|
KETOROLAC TROMETHAMINE 0.5 % OP SOLN [19733]
|
Facility
|
OP
|
$21.37
|
|
|
Service Code
|
NDC 60505100301
|
| Hospital Charge Code |
60505100301
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.48 |
| Max. Negotiated Rate |
$17.10 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$11.76
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$10.69
|
| Rate for Payer: Aetna Government |
$10.69
|
| Rate for Payer: Brighton Health Commercial |
$16.03
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$17.10
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$14.53
|
| Rate for Payer: Group Health Inc Commercial |
$10.69
|
| Rate for Payer: Group Health Inc Medicare |
$7.48
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.69
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$10.69
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$13.89
|
|
|
KETOROLAC TROMETHAMINE 0.5 % OP SOLN [19733]
|
Facility
|
OP
|
$21.20
|
|
|
Service Code
|
NDC 42571013725
|
| Hospital Charge Code |
42571013725
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.42 |
| Max. Negotiated Rate |
$16.96 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$11.66
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$10.60
|
| Rate for Payer: Aetna Government |
$10.60
|
| Rate for Payer: Brighton Health Commercial |
$15.90
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$16.96
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$14.42
|
| Rate for Payer: Group Health Inc Commercial |
$10.60
|
| Rate for Payer: Group Health Inc Medicare |
$7.42
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$10.60
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$13.78
|
|
|
KETOROLAC TROMETHAMINE 15 MG/ML IJ SOLN [22472]
|
Facility
|
OP
|
$3.61
|
|
|
Service Code
|
HCPCS J1885
|
| Hospital Charge Code |
00409379319
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.48 |
| Max. Negotiated Rate |
$2.89 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.99
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.48
|
| Rate for Payer: Aetna Government |
$0.48
|
| Rate for Payer: Brighton Health Commercial |
$2.71
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.89
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.45
|
| Rate for Payer: Group Health Inc Commercial |
$1.80
|
| Rate for Payer: Group Health Inc Medicare |
$1.26
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.80
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$0.70
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$0.74
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$0.74
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$0.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.35
|
|
|
KETOROLAC TROMETHAMINE 30 MG/ML IJ SOLN [22473]
|
Facility
|
OP
|
$0.84
|
|
|
Service Code
|
HCPCS J1885
|
| Hospital Charge Code |
63323016216
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$0.74 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.46
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.48
|
| Rate for Payer: Aetna Government |
$0.48
|
| Rate for Payer: Brighton Health Commercial |
$0.63
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.67
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.57
|
| Rate for Payer: Group Health Inc Commercial |
$0.42
|
| Rate for Payer: Group Health Inc Medicare |
$0.29
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.42
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$0.70
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$0.74
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$0.74
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$0.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.55
|
|
|
KETOROLAC TROMETHAMINE 30 MG/ML IJ SOLN [22473]
|
Facility
|
OP
|
$7.84
|
|
|
Service Code
|
HCPCS J1885
|
| Hospital Charge Code |
00409379501
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.48 |
| Max. Negotiated Rate |
$6.27 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.31
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.48
|
| Rate for Payer: Aetna Government |
$0.48
|
| Rate for Payer: Brighton Health Commercial |
$5.88
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.27
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.33
|
| Rate for Payer: Group Health Inc Commercial |
$3.92
|
| Rate for Payer: Group Health Inc Medicare |
$2.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.92
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$0.70
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$0.74
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$0.74
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$0.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.09
|
|
|
KETOROLAC TROMETHAMINE 30 MG/ML IJ SOLN [22473]
|
Facility
|
OP
|
$4.08
|
|
|
Service Code
|
HCPCS J1885
|
| Hospital Charge Code |
76045010410
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.48 |
| Max. Negotiated Rate |
$3.26 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.24
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.48
|
| Rate for Payer: Aetna Government |
$0.48
|
| Rate for Payer: Brighton Health Commercial |
$3.06
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.26
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.77
|
| Rate for Payer: Group Health Inc Commercial |
$2.04
|
| Rate for Payer: Group Health Inc Medicare |
$1.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.04
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$0.70
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$0.74
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$0.74
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$0.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.65
|
|
|
KETOROLAC TROMETHAMINE 30 MG/ML IJ SOLN [22473]
|
Facility
|
OP
|
$6.00
|
|
|
Service Code
|
HCPCS J1885
|
| Hospital Charge Code |
63323016201
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.48 |
| Max. Negotiated Rate |
$4.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.48
|
| Rate for Payer: Aetna Government |
$0.48
|
| Rate for Payer: Brighton Health Commercial |
$4.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.08
|
| Rate for Payer: Group Health Inc Commercial |
$3.00
|
| Rate for Payer: Group Health Inc Medicare |
$2.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.00
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$0.70
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$0.74
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$0.74
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$0.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.90
|
|
|
KETOROLAC TROMETHAMINE 30 MG/ML IJ SOLN [22473]
|
Facility
|
OP
|
$2.10
|
|
|
Service Code
|
HCPCS J1885
|
| Hospital Charge Code |
00338007225
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.48 |
| Max. Negotiated Rate |
$1.68 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.16
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.48
|
| Rate for Payer: Aetna Government |
$0.48
|
| Rate for Payer: Brighton Health Commercial |
$1.58
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.68
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.43
|
| Rate for Payer: Group Health Inc Commercial |
$1.05
|
| Rate for Payer: Group Health Inc Medicare |
$0.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.05
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$0.70
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$0.74
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$0.74
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$0.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.36
|
|
|
KETOROLAC TROMETHAMINE 30 MG/ML IJ SOLN [22473]
|
Facility
|
OP
|
$2.10
|
|
|
Service Code
|
HCPCS J1885
|
| Hospital Charge Code |
72266011801
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.48 |
| Max. Negotiated Rate |
$1.68 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.16
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.48
|
| Rate for Payer: Aetna Government |
$0.48
|
| Rate for Payer: Brighton Health Commercial |
$1.58
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.68
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.43
|
| Rate for Payer: Group Health Inc Commercial |
$1.05
|
| Rate for Payer: Group Health Inc Medicare |
$0.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.05
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$0.70
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$0.74
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$0.74
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$0.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.36
|
|
|
KETOROLAC TROMETHAMINE 30 MG/ML IJ SOLN [22473]
|
Facility
|
OP
|
$2.10
|
|
|
Service Code
|
HCPCS J1885
|
| Hospital Charge Code |
72266011825
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.48 |
| Max. Negotiated Rate |
$1.68 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.16
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.48
|
| Rate for Payer: Aetna Government |
$0.48
|
| Rate for Payer: Brighton Health Commercial |
$1.58
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.68
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.43
|
| Rate for Payer: Group Health Inc Commercial |
$1.05
|
| Rate for Payer: Group Health Inc Medicare |
$0.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.05
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$0.70
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$0.74
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$0.74
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$0.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.36
|
|
|
KETOROLAC TROMETHAMINE 30 MG/ML IJ SOLN [22473]
|
Facility
|
OP
|
$1.34
|
|
|
Service Code
|
HCPCS J1885
|
| Hospital Charge Code |
72611072225
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.47 |
| Max. Negotiated Rate |
$1.08 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.74
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.48
|
| Rate for Payer: Aetna Government |
$0.48
|
| Rate for Payer: Brighton Health Commercial |
$1.01
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.08
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.91
|
| Rate for Payer: Group Health Inc Commercial |
$0.67
|
| Rate for Payer: Group Health Inc Medicare |
$0.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.67
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.67
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$0.70
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$0.74
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$0.74
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$0.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.87
|
|
|
KETOROLAC TROMETHAMINE 30 MG/ML IJ SOLN [22473]
|
Facility
|
OP
|
$7.84
|
|
|
Service Code
|
HCPCS J1885
|
| Hospital Charge Code |
00409379519
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.48 |
| Max. Negotiated Rate |
$6.27 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.31
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.48
|
| Rate for Payer: Aetna Government |
$0.48
|
| Rate for Payer: Brighton Health Commercial |
$5.88
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.27
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.33
|
| Rate for Payer: Group Health Inc Commercial |
$3.92
|
| Rate for Payer: Group Health Inc Medicare |
$2.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.92
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$0.70
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$0.74
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$0.74
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$0.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.10
|
|
|
KETOROLAC TROMETHAMINE 60 MG/2ML IM SOLN [97716]
|
Facility
|
OP
|
$4.31
|
|
|
Service Code
|
HCPCS J1885
|
| Hospital Charge Code |
63323016202
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.48 |
| Max. Negotiated Rate |
$3.45 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.37
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.48
|
| Rate for Payer: Aetna Government |
$0.48
|
| Rate for Payer: Brighton Health Commercial |
$3.24
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.45
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.93
|
| Rate for Payer: Group Health Inc Commercial |
$2.16
|
| Rate for Payer: Group Health Inc Medicare |
$1.51
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.16
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$0.70
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$0.74
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$0.74
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$0.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.80
|
|
|
KETOROLAC TROMETHAMINE 60 MG/2ML IM SOLN [97716]
|
Facility
|
OP
|
$1.96
|
|
|
Service Code
|
HCPCS J1885
|
| Hospital Charge Code |
00409379601
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.48 |
| Max. Negotiated Rate |
$1.57 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.08
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.48
|
| Rate for Payer: Aetna Government |
$0.48
|
| Rate for Payer: Brighton Health Commercial |
$1.47
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.57
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.33
|
| Rate for Payer: Group Health Inc Commercial |
$0.98
|
| Rate for Payer: Group Health Inc Medicare |
$0.69
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.98
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$0.70
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$0.74
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$0.74
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$0.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.28
|
|
|
KETOROLAC TROMETHAMINE 60 MG/2ML IM SOLN [97716]
|
Facility
|
OP
|
$1.20
|
|
|
Service Code
|
HCPCS J1885
|
| Hospital Charge Code |
72266011901
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.42 |
| Max. Negotiated Rate |
$0.96 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.66
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.48
|
| Rate for Payer: Aetna Government |
$0.48
|
| Rate for Payer: Brighton Health Commercial |
$0.90
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.96
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.82
|
| Rate for Payer: Group Health Inc Commercial |
$0.60
|
| Rate for Payer: Group Health Inc Medicare |
$0.42
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.60
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$0.70
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$0.74
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$0.74
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$0.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.78
|
|
|
KETOROLAC TROMETHAMINE 60 MG/2ML IM SOLN [97716]
|
Facility
|
OP
|
$4.32
|
|
|
Service Code
|
HCPCS J1885
|
| Hospital Charge Code |
63323016203
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.48 |
| Max. Negotiated Rate |
$3.45 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.37
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.48
|
| Rate for Payer: Aetna Government |
$0.48
|
| Rate for Payer: Brighton Health Commercial |
$3.24
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.45
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.93
|
| Rate for Payer: Group Health Inc Commercial |
$2.16
|
| Rate for Payer: Group Health Inc Medicare |
$1.51
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.16
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$0.70
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$0.74
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$0.74
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$0.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.80
|
|
|
KETOROLAC TROMETHAMINE 60 MG/2ML IM SOLN [97716]
|
Facility
|
OP
|
$1.20
|
|
|
Service Code
|
HCPCS J1885
|
| Hospital Charge Code |
72266011925
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.42 |
| Max. Negotiated Rate |
$0.96 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.66
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.48
|
| Rate for Payer: Aetna Government |
$0.48
|
| Rate for Payer: Brighton Health Commercial |
$0.90
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.96
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.82
|
| Rate for Payer: Group Health Inc Commercial |
$0.60
|
| Rate for Payer: Group Health Inc Medicare |
$0.42
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.60
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$0.70
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$0.74
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$0.74
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$0.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.78
|
|
|
KETOROLAC TROMETHAMINE 60 MG/2ML IM SOLN [97716]
|
Facility
|
OP
|
$0.74
|
|
|
Service Code
|
HCPCS J1885
|
| Hospital Charge Code |
72611072525
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$0.74 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.41
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.48
|
| Rate for Payer: Aetna Government |
$0.48
|
| Rate for Payer: Brighton Health Commercial |
$0.56
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.51
|
| Rate for Payer: Group Health Inc Commercial |
$0.37
|
| Rate for Payer: Group Health Inc Medicare |
$0.26
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.37
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.37
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$0.70
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$0.74
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$0.74
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$0.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.48
|
|
|
KEY ELEVATOR 1/2
|
Facility
|
OP
|
$104.06
|
|
| Hospital Charge Code |
40200455
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$36.42 |
| Max. Negotiated Rate |
$83.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$57.23
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$52.03
|
| Rate for Payer: Aetna Government |
$52.03
|
| Rate for Payer: Brighton Health Commercial |
$78.04
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$83.25
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$70.76
|
| Rate for Payer: Group Health Inc Commercial |
$52.03
|
| Rate for Payer: Group Health Inc Medicare |
$36.42
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$52.03
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$52.03
|
|
|
KIDNER PROCEDURE
|
Facility
|
IP
|
$18,117.83
|
|
|
Service Code
|
HCPCS 28238
|
| Hospital Charge Code |
40082840
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$8,273.12
|
|
|
KIDNER PROCEDURE
|
Facility
|
OP
|
$18,117.83
|
|
|
Service Code
|
HCPCS 28238
|
| Hospital Charge Code |
40082840
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,505.00 |
| Max. Negotiated Rate |
$13,588.37 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,134.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8,273.12
|
| Rate for Payer: Aetna Government |
$8,273.12
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$5,791.18
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$5,791.18
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$5,791.18
|
| Rate for Payer: Brighton Health Commercial |
$13,588.37
|
| Rate for Payer: Cash Price |
$8,273.12
|
| Rate for Payer: Cash Price |
$8,273.12
|
| Rate for Payer: Cash Price |
$8,273.12
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$8,273.12
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$8,273.12
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$7,032.15
|
| Rate for Payer: Fidelis Essential Plan QHP |
$7,363.08
|
| Rate for Payer: Fidelis Medicare Advantage |
$8,273.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$7,363.08
|
| Rate for Payer: Group Health Inc Commercial |
$8,273.12
|
| Rate for Payer: Group Health Inc Medicare |
$8,273.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9,058.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8,273.12
|
| Rate for Payer: Healthfirst Medicare Advantage |
$7,032.15
|
| Rate for Payer: Healthfirst QHP |
$8,273.12
|
| Rate for Payer: Humana Medicare |
$8,438.58
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$8,273.12
|
| Rate for Payer: United Healthcare Commercial |
$2,546.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8,273.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8,273.12
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$6,618.50
|
| Rate for Payer: Wellcare Medicare |
$7,859.46
|
|
|
KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITH CC
|
Facility
|
IP
|
$45,240.35
|
|
|
Service Code
|
MSDRG 657
|
| Min. Negotiated Rate |
$15,299.46 |
| Max. Negotiated Rate |
$45,240.35 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$27,192.73
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$32,902.07
|
| Rate for Payer: Aetna Government |
$32,902.07
|
| Rate for Payer: Brighton Health Commercial |
$26,740.90
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$33,560.11
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$31,847.49
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$26,281.92
|
| Rate for Payer: Elderplan Medicare Advantage |
$31,256.97
|
| Rate for Payer: EmblemHealth Commercial |
$15,814.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$32,902.07
|
| Rate for Payer: Group Health Inc Commercial |
$32,902.07
|
| Rate for Payer: Group Health Inc Medicare |
$32,902.07
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$32,902.07
|
| Rate for Payer: Healthfirst Medicare Advantage |
$15,299.46
|
| Rate for Payer: Humana Medicare |
$45,240.35
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$32,902.07
|
| Rate for Payer: United Healthcare Commercial |
$36,675.61
|
| Rate for Payer: United Healthcare Medicare Advantage |
$32,902.07
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$32,902.07
|
| Rate for Payer: Wellcare Medicare |
$31,256.97
|
|
|
KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITH MCC
|
Facility
|
IP
|
$69,902.46
|
|
|
Service Code
|
MSDRG 656
|
| Min. Negotiated Rate |
$23,639.74 |
| Max. Negotiated Rate |
$69,902.46 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$46,263.91
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$50,838.15
|
| Rate for Payer: Aetna Government |
$50,838.15
|
| Rate for Payer: Brighton Health Commercial |
$45,495.20
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$51,854.91
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$54,183.21
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$44,714.31
|
| Rate for Payer: Elderplan Medicare Advantage |
$48,296.24
|
| Rate for Payer: EmblemHealth Commercial |
$26,904.90
|
| Rate for Payer: Fidelis Medicare Advantage |
$50,838.15
|
| Rate for Payer: Group Health Inc Commercial |
$50,838.15
|
| Rate for Payer: Group Health Inc Medicare |
$50,838.15
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$50,838.15
|
| Rate for Payer: Healthfirst Medicare Advantage |
$23,639.74
|
| Rate for Payer: Humana Medicare |
$69,902.46
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$50,838.15
|
| Rate for Payer: United Healthcare Commercial |
$62,397.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$50,838.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$50,838.15
|
| Rate for Payer: Wellcare Medicare |
$48,296.24
|
|
|
KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITHOUT CC/MCC
|
Facility
|
IP
|
$38,303.51
|
|
|
Service Code
|
MSDRG 658
|
| Min. Negotiated Rate |
$12,694.40 |
| Max. Negotiated Rate |
$38,303.51 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$21,828.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$27,857.10
|
| Rate for Payer: Aetna Government |
$27,857.10
|
| Rate for Payer: Brighton Health Commercial |
$21,465.80
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$28,414.24
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$25,565.03
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$21,097.36
|
| Rate for Payer: Elderplan Medicare Advantage |
$26,464.24
|
| Rate for Payer: EmblemHealth Commercial |
$12,694.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$27,857.10
|
| Rate for Payer: Group Health Inc Commercial |
$27,857.10
|
| Rate for Payer: Group Health Inc Medicare |
$27,857.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$27,857.10
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12,953.55
|
| Rate for Payer: Humana Medicare |
$38,303.51
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$27,857.10
|
| Rate for Payer: United Healthcare Commercial |
$29,440.71
|
| Rate for Payer: United Healthcare Medicare Advantage |
$27,857.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$27,857.10
|
| Rate for Payer: Wellcare Medicare |
$26,464.24
|
|
|
KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITH CC
|
Facility
|
IP
|
$35,738.94
|
|
|
Service Code
|
MSDRG 660
|
| Min. Negotiated Rate |
$11,541.10 |
| Max. Negotiated Rate |
$35,738.94 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$19,845.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$25,991.96
|
| Rate for Payer: Aetna Government |
$25,991.96
|
| Rate for Payer: Brighton Health Commercial |
$19,515.55
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$26,511.80
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$23,242.35
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$19,180.58
|
| Rate for Payer: Elderplan Medicare Advantage |
$24,692.36
|
| Rate for Payer: EmblemHealth Commercial |
$11,541.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$25,991.96
|
| Rate for Payer: Group Health Inc Commercial |
$25,991.96
|
| Rate for Payer: Group Health Inc Medicare |
$25,991.96
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$25,991.96
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12,086.26
|
| Rate for Payer: Humana Medicare |
$35,738.94
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$25,991.96
|
| Rate for Payer: United Healthcare Commercial |
$26,765.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$25,991.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$25,991.96
|
| Rate for Payer: Wellcare Medicare |
$24,692.36
|
|
