|
CEFTRIAXONE SODIUM 500 MG IJ SOLR
|
Facility
|
OP
|
$27.99
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
6050561524
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.43 |
| Max. Negotiated Rate |
$22.39 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$15.39
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.50
|
| Rate for Payer: Aetna Government |
$0.50
|
| Rate for Payer: Brighton Health Commercial |
$20.99
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$22.39
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$19.03
|
| Rate for Payer: EmblemHealth Commercial |
$13.99
|
| Rate for Payer: Group Health Inc Commercial |
$13.99
|
| Rate for Payer: Group Health Inc Medicare |
$9.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$13.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.99
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.43
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$18.19
|
|
|
CEFTRIAXONE SODIUM 500 MG IJ SOLR
|
Facility
|
OP
|
$1.16
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
0409733801
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.41 |
| Max. Negotiated Rate |
$0.93 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.64
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.50
|
| Rate for Payer: Aetna Government |
$0.50
|
| Rate for Payer: Brighton Health Commercial |
$0.87
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.93
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.79
|
| Rate for Payer: EmblemHealth Commercial |
$0.58
|
| Rate for Payer: Group Health Inc Commercial |
$0.58
|
| Rate for Payer: Group Health Inc Medicare |
$0.41
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.58
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.43
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.75
|
|
|
CEFTRIAXONE SODIUM 500 MG IJ SOLR
|
Facility
|
IP
|
$1.50
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
0143985801
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.75 |
| Max. Negotiated Rate |
$0.75 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.75
|
|
|
CEFTRIAXONE SODIUM 500 MG IJ SOLR
|
Facility
|
OP
|
$1.50
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
0143985801
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.43 |
| Max. Negotiated Rate |
$1.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.83
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.50
|
| Rate for Payer: Aetna Government |
$0.50
|
| Rate for Payer: Brighton Health Commercial |
$1.12
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.02
|
| Rate for Payer: EmblemHealth Commercial |
$0.75
|
| Rate for Payer: Group Health Inc Commercial |
$0.75
|
| Rate for Payer: Group Health Inc Medicare |
$0.53
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.75
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.43
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.98
|
|
|
CEFTRIAXONE SODIUM 500 MG IJ SOLR
|
Facility
|
OP
|
$1.16
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
0409733811
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.41 |
| Max. Negotiated Rate |
$0.93 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.64
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.50
|
| Rate for Payer: Aetna Government |
$0.50
|
| Rate for Payer: Brighton Health Commercial |
$0.87
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.93
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.79
|
| Rate for Payer: EmblemHealth Commercial |
$0.58
|
| Rate for Payer: Group Health Inc Commercial |
$0.58
|
| Rate for Payer: Group Health Inc Medicare |
$0.41
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.58
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.43
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.75
|
|
|
CEFTRIAXONE SODIUM-DEXTROSE 1-3.74 GM-%(50ML) IV SOLR
|
Facility
|
OP
|
$23.62
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
0264315311
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.43 |
| Max. Negotiated Rate |
$18.89 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$12.99
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.50
|
| Rate for Payer: Aetna Government |
$0.50
|
| Rate for Payer: Brighton Health Commercial |
$17.71
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$18.89
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$16.06
|
| Rate for Payer: EmblemHealth Commercial |
$11.81
|
| Rate for Payer: Group Health Inc Commercial |
$11.81
|
| Rate for Payer: Group Health Inc Medicare |
$8.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11.81
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$11.81
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.43
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$15.35
|
|
|
CEFTRIAXONE SODIUM-DEXTROSE 1-3.74 GM-%(50ML) IV SOLR
|
Facility
|
IP
|
$23.62
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
0264315311
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$11.81 |
| Max. Negotiated Rate |
$11.81 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11.81
|
|
|
CEFUROXIME AXETIL 250 MG PO TABS
|
Facility
|
OP
|
$4.40
|
|
|
Service Code
|
NDC 5723705860
|
| Hospital Charge Code |
5723705860
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.54 |
| Max. Negotiated Rate |
$3.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.42
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.20
|
| Rate for Payer: Aetna Government |
$2.20
|
| Rate for Payer: Brighton Health Commercial |
$3.30
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.99
|
| Rate for Payer: EmblemHealth Commercial |
$2.20
|
| Rate for Payer: Group Health Inc Commercial |
$2.20
|
| Rate for Payer: Group Health Inc Medicare |
$1.54
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.86
|
|
|
CEFUROXIME AXETIL 250 MG PO TABS
|
Facility
|
IP
|
$4.40
|
|
|
Service Code
|
NDC 5723705860
|
| Hospital Charge Code |
5723705860
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.20 |
| Max. Negotiated Rate |
$2.20 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.20
|
|
|
CEFUROXIME AXETIL 250 MG PO TABS
|
Facility
|
IP
|
$4.13
|
|
|
Service Code
|
NDC 6068727294
|
| Hospital Charge Code |
6068727294
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.06 |
| Max. Negotiated Rate |
$2.06 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.06
|
|
|
CEFUROXIME AXETIL 250 MG PO TABS
|
Facility
|
OP
|
$4.40
|
|
|
Service Code
|
NDC 6586269960
|
| Hospital Charge Code |
6586269960
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.54 |
| Max. Negotiated Rate |
$3.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.42
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.20
|
| Rate for Payer: Aetna Government |
$2.20
|
| Rate for Payer: Brighton Health Commercial |
$3.30
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.99
|
| Rate for Payer: EmblemHealth Commercial |
$2.20
|
| Rate for Payer: Group Health Inc Commercial |
$2.20
|
| Rate for Payer: Group Health Inc Medicare |
$1.54
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.86
|
|
|
CEFUROXIME AXETIL 250 MG PO TABS
|
Facility
|
IP
|
$4.40
|
|
|
Service Code
|
NDC 6586269960
|
| Hospital Charge Code |
6586269960
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.20 |
| Max. Negotiated Rate |
$2.20 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.20
|
|
|
CEFUROXIME AXETIL 250 MG PO TABS
|
Facility
|
OP
|
$4.13
|
|
|
Service Code
|
NDC 6068727294
|
| Hospital Charge Code |
6068727294
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.44 |
| Max. Negotiated Rate |
$3.30 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.27
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.06
|
| Rate for Payer: Aetna Government |
$2.06
|
| Rate for Payer: Brighton Health Commercial |
$3.09
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.30
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.81
|
| Rate for Payer: EmblemHealth Commercial |
$2.06
|
| Rate for Payer: Group Health Inc Commercial |
$2.06
|
| Rate for Payer: Group Health Inc Medicare |
$1.44
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.68
|
|
|
CEFUROXIME AXETIL 500 MG PO TABS
|
Facility
|
OP
|
$8.02
|
|
|
Service Code
|
NDC 5723705920
|
| Hospital Charge Code |
5723705920
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.81 |
| Max. Negotiated Rate |
$6.41 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.41
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.01
|
| Rate for Payer: Aetna Government |
$4.01
|
| Rate for Payer: Brighton Health Commercial |
$6.01
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.41
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.45
|
| Rate for Payer: EmblemHealth Commercial |
$4.01
|
| Rate for Payer: Group Health Inc Commercial |
$4.01
|
| Rate for Payer: Group Health Inc Medicare |
$2.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.21
|
|
|
CEFUROXIME AXETIL 500 MG PO TABS
|
Facility
|
IP
|
$8.02
|
|
|
Service Code
|
NDC 6586270020
|
| Hospital Charge Code |
6586270020
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.01 |
| Max. Negotiated Rate |
$4.01 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.01
|
|
|
CEFUROXIME AXETIL 500 MG PO TABS
|
Facility
|
IP
|
$8.02
|
|
|
Service Code
|
NDC 5723705920
|
| Hospital Charge Code |
5723705920
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.01 |
| Max. Negotiated Rate |
$4.01 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.01
|
|
|
CEFUROXIME AXETIL 500 MG PO TABS
|
Facility
|
IP
|
$11.10
|
|
|
Service Code
|
NDC 6787721660
|
| Hospital Charge Code |
6787721660
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.55 |
| Max. Negotiated Rate |
$5.55 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.55
|
|
|
CEFUROXIME AXETIL 500 MG PO TABS
|
Facility
|
OP
|
$8.02
|
|
|
Service Code
|
NDC 6586270020
|
| Hospital Charge Code |
6586270020
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.81 |
| Max. Negotiated Rate |
$6.41 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.41
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.01
|
| Rate for Payer: Aetna Government |
$4.01
|
| Rate for Payer: Brighton Health Commercial |
$6.01
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.41
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.45
|
| Rate for Payer: EmblemHealth Commercial |
$4.01
|
| Rate for Payer: Group Health Inc Commercial |
$4.01
|
| Rate for Payer: Group Health Inc Medicare |
$2.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.21
|
|
|
CEFUROXIME AXETIL 500 MG PO TABS
|
Facility
|
OP
|
$11.10
|
|
|
Service Code
|
NDC 6787721660
|
| Hospital Charge Code |
6787721660
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.88 |
| Max. Negotiated Rate |
$8.88 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.55
|
| Rate for Payer: Aetna Government |
$5.55
|
| Rate for Payer: Brighton Health Commercial |
$8.32
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.88
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7.55
|
| Rate for Payer: EmblemHealth Commercial |
$5.55
|
| Rate for Payer: Group Health Inc Commercial |
$5.55
|
| Rate for Payer: Group Health Inc Medicare |
$3.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.55
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.55
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$7.21
|
|
|
CEFUROXIME SODIUM 1.5 G IV SOLR
|
Facility
|
IP
|
$6.51
|
|
|
Service Code
|
HCPCS J0697
|
| Hospital Charge Code |
2502111920
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$3.26 |
| Max. Negotiated Rate |
$3.26 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.26
|
|
|
CEFUROXIME SODIUM 1.5 G IV SOLR
|
Facility
|
OP
|
$6.51
|
|
|
Service Code
|
HCPCS J0697
|
| Hospital Charge Code |
2502111920
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$1.85 |
| Max. Negotiated Rate |
$5.21 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.58
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.01
|
| Rate for Payer: Aetna Government |
$2.01
|
| Rate for Payer: Brighton Health Commercial |
$4.88
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5.21
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.43
|
| Rate for Payer: EmblemHealth Commercial |
$3.26
|
| Rate for Payer: Group Health Inc Commercial |
$3.26
|
| Rate for Payer: Group Health Inc Medicare |
$2.28
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.26
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1.85
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.23
|
|
|
CEFUROXIME SODIUM 750 MG IJ SOLR
|
Facility
|
IP
|
$3.51
|
|
|
Service Code
|
HCPCS J0697
|
| Hospital Charge Code |
0143997922
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.75 |
| Max. Negotiated Rate |
$1.75 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.75
|
|
|
CEFUROXIME SODIUM 750 MG IJ SOLR
|
Facility
|
OP
|
$3.51
|
|
|
Service Code
|
HCPCS J0697
|
| Hospital Charge Code |
0143997922
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.23 |
| Max. Negotiated Rate |
$2.81 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.93
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.01
|
| Rate for Payer: Aetna Government |
$2.01
|
| Rate for Payer: Brighton Health Commercial |
$2.63
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.81
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.38
|
| Rate for Payer: EmblemHealth Commercial |
$1.75
|
| Rate for Payer: Group Health Inc Commercial |
$1.75
|
| Rate for Payer: Group Health Inc Medicare |
$1.23
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.75
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1.85
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.28
|
|
|
CEFUROXIME SODIUM 750 MG IJ SOLR
|
Facility
|
OP
|
$3.67
|
|
|
Service Code
|
HCPCS J0697
|
| Hospital Charge Code |
2502111810
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.29 |
| Max. Negotiated Rate |
$2.94 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.02
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.01
|
| Rate for Payer: Aetna Government |
$2.01
|
| Rate for Payer: Brighton Health Commercial |
$2.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.94
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.50
|
| Rate for Payer: EmblemHealth Commercial |
$1.84
|
| Rate for Payer: Group Health Inc Commercial |
$1.84
|
| Rate for Payer: Group Health Inc Medicare |
$1.29
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.84
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1.85
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.39
|
|
|
CEFUROXIME SODIUM 750 MG IJ SOLR
|
Facility
|
IP
|
$3.67
|
|
|
Service Code
|
HCPCS J0697
|
| Hospital Charge Code |
2502111810
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.84 |
| Max. Negotiated Rate |
$1.84 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.84
|
|
