|
DIASOL 4.5 DXTRSE 1000CC
|
Facility
OP
|
$34.02
|
|
| Hospital Charge Code |
40509824
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$11.91 |
| Max. Negotiated Rate |
$27.22 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$18.71
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$17.01
|
| Rate for Payer: Aetna Government |
$17.01
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$27.22
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$23.13
|
| Rate for Payer: Group Health Inc Commercial |
$17.01
|
| Rate for Payer: Group Health Inc Medicare |
$11.91
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$17.01
|
|
|
DIASOL NSN-4 120 3.43 L
|
Facility
OP
|
$77.96
|
|
| Hospital Charge Code |
40509827
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$27.29 |
| Max. Negotiated Rate |
$62.37 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$42.88
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$38.98
|
| Rate for Payer: Aetna Government |
$38.98
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$62.37
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$53.01
|
| Rate for Payer: Group Health Inc Commercial |
$38.98
|
| Rate for Payer: Group Health Inc Medicare |
$27.29
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$38.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$38.98
|
|
|
DIASOL OCM POTASS. 3.43L
|
Facility
OP
|
$20.91
|
|
| Hospital Charge Code |
40509828
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$7.32 |
| Max. Negotiated Rate |
$16.73 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$11.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$10.46
|
| Rate for Payer: Aetna Government |
$10.46
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$16.73
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$14.22
|
| Rate for Payer: Group Health Inc Commercial |
$10.46
|
| Rate for Payer: Group Health Inc Medicare |
$7.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$10.46
|
|
|
DIATRIZOATE 15 ML SOLN
|
Facility
OP
|
$28.00
|
|
| Hospital Charge Code |
41653200
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.80 |
| Max. Negotiated Rate |
$22.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$15.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$14.00
|
| Rate for Payer: Aetna Government |
$14.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$22.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$19.04
|
| Rate for Payer: Group Health Inc Commercial |
$14.00
|
| Rate for Payer: Group Health Inc Medicare |
$9.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$18.20
|
|
|
DIATRIZOATE 15 ML SOLN
|
Facility
OP
|
$28.00
|
|
| Hospital Charge Code |
41643200
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.80 |
| Max. Negotiated Rate |
$22.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$15.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$14.00
|
| Rate for Payer: Aetna Government |
$14.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$22.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$19.04
|
| Rate for Payer: Group Health Inc Commercial |
$14.00
|
| Rate for Payer: Group Health Inc Medicare |
$9.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$18.20
|
|
|
DIAZEPAM 2 MG TAB
|
Facility
OP
|
$1.00
|
|
| Hospital Charge Code |
41641315
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$0.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.50
|
| Rate for Payer: Aetna Government |
$0.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.68
|
| Rate for Payer: Group Health Inc Commercial |
$0.50
|
| Rate for Payer: Group Health Inc Medicare |
$0.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.65
|
|
|
DIAZEPAM 2 MG TAB
|
Facility
OP
|
$1.00
|
|
| Hospital Charge Code |
41651315
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$0.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.50
|
| Rate for Payer: Aetna Government |
$0.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.68
|
| Rate for Payer: Group Health Inc Commercial |
$0.50
|
| Rate for Payer: Group Health Inc Medicare |
$0.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.65
|
|
|
DIAZEPAM 5 MG/5 ML ELIXIR
|
Facility
OP
|
$4.00
|
|
| Hospital Charge Code |
41642078
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.40 |
| Max. Negotiated Rate |
$3.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.20
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.00
|
| Rate for Payer: Aetna Government |
$2.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.72
|
| Rate for Payer: Group Health Inc Commercial |
$2.00
|
| Rate for Payer: Group Health Inc Medicare |
$1.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.60
|
|
|
DIAZEPAM 5 MG/5 ML ELIXIR
|
Facility
OP
|
$4.00
|
|
| Hospital Charge Code |
41652078
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.40 |
| Max. Negotiated Rate |
$3.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.20
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.00
|
| Rate for Payer: Aetna Government |
$2.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.72
|
| Rate for Payer: Group Health Inc Commercial |
$2.00
|
| Rate for Payer: Group Health Inc Medicare |
$1.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.60
|
|
|
DIAZEPAM 5 MG/ML INJ CARTRIDGE
|
Facility
OP
|
$2.11
|
|
| Hospital Charge Code |
41644247
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.74 |
| Max. Negotiated Rate |
$1.37 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.16
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.06
|
| Rate for Payer: Aetna Government |
$1.06
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.06
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.21
|
| Rate for Payer: Group Health Inc Commercial |
$1.06
|
| Rate for Payer: Group Health Inc Medicare |
$0.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.37
|
|
|
DIAZEPAM 5 MG/ML INJ CARTRIDGE
|
Facility
OP
|
$2.11
|
|
| Hospital Charge Code |
41654247
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.74 |
| Max. Negotiated Rate |
$1.37 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.16
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.06
|
| Rate for Payer: Aetna Government |
$1.06
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.06
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.21
|
| Rate for Payer: Group Health Inc Commercial |
$1.06
|
| Rate for Payer: Group Health Inc Medicare |
$0.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.37
|
|
|
DIAZEPAM 5 MG/ML INJ CARTRIDGE
|
Facility
IP
|
$2.11
|
|
| Hospital Charge Code |
41644247
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.06 |
| Max. Negotiated Rate |
$1.06 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.06
|
|
|
DIAZEPAM 5 MG/ML INJ CARTRIDGE
|
Facility
IP
|
$2.11
|
|
| Hospital Charge Code |
41654247
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.06 |
| Max. Negotiated Rate |
$1.06 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.06
|
|
|
DIAZEPAM 5 MG TAB
|
Facility
OP
|
$1.00
|
|
| Hospital Charge Code |
41650240
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$0.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.50
|
| Rate for Payer: Aetna Government |
$0.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.68
|
| Rate for Payer: Group Health Inc Commercial |
$0.50
|
| Rate for Payer: Group Health Inc Medicare |
$0.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.65
|
|
|
DIAZEPAM 5 MG TAB
|
Facility
OP
|
$1.00
|
|
| Hospital Charge Code |
41640240
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$0.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.50
|
| Rate for Payer: Aetna Government |
$0.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.68
|
| Rate for Payer: Group Health Inc Commercial |
$0.50
|
| Rate for Payer: Group Health Inc Medicare |
$0.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.65
|
|
|
DIAZEPAM RECTAL 10 MG
|
Facility
OP
|
$325.00
|
|
| Hospital Charge Code |
41654299
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$113.75 |
| Max. Negotiated Rate |
$260.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$178.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$162.50
|
| Rate for Payer: Aetna Government |
$162.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$260.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$221.00
|
| Rate for Payer: Group Health Inc Commercial |
$162.50
|
| Rate for Payer: Group Health Inc Medicare |
$113.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$162.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$162.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$211.25
|
|
|
DIAZEPAM RECTAL 10 MG
|
Facility
OP
|
$325.00
|
|
| Hospital Charge Code |
41644299
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$113.75 |
| Max. Negotiated Rate |
$260.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$178.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$162.50
|
| Rate for Payer: Aetna Government |
$162.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$260.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$221.00
|
| Rate for Payer: Group Health Inc Commercial |
$162.50
|
| Rate for Payer: Group Health Inc Medicare |
$113.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$162.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$162.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$211.25
|
|
|
DIAZEPAM RECTAL 2.5 MG
|
Facility
OP
|
$267.25
|
|
| Hospital Charge Code |
41652927
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$93.54 |
| Max. Negotiated Rate |
$213.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$146.99
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$133.62
|
| Rate for Payer: Aetna Government |
$133.62
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$213.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$181.73
|
| Rate for Payer: Group Health Inc Commercial |
$133.62
|
| Rate for Payer: Group Health Inc Medicare |
$93.54
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$133.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$133.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$173.71
|
|
|
DIAZEPAM RECTAL 2.5 MG
|
Facility
OP
|
$267.25
|
|
| Hospital Charge Code |
41642927
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$93.54 |
| Max. Negotiated Rate |
$213.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$146.99
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$133.62
|
| Rate for Payer: Aetna Government |
$133.62
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$213.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$181.73
|
| Rate for Payer: Group Health Inc Commercial |
$133.62
|
| Rate for Payer: Group Health Inc Medicare |
$93.54
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$133.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$133.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$173.71
|
|
|
DIAZOXIDE 50 MG/ML SUSP 30 ML
|
Facility
OP
|
$2.10
|
|
| Hospital Charge Code |
41643858
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.74 |
| Max. Negotiated Rate |
$1.68 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.16
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.05
|
| Rate for Payer: Aetna Government |
$1.05
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.68
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.43
|
| Rate for Payer: Group Health Inc Commercial |
$1.05
|
| Rate for Payer: Group Health Inc Medicare |
$0.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.36
|
|
|
DIAZOXIDE 50 MG/ML SUSP 30 ML
|
Facility
OP
|
$2.10
|
|
| Hospital Charge Code |
41653858
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.74 |
| Max. Negotiated Rate |
$1.68 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.16
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.05
|
| Rate for Payer: Aetna Government |
$1.05
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.68
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.43
|
| Rate for Payer: Group Health Inc Commercial |
$1.05
|
| Rate for Payer: Group Health Inc Medicare |
$0.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.36
|
|
|
DICLOXACILLIN 250 MG CAP
|
Facility
OP
|
$1.00
|
|
| Hospital Charge Code |
41643466
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$0.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.50
|
| Rate for Payer: Aetna Government |
$0.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.68
|
| Rate for Payer: Group Health Inc Commercial |
$0.50
|
| Rate for Payer: Group Health Inc Medicare |
$0.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.65
|
|
|
DICLOXACILLIN 250 MG CAP
|
Facility
OP
|
$1.00
|
|
| Hospital Charge Code |
41653466
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$0.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.50
|
| Rate for Payer: Aetna Government |
$0.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.68
|
| Rate for Payer: Group Health Inc Commercial |
$0.50
|
| Rate for Payer: Group Health Inc Medicare |
$0.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.65
|
|
|
DICLOXACILLIN 500 MG CAP
|
Facility
OP
|
$1.00
|
|
| Hospital Charge Code |
41643467
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$0.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.50
|
| Rate for Payer: Aetna Government |
$0.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.68
|
| Rate for Payer: Group Health Inc Commercial |
$0.50
|
| Rate for Payer: Group Health Inc Medicare |
$0.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.65
|
|
|
DICLOXACILLIN 500 MG CAP
|
Facility
OP
|
$1.00
|
|
| Hospital Charge Code |
41653467
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$0.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.50
|
| Rate for Payer: Aetna Government |
$0.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.68
|
| Rate for Payer: Group Health Inc Commercial |
$0.50
|
| Rate for Payer: Group Health Inc Medicare |
$0.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.65
|
|
