|
CALCIUM CHLORIDE 10 % IV SOLN
|
Facility
|
OP
|
$1.87
|
|
|
Service Code
|
NDC 0409492834
|
| Hospital Charge Code |
0409492834
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.65 |
| Max. Negotiated Rate |
$1.49 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.03
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.93
|
| Rate for Payer: Aetna Government |
$0.93
|
| Rate for Payer: Brighton Health Commercial |
$1.40
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.49
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.27
|
| Rate for Payer: EmblemHealth Commercial |
$0.93
|
| Rate for Payer: Group Health Inc Commercial |
$0.93
|
| Rate for Payer: Group Health Inc Medicare |
$0.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.93
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.93
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.21
|
|
|
CALCIUM CHLORIDE 10 % IV SOLN
|
Facility
|
IP
|
$1.87
|
|
|
Service Code
|
NDC 0409492834
|
| Hospital Charge Code |
0409492834
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.93 |
| Max. Negotiated Rate |
$0.93 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.93
|
|
|
CALCIUM GLUCONATE 10 % IV SOLN
|
Facility
|
IP
|
$1.20
|
|
|
Service Code
|
HCPCS J0612
|
| Hospital Charge Code |
7583417119
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$0.60 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.60
|
|
|
CALCIUM GLUCONATE 10 % IV SOLN
|
Facility
|
OP
|
$1.20
|
|
|
Service Code
|
HCPCS J0612
|
| Hospital Charge Code |
6332336001
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.96 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.66
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.60
|
| Rate for Payer: Aetna Government |
$0.60
|
| Rate for Payer: Brighton Health Commercial |
$0.90
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.96
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.82
|
| Rate for Payer: EmblemHealth Commercial |
$0.60
|
| Rate for Payer: Group Health Inc Commercial |
$0.60
|
| Rate for Payer: Group Health Inc Medicare |
$0.42
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.60
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.04
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.78
|
|
|
CALCIUM GLUCONATE 10 % IV SOLN
|
Facility
|
OP
|
$1.20
|
|
|
Service Code
|
HCPCS J0612
|
| Hospital Charge Code |
7583417119
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.96 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.66
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.60
|
| Rate for Payer: Aetna Government |
$0.60
|
| Rate for Payer: Brighton Health Commercial |
$0.90
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.96
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.82
|
| Rate for Payer: EmblemHealth Commercial |
$0.60
|
| Rate for Payer: Group Health Inc Commercial |
$0.60
|
| Rate for Payer: Group Health Inc Medicare |
$0.42
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.60
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.04
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.78
|
|
|
CALCIUM GLUCONATE 10 % IV SOLN
|
Facility
|
IP
|
$1.20
|
|
|
Service Code
|
HCPCS J0612
|
| Hospital Charge Code |
6332336019
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$0.60 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.60
|
|
|
CALCIUM GLUCONATE 10 % IV SOLN
|
Facility
|
OP
|
$1.20
|
|
|
Service Code
|
HCPCS J0612
|
| Hospital Charge Code |
6332336019
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.96 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.66
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.60
|
| Rate for Payer: Aetna Government |
$0.60
|
| Rate for Payer: Brighton Health Commercial |
$0.90
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.96
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.82
|
| Rate for Payer: EmblemHealth Commercial |
$0.60
|
| Rate for Payer: Group Health Inc Commercial |
$0.60
|
| Rate for Payer: Group Health Inc Medicare |
$0.42
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.60
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.04
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.78
|
|
|
CALCIUM GLUCONATE 10 % IV SOLN
|
Facility
|
IP
|
$1.20
|
|
|
Service Code
|
HCPCS J0612
|
| Hospital Charge Code |
6332336001
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$0.60 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.60
|
|
|
CALCIUM GLUCONATE 10 % IV SOLN
|
Facility
|
OP
|
$1.20
|
|
|
Service Code
|
HCPCS J0612
|
| Hospital Charge Code |
0143918025
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.96 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.66
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.60
|
| Rate for Payer: Aetna Government |
$0.60
|
| Rate for Payer: Brighton Health Commercial |
$0.90
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.96
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.82
|
| Rate for Payer: EmblemHealth Commercial |
$0.60
|
| Rate for Payer: Group Health Inc Commercial |
$0.60
|
| Rate for Payer: Group Health Inc Medicare |
$0.42
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.60
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.04
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.78
|
|
|
CALCIUM GLUCONATE 10 % IV SOLN
|
Facility
|
IP
|
$1.20
|
|
|
Service Code
|
HCPCS J0612
|
| Hospital Charge Code |
0143918025
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$0.60 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.60
|
|
|
CALCIUM GLUCONATE-NACL 1-0.675 GM/50ML-% IV SOLN
|
Facility
|
OP
|
$0.47
|
|
|
Service Code
|
HCPCS J0612
|
| Hospital Charge Code |
4456762001
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.38 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.26
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.24
|
| Rate for Payer: Aetna Government |
$0.24
|
| Rate for Payer: Brighton Health Commercial |
$0.36
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.38
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.32
|
| Rate for Payer: EmblemHealth Commercial |
$0.24
|
| Rate for Payer: Group Health Inc Commercial |
$0.24
|
| Rate for Payer: Group Health Inc Medicare |
$0.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.24
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.04
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.31
|
|
|
CALCIUM GLUCONATE-NACL 1-0.675 GM/50ML-% IV SOLN
|
Facility
|
IP
|
$0.47
|
|
|
Service Code
|
HCPCS J0612
|
| Hospital Charge Code |
4456762001
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$0.24 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.24
|
|
|
CALCIUM GLUCONATE-NACL 1-0.675 GM/50ML-% IV SOLN
|
Facility
|
IP
|
$0.47
|
|
|
Service Code
|
HCPCS J0612
|
| Hospital Charge Code |
6521916201
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$0.24 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.24
|
|
|
CALCIUM GLUCONATE-NACL 1-0.675 GM/50ML-% IV SOLN
|
Facility
|
OP
|
$0.47
|
|
|
Service Code
|
HCPCS J0612
|
| Hospital Charge Code |
6521916201
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.38 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.26
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.24
|
| Rate for Payer: Aetna Government |
$0.24
|
| Rate for Payer: Brighton Health Commercial |
$0.36
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.38
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.32
|
| Rate for Payer: EmblemHealth Commercial |
$0.24
|
| Rate for Payer: Group Health Inc Commercial |
$0.24
|
| Rate for Payer: Group Health Inc Medicare |
$0.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.24
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.04
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.31
|
|
|
CALCIUM GLUCONATE-NACL 1-0.675 GM/50ML-% IV SOLN
|
Facility
|
IP
|
$0.47
|
|
|
Service Code
|
HCPCS J0612
|
| Hospital Charge Code |
4456762024
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$0.24 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.24
|
|
|
CALCIUM GLUCONATE-NACL 1-0.675 GM/50ML-% IV SOLN
|
Facility
|
OP
|
$0.47
|
|
|
Service Code
|
HCPCS J0612
|
| Hospital Charge Code |
4456762024
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.38 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.26
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.24
|
| Rate for Payer: Aetna Government |
$0.24
|
| Rate for Payer: Brighton Health Commercial |
$0.36
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.38
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.32
|
| Rate for Payer: EmblemHealth Commercial |
$0.24
|
| Rate for Payer: Group Health Inc Commercial |
$0.24
|
| Rate for Payer: Group Health Inc Medicare |
$0.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.24
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.04
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.31
|
|
|
CALCIUM GLUCONATE-NACL 2-0.675 GM/100ML-% IV SOLN
|
Facility
|
IP
|
$0.47
|
|
|
Service Code
|
HCPCS J0613
|
| Hospital Charge Code |
4456762124
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$0.24 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.24
|
|
|
CALCIUM GLUCONATE-NACL 2-0.675 GM/100ML-% IV SOLN
|
Facility
|
OP
|
$0.47
|
|
|
Service Code
|
HCPCS J0613
|
| Hospital Charge Code |
4456762101
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.38 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.26
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.24
|
| Rate for Payer: Aetna Government |
$0.24
|
| Rate for Payer: Brighton Health Commercial |
$0.36
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.38
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.32
|
| Rate for Payer: EmblemHealth Commercial |
$0.24
|
| Rate for Payer: Group Health Inc Commercial |
$0.24
|
| Rate for Payer: Group Health Inc Medicare |
$0.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.24
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.31
|
|
|
CALCIUM GLUCONATE-NACL 2-0.675 GM/100ML-% IV SOLN
|
Facility
|
OP
|
$0.47
|
|
|
Service Code
|
HCPCS J0613
|
| Hospital Charge Code |
8083023631
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.38 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.26
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.24
|
| Rate for Payer: Aetna Government |
$0.24
|
| Rate for Payer: Brighton Health Commercial |
$0.36
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.38
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.32
|
| Rate for Payer: EmblemHealth Commercial |
$0.24
|
| Rate for Payer: Group Health Inc Commercial |
$0.24
|
| Rate for Payer: Group Health Inc Medicare |
$0.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.24
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.31
|
|
|
CALCIUM GLUCONATE-NACL 2-0.675 GM/100ML-% IV SOLN
|
Facility
|
IP
|
$0.47
|
|
|
Service Code
|
HCPCS J0613
|
| Hospital Charge Code |
4456762101
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$0.24 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.24
|
|
|
CALCIUM GLUCONATE-NACL 2-0.675 GM/100ML-% IV SOLN
|
Facility
|
OP
|
$0.47
|
|
|
Service Code
|
HCPCS J0613
|
| Hospital Charge Code |
4456762124
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.38 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.26
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.24
|
| Rate for Payer: Aetna Government |
$0.24
|
| Rate for Payer: Brighton Health Commercial |
$0.36
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.38
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.32
|
| Rate for Payer: EmblemHealth Commercial |
$0.24
|
| Rate for Payer: Group Health Inc Commercial |
$0.24
|
| Rate for Payer: Group Health Inc Medicare |
$0.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.24
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.31
|
|
|
CALCIUM GLUCONATE-NACL 2-0.675 GM/100ML-% IV SOLN
|
Facility
|
IP
|
$0.47
|
|
|
Service Code
|
HCPCS J0613
|
| Hospital Charge Code |
8083023631
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$0.24 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.24
|
|
|
CANDESARTAN CILEXETIL 16 MG PO TABS
|
Facility
|
IP
|
$5.39
|
|
|
Service Code
|
NDC 6068724125
|
| Hospital Charge Code |
6068724125
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.69 |
| Max. Negotiated Rate |
$2.69 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.69
|
|
|
CANDESARTAN CILEXETIL 16 MG PO TABS
|
Facility
|
OP
|
$3.06
|
|
|
Service Code
|
NDC 3334211607
|
| Hospital Charge Code |
3334211607
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.07 |
| Max. Negotiated Rate |
$2.44 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.68
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.53
|
| Rate for Payer: Aetna Government |
$1.53
|
| Rate for Payer: Brighton Health Commercial |
$2.29
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.44
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.08
|
| Rate for Payer: EmblemHealth Commercial |
$1.53
|
| Rate for Payer: Group Health Inc Commercial |
$1.53
|
| Rate for Payer: Group Health Inc Medicare |
$1.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.53
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.53
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.99
|
|
|
CANDESARTAN CILEXETIL 16 MG PO TABS
|
Facility
|
OP
|
$5.39
|
|
|
Service Code
|
NDC 6068724195
|
| Hospital Charge Code |
6068724195
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.89 |
| Max. Negotiated Rate |
$4.31 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.96
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.69
|
| Rate for Payer: Aetna Government |
$2.69
|
| Rate for Payer: Brighton Health Commercial |
$4.04
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.31
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.67
|
| Rate for Payer: EmblemHealth Commercial |
$2.69
|
| Rate for Payer: Group Health Inc Commercial |
$2.69
|
| Rate for Payer: Group Health Inc Medicare |
$1.89
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.69
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.69
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.50
|
|