|
ISOLATION SET
|
Facility
|
OP
|
$18.78
|
|
| Hospital Charge Code |
40202730
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$6.57 |
| Max. Negotiated Rate |
$15.02 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$10.33
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$9.39
|
| Rate for Payer: Aetna Government |
$9.39
|
| Rate for Payer: Brighton Health Commercial |
$14.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$15.02
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$12.77
|
| Rate for Payer: Group Health Inc Commercial |
$9.39
|
| Rate for Payer: Group Health Inc Medicare |
$6.57
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9.39
|
|
|
ISOLATION TRAY
|
Facility
|
OP
|
$20.56
|
|
| Hospital Charge Code |
40207613
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.20 |
| Max. Negotiated Rate |
$16.45 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$11.31
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$10.28
|
| Rate for Payer: Aetna Government |
$10.28
|
| Rate for Payer: Brighton Health Commercial |
$15.42
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$16.45
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$13.98
|
| Rate for Payer: Group Health Inc Commercial |
$10.28
|
| Rate for Payer: Group Health Inc Medicare |
$7.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.28
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$10.28
|
|
|
ISOLETTE
|
Facility
|
OP
|
$557.18
|
|
|
Service Code
|
HCPCS 94640
|
| Hospital Charge Code |
40307300
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$132.45 |
| Max. Negotiated Rate |
$417.88 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$306.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$246.65
|
| Rate for Payer: Aetna Government |
$246.65
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$172.66
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$172.66
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$172.66
|
| Rate for Payer: Brighton Health Commercial |
$417.88
|
| Rate for Payer: Cash Price |
$246.65
|
| Rate for Payer: Cash Price |
$246.65
|
| Rate for Payer: Cash Price |
$246.65
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$246.65
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$155.82
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$132.45
|
| Rate for Payer: Elderplan Medicare Advantage |
$246.65
|
| Rate for Payer: EmblemHealth Commercial |
$246.65
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$209.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$219.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$246.65
|
| Rate for Payer: Fidelis Qualified Health Plan |
$219.52
|
| Rate for Payer: Group Health Inc Commercial |
$246.65
|
| Rate for Payer: Group Health Inc Medicare |
$246.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$278.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$246.65
|
| Rate for Payer: Healthfirst Medicare Advantage |
$209.65
|
| Rate for Payer: Healthfirst QHP |
$246.65
|
| Rate for Payer: Humana Medicare |
$251.58
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$246.65
|
| Rate for Payer: United Healthcare Commercial |
$278.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$246.65
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$246.65
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$197.32
|
| Rate for Payer: Wellcare Medicare |
$234.32
|
|
|
ISOLETTE
|
Facility
|
IP
|
$557.18
|
|
|
Service Code
|
HCPCS 94640
|
| Hospital Charge Code |
40307300
|
|
Hospital Revenue Code
|
410
|
| Rate for Payer: Cash Price |
$246.65
|
|
|
ISONIAZID 100 MG PO TABS [4026]
|
Facility
|
OP
|
$0.15
|
|
|
Service Code
|
NDC 00555006602
|
| Hospital Charge Code |
00555006602
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.12 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.08
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.07
|
| Rate for Payer: Aetna Government |
$0.07
|
| Rate for Payer: Brighton Health Commercial |
$0.11
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.12
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.10
|
| Rate for Payer: Group Health Inc Commercial |
$0.07
|
| Rate for Payer: Group Health Inc Medicare |
$0.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.07
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.07
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.10
|
|
|
ISONIAZID 100 MG TAB
|
Facility
|
OP
|
$0.07
|
|
| Hospital Charge Code |
41641109
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.02 |
| 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 |
$0.02
|
| 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
|
|
|
ISONIAZID 100 MG TAB
|
Facility
|
OP
|
$0.07
|
|
| Hospital Charge Code |
41651109
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.02 |
| 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 |
$0.02
|
| 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
|
|
|
ISONIAZID 10 MG/ML SYRUP
|
Facility
|
OP
|
$56.17
|
|
| Hospital Charge Code |
41642324
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$19.66 |
| Max. Negotiated Rate |
$44.94 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$30.89
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$28.08
|
| Rate for Payer: Aetna Government |
$28.08
|
| Rate for Payer: Brighton Health Commercial |
$42.13
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$44.94
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$38.20
|
| Rate for Payer: Group Health Inc Commercial |
$28.08
|
| Rate for Payer: Group Health Inc Medicare |
$19.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$28.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$28.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$36.51
|
|
|
ISONIAZID 10 MG/ML SYRUP
|
Facility
|
OP
|
$56.17
|
|
| Hospital Charge Code |
41652324
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$19.66 |
| Max. Negotiated Rate |
$44.94 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$30.89
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$28.08
|
| Rate for Payer: Aetna Government |
$28.08
|
| Rate for Payer: Brighton Health Commercial |
$42.13
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$44.94
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$38.20
|
| Rate for Payer: Group Health Inc Commercial |
$28.08
|
| Rate for Payer: Group Health Inc Medicare |
$19.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$28.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$28.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$36.51
|
|
|
ISONIAZID 300 MG PO TABS [4027]
|
Facility
|
OP
|
$1.32
|
|
|
Service Code
|
NDC 60687055301
|
| Hospital Charge Code |
60687055301
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.46 |
| Max. Negotiated Rate |
$1.06 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.73
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.66
|
| Rate for Payer: Aetna Government |
$0.66
|
| Rate for Payer: Brighton Health Commercial |
$0.99
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.06
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.90
|
| Rate for Payer: Group Health Inc Commercial |
$0.66
|
| Rate for Payer: Group Health Inc Medicare |
$0.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.66
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.66
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.86
|
|
|
ISONIAZID 300 MG PO TABS [4027]
|
Facility
|
OP
|
$0.31
|
|
|
Service Code
|
NDC 00555007102
|
| Hospital Charge Code |
00555007102
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.17
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.16
|
| Rate for Payer: Aetna Government |
$0.16
|
| 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: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.20
|
|
|
ISONIAZID 300 MG PO TABS [4027]
|
Facility
|
OP
|
$0.51
|
|
|
Service Code
|
NDC 00555007101
|
| Hospital Charge Code |
00555007101
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$0.41 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.28
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.25
|
| Rate for Payer: Aetna Government |
$0.25
|
| Rate for Payer: Brighton Health Commercial |
$0.38
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.41
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.35
|
| Rate for Payer: Group Health Inc Commercial |
$0.25
|
| Rate for Payer: Group Health Inc Medicare |
$0.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.33
|
|
|
ISONIAZID 300 MG TAB
|
Facility
|
OP
|
$1.00
|
|
| Hospital Charge Code |
41640251
|
|
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
|
|
|
ISONIAZID 300 MG TAB
|
Facility
|
OP
|
$1.00
|
|
| Hospital Charge Code |
41650251
|
|
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
|
|
|
ISONIAZID 50 MG/5ML PO SYRP [4025]
|
Facility
|
OP
|
$0.86
|
|
|
Service Code
|
NDC 46287000901
|
| Hospital Charge Code |
46287000901
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.30 |
| Max. Negotiated Rate |
$0.69 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.48
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.43
|
| Rate for Payer: Aetna Government |
$0.43
|
| Rate for Payer: Brighton Health Commercial |
$0.65
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.69
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.59
|
| 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 |
$0.56
|
|
|
ISONIAZID (INH)
|
Facility
|
OP
|
$105.00
|
|
|
Service Code
|
HCPCS 80375
|
| Hospital Charge Code |
40609885
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$84.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$57.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.01
|
| Rate for Payer: Aetna Government |
$0.01
|
| Rate for Payer: Brighton Health Commercial |
$78.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$84.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$71.40
|
| Rate for Payer: Group Health Inc Commercial |
$52.50
|
| Rate for Payer: Group Health Inc Medicare |
$36.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$52.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$52.50
|
| Rate for Payer: United Healthcare Commercial |
$19.94
|
|
|
ISOPROPANOL
|
Facility
|
OP
|
$42.78
|
|
|
Service Code
|
HCPCS 84600
|
| Hospital Charge Code |
40609130
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.98 |
| Max. Negotiated Rate |
$32.08 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$23.53
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$17.11
|
| Rate for Payer: Aetna Government |
$17.11
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$11.98
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$11.98
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$11.98
|
| Rate for Payer: Brighton Health Commercial |
$32.08
|
| Rate for Payer: Cash Price |
$17.11
|
| Rate for Payer: Cash Price |
$17.11
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$17.11
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$25.54
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$21.62
|
| Rate for Payer: Elderplan Medicare Advantage |
$17.11
|
| Rate for Payer: EmblemHealth Commercial |
$17.11
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$14.54
|
| Rate for Payer: Fidelis Essential Plan QHP |
$15.23
|
| Rate for Payer: Fidelis Medicare Advantage |
$17.11
|
| Rate for Payer: Fidelis Qualified Health Plan |
$15.23
|
| Rate for Payer: Group Health Inc Commercial |
$17.11
|
| Rate for Payer: Group Health Inc Medicare |
$17.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$21.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$17.11
|
| Rate for Payer: Healthfirst Medicare Advantage |
$17.11
|
| Rate for Payer: Healthfirst QHP |
$17.11
|
| Rate for Payer: Humana Medicare |
$17.45
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$17.11
|
| Rate for Payer: United Healthcare Commercial |
$20.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.11
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$17.11
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$13.69
|
| Rate for Payer: Wellcare Medicare |
$15.40
|
|
|
ISOPROPANOL
|
Facility
|
IP
|
$42.78
|
|
|
Service Code
|
HCPCS 84600
|
| Hospital Charge Code |
40609130
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$17.11
|
|
|
ISOPROTERENOL 0.2 MG/ML INJ
|
Facility
|
IP
|
$90.16
|
|
|
Service Code
|
HCPCS J7659
|
| Hospital Charge Code |
41655030
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$45.08 |
| Max. Negotiated Rate |
$45.08 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$45.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$45.08
|
|
|
ISOPROTERENOL 0.2 MG/ML INJ
|
Facility
|
OP
|
$90.16
|
|
|
Service Code
|
HCPCS J7659
|
| Hospital Charge Code |
41645030
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.43 |
| Max. Negotiated Rate |
$58.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$49.59
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.43
|
| Rate for Payer: Aetna Government |
$1.43
|
| Rate for Payer: Brighton Health Commercial |
$54.10
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$45.08
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$51.84
|
| Rate for Payer: Group Health Inc Commercial |
$45.08
|
| Rate for Payer: Group Health Inc Medicare |
$31.56
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$45.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$45.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$58.60
|
|
|
ISOPROTERENOL 0.2 MG/ML INJ
|
Facility
|
IP
|
$90.16
|
|
|
Service Code
|
HCPCS J7659
|
| Hospital Charge Code |
41645030
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$45.08 |
| Max. Negotiated Rate |
$45.08 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$45.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$45.08
|
|
|
ISOPROTERENOL 0.2 MG/ML INJ
|
Facility
|
OP
|
$90.16
|
|
|
Service Code
|
HCPCS J7659
|
| Hospital Charge Code |
41655030
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.43 |
| Max. Negotiated Rate |
$58.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$49.59
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.43
|
| Rate for Payer: Aetna Government |
$1.43
|
| Rate for Payer: Brighton Health Commercial |
$54.10
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$45.08
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$51.84
|
| Rate for Payer: Group Health Inc Commercial |
$45.08
|
| Rate for Payer: Group Health Inc Medicare |
$31.56
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$45.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$45.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$58.60
|
|
|
ISOPROTERENOL HCL 0.2 MG/ML IJ SOLN [4034]
|
Facility
|
OP
|
$144.00
|
|
|
Service Code
|
NDC 14789001505
|
| Hospital Charge Code |
14789001505
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$50.40 |
| Max. Negotiated Rate |
$115.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$79.20
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$72.00
|
| Rate for Payer: Aetna Government |
$72.00
|
| Rate for Payer: Brighton Health Commercial |
$108.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$115.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$97.92
|
| Rate for Payer: Group Health Inc Commercial |
$72.00
|
| Rate for Payer: Group Health Inc Medicare |
$50.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$72.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$72.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$93.60
|
|
|
ISOPROTERENOL HCL 0.2 MG/ML IJ SOLN [4034]
|
Facility
|
OP
|
$540.00
|
|
|
Service Code
|
NDC 14789001101
|
| Hospital Charge Code |
14789001101
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$189.00 |
| Max. Negotiated Rate |
$432.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$297.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$270.00
|
| Rate for Payer: Aetna Government |
$270.00
|
| Rate for Payer: Brighton Health Commercial |
$405.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$432.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$367.20
|
| Rate for Payer: Group Health Inc Commercial |
$270.00
|
| Rate for Payer: Group Health Inc Medicare |
$189.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$270.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$270.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$351.00
|
|
|
ISOPROTERENOL HCL 0.2 MG/ML IJ SOLN [4034]
|
Facility
|
OP
|
$130.80
|
|
|
Service Code
|
NDC 55150031710
|
| Hospital Charge Code |
55150031710
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$45.78 |
| Max. Negotiated Rate |
$104.64 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$71.94
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$65.40
|
| Rate for Payer: Aetna Government |
$65.40
|
| Rate for Payer: Brighton Health Commercial |
$98.10
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$104.64
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$88.94
|
| Rate for Payer: Group Health Inc Commercial |
$65.40
|
| Rate for Payer: Group Health Inc Medicare |
$45.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$65.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$65.40
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$85.02
|
|
