.07
|
| Rate for Payer: Brighton Health Commercial |
$0.10
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.10
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.09
|
| Rate for Payer: Group Health Inc Commercial |
$0.07
|
| Rate for Payer: Group Health Inc Medicare |
$0.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.07
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.07
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.08
|
|
|
CETIRIZINE 10 MG TABLET
|
Facility
|
OP
|
$0.10
|
|
| Hospital Charge Code |
41656085
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.08 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.06
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.05
|
| Rate for Payer: Aetna Government |
$0.05
|
| Rate for Payer: Brighton Health Commercial |
$0.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.08
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.07
|
| Rate for Payer: Group Health Inc Commercial |
$0.05
|
| Rate for Payer: Group Health Inc Medicare |
$0.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.07
|
|
|
CETIRIZINE HCL 10 MG PO TABS [9506]
|
Facility
|
OP
|
$0.11
|
|
|
Service Code
|
NDC 00904671746
|
| Hospital Charge Code |
00904671746
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.09 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.06
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.05
|
| Rate for Payer: Aetna Government |
$0.05
|
| Rate for Payer: Brighton Health Commercial |
$0.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.09
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.07
|
| Rate for Payer: Group Health Inc Commercial |
$0.05
|
| Rate for Payer: Group Health Inc Medicare |
$0.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.07
|
|
|
CETIRIZINE HCL 10 MG PO TABS [9506]
|
Facility
|
OP
|
$2.49
|
|
|
Service Code
|
NDC 16571040250
|
| Hospital Charge Code |
16571040250
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.87 |
| Max. Negotiated Rate |
$2.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.37
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.25
|
| Rate for Payer: Aetna Government |
$1.25
|
| Rate for Payer: Brighton Health Commercial |
$1.87
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.70
|
| Rate for Payer: Group Health Inc Commercial |
$1.25
|
| Rate for Payer: Group Health Inc Medicare |
$0.87
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.62
|
|
|
CETIRIZINE HCL 10 MG PO TABS [9506]
|
Facility
|
OP
|
$2.49
|
|
|
Service Code
|
NDC 51079059720
|
| Hospital Charge Code |
51079059720
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.87 |
| Max. Negotiated Rate |
$2.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.37
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.25
|
| Rate for Payer: Aetna Government |
$1.25
|
| Rate for Payer: Brighton Health Commercial |
$1.87
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.70
|
| Rate for Payer: Group Health Inc Commercial |
$1.25
|
| Rate for Payer: Group Health Inc Medicare |
$0.87
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.62
|
|
|
CETIRIZINE HCL 10 MG PO TABS [9506]
|
Facility
|
OP
|
$0.03
|
|
|
Service Code
|
NDC 43598081115
|
| Hospital Charge Code |
43598081115
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.02 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.01
|
| Rate for Payer: Aetna Government |
$0.01
|
| Rate for Payer: Brighton Health Commercial |
$0.02
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.02
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.02
|
| Rate for Payer: Group Health Inc Commercial |
$0.01
|
| Rate for Payer: Group Health Inc Medicare |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.02
|
|
|
CETIRIZINE HCL 10 MG PO TABS [9506]
|
Facility
|
OP
|
$0.05
|
|
|
Service Code
|
NDC 00904671760
|
| Hospital Charge Code |
00904671760
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.04 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.03
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.03
|
| Rate for Payer: Aetna Government |
$0.03
|
| Rate for Payer: Brighton Health Commercial |
$0.04
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.04
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.04
|
| Rate for Payer: Group Health Inc Commercial |
$0.03
|
| Rate for Payer: Group Health Inc Medicare |
$0.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.03
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.03
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.03
|
|
|
CETIRIZINE HCL 10 MG PO TABS [9506]
|
Facility
|
OP
|
$0.07
|
|
|
Service Code
|
NDC 43598081112
|
| Hospital Charge Code |
43598081112
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.06 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.04
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.04
|
| Rate for Payer: Aetna Government |
$0.04
|
| Rate for Payer: Brighton Health Commercial |
$0.05
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.06
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.05
|
| Rate for Payer: Group Health Inc Commercial |
$0.04
|
| Rate for Payer: Group Health Inc Medicare |
$0.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.04
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.05
|
|
|
CETIRIZINE HCL 10 MG PO TABS [9506]
|
Facility
|
OP
|
$0.15
|
|
|
Service Code
|
NDC 00904671761
|
| Hospital Charge Code |
00904671761
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.12 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.08
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.08
|
| Rate for Payer: Aetna Government |
$0.08
|
| Rate for Payer: Brighton Health Commercial |
$0.11
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.12
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.10
|
| Rate for Payer: Group Health Inc Commercial |
$0.08
|
| Rate for Payer: Group Health Inc Medicare |
$0.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.10
|
|
|
CETIRIZINE HCL 5 MG/5ML PO SOLN [124409]
|
Facility
|
OP
|
$0.08
|
|
|
Service Code
|
NDC 51672210208
|
| Hospital Charge Code |
51672210208
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.07 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.05
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.04
|
| Rate for Payer: Aetna Government |
$0.04
|
| Rate for Payer: Brighton Health Commercial |
$0.06
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.07
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.06
|
| Rate for Payer: Group Health Inc Commercial |
$0.04
|
| Rate for Payer: Group Health Inc Medicare |
$0.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.04
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.05
|
|
|
CETIRIZINE HCL 5 MG/5ML PO SOLN [124409]
|
Facility
|
OP
|
$0.05
|
|
|
Service Code
|
NDC 00904676520
|
| Hospital Charge Code |
00904676520
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.04 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.03
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.02
|
| Rate for Payer: Aetna Government |
$0.02
|
| Rate for Payer: Brighton Health Commercial |
$0.04
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.04
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.03
|
| Rate for Payer: Group Health Inc Commercial |
$0.02
|
| Rate for Payer: Group Health Inc Medicare |
$0.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.03
|
|
