|
BENZTROPINE MESYLATE 2 MG PO TABS [1000]
|
Facility
|
OP
|
$0.52
|
|
|
Service Code
|
NDC 00603243921
|
| Hospital Charge Code |
00603243921
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$0.42 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.29
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.26
|
| Rate for Payer: Aetna Government |
$0.26
|
| Rate for Payer: Brighton Health Commercial |
$0.39
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.42
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.35
|
| Rate for Payer: Group Health Inc Commercial |
$0.26
|
| Rate for Payer: Group Health Inc Medicare |
$0.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.26
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.34
|
|
|
BENZTROPINE MESYLATE 2 MG PO TABS [1000]
|
Facility
|
OP
|
$0.52
|
|
|
Service Code
|
NDC 69097083207
|
| Hospital Charge Code |
69097083207
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$0.42 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.29
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.26
|
| Rate for Payer: Aetna Government |
$0.26
|
| Rate for Payer: Brighton Health Commercial |
$0.39
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.42
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.35
|
| Rate for Payer: Group Health Inc Commercial |
$0.26
|
| Rate for Payer: Group Health Inc Medicare |
$0.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.26
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.34
|
|
|
BENZYLPENICILLOYL POLYLYSINE INJ
|
Facility
|
OP
|
$33.00
|
|
| Hospital Charge Code |
41655419
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.55 |
| Max. Negotiated Rate |
$26.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$18.15
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$16.50
|
| Rate for Payer: Aetna Government |
$16.50
|
| Rate for Payer: Brighton Health Commercial |
$24.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$26.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$22.44
|
| Rate for Payer: Group Health Inc Commercial |
$16.50
|
| Rate for Payer: Group Health Inc Medicare |
$11.55
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$21.45
|
|
|
BENZYLPENICILLOYL POLYLYSINE INJ
|
Facility
|
OP
|
$33.00
|
|
| Hospital Charge Code |
41645419
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.55 |
| Max. Negotiated Rate |
$26.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$18.15
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$16.50
|
| Rate for Payer: Aetna Government |
$16.50
|
| Rate for Payer: Brighton Health Commercial |
$24.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$26.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$22.44
|
| Rate for Payer: Group Health Inc Commercial |
$16.50
|
| Rate for Payer: Group Health Inc Medicare |
$11.55
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$21.45
|
|
|
BERACTANT 25 MG/ML INTRATRACHEAL
|
Facility
|
OP
|
$510.58
|
|
| Hospital Charge Code |
41652282
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$178.70 |
| Max. Negotiated Rate |
$408.46 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$280.82
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$255.29
|
| Rate for Payer: Aetna Government |
$255.29
|
| Rate for Payer: Brighton Health Commercial |
$382.94
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$408.46
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$347.19
|
| Rate for Payer: Group Health Inc Commercial |
$255.29
|
| Rate for Payer: Group Health Inc Medicare |
$178.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$255.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$255.29
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$331.88
|
|
|
BERACTANT 25 MG/ML INTRATRACHEAL
|
Facility
|
OP
|
$510.58
|
|
| Hospital Charge Code |
41642282
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$178.70 |
| Max. Negotiated Rate |
$408.46 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$280.82
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$255.29
|
| Rate for Payer: Aetna Government |
$255.29
|
| Rate for Payer: Brighton Health Commercial |
$382.94
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$408.46
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$347.19
|
| Rate for Payer: Group Health Inc Commercial |
$255.29
|
| Rate for Payer: Group Health Inc Medicare |
$178.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$255.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$255.29
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$331.88
|
|
|
BETA-2 GLYCOPROTEIN I AB, IGG
|
Facility
|
OP
|
$63.63
|
|
|
Service Code
|
HCPCS 86146
|
| Hospital Charge Code |
40729325
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.82 |
| Max. Negotiated Rate |
$47.72 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$35.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$25.45
|
| Rate for Payer: Aetna Government |
$25.45
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$17.82
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$17.82
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$17.82
|
| Rate for Payer: Brighton Health Commercial |
$47.72
|
| Rate for Payer: Cash Price |
$25.45
|
| Rate for Payer: Cash Price |
$25.45
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$25.45
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$40.43
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$34.21
|
| Rate for Payer: Elderplan Medicare Advantage |
$25.45
|
| Rate for Payer: EmblemHealth Commercial |
$25.45
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$21.63
|
| Rate for Payer: Fidelis Essential Plan QHP |
$22.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$25.45
|
| Rate for Payer: Fidelis Qualified Health Plan |
$22.65
|
| Rate for Payer: Group Health Inc Commercial |
$25.45
|
| Rate for Payer: Group Health Inc Medicare |
$25.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$31.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$25.45
|
| Rate for Payer: Healthfirst Medicare Advantage |
$25.45
|
| Rate for Payer: Healthfirst QHP |
$25.45
|
| Rate for Payer: Humana Medicare |
$25.96
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$25.45
|
| Rate for Payer: United Healthcare Commercial |
$32.22
|
| Rate for Payer: United Healthcare Medicare Advantage |
$25.45
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$25.45
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$20.36
|
| Rate for Payer: Wellcare Medicare |
$22.90
|
|
|
BETA-2 GLYCOPROTEIN I AB, IGG
|
Facility
|
IP
|
$63.63
|
|
|
Service Code
|
HCPCS 86146
|
| Hospital Charge Code |
40729325
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$25.45
|
|
|
BETA-2 MICROGLOBULIN, SERUM
|
Facility
|
IP
|
$40.45
|
|
|
Service Code
|
HCPCS 82232
|
| Hospital Charge Code |
40609045
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$16.18
|
|
|
BETA-2 MICROGLOBULIN, SERUM
|
Facility
|
OP
|
$40.45
|
|
|
Service Code
|
HCPCS 82232
|
| Hospital Charge Code |
40609045
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.33 |
| Max. Negotiated Rate |
$30.34 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$22.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$16.18
|
| Rate for Payer: Aetna Government |
$16.18
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$11.33
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$11.33
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$11.33
|
| Rate for Payer: Brighton Health Commercial |
$30.34
|
| Rate for Payer: Cash Price |
$16.18
|
| Rate for Payer: Cash Price |
$16.18
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$16.18
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$25.70
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$21.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$16.18
|
| Rate for Payer: EmblemHealth Commercial |
$16.18
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$13.75
|
| Rate for Payer: Fidelis Essential Plan QHP |
$14.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$16.18
|
| Rate for Payer: Fidelis Qualified Health Plan |
$14.40
|
| Rate for Payer: Group Health Inc Commercial |
$16.18
|
| Rate for Payer: Group Health Inc Medicare |
$16.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$20.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.18
|
| Rate for Payer: Healthfirst Medicare Advantage |
$16.18
|
| Rate for Payer: Healthfirst QHP |
$16.18
|
| Rate for Payer: Humana Medicare |
$16.50
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$16.18
|
| Rate for Payer: United Healthcare Commercial |
$20.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.18
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$16.18
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$12.94
|
| Rate for Payer: Wellcare Medicare |
$14.56
|
|
|
BETA CAP CLAMP
|
Facility
|
OP
|
$11.70
|
|
| Hospital Charge Code |
42905255
|
|
Hospital Revenue Code
|
801
|
| Min. Negotiated Rate |
$4.10 |
| Max. Negotiated Rate |
$9.36 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.44
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.85
|
| Rate for Payer: Aetna Government |
$5.85
|
| Rate for Payer: Brighton Health Commercial |
$8.78
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$9.36
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7.96
|
| Rate for Payer: Group Health Inc Commercial |
$5.85
|
| Rate for Payer: Group Health Inc Medicare |
$4.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.85
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.85
|
|
|
BETA-HYDROXYBUTYRATE
|
Facility
|
OP
|
$20.43
|
|
|
Service Code
|
HCPCS 82010
|
| Hospital Charge Code |
40609031
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.72 |
| Max. Negotiated Rate |
$15.32 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$11.24
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8.17
|
| Rate for Payer: Aetna Government |
$8.17
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$5.72
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$5.72
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$5.72
|
| Rate for Payer: Brighton Health Commercial |
$15.32
|
| Rate for Payer: Cash Price |
$8.17
|
| Rate for Payer: Cash Price |
$8.17
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$8.17
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$13.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$11.00
|
| Rate for Payer: Elderplan Medicare Advantage |
$8.17
|
| Rate for Payer: EmblemHealth Commercial |
$8.17
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$6.94
|
| Rate for Payer: Fidelis Essential Plan QHP |
$7.27
|
| Rate for Payer: Fidelis Medicare Advantage |
$8.17
|
| Rate for Payer: Fidelis Qualified Health Plan |
$7.27
|
| Rate for Payer: Group Health Inc Commercial |
$8.17
|
| Rate for Payer: Group Health Inc Medicare |
$8.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.17
|
| Rate for Payer: Healthfirst Medicare Advantage |
$8.17
|
| Rate for Payer: Healthfirst QHP |
$8.17
|
| Rate for Payer: Humana Medicare |
$8.33
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$8.17
|
| Rate for Payer: United Healthcare Commercial |
$10.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.17
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8.17
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$6.54
|
| Rate for Payer: Wellcare Medicare |
$7.35
|
|
|
BETA-HYDROXYBUTYRATE
|
Facility
|
IP
|
$20.43
|
|
|
Service Code
|
HCPCS 82010
|
| Hospital Charge Code |
40609031
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$8.17
|
|
|
BETAMETHASONE DIPROPIONATE 0.05% CREAM -
|
Facility
|
OP
|
$2.00
|
|
| Hospital Charge Code |
41640047
|
|
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
|
|
|
BETAMETHASONE DIPROPIONATE 0.05% CREAM -
|
Facility
|
OP
|
$2.00
|
|
| Hospital Charge Code |
41650047
|
|
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
|
|
|
BETAMETHASONE DIPROPIONATE 0.05 % EX CREA [1027]
|
Facility
|
OP
|
$2.94
|
|
|
Service Code
|
NDC 51672127401
|
| Hospital Charge Code |
51672127401
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.03 |
| Max. Negotiated Rate |
$2.35 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.61
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.47
|
| Rate for Payer: Aetna Government |
$1.47
|
| Rate for Payer: Brighton Health Commercial |
$2.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.35
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.00
|
| Rate for Payer: Group Health Inc Commercial |
$1.47
|
| Rate for Payer: Group Health Inc Medicare |
$1.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.47
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.91
|
|
|
BETAMETHASONE DIPROPROPIONATE 0.05% OINT
|
Facility
|
OP
|
$3.00
|
|
| Hospital Charge Code |
41650897
|
|
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
|
|
|
BETAMETHASONE DIPROPROPIONATE 0.05% OINT
|
Facility
|
OP
|
$3.00
|
|
| Hospital Charge Code |
41640897
|
|
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
|
|
|
BETAMETHASONE SOD PHOS & ACET 6 (3-3) MG/ML IJ SUSP [9266]
|
Facility
|
OP
|
$9.66
|
|
|
Service Code
|
HCPCS J0702
|
| Hospital Charge Code |
00517079901
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.38 |
| Max. Negotiated Rate |
$8.04 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.31
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8.04
|
| Rate for Payer: Aetna Government |
$8.04
|
| Rate for Payer: Brighton Health Commercial |
$7.24
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7.73
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.57
|
| Rate for Payer: Group Health Inc Commercial |
$4.83
|
| Rate for Payer: Group Health Inc Medicare |
$3.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.83
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.83
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$6.88
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$7.30
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$7.30
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$7.30
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6.28
|
|
|
BETAMETHASONE SOD PHOS & ACET 6 (3-3) MG/ML IJ SUSP [9266]
|
Facility
|
OP
|
$13.21
|
|
|
Service Code
|
HCPCS J0702
|
| Hospital Charge Code |
00517072001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.62 |
| Max. Negotiated Rate |
$10.57 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.26
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8.04
|
| Rate for Payer: Aetna Government |
$8.04
|
| Rate for Payer: Brighton Health Commercial |
$9.91
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$10.57
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$8.98
|
| Rate for Payer: Group Health Inc Commercial |
$6.60
|
| Rate for Payer: Group Health Inc Medicare |
$4.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.60
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$6.88
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$7.30
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$7.30
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$7.30
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8.59
|
|
|
BETAMETHASONE SOD PHOS & ACET 6 (3-3) MG/ML IJ SUSP [9266]
|
Facility
|
OP
|
$9.98
|
|
|
Service Code
|
HCPCS J0702
|
| Hospital Charge Code |
78206011801
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.49 |
| Max. Negotiated Rate |
$8.04 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.49
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8.04
|
| Rate for Payer: Aetna Government |
$8.04
|
| Rate for Payer: Brighton Health Commercial |
$7.48
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7.98
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.79
|
| Rate for Payer: Group Health Inc Commercial |
$4.99
|
| Rate for Payer: Group Health Inc Medicare |
$3.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.99
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$6.88
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$7.30
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$7.30
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$7.30
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6.49
|
|
|
BETAMETHASONE SOD PHOS-ACETATE 6 MG/ML I
|
Facility
|
IP
|
$27.35
|
|
|
Service Code
|
HCPCS J0702
|
| Hospital Charge Code |
41641885
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.68 |
| Max. Negotiated Rate |
$13.68 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$13.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.68
|
|
|
BETAMETHASONE SOD PHOS-ACETATE 6 MG/ML I
|
Facility
|
IP
|
$27.35
|
|
|
Service Code
|
HCPCS J0702
|
| Hospital Charge Code |
41651885
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.68 |
| Max. Negotiated Rate |
$13.68 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$13.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.68
|
|
|
BETAMETHASONE SOD PHOS-ACETATE 6 MG/ML I
|
Facility
|
OP
|
$27.35
|
|
|
Service Code
|
HCPCS J0702
|
| Hospital Charge Code |
41651885
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.30 |
| Max. Negotiated Rate |
$17.78 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$15.04
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8.04
|
| Rate for Payer: Aetna Government |
$8.04
|
| Rate for Payer: Brighton Health Commercial |
$16.41
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$13.68
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$15.73
|
| Rate for Payer: Group Health Inc Commercial |
$13.68
|
| Rate for Payer: Group Health Inc Medicare |
$9.57
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$13.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.68
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$7.30
|
| Rate for Payer: SOMOS Essential |
$7.30
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$17.78
|
|
|
BETAMETHASONE SOD PHOS-ACETATE 6 MG/ML I
|
Facility
|
OP
|
$27.35
|
|
|
Service Code
|
HCPCS J0702
|
| Hospital Charge Code |
41641885
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.30 |
| Max. Negotiated Rate |
$17.78 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$15.04
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8.04
|
| Rate for Payer: Aetna Government |
$8.04
|
| Rate for Payer: Brighton Health Commercial |
$16.41
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$13.68
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$15.73
|
| Rate for Payer: Group Health Inc Commercial |
$13.68
|
| Rate for Payer: Group Health Inc Medicare |
$9.57
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$13.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.68
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$7.30
|
| Rate for Payer: SOMOS Essential |
$7.30
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$17.78
|
|
