|
ERYTHROMYCIN LACTOBIONATE 500 MG IV SOLR [2903]
|
Facility
|
IP
|
$240.00
|
|
|
Service Code
|
HCPCS J1364
|
| Hospital Charge Code |
14789011605
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$120.00 |
| Max. Negotiated Rate |
$120.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$120.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$120.00
|
|
|
ERYTHROMYCIN LACTOBIONATE 500 MG IV SOLR [2903]
|
Facility
|
IP
|
$109.06
|
|
|
Service Code
|
HCPCS J1364
|
| Hospital Charge Code |
00409648201
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$54.53 |
| Max. Negotiated Rate |
$54.53 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$54.53
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$54.53
|
|
|
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: Brighton Health Commercial |
$0.75
|
| 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 |
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: Brighton Health Commercial |
$0.75
|
| 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 |
$13.15 |
| Max. Negotiated Rate |
$35.24 |
| 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: Affinity Essential Plan 1&2 |
$13.15
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$13.15
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$13.15
|
| Rate for Payer: Brighton Health Commercial |
$35.24
|
| 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 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 Medicare Advantage |
$18.79
|
| Rate for Payer: Healthfirst QHP |
$18.79
|
| Rate for Payer: Humana Medicare |
$19.17
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$18.79
|
| Rate for Payer: United Healthcare Commercial |
$23.81
|
| Rate for Payer: United Healthcare 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
|
Facility
|
IP
|
$46.98
|
|
|
Service Code
|
HCPCS 82668
|
| Hospital Charge Code |
40607198
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$18.79
|
|
|
ERYTHROPOIETIN (EPO), SERUM
|
Facility
|
OP
|
$46.98
|
|
|
Service Code
|
HCPCS 82668
|
| Hospital Charge Code |
40609067
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.15 |
| Max. Negotiated Rate |
$35.24 |
| 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: Affinity Essential Plan 1&2 |
$13.15
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$13.15
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$13.15
|
| Rate for Payer: Brighton Health Commercial |
$35.24
|
| 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 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 Medicare Advantage |
$18.79
|
| Rate for Payer: Healthfirst QHP |
$18.79
|
| Rate for Payer: Humana Medicare |
$19.17
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$18.79
|
| Rate for Payer: United Healthcare Commercial |
$23.81
|
| Rate for Payer: United Healthcare 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
|
IP
|
$46.98
|
|
|
Service Code
|
HCPCS 82668
|
| Hospital Charge Code |
40609067
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$18.79
|
|
|
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: Brighton Health Commercial |
$367.50
|
| 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 |
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: Brighton Health Commercial |
$15.75
|
| 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 |
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: Brighton Health Commercial |
$15.75
|
| 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: Brighton Health Commercial |
$211.65
|
| 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: Brighton Health Commercial |
$211.65
|
| 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 HCL 100 MG/10ML IV SOLN [82085]
|
Facility
|
OP
|
$1.46
|
|
|
Service Code
|
HCPCS J1805
|
| Hospital Charge Code |
10019012001
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.21 |
| Max. Negotiated Rate |
$0.95 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.80
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.26
|
| Rate for Payer: Aetna Government |
$0.26
|
| Rate for Payer: Brighton Health Commercial |
$0.88
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$0.26
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.73
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.84
|
| Rate for Payer: Elderplan Medicare Advantage |
$0.26
|
| Rate for Payer: EmblemHealth Commercial |
$0.73
|
| Rate for Payer: Fidelis Medicare Advantage |
$0.26
|
| Rate for Payer: Group Health Inc Commercial |
$0.26
|
| Rate for Payer: Group Health Inc Medicare |
$0.26
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.73
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.73
|
| Rate for Payer: Healthfirst Medicare Advantage |
$0.22
|
| Rate for Payer: Healthfirst QHP |
$0.26
|
| Rate for Payer: Humana Medicare |
$0.27
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$0.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.26
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.95
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$0.21
|
|
|
ESMOLOL HCL 100 MG/10ML IV SOLN [82085]
|
Facility
|
IP
|
$0.88
|
|
|
Service Code
|
HCPCS J1805
|
| Hospital Charge Code |
67457018210
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.44 |
| Max. Negotiated Rate |
$0.44 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.44
|
|
|
ESMOLOL HCL 100 MG/10ML IV SOLN [82085]
|
Facility
|
OP
|
$0.88
|
|
|
Service Code
|
HCPCS J1805
|
| Hospital Charge Code |
67457018210
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.21 |
| Max. Negotiated Rate |
$0.57 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.48
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.26
|
| Rate for Payer: Aetna Government |
$0.26
|
| Rate for Payer: Brighton Health Commercial |
$0.53
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$0.26
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.44
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.50
|
| Rate for Payer: Elderplan Medicare Advantage |
$0.26
|
| Rate for Payer: EmblemHealth Commercial |
$0.44
|
| Rate for Payer: Fidelis Medicare Advantage |
$0.26
|
| Rate for Payer: Group Health Inc Commercial |
$0.26
|
| Rate for Payer: Group Health Inc Medicare |
$0.26
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.44
|
| Rate for Payer: Healthfirst Medicare Advantage |
$0.22
|
| Rate for Payer: Healthfirst QHP |
$0.26
|
| Rate for Payer: Humana Medicare |
$0.27
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$0.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.26
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.57
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$0.21
|
|
|
ESMOLOL HCL 100 MG/10ML IV SOLN [82085]
|
Facility
|
IP
|
$0.88
|
|
|
Service Code
|
HCPCS J1805
|
| Hospital Charge Code |
55150019410
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.44 |
| Max. Negotiated Rate |
$0.44 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.44
|
|
|
ESMOLOL HCL 100 MG/10ML IV SOLN [82085]
|
Facility
|
IP
|
$1.46
|
|
|
Service Code
|
HCPCS J1805
|
| Hospital Charge Code |
10019012001
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.73 |
| Max. Negotiated Rate |
$0.73 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.73
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.73
|
|
|
ESMOLOL HCL 100 MG/10ML IV SOLN [82085]
|
Facility
|
OP
|
$0.88
|
|
|
Service Code
|
HCPCS J1805
|
| Hospital Charge Code |
55150019410
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.21 |
| Max. Negotiated Rate |
$0.57 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.48
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.26
|
| Rate for Payer: Aetna Government |
$0.26
|
| Rate for Payer: Brighton Health Commercial |
$0.53
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$0.26
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.44
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.51
|
| Rate for Payer: Elderplan Medicare Advantage |
$0.26
|
| Rate for Payer: EmblemHealth Commercial |
$0.44
|
| Rate for Payer: Fidelis Medicare Advantage |
$0.26
|
| Rate for Payer: Group Health Inc Commercial |
$0.26
|
| Rate for Payer: Group Health Inc Medicare |
$0.26
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.44
|
| Rate for Payer: Healthfirst Medicare Advantage |
$0.22
|
| Rate for Payer: Healthfirst QHP |
$0.26
|
| Rate for Payer: Humana Medicare |
$0.27
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$0.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.26
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.57
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$0.21
|
|
|
ESMOLOL HCL-SODIUM CHLORIDE 2500 MG/250ML IV SOLN [29805]
|
Facility
|
IP
|
$2.02
|
|
|
Service Code
|
HCPCS J1805
|
| Hospital Charge Code |
67457065725
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1.01 |
| Max. Negotiated Rate |
$1.01 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.01
|
|
|
ESMOLOL HCL-SODIUM CHLORIDE 2500 MG/250ML IV SOLN [29805]
|
Facility
|
OP
|
$2.02
|
|
|
Service Code
|
HCPCS J1805
|
| Hospital Charge Code |
67457065725
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.21 |
| Max. Negotiated Rate |
$1.31 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.11
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.26
|
| Rate for Payer: Aetna Government |
$0.26
|
| Rate for Payer: Brighton Health Commercial |
$1.21
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$0.26
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.01
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.16
|
| Rate for Payer: Elderplan Medicare Advantage |
$0.26
|
| Rate for Payer: EmblemHealth Commercial |
$1.01
|
| Rate for Payer: Fidelis Medicare Advantage |
$0.26
|
| Rate for Payer: Group Health Inc Commercial |
$0.26
|
| Rate for Payer: Group Health Inc Medicare |
$0.26
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.01
|
| Rate for Payer: Healthfirst Medicare Advantage |
$0.22
|
| Rate for Payer: Healthfirst QHP |
$0.26
|
| Rate for Payer: Humana Medicare |
$0.27
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$0.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.26
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.31
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$0.21
|
|
|
ESMOLOL HCL-SODIUM CHLORIDE 2500 MG/250ML IV SOLN [29805]
|
Facility
|
OP
|
$2.25
|
|
|
Service Code
|
HCPCS J1805
|
| Hospital Charge Code |
10019005561
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.21 |
| Max. Negotiated Rate |
$1.46 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.23
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.26
|
| Rate for Payer: Aetna Government |
$0.26
|
| Rate for Payer: Brighton Health Commercial |
$1.35
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$0.26
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.12
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.29
|
| Rate for Payer: Elderplan Medicare Advantage |
$0.26
|
| Rate for Payer: EmblemHealth Commercial |
$1.12
|
| Rate for Payer: Fidelis Medicare Advantage |
$0.26
|
| Rate for Payer: Group Health Inc Commercial |
$0.26
|
| Rate for Payer: Group Health Inc Medicare |
$0.26
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.12
|
| Rate for Payer: Healthfirst Medicare Advantage |
$0.22
|
| Rate for Payer: Healthfirst QHP |
$0.26
|
| Rate for Payer: Humana Medicare |
$0.27
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$0.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.26
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.46
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$0.21
|
|
|
ESMOLOL HCL-SODIUM CHLORIDE 2500 MG/250ML IV SOLN [29805]
|
Facility
|
IP
|
$2.25
|
|
|
Service Code
|
HCPCS J1805
|
| Hospital Charge Code |
10019005561
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1.12 |
| Max. Negotiated Rate |
$1.12 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.12
|
|
|
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: Brighton Health Commercial |
$0.54
|
| 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: Brighton Health Commercial |
$0.54
|
| 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
|
|
