|
DEXAMETHASONE SODIUM PHOSPHATE 10 MG/ML IJ SOLN (WRAPPED)
|
Facility
|
OP
|
$6.29
|
|
|
Service Code
|
HCPCS J1100
|
| Hospital Charge Code |
7006902101
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$5.03 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.46
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.12
|
| Rate for Payer: Aetna Government |
$0.12
|
| Rate for Payer: Brighton Health Commercial |
$4.72
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5.03
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.28
|
| Rate for Payer: EmblemHealth Commercial |
$3.15
|
| Rate for Payer: Group Health Inc Commercial |
$3.15
|
| Rate for Payer: Group Health Inc Medicare |
$2.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.15
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.15
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.09
|
|
|
DEXAMETHASONE SODIUM PHOSPHATE 10 MG/ML IJ SOLN (WRAPPED)
|
Facility
|
IP
|
$6.29
|
|
|
Service Code
|
HCPCS J1100
|
| Hospital Charge Code |
9999123465
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.14 |
| Max. Negotiated Rate |
$3.14 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.14
|
|
|
DEXAMETHASONE SODIUM PHOSPHATE 10 MG/ML IJ SOLN (WRAPPED)
|
Facility
|
OP
|
$1.71
|
|
|
Service Code
|
HCPCS J1100
|
| Hospital Charge Code |
0641036725
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$1.37 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.94
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.12
|
| Rate for Payer: Aetna Government |
$0.12
|
| Rate for Payer: Brighton Health Commercial |
$1.29
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.37
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.17
|
| Rate for Payer: EmblemHealth Commercial |
$0.86
|
| Rate for Payer: Group Health Inc Commercial |
$0.86
|
| Rate for Payer: Group Health Inc Medicare |
$0.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.86
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.11
|
|
|
DEXAMETHASONE SODIUM PHOSPHATE 10 MG/ML IJ SOLN (WRAPPED)
|
Facility
|
IP
|
$6.29
|
|
|
Service Code
|
HCPCS J1100
|
| Hospital Charge Code |
7006902101
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.15 |
| Max. Negotiated Rate |
$3.15 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.15
|
|
|
DEXAMETHASONE SODIUM PHOSPHATE 10 MG/ML IJ SOLN (WRAPPED)
|
Facility
|
OP
|
$6.29
|
|
|
Service Code
|
HCPCS J1100
|
| Hospital Charge Code |
7006902125
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$5.03 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.46
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.12
|
| Rate for Payer: Aetna Government |
$0.12
|
| Rate for Payer: Brighton Health Commercial |
$4.72
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5.03
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.28
|
| Rate for Payer: EmblemHealth Commercial |
$3.14
|
| Rate for Payer: Group Health Inc Commercial |
$3.14
|
| Rate for Payer: Group Health Inc Medicare |
$2.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.14
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.09
|
|
|
DEXAMETHASONE SODIUM PHOSPHATE 10 MG/ML IJ SOLN (WRAPPED)
|
Facility
|
OP
|
$6.29
|
|
|
Service Code
|
HCPCS J1100
|
| Hospital Charge Code |
9999123465
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$5.03 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.46
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.12
|
| Rate for Payer: Aetna Government |
$0.12
|
| Rate for Payer: Brighton Health Commercial |
$4.72
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5.03
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.28
|
| Rate for Payer: EmblemHealth Commercial |
$3.14
|
| Rate for Payer: Group Health Inc Commercial |
$3.14
|
| Rate for Payer: Group Health Inc Medicare |
$2.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.14
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.09
|
|
|
DEXAMETHASONE SODIUM PHOSPHATE 10 MG/ML IJ SOLN (WRAPPED)
|
Facility
|
IP
|
$6.29
|
|
|
Service Code
|
HCPCS J1100
|
| Hospital Charge Code |
7006902125
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.14 |
| Max. Negotiated Rate |
$3.14 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.14
|
|
|
DEXAMETHASONE SODIUM PHOSPHATE 10 MG/ML IJ SOLN (WRAPPED)
|
Facility
|
OP
|
$1.72
|
|
|
Service Code
|
HCPCS J1100
|
| Hospital Charge Code |
0641036721
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$1.38 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.12
|
| Rate for Payer: Aetna Government |
$0.12
|
| Rate for Payer: Brighton Health Commercial |
$1.29
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.38
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.17
|
| Rate for Payer: EmblemHealth Commercial |
$0.86
|
| Rate for Payer: Group Health Inc Commercial |
$0.86
|
| Rate for Payer: Group Health Inc Medicare |
$0.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.86
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.12
|
|
|
DEXAMETHASONE SODIUM PHOSPHATE 20 MG/5ML IJ SOLN
|
Facility
|
IP
|
$0.21
|
|
|
Service Code
|
HCPCS J1100
|
| Hospital Charge Code |
6332316526
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.11 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.11
|
|
|
DEXAMETHASONE SODIUM PHOSPHATE 20 MG/5ML IJ SOLN
|
Facility
|
OP
|
$0.47
|
|
|
Service Code
|
HCPCS J1100
|
| Hospital Charge Code |
6745742200
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.37 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.26
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.12
|
| Rate for Payer: Aetna Government |
$0.12
|
| 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 |
$0.32
|
| Rate for Payer: EmblemHealth Commercial |
$0.23
|
| 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: Healthfirst CHP/FHP/Medicaid |
$0.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.30
|
|
|
DEXAMETHASONE SODIUM PHOSPHATE 20 MG/5ML IJ SOLN
|
Facility
|
IP
|
$0.47
|
|
|
Service Code
|
HCPCS J1100
|
| Hospital Charge Code |
6745742200
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.23 |
| Max. Negotiated Rate |
$0.23 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.23
|
|
|
DEXAMETHASONE SODIUM PHOSPHATE 20 MG/5ML IJ SOLN
|
Facility
|
OP
|
$0.21
|
|
|
Service Code
|
HCPCS J1100
|
| Hospital Charge Code |
6332316526
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.17 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.12
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.12
|
| Rate for Payer: Aetna Government |
$0.12
|
| Rate for Payer: Brighton Health Commercial |
$0.16
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.17
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.14
|
| Rate for Payer: EmblemHealth Commercial |
$0.11
|
| Rate for Payer: Group Health Inc Commercial |
$0.11
|
| Rate for Payer: Group Health Inc Medicare |
$0.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.11
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.11
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.14
|
|
|
DEXAMETHASONE SODIUM PHOSPHATE 20 MG/5ML IJ SOLN
|
Facility
|
IP
|
$1.66
|
|
|
Service Code
|
HCPCS J1100
|
| Hospital Charge Code |
6332316505
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.83 |
| Max. Negotiated Rate |
$0.83 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.83
|
|
|
DEXAMETHASONE SODIUM PHOSPHATE 20 MG/5ML IJ SOLN
|
Facility
|
OP
|
$0.26
|
|
|
Service Code
|
HCPCS J1100
|
| Hospital Charge Code |
2502105205
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.21 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.14
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.12
|
| Rate for Payer: Aetna Government |
$0.12
|
| Rate for Payer: Brighton Health Commercial |
$0.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.21
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.18
|
| Rate for Payer: EmblemHealth Commercial |
$0.13
|
| Rate for Payer: Group Health Inc Commercial |
$0.13
|
| Rate for Payer: Group Health Inc Medicare |
$0.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.13
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.13
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.17
|
|
|
DEXAMETHASONE SODIUM PHOSPHATE 20 MG/5ML IJ SOLN
|
Facility
|
OP
|
$1.66
|
|
|
Service Code
|
HCPCS J1100
|
| Hospital Charge Code |
6332316505
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$1.33 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.91
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.12
|
| Rate for Payer: Aetna Government |
$0.12
|
| Rate for Payer: Brighton Health Commercial |
$1.24
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.33
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.13
|
| Rate for Payer: EmblemHealth Commercial |
$0.83
|
| Rate for Payer: Group Health Inc Commercial |
$0.83
|
| Rate for Payer: Group Health Inc Medicare |
$0.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.83
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.83
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.08
|
|
|
DEXAMETHASONE SODIUM PHOSPHATE 20 MG/5ML IJ SOLN
|
Facility
|
IP
|
$0.47
|
|
|
Service Code
|
HCPCS J1100
|
| Hospital Charge Code |
6745742254
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.23 |
| Max. Negotiated Rate |
$0.23 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.23
|
|
|
DEXAMETHASONE SODIUM PHOSPHATE 20 MG/5ML IJ SOLN
|
Facility
|
IP
|
$0.26
|
|
|
Service Code
|
HCPCS J1100
|
| Hospital Charge Code |
2502105205
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.13 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.13
|
|
|
DEXAMETHASONE SODIUM PHOSPHATE 20 MG/5ML IJ SOLN
|
Facility
|
OP
|
$0.26
|
|
|
Service Code
|
HCPCS J1100
|
| Hospital Charge Code |
0641614625
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.21 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.15
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.12
|
| Rate for Payer: Aetna Government |
$0.12
|
| Rate for Payer: Brighton Health Commercial |
$0.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.21
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.18
|
| Rate for Payer: EmblemHealth Commercial |
$0.13
|
| Rate for Payer: Group Health Inc Commercial |
$0.13
|
| Rate for Payer: Group Health Inc Medicare |
$0.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.13
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.13
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.17
|
|
|
DEXAMETHASONE SODIUM PHOSPHATE 20 MG/5ML IJ SOLN
|
Facility
|
IP
|
$0.26
|
|
|
Service Code
|
HCPCS J1100
|
| Hospital Charge Code |
0641614625
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.13 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.13
|
|
|
DEXAMETHASONE SODIUM PHOSPHATE 20 MG/5ML IJ SOLN
|
Facility
|
OP
|
$0.47
|
|
|
Service Code
|
HCPCS J1100
|
| Hospital Charge Code |
6745742254
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.37 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.26
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.12
|
| Rate for Payer: Aetna Government |
$0.12
|
| 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 |
$0.32
|
| Rate for Payer: EmblemHealth Commercial |
$0.23
|
| 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: Healthfirst CHP/FHP/Medicaid |
$0.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.30
|
|
|
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML IJ SOLN
|
Facility
|
IP
|
$1.16
|
|
|
Service Code
|
HCPCS J1100
|
| Hospital Charge Code |
0641614525
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$0.58 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.58
|
|
|
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML IJ SOLN
|
Facility
|
OP
|
$1.16
|
|
|
Service Code
|
HCPCS J1100
|
| Hospital Charge Code |
0641614501
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.93 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.64
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.12
|
| Rate for Payer: Aetna Government |
$0.12
|
| Rate for Payer: Brighton Health Commercial |
$0.87
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.93
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.79
|
| Rate for Payer: EmblemHealth Commercial |
$0.58
|
| Rate for Payer: Group Health Inc Commercial |
$0.58
|
| Rate for Payer: Group Health Inc Medicare |
$0.41
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.58
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.75
|
|
|
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML IJ SOLN
|
Facility
|
IP
|
$3.46
|
|
|
Service Code
|
HCPCS J1100
|
| Hospital Charge Code |
6332316502
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.73 |
| Max. Negotiated Rate |
$1.73 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.73
|
|
|
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML IJ SOLN
|
Facility
|
IP
|
$3.46
|
|
|
Service Code
|
HCPCS J1100
|
| Hospital Charge Code |
6332316501
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.73 |
| Max. Negotiated Rate |
$1.73 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.73
|
|
|
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML IJ SOLN
|
Facility
|
IP
|
$1.16
|
|
|
Service Code
|
HCPCS J1100
|
| Hospital Charge Code |
0641614501
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$0.58 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.58
|
|
