|
PREDNISOLONE ACETATE 1 % OP SUSP
|
Facility
|
OP
|
$38.50
|
|
|
Service Code
|
NDC 1198018005
|
| Hospital Charge Code |
1198018005
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.47 |
| Max. Negotiated Rate |
$30.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$21.17
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$19.25
|
| Rate for Payer: Aetna Government |
$19.25
|
| Rate for Payer: Brighton Health Commercial |
$28.87
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$30.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$26.18
|
| Rate for Payer: EmblemHealth Commercial |
$19.25
|
| Rate for Payer: Group Health Inc Commercial |
$19.25
|
| Rate for Payer: Group Health Inc Medicare |
$13.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$19.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$19.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$25.02
|
|
|
PREDNISOLONE ACETATE 1 % OP SUSP
|
Facility
|
IP
|
$38.50
|
|
|
Service Code
|
NDC 1198018005
|
| Hospital Charge Code |
1198018005
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$19.25 |
| Max. Negotiated Rate |
$19.25 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$19.25
|
|
|
PREDNISOLONE SODIUM PHOSPHATE 15 MG/5ML PO SOLN
|
Facility
|
IP
|
$1.65
|
|
|
Service Code
|
HCPCS J7510
|
| Hospital Charge Code |
0121475905
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.83 |
| Max. Negotiated Rate |
$0.83 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.83
|
|
|
PREDNISOLONE SODIUM PHOSPHATE 15 MG/5ML PO SOLN
|
Facility
|
IP
|
$0.35
|
|
|
Service Code
|
HCPCS J7510
|
| Hospital Charge Code |
1785607592
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.17 |
| Max. Negotiated Rate |
$0.17 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.17
|
|
|
PREDNISOLONE SODIUM PHOSPHATE 15 MG/5ML PO SOLN
|
Facility
|
IP
|
$1.65
|
|
|
Service Code
|
HCPCS J7510
|
| Hospital Charge Code |
0121475950
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.83 |
| Max. Negotiated Rate |
$0.83 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.83
|
|
|
PREDNISOLONE SODIUM PHOSPHATE 15 MG/5ML PO SOLN
|
Facility
|
OP
|
$1.65
|
|
|
Service Code
|
HCPCS J7510
|
| Hospital Charge Code |
0121475905
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.23 |
| Max. Negotiated Rate |
$1.32 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.91
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.23
|
| Rate for Payer: Aetna Government |
$0.23
|
| Rate for Payer: Brighton Health Commercial |
$1.24
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.32
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.12
|
| Rate for Payer: EmblemHealth Commercial |
$0.83
|
| Rate for Payer: Group Health Inc Commercial |
$0.83
|
| Rate for Payer: Group Health Inc Medicare |
$0.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.83
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.83
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.23
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.07
|
|
|
PREDNISOLONE SODIUM PHOSPHATE 15 MG/5ML PO SOLN
|
Facility
|
OP
|
$0.31
|
|
|
Service Code
|
HCPCS J7510
|
| Hospital Charge Code |
0121075908
|
|
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 |
$0.23
|
| Rate for Payer: Aetna Government |
$0.23
|
| 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: EmblemHealth Commercial |
$0.16
|
| 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: Healthfirst CHP/FHP/Medicaid |
$0.23
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.20
|
|
|
PREDNISOLONE SODIUM PHOSPHATE 15 MG/5ML PO SOLN
|
Facility
|
IP
|
$0.31
|
|
|
Service Code
|
HCPCS J7510
|
| Hospital Charge Code |
0121075908
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$0.16 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.16
|
|
|
PREDNISOLONE SODIUM PHOSPHATE 15 MG/5ML PO SOLN
|
Facility
|
OP
|
$1.65
|
|
|
Service Code
|
HCPCS J7510
|
| Hospital Charge Code |
0121475950
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.23 |
| Max. Negotiated Rate |
$1.32 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.91
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.23
|
| Rate for Payer: Aetna Government |
$0.23
|
| Rate for Payer: Brighton Health Commercial |
$1.24
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.32
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.12
|
| Rate for Payer: EmblemHealth Commercial |
$0.83
|
| Rate for Payer: Group Health Inc Commercial |
$0.83
|
| Rate for Payer: Group Health Inc Medicare |
$0.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.83
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.83
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.23
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.07
|
|
|
PREDNISOLONE SODIUM PHOSPHATE 15 MG/5ML PO SOLN
|
Facility
|
OP
|
$0.57
|
|
|
Service Code
|
HCPCS J7510
|
| Hospital Charge Code |
7016654905
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$0.45 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.31
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.23
|
| Rate for Payer: Aetna Government |
$0.23
|
| Rate for Payer: Brighton Health Commercial |
$0.43
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.45
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.39
|
| Rate for Payer: EmblemHealth Commercial |
$0.28
|
| Rate for Payer: Group Health Inc Commercial |
$0.28
|
| Rate for Payer: Group Health Inc Medicare |
$0.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.28
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.28
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.23
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.37
|
|
|
PREDNISOLONE SODIUM PHOSPHATE 15 MG/5ML PO SOLN
|
Facility
|
IP
|
$0.49
|
|
|
Service Code
|
HCPCS J7510
|
| Hospital Charge Code |
1785675905
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$0.24 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.24
|
|
|
PREDNISOLONE SODIUM PHOSPHATE 15 MG/5ML PO SOLN
|
Facility
|
OP
|
$0.49
|
|
|
Service Code
|
HCPCS J7510
|
| Hospital Charge Code |
1785675905
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.17 |
| Max. Negotiated Rate |
$0.39 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.27
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.23
|
| Rate for Payer: Aetna Government |
$0.23
|
| Rate for Payer: Brighton Health Commercial |
$0.36
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.39
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.33
|
| Rate for Payer: EmblemHealth Commercial |
$0.24
|
| Rate for Payer: Group Health Inc Commercial |
$0.24
|
| Rate for Payer: Group Health Inc Medicare |
$0.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.24
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.23
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.32
|
|
|
PREDNISOLONE SODIUM PHOSPHATE 15 MG/5ML PO SOLN
|
Facility
|
IP
|
$0.57
|
|
|
Service Code
|
HCPCS J7510
|
| Hospital Charge Code |
7016654905
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.28 |
| Max. Negotiated Rate |
$0.28 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.28
|
|
|
PREDNISOLONE SODIUM PHOSPHATE 15 MG/5ML PO SOLN
|
Facility
|
OP
|
$0.35
|
|
|
Service Code
|
HCPCS J7510
|
| Hospital Charge Code |
1785607592
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.28 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.19
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.23
|
| Rate for Payer: Aetna Government |
$0.23
|
| Rate for Payer: Brighton Health Commercial |
$0.26
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.28
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.24
|
| Rate for Payer: EmblemHealth Commercial |
$0.17
|
| Rate for Payer: Group Health Inc Commercial |
$0.17
|
| Rate for Payer: Group Health Inc Medicare |
$0.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.17
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.17
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.23
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.23
|
|
|
PREDNISONE 10 MG PO TABS
|
Facility
|
IP
|
$0.25
|
|
|
Service Code
|
HCPCS J7512
|
| Hospital Charge Code |
7095405910
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.12 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.12
|
|
|
PREDNISONE 10 MG PO TABS
|
Facility
|
IP
|
$0.91
|
|
|
Service Code
|
HCPCS J7512
|
| Hospital Charge Code |
5974617306
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.46 |
| Max. Negotiated Rate |
$0.46 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.46
|
|
|
PREDNISONE 10 MG PO TABS
|
Facility
|
OP
|
$0.91
|
|
|
Service Code
|
HCPCS J7512
|
| Hospital Charge Code |
5974617306
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.73 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.02
|
| Rate for Payer: Aetna Government |
$0.02
|
| Rate for Payer: Brighton Health Commercial |
$0.68
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.73
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.62
|
| Rate for Payer: EmblemHealth Commercial |
$0.46
|
| Rate for Payer: Group Health Inc Commercial |
$0.46
|
| Rate for Payer: Group Health Inc Medicare |
$0.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.46
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.59
|
|
|
PREDNISONE 10 MG PO TABS
|
Facility
|
OP
|
$0.25
|
|
|
Service Code
|
HCPCS J7512
|
| Hospital Charge Code |
7095405910
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.13
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.02
|
| Rate for Payer: Aetna Government |
$0.02
|
| Rate for Payer: Brighton Health Commercial |
$0.18
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.17
|
| Rate for Payer: EmblemHealth Commercial |
$0.12
|
| Rate for Payer: Group Health Inc Commercial |
$0.12
|
| Rate for Payer: Group Health Inc Medicare |
$0.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.16
|
|
|
PREDNISONE 10 MG PO TABS
|
Facility
|
OP
|
$0.19
|
|
|
Service Code
|
HCPCS J7512
|
| Hospital Charge Code |
0904692361
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.15 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.02
|
| Rate for Payer: Aetna Government |
$0.02
|
| Rate for Payer: Brighton Health Commercial |
$0.14
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.15
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.13
|
| Rate for Payer: EmblemHealth Commercial |
$0.09
|
| Rate for Payer: Group Health Inc Commercial |
$0.09
|
| Rate for Payer: Group Health Inc Medicare |
$0.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.09
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.12
|
|
|
PREDNISONE 10 MG PO TABS
|
Facility
|
OP
|
$0.27
|
|
|
Service Code
|
HCPCS J7512
|
| Hospital Charge Code |
0054001720
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.21 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.15
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.02
|
| Rate for Payer: Aetna Government |
$0.02
|
| 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 |
$0.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.17
|
|
|
PREDNISONE 10 MG PO TABS
|
Facility
|
IP
|
$0.27
|
|
|
Service Code
|
HCPCS J7512
|
| Hospital Charge Code |
0054001720
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.13 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.13
|
|
|
PREDNISONE 10 MG PO TABS
|
Facility
|
IP
|
$0.24
|
|
|
Service Code
|
HCPCS J7512
|
| Hospital Charge Code |
0054001729
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.12 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.12
|
|
|
PREDNISONE 10 MG PO TABS
|
Facility
|
OP
|
$0.24
|
|
|
Service Code
|
HCPCS J7512
|
| Hospital Charge Code |
0054001729
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.19 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.13
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.02
|
| Rate for Payer: Aetna Government |
$0.02
|
| Rate for Payer: Brighton Health Commercial |
$0.18
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.19
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.16
|
| Rate for Payer: EmblemHealth Commercial |
$0.12
|
| Rate for Payer: Group Health Inc Commercial |
$0.12
|
| Rate for Payer: Group Health Inc Medicare |
$0.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.16
|
|
|
PREDNISONE 10 MG PO TABS
|
Facility
|
IP
|
$0.19
|
|
|
Service Code
|
HCPCS J7512
|
| Hospital Charge Code |
0904692361
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.09 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.09
|
|
|
PREDNISONE 1 MG PO TABS
|
Facility
|
IP
|
$0.25
|
|
|
Service Code
|
HCPCS J7512
|
| Hospital Charge Code |
0603533521
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.13 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.13
|
|