|
SACCHAROMYCES BOULARDII 250 MG PO CAPS
|
Facility
|
IP
|
$0.99
|
|
|
Service Code
|
NDC 0414200007
|
| Hospital Charge Code |
0414200007
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.50 |
| Max. Negotiated Rate |
$0.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.50
|
|
|
SACCHAROMYCES BOULARDII 250 MG PO CAPS
|
Facility
|
OP
|
$0.99
|
|
|
Service Code
|
NDC 0414200007
|
| Hospital Charge Code |
0414200007
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$0.79 |
| 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 |
$0.74
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.79
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.67
|
| Rate for Payer: EmblemHealth Commercial |
$0.50
|
| 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 |
$0.64
|
|
|
SACITUZUMAB GOVITECAN-HZIY 180 MG/18ML IV (WET SOLR VIAL)
|
Facility
|
IP
|
$2.00
|
|
|
Service Code
|
HCPCS J9317
|
| Hospital Charge Code |
5513513201
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$1.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.00
|
|
|
SACITUZUMAB GOVITECAN-HZIY 180 MG/18ML IV (WET SOLR VIAL)
|
Facility
|
OP
|
$2.00
|
|
|
Service Code
|
HCPCS J9317
|
| Hospital Charge Code |
5513513201
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$1.10 |
| Max. Negotiated Rate |
$37.01 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$36.28
|
| Rate for Payer: Aetna Government |
$36.28
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$25.40
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$25.40
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$25.40
|
| Rate for Payer: Brighton Health Commercial |
$1.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$36.28
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.36
|
| Rate for Payer: Elderplan Medicare Advantage |
$36.28
|
| Rate for Payer: EmblemHealth Commercial |
$36.28
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$32.65
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$30.84
|
| Rate for Payer: Fidelis Essential Plan QHP |
$32.29
|
| Rate for Payer: Fidelis Medicare Advantage |
$36.28
|
| Rate for Payer: Fidelis Qualified Health Plan |
$32.29
|
| Rate for Payer: Group Health Inc Commercial |
$36.28
|
| Rate for Payer: Group Health Inc Medicare |
$36.28
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$36.28
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$36.28
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$36.28
|
| Rate for Payer: Healthfirst Medicare Advantage |
$30.84
|
| Rate for Payer: Healthfirst QHP |
$36.28
|
| Rate for Payer: Humana Medicare |
$37.01
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$36.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$36.28
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.30
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$34.47
|
| Rate for Payer: Wellcare Medicare |
$34.47
|
|
|
SACITUZUMAB GOVITECAN-HZIY 180 MG IV SOLR
|
Facility
|
IP
|
$2.00
|
|
|
Service Code
|
HCPCS J9317
|
| Hospital Charge Code |
5513513201
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$1.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.00
|
|
|
SACITUZUMAB GOVITECAN-HZIY 180 MG IV SOLR
|
Facility
|
OP
|
$2.00
|
|
|
Service Code
|
HCPCS J9317
|
| Hospital Charge Code |
5513513201
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$1.10 |
| Max. Negotiated Rate |
$37.01 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$36.28
|
| Rate for Payer: Aetna Government |
$36.28
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$25.40
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$25.40
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$25.40
|
| Rate for Payer: Brighton Health Commercial |
$1.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$36.28
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.36
|
| Rate for Payer: Elderplan Medicare Advantage |
$36.28
|
| Rate for Payer: EmblemHealth Commercial |
$36.28
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$32.65
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$30.84
|
| Rate for Payer: Fidelis Essential Plan QHP |
$32.29
|
| Rate for Payer: Fidelis Medicare Advantage |
$36.28
|
| Rate for Payer: Fidelis Qualified Health Plan |
$32.29
|
| Rate for Payer: Group Health Inc Commercial |
$36.28
|
| Rate for Payer: Group Health Inc Medicare |
$36.28
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$36.28
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$36.28
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$36.28
|
| Rate for Payer: Healthfirst Medicare Advantage |
$30.84
|
| Rate for Payer: Healthfirst QHP |
$36.28
|
| Rate for Payer: Humana Medicare |
$37.01
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$36.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$36.28
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.30
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$34.47
|
| Rate for Payer: Wellcare Medicare |
$34.47
|
|
|
SACUBITRIL-VALSARTAN 24-26 MG PO TABS
|
Facility
|
IP
|
$13.76
|
|
|
Service Code
|
NDC 0078065920
|
| Hospital Charge Code |
0078065920
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.88 |
| Max. Negotiated Rate |
$6.88 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.88
|
|
|
SACUBITRIL-VALSARTAN 24-26 MG PO TABS
|
Facility
|
IP
|
$13.76
|
|
|
Service Code
|
NDC 0078065967
|
| Hospital Charge Code |
0078065967
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.88 |
| Max. Negotiated Rate |
$6.88 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.88
|
|
|
SACUBITRIL-VALSARTAN 24-26 MG PO TABS
|
Facility
|
OP
|
$13.76
|
|
|
Service Code
|
NDC 0078065967
|
| Hospital Charge Code |
0078065967
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.82 |
| Max. Negotiated Rate |
$11.01 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.57
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.88
|
| Rate for Payer: Aetna Government |
$6.88
|
| Rate for Payer: Brighton Health Commercial |
$10.32
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$11.01
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$9.36
|
| Rate for Payer: EmblemHealth Commercial |
$6.88
|
| Rate for Payer: Group Health Inc Commercial |
$6.88
|
| Rate for Payer: Group Health Inc Medicare |
$4.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8.94
|
|
|
SACUBITRIL-VALSARTAN 24-26 MG PO TABS
|
Facility
|
IP
|
$1.33
|
|
|
Service Code
|
NDC 7220528060
|
| Hospital Charge Code |
7220528060
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.67 |
| Max. Negotiated Rate |
$0.67 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.67
|
|
|
SACUBITRIL-VALSARTAN 24-26 MG PO TABS
|
Facility
|
OP
|
$13.76
|
|
|
Service Code
|
NDC 0078065920
|
| Hospital Charge Code |
0078065920
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.82 |
| Max. Negotiated Rate |
$11.01 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.57
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.88
|
| Rate for Payer: Aetna Government |
$6.88
|
| Rate for Payer: Brighton Health Commercial |
$10.32
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$11.01
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$9.36
|
| Rate for Payer: EmblemHealth Commercial |
$6.88
|
| Rate for Payer: Group Health Inc Commercial |
$6.88
|
| Rate for Payer: Group Health Inc Medicare |
$4.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8.94
|
|
|
SACUBITRIL-VALSARTAN 24-26 MG PO TABS
|
Facility
|
OP
|
$1.33
|
|
|
Service Code
|
NDC 7220528060
|
| Hospital Charge Code |
7220528060
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.47 |
| Max. Negotiated Rate |
$1.06 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.73
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.67
|
| Rate for Payer: Aetna Government |
$0.67
|
| Rate for Payer: Brighton Health Commercial |
$1.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.06
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.90
|
| Rate for Payer: EmblemHealth Commercial |
$0.67
|
| 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: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.86
|
|
|
SACUBITRIL-VALSARTAN 49-51 MG PO TABS
|
Facility
|
IP
|
$13.76
|
|
|
Service Code
|
NDC 0078077720
|
| Hospital Charge Code |
0078077720
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.88 |
| Max. Negotiated Rate |
$6.88 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.88
|
|
|
SACUBITRIL-VALSARTAN 49-51 MG PO TABS
|
Facility
|
OP
|
$13.76
|
|
|
Service Code
|
NDC 0078077720
|
| Hospital Charge Code |
0078077720
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.82 |
| Max. Negotiated Rate |
$11.01 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.57
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.88
|
| Rate for Payer: Aetna Government |
$6.88
|
| Rate for Payer: Brighton Health Commercial |
$10.32
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$11.01
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$9.36
|
| Rate for Payer: EmblemHealth Commercial |
$6.88
|
| Rate for Payer: Group Health Inc Commercial |
$6.88
|
| Rate for Payer: Group Health Inc Medicare |
$4.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8.94
|
|
|
SACUBITRIL-VALSARTAN 97-103 MG PO TABS
|
Facility
|
IP
|
$13.76
|
|
|
Service Code
|
NDC 0078069620
|
| Hospital Charge Code |
0078069620
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.88 |
| Max. Negotiated Rate |
$6.88 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.88
|
|
|
SACUBITRIL-VALSARTAN 97-103 MG PO TABS
|
Facility
|
OP
|
$13.76
|
|
|
Service Code
|
NDC 0078069620
|
| Hospital Charge Code |
0078069620
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.82 |
| Max. Negotiated Rate |
$11.01 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.57
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.88
|
| Rate for Payer: Aetna Government |
$6.88
|
| Rate for Payer: Brighton Health Commercial |
$10.32
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$11.01
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$9.36
|
| Rate for Payer: EmblemHealth Commercial |
$6.88
|
| Rate for Payer: Group Health Inc Commercial |
$6.88
|
| Rate for Payer: Group Health Inc Medicare |
$4.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8.94
|
|
|
SACUBITRIL-VALSARTAN 97-103 MG PO TABS
|
Facility
|
OP
|
$1.30
|
|
|
Service Code
|
NDC 7220528260
|
| Hospital Charge Code |
7220528260
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.46 |
| Max. Negotiated Rate |
$1.04 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.72
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.65
|
| Rate for Payer: Aetna Government |
$0.65
|
| Rate for Payer: Brighton Health Commercial |
$0.98
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.04
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.88
|
| Rate for Payer: EmblemHealth Commercial |
$0.65
|
| Rate for Payer: Group Health Inc Commercial |
$0.65
|
| Rate for Payer: Group Health Inc Medicare |
$0.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.65
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.65
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.85
|
|
|
SACUBITRIL-VALSARTAN 97-103 MG PO TABS
|
Facility
|
IP
|
$1.30
|
|
|
Service Code
|
NDC 7220528260
|
| Hospital Charge Code |
7220528260
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.65 |
| Max. Negotiated Rate |
$0.65 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.65
|
|
|
SALICYLIC ACID 6 % EX GEL
|
Facility
|
IP
|
$8.90
|
|
|
Service Code
|
NDC 4219213440
|
| Hospital Charge Code |
4219213440
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.45 |
| Max. Negotiated Rate |
$4.45 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.45
|
|
|
SALICYLIC ACID 6 % EX GEL
|
Facility
|
OP
|
$8.90
|
|
|
Service Code
|
NDC 4219213440
|
| Hospital Charge Code |
4219213440
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.12 |
| Max. Negotiated Rate |
$7.12 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.45
|
| Rate for Payer: Aetna Government |
$4.45
|
| Rate for Payer: Brighton Health Commercial |
$6.68
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7.12
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.05
|
| Rate for Payer: EmblemHealth Commercial |
$4.45
|
| Rate for Payer: Group Health Inc Commercial |
$4.45
|
| Rate for Payer: Group Health Inc Medicare |
$3.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.45
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.45
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.79
|
|
|
SALICYLIC ACID-SULFUR 2-2 % EX SHAM
|
Facility
|
IP
|
$0.04
|
|
|
Service Code
|
NDC 0536196297
|
| Hospital Charge Code |
0536196297
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.02 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.02
|
|
|
SALICYLIC ACID-SULFUR 2-2 % EX SHAM
|
Facility
|
OP
|
$0.04
|
|
|
Service Code
|
NDC 0536196297
|
| Hospital Charge Code |
0536196297
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.02
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.02
|
| Rate for Payer: Aetna Government |
$0.02
|
| Rate for Payer: Brighton Health Commercial |
$0.03
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.03
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.03
|
| Rate for Payer: EmblemHealth Commercial |
$0.02
|
| Rate for Payer: Group Health Inc Commercial |
$0.02
|
| Rate for Payer: Group Health Inc Medicare |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.02
|
|
|
SALINE 0.65 % NA SOLN
|
Facility
|
IP
|
$0.05
|
|
|
Service Code
|
NDC 0225038280
|
| Hospital Charge Code |
0225038280
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.03
|
|
|
SALINE 0.65 % NA SOLN
|
Facility
|
OP
|
$0.05
|
|
|
Service Code
|
NDC 0225038280
|
| Hospital Charge Code |
0225038280
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.04 |
| 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 |
$0.04
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.04
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.03
|
| Rate for Payer: EmblemHealth Commercial |
$0.03
|
| 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 |
$0.03
|
|
|
SALINE NASAL SPRAY 0.65 % NA SOLN
|
Facility
|
OP
|
$0.05
|
|
|
Service Code
|
NDC 0225038080
|
| Hospital Charge Code |
0225038080
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.04 |
| 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 |
$0.04
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.04
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.03
|
| Rate for Payer: EmblemHealth Commercial |
$0.03
|
| 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 |
$0.03
|
|
