FENTANYL PCA 1300 MCG/130 ML NS (PREMIX) [401261]
|
Facility
|
OP
|
$0.31
|
|
Service Code
|
HCPCS J3010
|
Hospital Charge Code |
63323013099
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$0.11 |
Max. Negotiated Rate |
$1.05 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.17
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.63
|
Rate for Payer: Aetna Government |
$0.63
|
Rate for Payer: Brighton Health Commercial |
$0.23
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.25
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.21
|
Rate for Payer: Group Health Inc Commercial |
$0.16
|
Rate for Payer: Group Health Inc Medicare |
$0.11
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.16
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$0.16
|
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$0.99
|
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1.05
|
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1.05
|
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1.05
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.20
|
|
FENTANYL, URINE
|
Facility
|
OP
|
$89.42
|
|
Service Code
|
HCPCS 80361
|
Hospital Charge Code |
40601237
|
Hospital Revenue Code
|
301
|
Min. Negotiated Rate |
$0.01 |
Max. Negotiated Rate |
$71.54 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$49.18
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.01
|
Rate for Payer: Aetna Government |
$0.01
|
Rate for Payer: Brighton Health Commercial |
$67.06
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$71.54
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$60.81
|
Rate for Payer: Group Health Inc Commercial |
$44.71
|
Rate for Payer: Group Health Inc Medicare |
$31.30
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$44.71
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$44.71
|
Rate for Payer: United Healthcare Commercial |
$31.48
|
|
FENWAL SINGLE BLOOD PACK 450ML
|
Facility
|
OP
|
$28.50
|
|
Hospital Charge Code |
64905492
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$9.98 |
Max. Negotiated Rate |
$22.80 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$15.68
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$14.25
|
Rate for Payer: Aetna Government |
$14.25
|
Rate for Payer: Brighton Health Commercial |
$21.38
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$22.80
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$19.38
|
Rate for Payer: Group Health Inc Commercial |
$14.25
|
Rate for Payer: Group Health Inc Medicare |
$9.98
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.25
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$14.25
|
|
FERRIC CARBOXYMALTOSE 750MG/15INJ
|
Facility
|
OP
|
$1.94
|
|
Service Code
|
HCPCS J1439
|
Hospital Charge Code |
41656593
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$0.80 |
Max. Negotiated Rate |
$1.26 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.07
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.15
|
Rate for Payer: Aetna Government |
$1.15
|
Rate for Payer: Affinity Essential Plan 1&2 |
$0.80
|
Rate for Payer: Affinity Essential Plan 3&4 |
$0.80
|
Rate for Payer: Affinity Medicaid/CHP/HARP |
$0.80
|
Rate for Payer: Brighton Health Commercial |
$1.16
|
Rate for Payer: Cash Price |
$1.15
|
Rate for Payer: Cash Price |
$1.15
|
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1.15
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.97
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.12
|
Rate for Payer: Elderplan Medicare Advantage |
$1.15
|
Rate for Payer: EmblemHealth Commercial |
$1.15
|
Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1.15
|
Rate for Payer: Fidelis Essential Plan Aliesa |
$1.15
|
Rate for Payer: Fidelis Essential Plan QHP |
$1.20
|
Rate for Payer: Fidelis Medicare Advantage |
$1.15
|
Rate for Payer: Fidelis Qualified Health Plan |
$1.20
|
Rate for Payer: Group Health Inc Commercial |
$1.15
|
Rate for Payer: Group Health Inc Medicare |
$1.15
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.97
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$0.97
|
Rate for Payer: Healthfirst Medicare Advantage |
$0.97
|
Rate for Payer: Healthfirst QHP |
$1.15
|
Rate for Payer: Humana Medicare |
$1.17
|
Rate for Payer: Senior Whole Health Medicare Advantage |
$1.15
|
Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1.16
|
Rate for Payer: SOMOS Essential |
$1.16
|
Rate for Payer: United Healthcare Commercial |
$1.10
|
Rate for Payer: United Healthcare Medicare Advantage |
$1.15
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.26
|
Rate for Payer: Wellcare CHP/FHP/Medicaid |
$0.92
|
Rate for Payer: Wellcare Medicare |
$1.09
|
|
FERRIC CARBOXYMALTOSE 750MG/15INJ
|
Facility
|
OP
|
$1.94
|
|
Service Code
|
HCPCS J1439
|
Hospital Charge Code |
41646593
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$0.80 |
Max. Negotiated Rate |
$1.26 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.07
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.15
|
Rate for Payer: Aetna Government |
$1.15
|
Rate for Payer: Affinity Essential Plan 1&2 |
$0.80
|
Rate for Payer: Affinity Essential Plan 3&4 |
$0.80
|
Rate for Payer: Affinity Medicaid/CHP/HARP |
$0.80
|
Rate for Payer: Brighton Health Commercial |
$1.16
|
Rate for Payer: Cash Price |
$1.15
|
Rate for Payer: Cash Price |
$1.15
|
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1.15
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.97
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.12
|
Rate for Payer: Elderplan Medicare Advantage |
$1.15
|
Rate for Payer: EmblemHealth Commercial |
$1.15
|
Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1.15
|
Rate for Payer: Fidelis Essential Plan Aliesa |
$1.15
|
Rate for Payer: Fidelis Essential Plan QHP |
$1.20
|
Rate for Payer: Fidelis Medicare Advantage |
$1.15
|
Rate for Payer: Fidelis Qualified Health Plan |
$1.20
|
Rate for Payer: Group Health Inc Commercial |
$1.15
|
Rate for Payer: Group Health Inc Medicare |
$1.15
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.97
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$0.97
|
Rate for Payer: Healthfirst Medicare Advantage |
$0.97
|
Rate for Payer: Healthfirst QHP |
$1.15
|
Rate for Payer: Humana Medicare |
$1.17
|
Rate for Payer: Senior Whole Health Medicare Advantage |
$1.15
|
Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1.16
|
Rate for Payer: SOMOS Essential |
$1.16
|
Rate for Payer: United Healthcare Commercial |
$1.10
|
Rate for Payer: United Healthcare Medicare Advantage |
$1.15
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.26
|
Rate for Payer: Wellcare CHP/FHP/Medicaid |
$0.92
|
Rate for Payer: Wellcare Medicare |
$1.09
|
|
FERRIC CARBOXYMALTOSE 750MG/15INJ
|
Facility
|
IP
|
$1.94
|
|
Service Code
|
HCPCS J1439
|
Hospital Charge Code |
41656593
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$0.97 |
Max. Negotiated Rate |
$0.97 |
Rate for Payer: Cash Price |
$1.15
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.97
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$0.97
|
|
FERRIC CARBOXYMALTOSE 750MG/15INJ
|
Facility
|
IP
|
$1.94
|
|
Service Code
|
HCPCS J1439
|
Hospital Charge Code |
41646593
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$0.97 |
Max. Negotiated Rate |
$0.97 |
Rate for Payer: Cash Price |
$1.15
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.97
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$0.97
|
|
FERRIC CARBOXYMALTOSE 750 MG/15ML IV SOLN [122648]
|
Facility
|
OP
|
$115.67
|
|
Service Code
|
HCPCS J1439
|
Hospital Charge Code |
00517065001
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$0.92 |
Max. Negotiated Rate |
$75.19 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$63.62
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.15
|
Rate for Payer: Aetna Government |
$1.15
|
Rate for Payer: Brighton Health Commercial |
$69.40
|
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1.15
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$57.84
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$66.51
|
Rate for Payer: Elderplan Medicare Advantage |
$1.15
|
Rate for Payer: EmblemHealth Commercial |
$57.84
|
Rate for Payer: Fidelis Medicare Advantage |
$1.15
|
Rate for Payer: Group Health Inc Commercial |
$1.15
|
Rate for Payer: Group Health Inc Medicare |
$1.15
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$57.84
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$57.84
|
Rate for Payer: Healthfirst Medicare Advantage |
$0.97
|
Rate for Payer: Healthfirst QHP |
$1.15
|
Rate for Payer: Humana Medicare |
$1.17
|
Rate for Payer: Senior Whole Health Medicare Advantage |
$1.15
|
Rate for Payer: United Healthcare Medicare Advantage |
$1.15
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$75.19
|
Rate for Payer: Wellcare CHP/FHP/Medicaid |
$0.92
|
|
FERRIC CARBOXYMALTOSE 750 MG/15ML IV SOLN [122648]
|
Facility
|
IP
|
$115.67
|
|
Service Code
|
HCPCS J1439
|
Hospital Charge Code |
00517065001
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$57.84 |
Max. Negotiated Rate |
$57.84 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$57.84
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$57.84
|
|
FERRIC SUBSULFATE 259 MG/GM EX SOLN [28357]
|
Facility
|
OP
|
$2.46
|
|
Service Code
|
NDC 59365606501
|
Hospital Charge Code |
59365606501
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$0.86 |
Max. Negotiated Rate |
$1.96 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.35
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.23
|
Rate for Payer: Aetna Government |
$1.23
|
Rate for Payer: Brighton Health Commercial |
$1.84
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.96
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.67
|
Rate for Payer: Group Health Inc Commercial |
$1.23
|
Rate for Payer: Group Health Inc Medicare |
$0.86
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.23
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1.23
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.60
|
|
FERRIC SUBSULFATE PASTE 8G
|
Facility
|
OP
|
$24.51
|
|
Hospital Charge Code |
41654566
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$8.58 |
Max. Negotiated Rate |
$19.61 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$13.48
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12.26
|
Rate for Payer: Aetna Government |
$12.26
|
Rate for Payer: Brighton Health Commercial |
$18.38
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$19.61
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$16.67
|
Rate for Payer: Group Health Inc Commercial |
$12.26
|
Rate for Payer: Group Health Inc Medicare |
$8.58
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.26
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$12.26
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$15.93
|
|
FERRIC SUBSULFATE PASTE 8G
|
Facility
|
OP
|
$24.51
|
|
Hospital Charge Code |
41644566
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$8.58 |
Max. Negotiated Rate |
$19.61 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$13.48
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12.26
|
Rate for Payer: Aetna Government |
$12.26
|
Rate for Payer: Brighton Health Commercial |
$18.38
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$19.61
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$16.67
|
Rate for Payer: Group Health Inc Commercial |
$12.26
|
Rate for Payer: Group Health Inc Medicare |
$8.58
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.26
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$12.26
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$15.93
|
|
FERRITIN RIA
|
Facility
|
IP
|
$34.08
|
|
Service Code
|
HCPCS 82728
|
Hospital Charge Code |
40602375
|
Hospital Revenue Code
|
301
|
Rate for Payer: Cash Price |
$13.63
|
|
FERRITIN RIA
|
Facility
|
OP
|
$34.08
|
|
Service Code
|
HCPCS 82728
|
Hospital Charge Code |
40602375
|
Hospital Revenue Code
|
301
|
Min. Negotiated Rate |
$9.54 |
Max. Negotiated Rate |
$25.56 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$18.74
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$13.63
|
Rate for Payer: Aetna Government |
$13.63
|
Rate for Payer: Affinity Essential Plan 1&2 |
$9.54
|
Rate for Payer: Affinity Essential Plan 3&4 |
$9.54
|
Rate for Payer: Affinity Medicaid/CHP/HARP |
$9.54
|
Rate for Payer: Brighton Health Commercial |
$25.56
|
Rate for Payer: Cash Price |
$13.63
|
Rate for Payer: Cash Price |
$13.63
|
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$13.63
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$21.64
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$18.32
|
Rate for Payer: Elderplan Medicare Advantage |
$13.63
|
Rate for Payer: EmblemHealth Commercial |
$13.63
|
Rate for Payer: Fidelis Essential Plan Aliesa |
$11.59
|
Rate for Payer: Fidelis Essential Plan QHP |
$12.13
|
Rate for Payer: Fidelis Medicare Advantage |
$13.63
|
Rate for Payer: Fidelis Qualified Health Plan |
$12.13
|
Rate for Payer: Group Health Inc Commercial |
$13.63
|
Rate for Payer: Group Health Inc Medicare |
$13.63
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.04
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$13.63
|
Rate for Payer: Healthfirst Medicare Advantage |
$13.63
|
Rate for Payer: Healthfirst QHP |
$13.63
|
Rate for Payer: Humana Medicare |
$13.90
|
Rate for Payer: Senior Whole Health Medicare Advantage |
$13.63
|
Rate for Payer: United Healthcare Commercial |
$17.25
|
Rate for Payer: United Healthcare Medicare Advantage |
$13.63
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$13.63
|
Rate for Payer: Wellcare CHP/FHP/Medicaid |
$10.90
|
Rate for Payer: Wellcare Medicare |
$12.27
|
|
FERROUS GLUCONATE 300 MG TAB
|
Facility
|
OP
|
$0.05
|
|
Hospital Charge Code |
41651190
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$0.02 |
Max. Negotiated Rate |
$0.04 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.03
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.03
|
Rate for Payer: Aetna Government |
$0.03
|
Rate for Payer: Brighton Health Commercial |
$0.04
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.04
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.03
|
Rate for Payer: Group Health Inc Commercial |
$0.03
|
Rate for Payer: Group Health Inc Medicare |
$0.02
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.03
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$0.03
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.03
|
|
FERROUS GLUCONATE 300 MG TAB
|
Facility
|
OP
|
$0.05
|
|
Hospital Charge Code |
41641190
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$0.02 |
Max. Negotiated Rate |
$0.04 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.03
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.03
|
Rate for Payer: Aetna Government |
$0.03
|
Rate for Payer: Brighton Health Commercial |
$0.04
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.04
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.03
|
Rate for Payer: Group Health Inc Commercial |
$0.03
|
Rate for Payer: Group Health Inc Medicare |
$0.02
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.03
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$0.03
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.03
|
|
FERROUS GLUCONATE 324 (37.5 FE) MG PO TABS [111196]
|
Facility
|
OP
|
$0.07
|
|
Service Code
|
NDC 00904213761
|
Hospital Charge Code |
00904213761
|
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: Brighton Health Commercial |
$0.05
|
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
|
|
FERROUS SULFATE 220MG/5ML,480ML
|
Facility
|
OP
|
$0.01
|
|
Hospital Charge Code |
41657031
|
Hospital Revenue Code
|
250
|
Max. Negotiated Rate |
$0.01 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.01
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.01
|
Rate for Payer: Aetna Government |
$0.01
|
Rate for Payer: Brighton Health Commercial |
$0.01
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.01
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.01
|
Rate for Payer: Group Health Inc Commercial |
$0.01
|
Rate for Payer: Group Health Inc Medicare |
$0.00
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.01
|
|
FERROUS SULFATE 220MG/5ML,480ML
|
Facility
|
OP
|
$0.01
|
|
Hospital Charge Code |
41647031
|
Hospital Revenue Code
|
250
|
Max. Negotiated Rate |
$0.01 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.01
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.01
|
Rate for Payer: Aetna Government |
$0.01
|
Rate for Payer: Brighton Health Commercial |
$0.01
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.01
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.01
|
Rate for Payer: Group Health Inc Commercial |
$0.01
|
Rate for Payer: Group Health Inc Medicare |
$0.00
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.01
|
|
FERROUS SULFATE 25 MG/ML DROPS
|
Facility
|
OP
|
$0.09
|
|
Hospital Charge Code |
41641423
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$0.03 |
Max. Negotiated Rate |
$0.07 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.05
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.05
|
Rate for Payer: Aetna Government |
$0.05
|
Rate for Payer: Brighton Health Commercial |
$0.07
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.07
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.06
|
Rate for Payer: Group Health Inc Commercial |
$0.05
|
Rate for Payer: Group Health Inc Medicare |
$0.03
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.05
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$0.05
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.06
|
|
FERROUS SULFATE 25 MG/ML DROPS
|
Facility
|
OP
|
$0.09
|
|
Hospital Charge Code |
41651423
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$0.03 |
Max. Negotiated Rate |
$0.07 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.05
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.05
|
Rate for Payer: Aetna Government |
$0.05
|
Rate for Payer: Brighton Health Commercial |
$0.07
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.07
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.06
|
Rate for Payer: Group Health Inc Commercial |
$0.05
|
Rate for Payer: Group Health Inc Medicare |
$0.03
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.05
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$0.05
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.06
|
|
FERROUS SULFATE 300 (60 FE) MG/5ML PO SOLN [191196]
|
Facility
|
OP
|
$0.81
|
|
Service Code
|
NDC 00121053005
|
Hospital Charge Code |
00121053005
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$0.28 |
Max. Negotiated Rate |
$0.65 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.45
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.41
|
Rate for Payer: Aetna Government |
$0.41
|
Rate for Payer: Brighton Health Commercial |
$0.61
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.65
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.55
|
Rate for Payer: Group Health Inc Commercial |
$0.41
|
Rate for Payer: Group Health Inc Medicare |
$0.28
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.41
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$0.41
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.53
|
|
FERROUS SULFATE 300 (60 FE) MG/5ML PO SOLN [191196]
|
Facility
|
OP
|
$0.52
|
|
Service Code
|
NDC 00904727741
|
Hospital Charge Code |
00904727741
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$0.18 |
Max. Negotiated Rate |
$0.42 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.29
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.26
|
Rate for Payer: Aetna Government |
$0.26
|
Rate for Payer: Brighton Health Commercial |
$0.39
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.42
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.36
|
Rate for Payer: Group Health Inc Commercial |
$0.26
|
Rate for Payer: Group Health Inc Medicare |
$0.18
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.26
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$0.26
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.34
|
|
FERROUS SULFATE 300 (60 FE) MG/5ML PO SOLN [191196]
|
Facility
|
OP
|
$0.74
|
|
Service Code
|
NDC 39328015705
|
Hospital Charge Code |
39328015705
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$0.26 |
Max. Negotiated Rate |
$0.59 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.41
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.37
|
Rate for Payer: Aetna Government |
$0.37
|
Rate for Payer: Brighton Health Commercial |
$0.55
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.59
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.50
|
Rate for Payer: Group Health Inc Commercial |
$0.37
|
Rate for Payer: Group Health Inc Medicare |
$0.26
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.37
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$0.37
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.48
|
|
FERROUS SULFATE 300 (60 FE) MG/5ML PO SOLN [191196]
|
Facility
|
OP
|
$0.52
|
|
Service Code
|
NDC 00904727770
|
Hospital Charge Code |
00904727770
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$0.18 |
Max. Negotiated Rate |
$0.42 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.29
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.26
|
Rate for Payer: Aetna Government |
$0.26
|
Rate for Payer: Brighton Health Commercial |
$0.39
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.42
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.36
|
Rate for Payer: Group Health Inc Commercial |
$0.26
|
Rate for Payer: Group Health Inc Medicare |
$0.18
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.26
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$0.26
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.34
|
|