|
NALTREXONE 380MG DEPOT
|
Facility
|
IP
|
$3.39
|
|
|
Service Code
|
HCPCS J2315
|
| Hospital Charge Code |
41656482
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.70 |
| Max. Negotiated Rate |
$1.70 |
| Rate for Payer: Cash Price |
$3.96
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.70
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.70
|
|
|
NALTREXONE 380MG DEPOT
|
Facility
|
OP
|
$3.39
|
|
|
Service Code
|
HCPCS J2315
|
| Hospital Charge Code |
41656482
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.70 |
| Max. Negotiated Rate |
$321.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.86
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.96
|
| Rate for Payer: Aetna Government |
$3.96
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$7.22
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$7.22
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$3.21
|
| Rate for Payer: Amida Care Medicaid |
$3.21
|
| Rate for Payer: Brighton Health Commercial |
$2.03
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$3.96
|
| Rate for Payer: Cash Price |
$3.96
|
| Rate for Payer: Cash Price |
$3.96
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3.96
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.70
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.95
|
| Rate for Payer: Elderplan Medicare Advantage |
$3.96
|
| Rate for Payer: EmblemHealth Commercial |
$3.96
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$321.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3.21
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3.21
|
| Rate for Payer: Fidelis Medicare Advantage |
$3.96
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3.37
|
| Rate for Payer: Group Health Inc Commercial |
$3.96
|
| Rate for Payer: Group Health Inc Medicare |
$3.96
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.70
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3.21
|
| Rate for Payer: Healthfirst Essential Plan |
$7.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3.37
|
| Rate for Payer: Healthfirst QHP |
$3.21
|
| Rate for Payer: Humana Medicare |
$4.04
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3.96
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$3.21
|
| Rate for Payer: SOMOS Essential |
$3.21
|
| Rate for Payer: United Healthcare Commercial |
$3.74
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$7.22
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$3.53
|
| Rate for Payer: United Healthcare Medicaid |
$3.21
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.20
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3.17
|
| Rate for Payer: Wellcare Medicare |
$3.76
|
|
|
NALTREXONE 380MG DEPOT
|
Facility
|
IP
|
$573.80
|
|
|
Service Code
|
HCPCS J2315
|
| Hospital Charge Code |
30406482
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$286.90 |
| Max. Negotiated Rate |
$286.90 |
| Rate for Payer: Cash Price |
$3.96
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$286.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$286.90
|
|
|
NALTREXONE 380MG DEPOT
|
Facility
|
OP
|
$573.80
|
|
|
Service Code
|
HCPCS J2315
|
| Hospital Charge Code |
30406482
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.17 |
| Max. Negotiated Rate |
$372.97 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$315.59
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.96
|
| Rate for Payer: Aetna Government |
$3.96
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$7.22
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$7.22
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$3.21
|
| Rate for Payer: Amida Care Medicaid |
$3.21
|
| Rate for Payer: Brighton Health Commercial |
$344.28
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$3.96
|
| Rate for Payer: Cash Price |
$3.96
|
| Rate for Payer: Cash Price |
$3.96
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3.96
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$286.90
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$329.94
|
| Rate for Payer: Elderplan Medicare Advantage |
$3.96
|
| Rate for Payer: EmblemHealth Commercial |
$3.96
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$321.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3.21
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3.21
|
| Rate for Payer: Fidelis Medicare Advantage |
$3.96
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3.37
|
| Rate for Payer: Group Health Inc Commercial |
$3.96
|
| Rate for Payer: Group Health Inc Medicare |
$3.96
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$286.90
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3.21
|
| Rate for Payer: Healthfirst Essential Plan |
$7.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3.37
|
| Rate for Payer: Healthfirst QHP |
$3.21
|
| Rate for Payer: Humana Medicare |
$4.04
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3.96
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$3.21
|
| Rate for Payer: SOMOS Essential |
$3.21
|
| Rate for Payer: United Healthcare Commercial |
$3.74
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$7.22
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$3.53
|
| Rate for Payer: United Healthcare Medicaid |
$3.21
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$372.97
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3.17
|
| Rate for Payer: Wellcare Medicare |
$3.76
|
|
|
NALTREXONE 380MG DEPT
|
Facility
|
IP
|
$3.39
|
|
|
Service Code
|
HCPCS J2315
|
| Hospital Charge Code |
41646482
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.70 |
| Max. Negotiated Rate |
$1.70 |
| Rate for Payer: Cash Price |
$3.96
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.70
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.70
|
|
|
NALTREXONE 380MG DEPT
|
Facility
|
OP
|
$3.39
|
|
|
Service Code
|
HCPCS J2315
|
| Hospital Charge Code |
41646482
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.70 |
| Max. Negotiated Rate |
$321.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.86
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.96
|
| Rate for Payer: Aetna Government |
$3.96
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$7.22
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$7.22
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$3.21
|
| Rate for Payer: Amida Care Medicaid |
$3.21
|
| Rate for Payer: Brighton Health Commercial |
$2.03
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$3.96
|
| Rate for Payer: Cash Price |
$3.96
|
| Rate for Payer: Cash Price |
$3.96
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3.96
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.70
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.95
|
| Rate for Payer: Elderplan Medicare Advantage |
$3.96
|
| Rate for Payer: EmblemHealth Commercial |
$3.96
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$321.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3.21
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3.21
|
| Rate for Payer: Fidelis Medicare Advantage |
$3.96
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3.37
|
| Rate for Payer: Group Health Inc Commercial |
$3.96
|
| Rate for Payer: Group Health Inc Medicare |
$3.96
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.70
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3.21
|
| Rate for Payer: Healthfirst Essential Plan |
$7.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3.37
|
| Rate for Payer: Healthfirst QHP |
$3.21
|
| Rate for Payer: Humana Medicare |
$4.04
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3.96
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$3.21
|
| Rate for Payer: SOMOS Essential |
$3.21
|
| Rate for Payer: United Healthcare Commercial |
$3.74
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$7.22
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$3.53
|
| Rate for Payer: United Healthcare Medicaid |
$3.21
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.20
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3.17
|
| Rate for Payer: Wellcare Medicare |
$3.76
|
|
|
NALTREXONE 380 MG IM SUSR [76527]
|
Facility
|
OP
|
$1,969.33
|
|
|
Service Code
|
HCPCS J2315
|
| Hospital Charge Code |
65757030001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.17 |
| Max. Negotiated Rate |
$1,575.46 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,083.13
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.96
|
| Rate for Payer: Aetna Government |
$3.96
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$7.22
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$7.22
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$3.21
|
| Rate for Payer: Amida Care Medicaid |
$3.21
|
| Rate for Payer: Brighton Health Commercial |
$1,477.00
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$3.96
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3.96
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,575.46
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,339.14
|
| Rate for Payer: Elderplan Medicare Advantage |
$3.96
|
| Rate for Payer: EmblemHealth Commercial |
$3.96
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$321.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3.21
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3.21
|
| Rate for Payer: Fidelis Medicare Advantage |
$3.96
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3.37
|
| Rate for Payer: Group Health Inc Commercial |
$3.96
|
| Rate for Payer: Group Health Inc Medicare |
$3.96
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.96
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3.21
|
| Rate for Payer: Healthfirst Essential Plan |
$7.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3.37
|
| Rate for Payer: Healthfirst QHP |
$3.21
|
| Rate for Payer: Humana Medicare |
$4.04
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$3.97
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$4.21
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$4.21
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$4.21
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3.96
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$3.21
|
| Rate for Payer: SOMOS Essential |
$3.21
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$7.22
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$3.53
|
| Rate for Payer: United Healthcare Medicaid |
$3.21
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,280.06
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3.17
|
| Rate for Payer: Wellcare Medicare |
$3.76
|
|
|
N ANTIGEN
|
Facility
|
IP
|
$858.38
|
|
|
Service Code
|
HCPCS 86905
|
| Hospital Charge Code |
40701261
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$415.67
|
|
|
N ANTIGEN
|
Facility
|
OP
|
$858.38
|
|
|
Service Code
|
HCPCS 86905
|
| Hospital Charge Code |
40701261
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.84 |
| Max. Negotiated Rate |
$643.78 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$472.11
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$415.67
|
| Rate for Payer: Aetna Government |
$415.67
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$290.97
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$290.97
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$290.97
|
| Rate for Payer: Brighton Health Commercial |
$643.78
|
| Rate for Payer: Cash Price |
$415.67
|
| Rate for Payer: Cash Price |
$415.67
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$415.67
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.08
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.15
|
| Rate for Payer: Elderplan Medicare Advantage |
$415.67
|
| Rate for Payer: EmblemHealth Commercial |
$415.67
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$353.32
|
| Rate for Payer: Fidelis Essential Plan QHP |
$369.95
|
| Rate for Payer: Fidelis Medicare Advantage |
$415.67
|
| Rate for Payer: Fidelis Qualified Health Plan |
$369.95
|
| Rate for Payer: Group Health Inc Commercial |
$415.67
|
| Rate for Payer: Group Health Inc Medicare |
$415.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$429.19
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$415.67
|
| Rate for Payer: Healthfirst Medicare Advantage |
$415.67
|
| Rate for Payer: Healthfirst QHP |
$415.67
|
| Rate for Payer: Humana Medicare |
$423.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$415.67
|
| Rate for Payer: United Healthcare Commercial |
$4.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$415.67
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$415.67
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$332.54
|
| Rate for Payer: Wellcare Medicare |
$374.10
|
|
|
NAPHAZOLINE 0.1% OPHTHALMIC SOLN
|
Facility
|
OP
|
$2.90
|
|
| Hospital Charge Code |
41642468
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.02 |
| Max. Negotiated Rate |
$2.32 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.45
|
| Rate for Payer: Aetna Government |
$1.45
|
| Rate for Payer: Brighton Health Commercial |
$2.18
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.32
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.97
|
| Rate for Payer: Group Health Inc Commercial |
$1.45
|
| Rate for Payer: Group Health Inc Medicare |
$1.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.45
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.45
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.88
|
|
|
NAPHAZOLINE 0.1% OPHTHALMIC SOLN
|
Facility
|
OP
|
$2.90
|
|
| Hospital Charge Code |
41652468
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.02 |
| Max. Negotiated Rate |
$2.32 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.45
|
| Rate for Payer: Aetna Government |
$1.45
|
| Rate for Payer: Brighton Health Commercial |
$2.18
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.32
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.97
|
| Rate for Payer: Group Health Inc Commercial |
$1.45
|
| Rate for Payer: Group Health Inc Medicare |
$1.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.45
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.45
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.88
|
|
|
NAPHAZOLINE-PHENIRAMINE 0.025-0.3 % OP SOLN [5384]
|
Facility
|
OP
|
$0.67
|
|
|
Service Code
|
NDC 00065008542
|
| Hospital Charge Code |
00065008542
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.23 |
| Max. Negotiated Rate |
$0.53 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.37
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.33
|
| Rate for Payer: Aetna Government |
$0.33
|
| Rate for Payer: Brighton Health Commercial |
$0.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.53
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.45
|
| Rate for Payer: Group Health Inc Commercial |
$0.33
|
| Rate for Payer: Group Health Inc Medicare |
$0.23
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.33
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.33
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.43
|
|
|
NAPHAZOLINE-PHENIRAMINE 0.025-0.3 % OP SOLN [5384]
|
Facility
|
OP
|
$0.63
|
|
|
Service Code
|
NDC 00065008515
|
| Hospital Charge Code |
00065008515
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$0.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.34
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.31
|
| Rate for Payer: Aetna Government |
$0.31
|
| Rate for Payer: Brighton Health Commercial |
$0.47
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.43
|
| Rate for Payer: Group Health Inc Commercial |
$0.31
|
| Rate for Payer: Group Health Inc Medicare |
$0.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.31
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.31
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.41
|
|
|
NAPHAZOLINE + PHENIRAMINE OPHTHALMIC SOL
|
Facility
|
OP
|
$6.75
|
|
| Hospital Charge Code |
41654536
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.36 |
| Max. Negotiated Rate |
$5.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.71
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.38
|
| Rate for Payer: Aetna Government |
$3.38
|
| Rate for Payer: Brighton Health Commercial |
$5.06
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.59
|
| Rate for Payer: Group Health Inc Commercial |
$3.38
|
| Rate for Payer: Group Health Inc Medicare |
$2.36
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.39
|
|
|
NAPHAZOLINE + PHENIRAMINE OPHTHALMIC SOL
|
Facility
|
OP
|
$7.00
|
|
| Hospital Charge Code |
41653373
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.45 |
| Max. Negotiated Rate |
$5.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.85
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.50
|
| Rate for Payer: Aetna Government |
$3.50
|
| Rate for Payer: Brighton Health Commercial |
$5.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.76
|
| Rate for Payer: Group Health Inc Commercial |
$3.50
|
| Rate for Payer: Group Health Inc Medicare |
$2.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.55
|
|
|
NAPHAZOLINE + PHENIRAMINE OPHTHALMIC SOL
|
Facility
|
OP
|
$6.75
|
|
| Hospital Charge Code |
41644536
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.36 |
| Max. Negotiated Rate |
$5.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.71
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.38
|
| Rate for Payer: Aetna Government |
$3.38
|
| Rate for Payer: Brighton Health Commercial |
$5.06
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.59
|
| Rate for Payer: Group Health Inc Commercial |
$3.38
|
| Rate for Payer: Group Health Inc Medicare |
$2.36
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.39
|
|
|
NAPHAZOLINE + PHENIRAMINE OPHTHALMIC SOL
|
Facility
|
OP
|
$7.00
|
|
| Hospital Charge Code |
41643373
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.45 |
| Max. Negotiated Rate |
$5.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.85
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.50
|
| Rate for Payer: Aetna Government |
$3.50
|
| Rate for Payer: Brighton Health Commercial |
$5.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.76
|
| Rate for Payer: Group Health Inc Commercial |
$3.50
|
| Rate for Payer: Group Health Inc Medicare |
$2.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.55
|
|
|
NAPROXEN 250 MG PO TABS [5391]
|
Facility
|
OP
|
$0.78
|
|
|
Service Code
|
NDC 50268059415
|
| Hospital Charge Code |
50268059415
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.27 |
| Max. Negotiated Rate |
$0.62 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.43
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.39
|
| Rate for Payer: Aetna Government |
$0.39
|
| Rate for Payer: Brighton Health Commercial |
$0.58
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.62
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.53
|
| Rate for Payer: Group Health Inc Commercial |
$0.39
|
| Rate for Payer: Group Health Inc Medicare |
$0.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.51
|
|
|
NAPROXEN 250 MG PO TABS [5391]
|
Facility
|
OP
|
$0.78
|
|
|
Service Code
|
NDC 68462018801
|
| Hospital Charge Code |
68462018801
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.27 |
| Max. Negotiated Rate |
$0.62 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.43
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.39
|
| Rate for Payer: Aetna Government |
$0.39
|
| Rate for Payer: Brighton Health Commercial |
$0.58
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.62
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.53
|
| Rate for Payer: Group Health Inc Commercial |
$0.39
|
| Rate for Payer: Group Health Inc Medicare |
$0.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.50
|
|
|
NAPROXEN 250 MG PO TABS [5391]
|
Facility
|
OP
|
$0.67
|
|
|
Service Code
|
NDC 70010013705
|
| Hospital Charge Code |
70010013705
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.23 |
| Max. Negotiated Rate |
$0.53 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.37
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.33
|
| Rate for Payer: Aetna Government |
$0.33
|
| Rate for Payer: Brighton Health Commercial |
$0.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.53
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.45
|
| Rate for Payer: Group Health Inc Commercial |
$0.33
|
| Rate for Payer: Group Health Inc Medicare |
$0.23
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.33
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.33
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.43
|
|
|
NAPROXEN 250 MG TAB
|
Facility
|
OP
|
$1.00
|
|
| Hospital Charge Code |
41650324
|
|
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
|
|
|
NAPROXEN 250 MG TAB
|
Facility
|
OP
|
$1.00
|
|
| Hospital Charge Code |
41640324
|
|
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
|
|
|
NAPROXEN 375 MG PO TABS [5392]
|
Facility
|
OP
|
$0.99
|
|
|
Service Code
|
NDC 50268059515
|
| Hospital Charge Code |
50268059515
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$0.79 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.54
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.49
|
| Rate for Payer: Aetna Government |
$0.49
|
| Rate for Payer: Brighton Health Commercial |
$0.74
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.79
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.67
|
| Rate for Payer: Group Health Inc Commercial |
$0.49
|
| Rate for Payer: Group Health Inc Medicare |
$0.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.49
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.64
|
|
|
NAPROXEN 375 MG PO TABS [5392]
|
Facility
|
OP
|
$0.99
|
|
|
Service Code
|
NDC 50268059511
|
| Hospital Charge Code |
50268059511
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$0.79 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.54
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.49
|
| Rate for Payer: Aetna Government |
$0.49
|
| Rate for Payer: Brighton Health Commercial |
$0.74
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.79
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.67
|
| Rate for Payer: Group Health Inc Commercial |
$0.49
|
| Rate for Payer: Group Health Inc Medicare |
$0.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.49
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.64
|
|
|
NAPROXEN 375 MG PO TABS [5392]
|
Facility
|
OP
|
$1.06
|
|
|
Service Code
|
NDC 68462018901
|
| Hospital Charge Code |
68462018901
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.37 |
| Max. Negotiated Rate |
$0.85 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.58
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.53
|
| Rate for Payer: Aetna Government |
$0.53
|
| Rate for Payer: Brighton Health Commercial |
$0.80
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.85
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.72
|
| Rate for Payer: Group Health Inc Commercial |
$0.53
|
| Rate for Payer: Group Health Inc Medicare |
$0.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.53
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.53
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.69
|
|
