|
PENICILLIN G BENZATHINE 600000 UNIT/ML IM SUSY
|
Facility
|
IP
|
$192.11
|
|
|
Service Code
|
HCPCS J0561
|
| Hospital Charge Code |
6079370001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$96.06 |
| Max. Negotiated Rate |
$96.06 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$96.06
|
|
|
PENICILLIN G POTASSIUM 20000000 UNITS IJ SOLR
|
Facility
|
IP
|
$61.06
|
|
|
Service Code
|
HCPCS J2540
|
| Hospital Charge Code |
0049053028
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$30.53 |
| Max. Negotiated Rate |
$30.53 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$30.53
|
|
|
PENICILLIN G POTASSIUM 20000000 UNITS IJ SOLR
|
Facility
|
OP
|
$61.06
|
|
|
Service Code
|
HCPCS J2540
|
| Hospital Charge Code |
0049053028
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.79 |
| Max. Negotiated Rate |
$48.85 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$33.58
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.92
|
| Rate for Payer: Aetna Government |
$0.92
|
| Rate for Payer: Brighton Health Commercial |
$45.80
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$48.85
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$41.52
|
| Rate for Payer: EmblemHealth Commercial |
$30.53
|
| Rate for Payer: Group Health Inc Commercial |
$30.53
|
| Rate for Payer: Group Health Inc Medicare |
$21.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$30.53
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$30.53
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.79
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$39.69
|
|
|
PENICILLIN G POTASSIUM 5000000 UNITS IJ SOLR
|
Facility
|
OP
|
$15.27
|
|
|
Service Code
|
HCPCS J2540
|
| Hospital Charge Code |
0049042010
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.79 |
| Max. Negotiated Rate |
$12.21 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$8.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.92
|
| Rate for Payer: Aetna Government |
$0.92
|
| Rate for Payer: Brighton Health Commercial |
$11.45
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$12.21
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$10.38
|
| Rate for Payer: EmblemHealth Commercial |
$7.63
|
| Rate for Payer: Group Health Inc Commercial |
$7.63
|
| Rate for Payer: Group Health Inc Medicare |
$5.34
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.63
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.63
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.79
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$9.92
|
|
|
PENICILLIN G POTASSIUM 5000000 UNITS IJ SOLR
|
Facility
|
IP
|
$15.27
|
|
|
Service Code
|
HCPCS J2540
|
| Hospital Charge Code |
0049042010
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.63 |
| Max. Negotiated Rate |
$7.63 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.63
|
|
|
PENICILLIN G POTASSIUM 5000000 UNITS IJ SOLR
|
Facility
|
IP
|
$15.26
|
|
|
Service Code
|
HCPCS J2540
|
| Hospital Charge Code |
0049052084
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.63 |
| Max. Negotiated Rate |
$7.63 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.63
|
|
|
PENICILLIN G POTASSIUM 5000000 UNITS IJ SOLR
|
Facility
|
OP
|
$15.27
|
|
|
Service Code
|
HCPCS J2540
|
| Hospital Charge Code |
0049052083
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.79 |
| Max. Negotiated Rate |
$12.21 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$8.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.92
|
| Rate for Payer: Aetna Government |
$0.92
|
| Rate for Payer: Brighton Health Commercial |
$11.45
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$12.21
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$10.38
|
| Rate for Payer: EmblemHealth Commercial |
$7.63
|
| Rate for Payer: Group Health Inc Commercial |
$7.63
|
| Rate for Payer: Group Health Inc Medicare |
$5.34
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.63
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.63
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.79
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$9.92
|
|
|
PENICILLIN G POTASSIUM 5000000 UNITS IJ SOLR
|
Facility
|
IP
|
$15.27
|
|
|
Service Code
|
HCPCS J2540
|
| Hospital Charge Code |
0049052083
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.63 |
| Max. Negotiated Rate |
$7.63 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.63
|
|
|
PENICILLIN G POTASSIUM 5000000 UNITS IJ SOLR
|
Facility
|
OP
|
$15.26
|
|
|
Service Code
|
HCPCS J2540
|
| Hospital Charge Code |
0049052084
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.79 |
| Max. Negotiated Rate |
$12.21 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$8.39
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.92
|
| Rate for Payer: Aetna Government |
$0.92
|
| Rate for Payer: Brighton Health Commercial |
$11.45
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$12.21
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$10.38
|
| Rate for Payer: EmblemHealth Commercial |
$7.63
|
| Rate for Payer: Group Health Inc Commercial |
$7.63
|
| Rate for Payer: Group Health Inc Medicare |
$5.34
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.63
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.63
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.79
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$9.92
|
|
|
PENICILLIN V POTASSIUM 125 MG/5ML PO SOLR
|
Facility
|
OP
|
$0.10
|
|
|
Service Code
|
NDC 0093412573
|
| Hospital Charge Code |
0093412573
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.08 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.06
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.05
|
| Rate for Payer: Aetna Government |
$0.05
|
| Rate for Payer: Brighton Health Commercial |
$0.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.08
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.07
|
| Rate for Payer: EmblemHealth Commercial |
$0.05
|
| Rate for Payer: Group Health Inc Commercial |
$0.05
|
| Rate for Payer: Group Health Inc Medicare |
$0.04
|
| 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 |
$0.07
|
|
|
PENICILLIN V POTASSIUM 125 MG/5ML PO SOLR
|
Facility
|
IP
|
$0.10
|
|
|
Service Code
|
NDC 0093412573
|
| Hospital Charge Code |
0093412573
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.05
|
|
|
PENICILLIN V POTASSIUM 250 MG/5ML PO SOLR
|
Facility
|
OP
|
$0.08
|
|
|
Service Code
|
NDC 0093412774
|
| Hospital Charge Code |
0093412774
|
|
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 |
$0.06
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.06
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.06
|
| Rate for Payer: EmblemHealth Commercial |
$0.04
|
| 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
|
|
|
PENICILLIN V POTASSIUM 250 MG/5ML PO SOLR
|
Facility
|
OP
|
$0.11
|
|
|
Service Code
|
NDC 0093412773
|
| Hospital Charge Code |
0093412773
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.09 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.06
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.06
|
| Rate for Payer: Aetna Government |
$0.06
|
| Rate for Payer: Brighton Health Commercial |
$0.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.09
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.08
|
| Rate for Payer: EmblemHealth Commercial |
$0.06
|
| Rate for Payer: Group Health Inc Commercial |
$0.06
|
| Rate for Payer: Group Health Inc Medicare |
$0.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.07
|
|
|
PENICILLIN V POTASSIUM 250 MG/5ML PO SOLR
|
Facility
|
IP
|
$0.11
|
|
|
Service Code
|
NDC 0093412773
|
| Hospital Charge Code |
0093412773
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.06 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.06
|
|
|
PENICILLIN V POTASSIUM 250 MG/5ML PO SOLR
|
Facility
|
IP
|
$0.08
|
|
|
Service Code
|
NDC 0093412774
|
| Hospital Charge Code |
0093412774
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.04 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.04
|
|
|
PENICILLIN V POTASSIUM 250 MG PO TABS
|
Facility
|
IP
|
$0.85
|
|
|
Service Code
|
NDC 0143983701
|
| Hospital Charge Code |
0143983701
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.43 |
| Max. Negotiated Rate |
$0.43 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.43
|
|
|
PENICILLIN V POTASSIUM 250 MG PO TABS
|
Facility
|
IP
|
$1.13
|
|
|
Service Code
|
NDC 0093117210
|
| Hospital Charge Code |
0093117210
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$0.57 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.57
|
|
|
PENICILLIN V POTASSIUM 250 MG PO TABS
|
Facility
|
OP
|
$1.13
|
|
|
Service Code
|
NDC 0093117210
|
| Hospital Charge Code |
0093117210
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$0.90 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.62
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.57
|
| Rate for Payer: Aetna Government |
$0.57
|
| Rate for Payer: Brighton Health Commercial |
$0.85
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.90
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.77
|
| Rate for Payer: EmblemHealth Commercial |
$0.57
|
| Rate for Payer: Group Health Inc Commercial |
$0.57
|
| Rate for Payer: Group Health Inc Medicare |
$0.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.57
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.57
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.73
|
|
|
PENICILLIN V POTASSIUM 250 MG PO TABS
|
Facility
|
OP
|
$0.85
|
|
|
Service Code
|
NDC 0143983701
|
| Hospital Charge Code |
0143983701
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.30 |
| Max. Negotiated Rate |
$0.68 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.47
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.43
|
| Rate for Payer: Aetna Government |
$0.43
|
| Rate for Payer: Brighton Health Commercial |
$0.64
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.68
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.58
|
| Rate for Payer: EmblemHealth Commercial |
$0.43
|
| Rate for Payer: Group Health Inc Commercial |
$0.43
|
| Rate for Payer: Group Health Inc Medicare |
$0.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.43
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.43
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.55
|
|
|
PENICILLIN V POTASSIUM 500 MG PO TABS
|
Facility
|
OP
|
$0.78
|
|
|
Service Code
|
NDC 0143983601
|
| Hospital Charge Code |
0143983601
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.27 |
| Max. Negotiated Rate |
$0.62 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.43
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.39
|
| Rate for Payer: Aetna Government |
$0.39
|
| Rate for Payer: Brighton Health Commercial |
$0.58
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.62
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.53
|
| Rate for Payer: EmblemHealth Commercial |
$0.39
|
| Rate for Payer: Group Health Inc Commercial |
$0.39
|
| Rate for Payer: Group Health Inc Medicare |
$0.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.51
|
|
|
PENICILLIN V POTASSIUM 500 MG PO TABS
|
Facility
|
IP
|
$0.78
|
|
|
Service Code
|
NDC 0143983601
|
| Hospital Charge Code |
0143983601
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.39 |
| Max. Negotiated Rate |
$0.39 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.39
|
|
|
PENICILLIN V POTASSIUM 500 MG PO TABS
|
Facility
|
OP
|
$2.02
|
|
|
Service Code
|
NDC 0093117401
|
| Hospital Charge Code |
0093117401
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.71 |
| Max. Negotiated Rate |
$1.62 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.11
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.01
|
| Rate for Payer: Aetna Government |
$1.01
|
| Rate for Payer: Brighton Health Commercial |
$1.52
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.62
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.37
|
| Rate for Payer: EmblemHealth Commercial |
$1.01
|
| Rate for Payer: Group Health Inc Commercial |
$1.01
|
| Rate for Payer: Group Health Inc Medicare |
$0.71
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.31
|
|
|
PENICILLIN V POTASSIUM 500 MG PO TABS
|
Facility
|
IP
|
$2.02
|
|
|
Service Code
|
NDC 0093117401
|
| Hospital Charge Code |
0093117401
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.01 |
| Max. Negotiated Rate |
$1.01 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.01
|
|
|
PENICILLIN V POTASSIUM 500 MG PO TABS
|
Facility
|
IP
|
$0.78
|
|
|
Service Code
|
NDC 6586217601
|
| Hospital Charge Code |
6586217601
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.39 |
| Max. Negotiated Rate |
$0.39 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.39
|
|
|
PENICILLIN V POTASSIUM 500 MG PO TABS
|
Facility
|
OP
|
$0.78
|
|
|
Service Code
|
NDC 6586217601
|
| Hospital Charge Code |
6586217601
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.27 |
| Max. Negotiated Rate |
$0.62 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.43
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.39
|
| Rate for Payer: Aetna Government |
$0.39
|
| Rate for Payer: Brighton Health Commercial |
$0.58
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.62
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.53
|
| Rate for Payer: EmblemHealth Commercial |
$0.39
|
| Rate for Payer: Group Health Inc Commercial |
$0.39
|
| Rate for Payer: Group Health Inc Medicare |
$0.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.51
|
|
