|
MOPATH PROCEDRE LEVEL 2
|
Facility
|
IP
|
$342.50
|
|
|
Service Code
|
HCPCS 81401
|
| Hospital Charge Code |
40609864
|
|
Hospital Revenue Code
|
310
|
| Rate for Payer: Cash Price |
$137.00
|
|
|
MOPATH PROCEDRE LEVEL 2
|
Facility
|
OP
|
$342.50
|
|
|
Service Code
|
HCPCS 81401
|
| Hospital Charge Code |
40609864
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$95.90 |
| Max. Negotiated Rate |
$274.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$188.38
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$137.00
|
| Rate for Payer: Aetna Government |
$137.00
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$95.90
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$95.90
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$95.90
|
| Rate for Payer: Brighton Health Commercial |
$137.00
|
| Rate for Payer: Cash Price |
$137.00
|
| Rate for Payer: Cash Price |
$137.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$137.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$274.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$232.90
|
| Rate for Payer: Elderplan Medicare Advantage |
$137.00
|
| Rate for Payer: EmblemHealth Commercial |
$137.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$116.45
|
| Rate for Payer: Fidelis Essential Plan QHP |
$121.93
|
| Rate for Payer: Fidelis Medicare Advantage |
$137.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$121.93
|
| Rate for Payer: Group Health Inc Commercial |
$137.00
|
| Rate for Payer: Group Health Inc Medicare |
$137.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$171.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$137.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$137.00
|
| Rate for Payer: Healthfirst QHP |
$137.00
|
| Rate for Payer: Humana Medicare |
$139.74
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$137.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$137.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$137.00
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$109.60
|
| Rate for Payer: Wellcare Medicare |
$123.30
|
|
|
MOPATH PROCEDURE LEVEL 2
|
Facility
|
OP
|
$342.50
|
|
|
Service Code
|
HCPCS 81401
|
| Hospital Charge Code |
40729233
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$95.90 |
| Max. Negotiated Rate |
$274.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$188.38
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$137.00
|
| Rate for Payer: Aetna Government |
$137.00
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$95.90
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$95.90
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$95.90
|
| Rate for Payer: Brighton Health Commercial |
$137.00
|
| Rate for Payer: Cash Price |
$137.00
|
| Rate for Payer: Cash Price |
$137.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$137.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$274.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$232.90
|
| Rate for Payer: Elderplan Medicare Advantage |
$137.00
|
| Rate for Payer: EmblemHealth Commercial |
$137.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$116.45
|
| Rate for Payer: Fidelis Essential Plan QHP |
$121.93
|
| Rate for Payer: Fidelis Medicare Advantage |
$137.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$121.93
|
| Rate for Payer: Group Health Inc Commercial |
$137.00
|
| Rate for Payer: Group Health Inc Medicare |
$137.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$171.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$137.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$137.00
|
| Rate for Payer: Healthfirst QHP |
$137.00
|
| Rate for Payer: Humana Medicare |
$139.74
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$137.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$137.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$137.00
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$109.60
|
| Rate for Payer: Wellcare Medicare |
$123.30
|
|
|
MOPATH PROCEDURE LEVEL 2
|
Facility
|
IP
|
$342.50
|
|
|
Service Code
|
HCPCS 81401
|
| Hospital Charge Code |
40729233
|
|
Hospital Revenue Code
|
310
|
| Rate for Payer: Cash Price |
$137.00
|
|
|
MOPATH PROCEDURE LEVEL 4
|
Facility
|
OP
|
$463.00
|
|
|
Service Code
|
HCPCS 81403
|
| Hospital Charge Code |
40609896
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$129.64 |
| Max. Negotiated Rate |
$370.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$254.65
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$185.20
|
| Rate for Payer: Aetna Government |
$185.20
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$129.64
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$129.64
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$129.64
|
| Rate for Payer: Brighton Health Commercial |
$185.20
|
| Rate for Payer: Cash Price |
$185.20
|
| Rate for Payer: Cash Price |
$185.20
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$185.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$370.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$314.84
|
| Rate for Payer: Elderplan Medicare Advantage |
$185.20
|
| Rate for Payer: EmblemHealth Commercial |
$185.20
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$157.42
|
| Rate for Payer: Fidelis Essential Plan QHP |
$164.83
|
| Rate for Payer: Fidelis Medicare Advantage |
$185.20
|
| Rate for Payer: Fidelis Qualified Health Plan |
$164.83
|
| Rate for Payer: Group Health Inc Commercial |
$185.20
|
| Rate for Payer: Group Health Inc Medicare |
$185.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$231.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$185.20
|
| Rate for Payer: Healthfirst Medicare Advantage |
$185.20
|
| Rate for Payer: Healthfirst QHP |
$185.20
|
| Rate for Payer: Humana Medicare |
$188.90
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$185.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$185.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$185.20
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$148.16
|
| Rate for Payer: Wellcare Medicare |
$166.68
|
|
|
MOPATH PROCEDURE LEVEL 4
|
Facility
|
IP
|
$463.00
|
|
|
Service Code
|
HCPCS 81403
|
| Hospital Charge Code |
40609896
|
|
Hospital Revenue Code
|
310
|
| Rate for Payer: Cash Price |
$185.20
|
|
|
MOP MINI-ALPHA CLEANROOM KIT
|
Facility
|
OP
|
$435.78
|
|
| Hospital Charge Code |
64902606
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$152.52 |
| Max. Negotiated Rate |
$348.62 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$239.68
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$217.89
|
| Rate for Payer: Aetna Government |
$217.89
|
| Rate for Payer: Brighton Health Commercial |
$326.84
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$348.62
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$296.33
|
| Rate for Payer: Group Health Inc Commercial |
$217.89
|
| Rate for Payer: Group Health Inc Medicare |
$152.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$217.89
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$217.89
|
|
|
MORGAN DELIVERY SET
|
Facility
|
OP
|
$21.27
|
|
| Hospital Charge Code |
64902766
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.44 |
| Max. Negotiated Rate |
$17.02 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$11.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$10.64
|
| Rate for Payer: Aetna Government |
$10.64
|
| Rate for Payer: Brighton Health Commercial |
$15.95
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$17.02
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$14.46
|
| Rate for Payer: Group Health Inc Commercial |
$10.64
|
| Rate for Payer: Group Health Inc Medicare |
$7.44
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$10.64
|
|
|
MORPHINE 0.3 MG/0.75 ML SOLN NEONATAL
|
Facility
|
OP
|
$1.00
|
|
| Hospital Charge Code |
41645181
|
|
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
|
|
|
MORPHINE 0.3 MG/0.75 ML SOLN NEONATAL
|
Facility
|
OP
|
$1.00
|
|
| Hospital Charge Code |
41655181
|
|
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
|
|
|
MORPHINE 100 MG/D5W INFUSION 100 ML
|
Facility
|
OP
|
$15.00
|
|
| Hospital Charge Code |
41652672
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.25 |
| Max. Negotiated Rate |
$12.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$8.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$7.50
|
| Rate for Payer: Aetna Government |
$7.50
|
| Rate for Payer: Brighton Health Commercial |
$11.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$12.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$10.20
|
| Rate for Payer: Group Health Inc Commercial |
$7.50
|
| Rate for Payer: Group Health Inc Medicare |
$5.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$9.75
|
|
|
MORPHINE 100 MG/D5W INFUSION 100 ML
|
Facility
|
OP
|
$15.00
|
|
| Hospital Charge Code |
41642672
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.25 |
| Max. Negotiated Rate |
$12.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$8.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$7.50
|
| Rate for Payer: Aetna Government |
$7.50
|
| Rate for Payer: Brighton Health Commercial |
$11.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$12.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$10.20
|
| Rate for Payer: Group Health Inc Commercial |
$7.50
|
| Rate for Payer: Group Health Inc Medicare |
$5.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$9.75
|
|
|
MORPHINE 10 MG/0.5 ML CONC LIQUID (HOSPI
|
Facility
|
OP
|
$0.46
|
|
| Hospital Charge Code |
41645317
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$0.37 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.23
|
| Rate for Payer: Aetna Government |
$0.23
|
| Rate for Payer: Brighton Health Commercial |
$0.35
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.37
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.31
|
| Rate for Payer: Group Health Inc Commercial |
$0.23
|
| Rate for Payer: Group Health Inc Medicare |
$0.16
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.23
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.23
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.30
|
|
|
MORPHINE 10 MG/0.5 ML CONC LIQUID (HOSPI
|
Facility
|
OP
|
$0.46
|
|
| Hospital Charge Code |
41655317
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$0.37 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.23
|
| Rate for Payer: Aetna Government |
$0.23
|
| Rate for Payer: Brighton Health Commercial |
$0.35
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.37
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.31
|
| Rate for Payer: Group Health Inc Commercial |
$0.23
|
| Rate for Payer: Group Health Inc Medicare |
$0.16
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.23
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.23
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.30
|
|
|
MORPHINE 10 MG/1ML SYRINGE
|
Facility
|
OP
|
$3.00
|
|
| Hospital Charge Code |
41646096
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.05 |
| Max. Negotiated Rate |
$2.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.65
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.50
|
| Rate for Payer: Aetna Government |
$1.50
|
| Rate for Payer: Brighton Health Commercial |
$2.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.04
|
| Rate for Payer: Group Health Inc Commercial |
$1.50
|
| Rate for Payer: Group Health Inc Medicare |
$1.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.95
|
|
|
MORPHINE 10MG/1ML SYRINGE
|
Facility
|
OP
|
$3.00
|
|
|
Service Code
|
HCPCS J2270
|
| Hospital Charge Code |
41656096
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.05 |
| Max. Negotiated Rate |
$4.72 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.65
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.39
|
| Rate for Payer: Aetna Government |
$3.39
|
| Rate for Payer: Brighton Health Commercial |
$1.80
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.72
|
| Rate for Payer: Group Health Inc Commercial |
$1.50
|
| Rate for Payer: Group Health Inc Medicare |
$1.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.50
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$4.72
|
| Rate for Payer: SOMOS Essential |
$4.72
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.95
|
|
|
MORPHINE 10MG/1ML SYRINGE
|
Facility
|
IP
|
$3.00
|
|
|
Service Code
|
HCPCS J2270
|
| Hospital Charge Code |
41656096
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.50 |
| Max. Negotiated Rate |
$1.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.50
|
|
|
MORPHINE 10MG/1ML VIAL
|
Facility
|
OP
|
$2.00
|
|
|
Service Code
|
HCPCS J2270
|
| Hospital Charge Code |
41646097
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.70 |
| Max. Negotiated Rate |
$4.72 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.39
|
| Rate for Payer: Aetna Government |
$3.39
|
| Rate for Payer: Brighton Health Commercial |
$1.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.15
|
| Rate for Payer: Group Health Inc Commercial |
$1.00
|
| Rate for Payer: Group Health Inc Medicare |
$0.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$4.72
|
| Rate for Payer: SOMOS Essential |
$4.72
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.30
|
|
|
MORPHINE 10MG/1ML VIAL
|
Facility
|
IP
|
$2.00
|
|
|
Service Code
|
HCPCS J2270
|
| Hospital Charge Code |
41646097
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$1.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.00
|
|
|
MORPHINE 10MG/5ML 500ML
|
Facility
|
OP
|
$0.06
|
|
| Hospital Charge Code |
41657905
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.03
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.03
|
| Rate for Payer: Aetna Government |
$0.03
|
| Rate for Payer: Brighton Health Commercial |
$0.05
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.05
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.04
|
| Rate for Payer: Group Health Inc Commercial |
$0.03
|
| Rate for Payer: Group Health Inc Medicare |
$0.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.03
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.03
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.04
|
|
|
MORPHINE 10MG/5ML, 500ML
|
Facility
|
OP
|
$0.06
|
|
| Hospital Charge Code |
41647905
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.03
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.03
|
| Rate for Payer: Aetna Government |
$0.03
|
| Rate for Payer: Brighton Health Commercial |
$0.05
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.05
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.04
|
| Rate for Payer: Group Health Inc Commercial |
$0.03
|
| Rate for Payer: Group Health Inc Medicare |
$0.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.03
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.03
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.04
|
|
|
MORPHINE 10 MG/5 ML ELIXIR UDC
|
Facility
|
OP
|
$2.00
|
|
| Hospital Charge Code |
41640740
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.70 |
| Max. Negotiated Rate |
$1.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.00
|
| Rate for Payer: Aetna Government |
$1.00
|
| Rate for Payer: Brighton Health Commercial |
$1.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.36
|
| Rate for Payer: Group Health Inc Commercial |
$1.00
|
| Rate for Payer: Group Health Inc Medicare |
$0.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.30
|
|
|
MORPHINE 10 MG/5 ML ELIXIR UDC
|
Facility
|
OP
|
$2.00
|
|
| Hospital Charge Code |
41650740
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.70 |
| Max. Negotiated Rate |
$1.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.00
|
| Rate for Payer: Aetna Government |
$1.00
|
| Rate for Payer: Brighton Health Commercial |
$1.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.36
|
| Rate for Payer: Group Health Inc Commercial |
$1.00
|
| Rate for Payer: Group Health Inc Medicare |
$0.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.30
|
|
|
MORPHINE 10MG/.5ML ORAL SYRINGE
|
Facility
|
OP
|
$0.55
|
|
| Hospital Charge Code |
41648421
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.19 |
| Max. Negotiated Rate |
$0.44 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.28
|
| Rate for Payer: Aetna Government |
$0.28
|
| Rate for Payer: Brighton Health Commercial |
$0.41
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.44
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.37
|
| Rate for Payer: Group Health Inc Commercial |
$0.28
|
| Rate for Payer: Group Health Inc Medicare |
$0.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.28
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.28
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.36
|
|
|
MORPHINE 10MG/.5ML ORAL SYRINGE
|
Facility
|
OP
|
$0.55
|
|
| Hospital Charge Code |
41658421
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.19 |
| Max. Negotiated Rate |
$0.44 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.28
|
| Rate for Payer: Aetna Government |
$0.28
|
| Rate for Payer: Brighton Health Commercial |
$0.41
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.44
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.37
|
| Rate for Payer: Group Health Inc Commercial |
$0.28
|
| Rate for Payer: Group Health Inc Medicare |
$0.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.28
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.28
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.36
|
|
