|
ACETYLCYSTEINE 200 MG/ML IV SOLN
|
Facility
|
OP
|
$11.67
|
|
|
Service Code
|
HCPCS J0132
|
| Hospital Charge Code |
5515025930
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.39 |
| Max. Negotiated Rate |
$9.33 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.42
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.83
|
| Rate for Payer: Aetna Government |
$0.83
|
| Rate for Payer: Brighton Health Commercial |
$8.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$9.33
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7.93
|
| Rate for Payer: EmblemHealth Commercial |
$5.83
|
| Rate for Payer: Group Health Inc Commercial |
$5.83
|
| Rate for Payer: Group Health Inc Medicare |
$4.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.83
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.83
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$7.58
|
|
|
ACETYLCYSTEINE 200 MG/ML IV SOLN
|
Facility
|
IP
|
$11.67
|
|
|
Service Code
|
HCPCS J0132
|
| Hospital Charge Code |
5515025930
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$5.83 |
| Max. Negotiated Rate |
$5.83 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.83
|
|
|
ACETYLCYSTEINE 200 MG/ML IV SOLN
|
Facility
|
OP
|
$2.22
|
|
|
Service Code
|
HCPCS J0132
|
| Hospital Charge Code |
6846294630
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.39 |
| Max. Negotiated Rate |
$1.78 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.22
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.83
|
| Rate for Payer: Aetna Government |
$0.83
|
| Rate for Payer: Brighton Health Commercial |
$1.66
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.78
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.51
|
| Rate for Payer: EmblemHealth Commercial |
$1.11
|
| Rate for Payer: Group Health Inc Commercial |
$1.11
|
| Rate for Payer: Group Health Inc Medicare |
$0.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.11
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.11
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.44
|
|
|
ACETYLCYSTEINE 200 MG/ML IV SOLN
|
Facility
|
IP
|
$4.40
|
|
|
Service Code
|
HCPCS J0132
|
| Hospital Charge Code |
6332396330
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$2.20 |
| Max. Negotiated Rate |
$2.20 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.20
|
|
|
ACETYLCYSTEINE 200 MG/ML IV SOLN
|
Facility
|
IP
|
$2.22
|
|
|
Service Code
|
HCPCS J0132
|
| Hospital Charge Code |
6846294630
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$1.11 |
| Max. Negotiated Rate |
$1.11 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.11
|
|
|
ACETYLCYSTEINE 200 MG/ML IV SOLN
|
Facility
|
OP
|
$4.40
|
|
|
Service Code
|
HCPCS J0132
|
| Hospital Charge Code |
6332396330
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.39 |
| Max. Negotiated Rate |
$3.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.42
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.83
|
| Rate for Payer: Aetna Government |
$0.83
|
| 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: Healthfirst CHP/FHP/Medicaid |
$0.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.86
|
|
|
ACETYLCYSTEINE 20 % IN SOLN
|
Facility
|
IP
|
$1.80
|
|
|
Service Code
|
HCPCS J7608
|
| Hospital Charge Code |
6332369441
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$0.90 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.90
|
|
|
ACETYLCYSTEINE 20 % IN SOLN
|
Facility
|
IP
|
$1.60
|
|
|
Service Code
|
HCPCS J7608
|
| Hospital Charge Code |
6332369210
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.80 |
| Max. Negotiated Rate |
$0.80 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.80
|
|
|
ACETYLCYSTEINE 20 % IN SOLN
|
Facility
|
OP
|
$1.80
|
|
|
Service Code
|
HCPCS J7608
|
| Hospital Charge Code |
6332369441
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.63 |
| Max. Negotiated Rate |
$8.66 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.99
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.08
|
| Rate for Payer: Aetna Government |
$6.08
|
| Rate for Payer: Brighton Health Commercial |
$1.35
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.44
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.22
|
| Rate for Payer: EmblemHealth Commercial |
$0.90
|
| Rate for Payer: Group Health Inc Commercial |
$0.90
|
| Rate for Payer: Group Health Inc Medicare |
$0.63
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.90
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$8.66
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.17
|
|
|
ACETYLCYSTEINE 20 % IN SOLN
|
Facility
|
OP
|
$0.26
|
|
|
Service Code
|
HCPCS J7608
|
| Hospital Charge Code |
6332369044
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$8.66 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.14
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.08
|
| Rate for Payer: Aetna Government |
$6.08
|
| Rate for Payer: Brighton Health Commercial |
$0.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.21
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.18
|
| Rate for Payer: EmblemHealth Commercial |
$0.13
|
| Rate for Payer: Group Health Inc Commercial |
$0.13
|
| Rate for Payer: Group Health Inc Medicare |
$0.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.13
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.13
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$8.66
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.17
|
|
|
ACETYLCYSTEINE 20 % IN SOLN
|
Facility
|
OP
|
$0.26
|
|
|
Service Code
|
HCPCS J7608
|
| Hospital Charge Code |
6332369041
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$8.66 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.14
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.08
|
| Rate for Payer: Aetna Government |
$6.08
|
| Rate for Payer: Brighton Health Commercial |
$0.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.21
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.18
|
| Rate for Payer: EmblemHealth Commercial |
$0.13
|
| Rate for Payer: Group Health Inc Commercial |
$0.13
|
| Rate for Payer: Group Health Inc Medicare |
$0.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.13
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.13
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$8.66
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.17
|
|
|
ACETYLCYSTEINE 20 % IN SOLN
|
Facility
|
OP
|
$1.80
|
|
|
Service Code
|
HCPCS J7608
|
| Hospital Charge Code |
6332369444
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.63 |
| Max. Negotiated Rate |
$8.66 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.99
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.08
|
| Rate for Payer: Aetna Government |
$6.08
|
| Rate for Payer: Brighton Health Commercial |
$1.35
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.44
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.22
|
| Rate for Payer: EmblemHealth Commercial |
$0.90
|
| Rate for Payer: Group Health Inc Commercial |
$0.90
|
| Rate for Payer: Group Health Inc Medicare |
$0.63
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.90
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$8.66
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.17
|
|
|
ACETYLCYSTEINE 20 % IN SOLN
|
Facility
|
OP
|
$3.96
|
|
|
Service Code
|
HCPCS J7608
|
| Hospital Charge Code |
0517760425
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.38 |
| Max. Negotiated Rate |
$8.66 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.18
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.08
|
| Rate for Payer: Aetna Government |
$6.08
|
| Rate for Payer: Brighton Health Commercial |
$2.97
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.17
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.69
|
| Rate for Payer: EmblemHealth Commercial |
$1.98
|
| Rate for Payer: Group Health Inc Commercial |
$1.98
|
| Rate for Payer: Group Health Inc Medicare |
$1.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.98
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$8.66
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.57
|
|
|
ACETYLCYSTEINE 20 % IN SOLN
|
Facility
|
IP
|
$1.80
|
|
|
Service Code
|
HCPCS J7608
|
| Hospital Charge Code |
6332369444
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$0.90 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.90
|
|
|
ACETYLCYSTEINE 20 % IN SOLN
|
Facility
|
IP
|
$0.26
|
|
|
Service Code
|
HCPCS J7608
|
| Hospital Charge Code |
6332369041
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.13 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.13
|
|
|
ACETYLCYSTEINE 20 % IN SOLN
|
Facility
|
IP
|
$0.26
|
|
|
Service Code
|
HCPCS J7608
|
| Hospital Charge Code |
6332369044
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.13 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.13
|
|
|
ACETYLCYSTEINE 20 % IN SOLN
|
Facility
|
OP
|
$4.20
|
|
|
Service Code
|
HCPCS J7608
|
| Hospital Charge Code |
6332369404
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.47 |
| Max. Negotiated Rate |
$8.66 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.31
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.08
|
| Rate for Payer: Aetna Government |
$6.08
|
| Rate for Payer: Brighton Health Commercial |
$3.15
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.36
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.86
|
| Rate for Payer: EmblemHealth Commercial |
$2.10
|
| Rate for Payer: Group Health Inc Commercial |
$2.10
|
| Rate for Payer: Group Health Inc Medicare |
$1.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.10
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$8.66
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.73
|
|
|
ACETYLCYSTEINE 20 % IN SOLN
|
Facility
|
IP
|
$3.96
|
|
|
Service Code
|
HCPCS J7608
|
| Hospital Charge Code |
0517760425
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.98 |
| Max. Negotiated Rate |
$1.98 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.98
|
|
|
ACETYLCYSTEINE 20 % IN SOLN
|
Facility
|
IP
|
$4.20
|
|
|
Service Code
|
HCPCS J7608
|
| Hospital Charge Code |
6332369404
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.10 |
| Max. Negotiated Rate |
$2.10 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.10
|
|
|
ACETYLCYSTEINE 20 % IN SOLN
|
Facility
|
OP
|
$1.60
|
|
|
Service Code
|
HCPCS J7608
|
| Hospital Charge Code |
6332369210
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.56 |
| Max. Negotiated Rate |
$8.66 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.88
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.08
|
| Rate for Payer: Aetna Government |
$6.08
|
| Rate for Payer: Brighton Health Commercial |
$1.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.28
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.09
|
| Rate for Payer: EmblemHealth Commercial |
$0.80
|
| Rate for Payer: Group Health Inc Commercial |
$0.80
|
| Rate for Payer: Group Health Inc Medicare |
$0.56
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.80
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$8.66
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.04
|
|
|
ACIDOPHILUS/CITRUS PECTIN PO TABS
|
Facility
|
OP
|
$0.08
|
|
|
Service Code
|
NDC 0536142401
|
| Hospital Charge Code |
0536142401
|
|
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 |
$0.05
|
| 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
|
|
|
ACIDOPHILUS/CITRUS PECTIN PO TABS
|
Facility
|
IP
|
$0.08
|
|
|
Service Code
|
NDC 0536142401
|
| Hospital Charge Code |
0536142401
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.04 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.04
|
|
|
ACIDOPHILUS LACTOBACILLUS PO CAPS
|
Facility
|
IP
|
$0.54
|
|
|
Service Code
|
NDC 7733300450
|
| Hospital Charge Code |
7733300450
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.27 |
| Max. Negotiated Rate |
$0.27 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.27
|
|
|
ACIDOPHILUS LACTOBACILLUS PO CAPS
|
Facility
|
OP
|
$0.54
|
|
|
Service Code
|
NDC 7733300450
|
| Hospital Charge Code |
7733300450
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.19 |
| Max. Negotiated Rate |
$0.43 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.27
|
| Rate for Payer: Aetna Government |
$0.27
|
| Rate for Payer: Brighton Health Commercial |
$0.40
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.43
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.37
|
| Rate for Payer: EmblemHealth Commercial |
$0.27
|
| Rate for Payer: Group Health Inc Commercial |
$0.27
|
| Rate for Payer: Group Health Inc Medicare |
$0.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.27
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.35
|
|
|
ACIDOPHILUS PROBIOTIC BLEND PO TABS
|
Facility
|
OP
|
$0.09
|
|
|
Service Code
|
NDC 3504600100
|
| Hospital Charge Code |
3504600100
|
|
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 |
$0.04
|
| Rate for Payer: Aetna Government |
$0.04
|
| 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: 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 |
$0.06
|
|
