|
ETHINYL ESTRADIOL + LEVONORGESTREL 0.03
|
Facility
OP
|
$2.00
|
|
| Hospital Charge Code |
41653897
|
|
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
|
|
|
ETHINYL ESTRADIOL + LEVONORGESTREL 0.03
|
Facility
OP
|
$2.00
|
|
| Hospital Charge Code |
41643897
|
|
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
|
|
|
ETHIODIZED OIL INJ - NF
|
Facility
OP
|
$151.00
|
|
| Hospital Charge Code |
41653274
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$52.85 |
| Max. Negotiated Rate |
$120.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$83.05
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$75.50
|
| Rate for Payer: Aetna Government |
$75.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$120.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$102.68
|
| Rate for Payer: Group Health Inc Commercial |
$75.50
|
| Rate for Payer: Group Health Inc Medicare |
$52.85
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$75.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$75.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$98.15
|
|
|
ETHIODIZED OIL INJ - NF
|
Facility
OP
|
$151.00
|
|
| Hospital Charge Code |
41643274
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$52.85 |
| Max. Negotiated Rate |
$120.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$83.05
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$75.50
|
| Rate for Payer: Aetna Government |
$75.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$120.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$102.68
|
| Rate for Payer: Group Health Inc Commercial |
$75.50
|
| Rate for Payer: Group Health Inc Medicare |
$52.85
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$75.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$75.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$98.15
|
|
|
ETHIONAMIDE 250MG TAB
|
Facility
OP
|
$6.96
|
|
| Hospital Charge Code |
41653992
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.44 |
| Max. Negotiated Rate |
$5.57 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.83
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.48
|
| Rate for Payer: Aetna Government |
$3.48
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5.57
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.73
|
| Rate for Payer: Group Health Inc Commercial |
$3.48
|
| Rate for Payer: Group Health Inc Medicare |
$2.44
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.48
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.48
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.52
|
|
|
ETHIONAMIDE 250MG TAB
|
Facility
OP
|
$6.96
|
|
| Hospital Charge Code |
41643992
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.44 |
| Max. Negotiated Rate |
$5.57 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.83
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.48
|
| Rate for Payer: Aetna Government |
$3.48
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5.57
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.73
|
| Rate for Payer: Group Health Inc Commercial |
$3.48
|
| Rate for Payer: Group Health Inc Medicare |
$2.44
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.48
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.48
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.52
|
|
|
ETHI REL ECHELO 60 3.6MM X 60
|
Facility
OP
|
$4,313.76
|
|
| Hospital Charge Code |
40004204
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,509.82 |
| Max. Negotiated Rate |
$3,451.01 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,372.57
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,156.88
|
| Rate for Payer: Aetna Government |
$2,156.88
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3,451.01
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,933.36
|
| Rate for Payer: Group Health Inc Commercial |
$2,156.88
|
| Rate for Payer: Group Health Inc Medicare |
$1,509.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,156.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,156.88
|
|
|
ETHI VENTRAL PATCH 4.3X4.3CM PVPS
|
Facility
IP
|
$1,030.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
40208103
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$515.00 |
| Max. Negotiated Rate |
$515.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$515.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$515.00
|
|
|
ETHI VENTRAL PATCH 4.3X4.3CM PVPS
|
Facility
OP
|
$1,030.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
40208103
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$69.35 |
| Max. Negotiated Rate |
$1,081.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$566.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$69.35
|
| Rate for Payer: Aetna Government |
$69.35
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$515.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$592.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,081.50
|
| Rate for Payer: Group Health Inc Commercial |
$515.00
|
| Rate for Payer: Group Health Inc Medicare |
$360.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$515.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$515.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$669.50
|
|
|
ETHI VENTRAL PTCH 6.4X6.4CM PVPM
|
Facility
OP
|
$1,232.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
40208100
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$69.35 |
| Max. Negotiated Rate |
$1,293.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$677.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$69.35
|
| Rate for Payer: Aetna Government |
$69.35
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$616.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$708.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,293.60
|
| Rate for Payer: Group Health Inc Commercial |
$616.00
|
| Rate for Payer: Group Health Inc Medicare |
$431.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$616.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$616.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$800.80
|
|
|
ETHI VENTRAL PTCH 6.4X6.4CM PVPM
|
Facility
IP
|
$1,232.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
40208100
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$616.00 |
| Max. Negotiated Rate |
$616.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$616.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$616.00
|
|
|
ETHOSUXIMIDE 250MG/5ML SYRUP
|
Facility
OP
|
$0.08
|
|
| Hospital Charge Code |
41652662
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.03 |
| 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: 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 |
$0.03
|
| 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
|
|
|
ETHOSUXIMIDE 250MG/5ML SYRUP
|
Facility
OP
|
$0.08
|
|
| Hospital Charge Code |
41642662
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.03 |
| 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: 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 |
$0.03
|
| 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
|
|
|
ETHOSUXIMIDE (ZARONTIN) SERUM
|
Facility
OP
|
$40.85
|
|
|
Service Code
|
HCPCS 80168
|
| Hospital Charge Code |
40609716
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.07 |
| Max. Negotiated Rate |
$25.97 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$22.47
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$16.34
|
| Rate for Payer: Aetna Government |
$16.34
|
| Rate for Payer: Cash Price |
$16.34
|
| Rate for Payer: Cash Price |
$16.34
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$16.34
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$25.97
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$21.98
|
| Rate for Payer: Elderplan Medicare Advantage |
$16.34
|
| Rate for Payer: EmblemHealth Commercial |
$16.34
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$14.71
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$13.89
|
| Rate for Payer: Fidelis Essential Plan QHP |
$14.54
|
| Rate for Payer: Fidelis Medicare Advantage |
$16.34
|
| Rate for Payer: Fidelis Qualified Health Plan |
$14.54
|
| Rate for Payer: Group Health Inc Commercial |
$16.34
|
| Rate for Payer: Group Health Inc Medicare |
$16.34
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$20.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.34
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$16.34
|
| Rate for Payer: Healthfirst Medicare Advantage |
$16.34
|
| Rate for Payer: Healthfirst QHP |
$16.34
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$16.34
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$16.34
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$13.07
|
| Rate for Payer: Wellcare Medicare |
$14.71
|
|
|
ETHYL CHLORIDE TOPICAL AEROSOL
|
Facility
OP
|
$49.00
|
|
| Hospital Charge Code |
41640439
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.15 |
| Max. Negotiated Rate |
$39.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$26.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$24.50
|
| Rate for Payer: Aetna Government |
$24.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$39.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$33.32
|
| Rate for Payer: Group Health Inc Commercial |
$24.50
|
| Rate for Payer: Group Health Inc Medicare |
$17.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$24.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$24.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$31.85
|
|
|
ETHYL CHLORIDE TOPICAL AEROSOL
|
Facility
OP
|
$49.00
|
|
| Hospital Charge Code |
41650439
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.15 |
| Max. Negotiated Rate |
$39.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$26.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$24.50
|
| Rate for Payer: Aetna Government |
$24.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$39.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$33.32
|
| Rate for Payer: Group Health Inc Commercial |
$24.50
|
| Rate for Payer: Group Health Inc Medicare |
$17.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$24.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$24.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$31.85
|
|
|
ETHYLENE GLYCOL, SERUM
|
Facility
OP
|
$37.25
|
|
|
Service Code
|
HCPCS 82693
|
| Hospital Charge Code |
40609071
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.92 |
| Max. Negotiated Rate |
$23.66 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$20.49
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$14.90
|
| Rate for Payer: Aetna Government |
$14.90
|
| Rate for Payer: Cash Price |
$14.90
|
| Rate for Payer: Cash Price |
$14.90
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$14.90
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$23.66
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$20.02
|
| Rate for Payer: Elderplan Medicare Advantage |
$14.90
|
| Rate for Payer: EmblemHealth Commercial |
$14.90
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$13.41
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$12.66
|
| Rate for Payer: Fidelis Essential Plan QHP |
$13.26
|
| Rate for Payer: Fidelis Medicare Advantage |
$14.90
|
| Rate for Payer: Fidelis Qualified Health Plan |
$13.26
|
| Rate for Payer: Group Health Inc Commercial |
$14.90
|
| Rate for Payer: Group Health Inc Medicare |
$14.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$18.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.90
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$14.90
|
| Rate for Payer: Healthfirst Medicare Advantage |
$14.90
|
| Rate for Payer: Healthfirst QHP |
$14.90
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$14.90
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$14.90
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$11.92
|
| Rate for Payer: Wellcare Medicare |
$13.41
|
|
|
ETOMIDATE 2 MG/ML INJ
|
Facility
OP
|
$19.78
|
|
| Hospital Charge Code |
41644280
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.92 |
| Max. Negotiated Rate |
$15.82 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$10.88
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$9.89
|
| Rate for Payer: Aetna Government |
$9.89
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$15.82
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$13.45
|
| Rate for Payer: Group Health Inc Commercial |
$9.89
|
| Rate for Payer: Group Health Inc Medicare |
$6.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.89
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12.86
|
|
|
ETOMIDATE 2 MG/ML INJ
|
Facility
OP
|
$19.78
|
|
| Hospital Charge Code |
41654280
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.92 |
| Max. Negotiated Rate |
$15.82 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$10.88
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$9.89
|
| Rate for Payer: Aetna Government |
$9.89
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$15.82
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$13.45
|
| Rate for Payer: Group Health Inc Commercial |
$9.89
|
| Rate for Payer: Group Health Inc Medicare |
$6.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.89
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12.86
|
|
|
ETOMIDATE INJECTION 2MG/ML, 10ML
|
Facility
OP
|
$17.80
|
|
| Hospital Charge Code |
41646046
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.23 |
| Max. Negotiated Rate |
$14.24 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$9.79
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8.90
|
| Rate for Payer: Aetna Government |
$8.90
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$14.24
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$12.10
|
| Rate for Payer: Group Health Inc Commercial |
$8.90
|
| Rate for Payer: Group Health Inc Medicare |
$6.23
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.90
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$11.57
|
|
|
ETOMIDATE INJECTION 2MG/ML, 10ML
|
Facility
OP
|
$17.80
|
|
| Hospital Charge Code |
41656046
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.23 |
| Max. Negotiated Rate |
$14.24 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$9.79
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8.90
|
| Rate for Payer: Aetna Government |
$8.90
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$14.24
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$12.10
|
| Rate for Payer: Group Health Inc Commercial |
$8.90
|
| Rate for Payer: Group Health Inc Medicare |
$6.23
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.90
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$11.57
|
|
|
ETONOGESTREL 68MG
|
Facility
OP
|
$39.30
|
|
|
Service Code
|
HCPCS J7307
|
| Hospital Charge Code |
41656614
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.76 |
| Max. Negotiated Rate |
$1,030.64 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$21.62
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,030.64
|
| Rate for Payer: Aetna Government |
$1,030.64
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$19.65
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$22.60
|
| Rate for Payer: Group Health Inc Commercial |
$19.65
|
| Rate for Payer: Group Health Inc Medicare |
$13.76
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$19.65
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$19.65
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$25.54
|
|
|
ETONOGESTREL 68MG
|
Facility
IP
|
$39.30
|
|
|
Service Code
|
HCPCS J7307
|
| Hospital Charge Code |
41656614
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19.65 |
| Max. Negotiated Rate |
$19.65 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$19.65
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$19.65
|
|
|
ETOPOSIDE 20 MG/ML INJ MDV
|
Facility
IP
|
$8.00
|
|
|
Service Code
|
HCPCS J9181
|
| Hospital Charge Code |
41653832
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$4.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.00
|
|
|
ETOPOSIDE 20 MG/ML INJ MDV
|
Facility
IP
|
$8.00
|
|
|
Service Code
|
HCPCS J9181
|
| Hospital Charge Code |
41643832
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$4.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.00
|
|
