|
ERYTHROMYCIN 500 MG INJ
|
Facility
OP
|
$165.00
|
|
|
Service Code
|
HCPCS J1364
|
| Hospital Charge Code |
41644363
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$78.43 |
| Max. Negotiated Rate |
$107.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$90.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$98.04
|
| Rate for Payer: Aetna Government |
$98.04
|
| Rate for Payer: Cash Price |
$98.04
|
| Rate for Payer: Cash Price |
$98.04
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$98.04
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$82.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$94.88
|
| Rate for Payer: Elderplan Medicare Advantage |
$98.04
|
| Rate for Payer: EmblemHealth Commercial |
$98.04
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$98.04
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$98.04
|
| Rate for Payer: Fidelis Essential Plan QHP |
$102.94
|
| Rate for Payer: Fidelis Medicare Advantage |
$98.04
|
| Rate for Payer: Fidelis Qualified Health Plan |
$102.94
|
| Rate for Payer: Group Health Inc Commercial |
$98.04
|
| Rate for Payer: Group Health Inc Medicare |
$98.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$82.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$82.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$87.33
|
| Rate for Payer: Healthfirst Medicare Advantage |
$83.33
|
| Rate for Payer: Healthfirst QHP |
$98.04
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$98.04
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$82.52
|
| Rate for Payer: SOMOS Essential |
$82.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$107.25
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$78.43
|
| Rate for Payer: Wellcare Medicare |
$93.14
|
|
|
ERYTHROMYCIN 500 MG INJ
|
Facility
OP
|
$165.00
|
|
|
Service Code
|
HCPCS J1364
|
| Hospital Charge Code |
41654363
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$78.43 |
| Max. Negotiated Rate |
$107.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$90.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$98.04
|
| Rate for Payer: Aetna Government |
$98.04
|
| Rate for Payer: Cash Price |
$98.04
|
| Rate for Payer: Cash Price |
$98.04
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$98.04
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$82.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$94.88
|
| Rate for Payer: Elderplan Medicare Advantage |
$98.04
|
| Rate for Payer: EmblemHealth Commercial |
$98.04
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$98.04
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$98.04
|
| Rate for Payer: Fidelis Essential Plan QHP |
$102.94
|
| Rate for Payer: Fidelis Medicare Advantage |
$98.04
|
| Rate for Payer: Fidelis Qualified Health Plan |
$102.94
|
| Rate for Payer: Group Health Inc Commercial |
$98.04
|
| Rate for Payer: Group Health Inc Medicare |
$98.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$82.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$82.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$87.33
|
| Rate for Payer: Healthfirst Medicare Advantage |
$83.33
|
| Rate for Payer: Healthfirst QHP |
$98.04
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$98.04
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$82.52
|
| Rate for Payer: SOMOS Essential |
$82.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$107.25
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$78.43
|
| Rate for Payer: Wellcare Medicare |
$93.14
|
|
|
ERYTHROMYCIN 500 MG INJ
|
Facility
IP
|
$165.00
|
|
|
Service Code
|
HCPCS J1364
|
| Hospital Charge Code |
41644363
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$82.50 |
| Max. Negotiated Rate |
$82.50 |
| Rate for Payer: Cash Price |
$98.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$82.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$82.50
|
|
|
ERYTHROMYCIN 5 MG/ML INJ PEDIATRIC
|
Facility
OP
|
$2.00
|
|
|
Service Code
|
HCPCS J1364
|
| Hospital Charge Code |
41644364
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$102.94 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$98.04
|
| Rate for Payer: Aetna Government |
$98.04
|
| Rate for Payer: Cash Price |
$98.04
|
| Rate for Payer: Cash Price |
$98.04
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$98.04
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.15
|
| Rate for Payer: Elderplan Medicare Advantage |
$98.04
|
| Rate for Payer: EmblemHealth Commercial |
$98.04
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$98.04
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$98.04
|
| Rate for Payer: Fidelis Essential Plan QHP |
$102.94
|
| Rate for Payer: Fidelis Medicare Advantage |
$98.04
|
| Rate for Payer: Fidelis Qualified Health Plan |
$102.94
|
| Rate for Payer: Group Health Inc Commercial |
$98.04
|
| Rate for Payer: Group Health Inc Medicare |
$98.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$87.33
|
| Rate for Payer: Healthfirst Medicare Advantage |
$83.33
|
| Rate for Payer: Healthfirst QHP |
$98.04
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$98.04
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$82.52
|
| Rate for Payer: SOMOS Essential |
$82.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.30
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$78.43
|
| Rate for Payer: Wellcare Medicare |
$93.14
|
|
|
ERYTHROMYCIN 5 MG/ML INJ PEDIATRIC
|
Facility
OP
|
$2.00
|
|
| Hospital Charge Code |
41654364
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.70 |
| Max. Negotiated Rate |
$1.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.00
|
| Rate for Payer: Aetna Government |
$1.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.36
|
| Rate for Payer: Group Health Inc Commercial |
$1.00
|
| Rate for Payer: Group Health Inc Medicare |
$0.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.30
|
|
|
ERYTHROMYCIN 5 MG/ML INJ PEDIATRIC
|
Facility
IP
|
$2.00
|
|
|
Service Code
|
HCPCS J1364
|
| Hospital Charge Code |
41644364
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$1.00 |
| Rate for Payer: Cash Price |
$98.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.00
|
|
|
ERYTHROMYCIN BASE 250MG CAPSULE
|
Facility
OP
|
$11.97
|
|
| Hospital Charge Code |
41646615
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.19 |
| Max. Negotiated Rate |
$9.58 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.58
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.98
|
| Rate for Payer: Aetna Government |
$5.98
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$9.58
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$8.14
|
| Rate for Payer: Group Health Inc Commercial |
$5.98
|
| Rate for Payer: Group Health Inc Medicare |
$4.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$7.78
|
|
|
ERYTHROMYCIN BASE 250MG CAPSULE
|
Facility
OP
|
$11.97
|
|
| Hospital Charge Code |
41656615
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.19 |
| Max. Negotiated Rate |
$9.58 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.58
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.98
|
| Rate for Payer: Aetna Government |
$5.98
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$9.58
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$8.14
|
| Rate for Payer: Group Health Inc Commercial |
$5.98
|
| Rate for Payer: Group Health Inc Medicare |
$4.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$7.78
|
|
|
ERYTHROMYCIN ETHYLSUCCINATE 40 MG/ML SUS
|
Facility
OP
|
$1.38
|
|
| Hospital Charge Code |
41645223
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.48 |
| Max. Negotiated Rate |
$1.10 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.76
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.69
|
| Rate for Payer: Aetna Government |
$0.69
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.10
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.94
|
| Rate for Payer: Group Health Inc Commercial |
$0.69
|
| Rate for Payer: Group Health Inc Medicare |
$0.48
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.69
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.69
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.90
|
|
|
ERYTHROMYCIN ETHYLSUCCINATE 40 MG/ML SUS
|
Facility
OP
|
$1.38
|
|
| Hospital Charge Code |
41655223
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.48 |
| Max. Negotiated Rate |
$1.10 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.76
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.69
|
| Rate for Payer: Aetna Government |
$0.69
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.10
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.94
|
| Rate for Payer: Group Health Inc Commercial |
$0.69
|
| Rate for Payer: Group Health Inc Medicare |
$0.48
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.69
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.69
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.90
|
|
|
ERYTHROMYCIN + SULFISOXAZOLE 40 MG-120 M
|
Facility
OP
|
$1.00
|
|
| Hospital Charge Code |
41652227
|
|
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
|
|
|
ERYTHROMYCIN + SULFISOXAZOLE 40 MG-120 M
|
Facility
OP
|
$1.00
|
|
| Hospital Charge Code |
41642227
|
|
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
|
|
|
ERYTHROPOIETIN
|
Facility
OP
|
$46.98
|
|
|
Service Code
|
HCPCS 82668
|
| Hospital Charge Code |
40607198
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.03 |
| Max. Negotiated Rate |
$29.89 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$25.84
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$18.79
|
| Rate for Payer: Aetna Government |
$18.79
|
| Rate for Payer: Cash Price |
$18.79
|
| Rate for Payer: Cash Price |
$18.79
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$18.79
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$29.89
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$25.29
|
| Rate for Payer: Elderplan Medicare Advantage |
$18.79
|
| Rate for Payer: EmblemHealth Commercial |
$18.79
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$16.91
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$15.97
|
| Rate for Payer: Fidelis Essential Plan QHP |
$16.72
|
| Rate for Payer: Fidelis Medicare Advantage |
$18.79
|
| Rate for Payer: Fidelis Qualified Health Plan |
$16.72
|
| Rate for Payer: Group Health Inc Commercial |
$18.79
|
| Rate for Payer: Group Health Inc Medicare |
$18.79
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$23.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$18.79
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$18.79
|
| Rate for Payer: Healthfirst Medicare Advantage |
$18.79
|
| Rate for Payer: Healthfirst QHP |
$18.79
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$18.79
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$18.79
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$15.03
|
| Rate for Payer: Wellcare Medicare |
$16.91
|
|
|
ERYTHROPOIETIN (EPO), SERUM
|
Facility
OP
|
$46.98
|
|
|
Service Code
|
HCPCS 82668
|
| Hospital Charge Code |
40609067
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.03 |
| Max. Negotiated Rate |
$29.89 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$25.84
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$18.79
|
| Rate for Payer: Aetna Government |
$18.79
|
| Rate for Payer: Cash Price |
$18.79
|
| Rate for Payer: Cash Price |
$18.79
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$18.79
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$29.89
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$25.29
|
| Rate for Payer: Elderplan Medicare Advantage |
$18.79
|
| Rate for Payer: EmblemHealth Commercial |
$18.79
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$16.91
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$15.97
|
| Rate for Payer: Fidelis Essential Plan QHP |
$16.72
|
| Rate for Payer: Fidelis Medicare Advantage |
$18.79
|
| Rate for Payer: Fidelis Qualified Health Plan |
$16.72
|
| Rate for Payer: Group Health Inc Commercial |
$18.79
|
| Rate for Payer: Group Health Inc Medicare |
$18.79
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$23.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$18.79
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$18.79
|
| Rate for Payer: Healthfirst Medicare Advantage |
$18.79
|
| Rate for Payer: Healthfirst QHP |
$18.79
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$18.79
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$18.79
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$15.03
|
| Rate for Payer: Wellcare Medicare |
$16.91
|
|
|
ESCAPE BASKET 1.9 ZERO DIP
|
Facility
OP
|
$490.00
|
|
| Hospital Charge Code |
40200812
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$171.50 |
| Max. Negotiated Rate |
$392.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$269.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$245.00
|
| Rate for Payer: Aetna Government |
$245.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$392.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$333.20
|
| Rate for Payer: Group Health Inc Commercial |
$245.00
|
| Rate for Payer: Group Health Inc Medicare |
$171.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$245.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$245.00
|
|
|
ESMOLOL 100 MG/10 ML INJ
|
Facility
OP
|
$21.00
|
|
| Hospital Charge Code |
41653366
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.35 |
| Max. Negotiated Rate |
$16.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$11.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$10.50
|
| Rate for Payer: Aetna Government |
$10.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$16.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$14.28
|
| Rate for Payer: Group Health Inc Commercial |
$10.50
|
| Rate for Payer: Group Health Inc Medicare |
$7.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$10.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$13.65
|
|
|
ESMOLOL 100 MG/10 ML INJ
|
Facility
OP
|
$21.00
|
|
| Hospital Charge Code |
41643366
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.35 |
| Max. Negotiated Rate |
$16.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$11.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$10.50
|
| Rate for Payer: Aetna Government |
$10.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$16.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$14.28
|
| Rate for Payer: Group Health Inc Commercial |
$10.50
|
| Rate for Payer: Group Health Inc Medicare |
$7.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$10.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$13.65
|
|
|
ESMOLOL 2500 MG/250 ML PREMIX INJ
|
Facility
OP
|
$282.20
|
|
| Hospital Charge Code |
41643856
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$98.77 |
| Max. Negotiated Rate |
$225.76 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$155.21
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$141.10
|
| Rate for Payer: Aetna Government |
$141.10
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$225.76
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$191.90
|
| Rate for Payer: Group Health Inc Commercial |
$141.10
|
| Rate for Payer: Group Health Inc Medicare |
$98.77
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$141.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$141.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$183.43
|
|
|
ESMOLOL 2500 MG/250 ML PREMIX INJ
|
Facility
OP
|
$282.20
|
|
| Hospital Charge Code |
41653856
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$98.77 |
| Max. Negotiated Rate |
$225.76 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$155.21
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$141.10
|
| Rate for Payer: Aetna Government |
$141.10
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$225.76
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$191.90
|
| Rate for Payer: Group Health Inc Commercial |
$141.10
|
| Rate for Payer: Group Health Inc Medicare |
$98.77
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$141.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$141.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$183.43
|
|
|
ESOMEPRAZOLE 40 MG DR CAP
|
Facility
OP
|
$0.72
|
|
| Hospital Charge Code |
41654370
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.25 |
| Max. Negotiated Rate |
$0.58 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.36
|
| Rate for Payer: Aetna Government |
$0.36
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.58
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.49
|
| Rate for Payer: Group Health Inc Commercial |
$0.36
|
| Rate for Payer: Group Health Inc Medicare |
$0.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.36
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.47
|
|
|
ESOMEPRAZOLE 40 MG DR CAP
|
Facility
OP
|
$0.72
|
|
| Hospital Charge Code |
41644370
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.25 |
| Max. Negotiated Rate |
$0.58 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.36
|
| Rate for Payer: Aetna Government |
$0.36
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.58
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.49
|
| Rate for Payer: Group Health Inc Commercial |
$0.36
|
| Rate for Payer: Group Health Inc Medicare |
$0.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.36
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.47
|
|
|
ESOMEPRAZOLE 40 MG INJ
|
Facility
OP
|
$9.43
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
41644369
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.30 |
| Max. Negotiated Rate |
$6.13 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.19
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.72
|
| Rate for Payer: Aetna Government |
$4.72
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.72
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.42
|
| Rate for Payer: Group Health Inc Commercial |
$4.72
|
| Rate for Payer: Group Health Inc Medicare |
$3.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.72
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6.13
|
|
|
ESOMEPRAZOLE 40 MG INJ
|
Facility
IP
|
$9.43
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
41654369
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.72 |
| Max. Negotiated Rate |
$4.72 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.72
|
|
|
ESOMEPRAZOLE 40 MG INJ
|
Facility
OP
|
$9.43
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
41654369
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.30 |
| Max. Negotiated Rate |
$6.13 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.19
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.72
|
| Rate for Payer: Aetna Government |
$4.72
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.72
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.42
|
| Rate for Payer: Group Health Inc Commercial |
$4.72
|
| Rate for Payer: Group Health Inc Medicare |
$3.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.72
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6.13
|
|
|
ESOMEPRAZOLE 40 MG INJ
|
Facility
IP
|
$9.43
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
41644369
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.72 |
| Max. Negotiated Rate |
$4.72 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.72
|
|
