|
TRIAMCINOLONE ACETONIDE 0.1 % EX CREA [8113]
|
Facility
|
OP
|
$0.16
|
|
|
Service Code
|
NDC 51672128208
|
| Hospital Charge Code |
51672128208
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.13 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.09
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.08
|
| Rate for Payer: Aetna Government |
$0.08
|
| Rate for Payer: Brighton Health Commercial |
$0.12
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.13
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.11
|
| Rate for Payer: Group Health Inc Commercial |
$0.08
|
| Rate for Payer: Group Health Inc Medicare |
$0.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.10
|
|
|
TRIAMCINOLONE ACETONIDE 0.1 % EX CREA [8113]
|
Facility
|
OP
|
$0.24
|
|
|
Service Code
|
NDC 00168000415
|
| Hospital Charge Code |
00168000415
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.19 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.13
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.12
|
| Rate for Payer: Aetna Government |
$0.12
|
| Rate for Payer: Brighton Health Commercial |
$0.18
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.19
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.16
|
| Rate for Payer: Group Health Inc Commercial |
$0.12
|
| Rate for Payer: Group Health Inc Medicare |
$0.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.16
|
|
|
TRIAMCINOLONE ACETONIDE 0.1 % EX OINT [8118]
|
Facility
|
OP
|
$0.07
|
|
|
Service Code
|
NDC 00168000616
|
| Hospital Charge Code |
00168000616
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.04
|
| 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
|
|
|
TRIAMCINOLONE ACETONIDE 0.1 % EX OINT [8118]
|
Facility
|
OP
|
$0.37
|
|
|
Service Code
|
NDC 45802005535
|
| Hospital Charge Code |
45802005535
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.30 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.20
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.19
|
| Rate for Payer: Aetna Government |
$0.19
|
| Rate for Payer: Brighton Health Commercial |
$0.28
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.30
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.25
|
| Rate for Payer: Group Health Inc Commercial |
$0.19
|
| Rate for Payer: Group Health Inc Medicare |
$0.13
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.19
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.24
|
|
|
TRIAMCINOLONE ACETONIDE 0.1 % EX OINT [8118]
|
Facility
|
OP
|
$0.09
|
|
|
Service Code
|
NDC 33342033354
|
| Hospital Charge Code |
33342033354
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.07 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.05
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.05
|
| Rate for Payer: Aetna Government |
$0.05
|
| Rate for Payer: Brighton Health Commercial |
$0.07
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.07
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.06
|
| Rate for Payer: Group Health Inc Commercial |
$0.05
|
| Rate for Payer: Group Health Inc Medicare |
$0.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.06
|
|
|
TRIAMCINOLONE ACETONIDE 0.1 % EX OINT [8118]
|
Facility
|
OP
|
$0.37
|
|
|
Service Code
|
NDC 33342033315
|
| Hospital Charge Code |
33342033315
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.30 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.20
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.19
|
| Rate for Payer: Aetna Government |
$0.19
|
| Rate for Payer: Brighton Health Commercial |
$0.28
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.30
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.25
|
| Rate for Payer: Group Health Inc Commercial |
$0.19
|
| Rate for Payer: Group Health Inc Medicare |
$0.13
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.19
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.24
|
|
|
TRIAMCINOLONE ACETONIDE 0.1 % EX OINT [8118]
|
Facility
|
OP
|
$0.24
|
|
|
Service Code
|
NDC 51672128402
|
| Hospital Charge Code |
51672128402
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.19 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.13
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.12
|
| Rate for Payer: Aetna Government |
$0.12
|
| Rate for Payer: Brighton Health Commercial |
$0.18
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.19
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.16
|
| Rate for Payer: Group Health Inc Commercial |
$0.12
|
| Rate for Payer: Group Health Inc Medicare |
$0.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.16
|
|
|
TRIAMCINOLONE ACETONIDE 0.1 % EX OINT [8118]
|
Facility
|
OP
|
$0.37
|
|
|
Service Code
|
NDC 00168000615
|
| Hospital Charge Code |
00168000615
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.30 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.20
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.19
|
| Rate for Payer: Aetna Government |
$0.19
|
| Rate for Payer: Brighton Health Commercial |
$0.28
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.30
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.25
|
| Rate for Payer: Group Health Inc Commercial |
$0.19
|
| Rate for Payer: Group Health Inc Medicare |
$0.13
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.19
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.24
|
|
|
TRIAMCINOLONE ACETONIDE 0.1 % EX OINT [8118]
|
Facility
|
OP
|
$0.09
|
|
|
Service Code
|
NDC 45802005505
|
| Hospital Charge Code |
45802005505
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.07 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.05
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.05
|
| Rate for Payer: Aetna Government |
$0.05
|
| Rate for Payer: Brighton Health Commercial |
$0.07
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.07
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.06
|
| Rate for Payer: Group Health Inc Commercial |
$0.05
|
| Rate for Payer: Group Health Inc Medicare |
$0.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.06
|
|
|
TRIAMCINOLONE ACETONIDE 0.1 % EX OINT [8118]
|
Facility
|
OP
|
$0.16
|
|
|
Service Code
|
NDC 33342033380
|
| Hospital Charge Code |
33342033380
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.13 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.09
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.08
|
| Rate for Payer: Aetna Government |
$0.08
|
| Rate for Payer: Brighton Health Commercial |
$0.12
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.13
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.11
|
| Rate for Payer: Group Health Inc Commercial |
$0.08
|
| Rate for Payer: Group Health Inc Medicare |
$0.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.10
|
|
|
TRIAMCINOLONE ACETONIDE 0.1 % EX OINT [8118]
|
Facility
|
OP
|
$0.17
|
|
|
Service Code
|
NDC 00168000680
|
| Hospital Charge Code |
00168000680
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.14 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.09
|
| Rate for Payer: Aetna Government |
$0.09
|
| Rate for Payer: Brighton Health Commercial |
$0.13
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.14
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.12
|
| Rate for Payer: Group Health Inc Commercial |
$0.09
|
| Rate for Payer: Group Health Inc Medicare |
$0.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.11
|
|
|
TRIAMCINOLONE ACETONIDE 0.1 % MT PSTE [8121]
|
Facility
|
OP
|
$16.12
|
|
|
Service Code
|
NDC 51672126705
|
| Hospital Charge Code |
51672126705
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.64 |
| Max. Negotiated Rate |
$12.89 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$8.86
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8.06
|
| Rate for Payer: Aetna Government |
$8.06
|
| Rate for Payer: Brighton Health Commercial |
$12.09
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$12.89
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$10.96
|
| Rate for Payer: Group Health Inc Commercial |
$8.06
|
| Rate for Payer: Group Health Inc Medicare |
$5.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$10.48
|
|
|
TRIAMCINOLONE ACETONIDE 0.5 % EX CREA [8114]
|
Facility
|
OP
|
$0.76
|
|
|
Service Code
|
NDC 33342032815
|
| Hospital Charge Code |
33342032815
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$0.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.42
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.38
|
| Rate for Payer: Aetna Government |
$0.38
|
| Rate for Payer: Brighton Health Commercial |
$0.57
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.51
|
| Rate for Payer: Group Health Inc Commercial |
$0.38
|
| Rate for Payer: Group Health Inc Medicare |
$0.26
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.49
|
|
|
TRIAMCINOLONE ACETONIDE 0.5 % EX CREA [8114]
|
Facility
|
OP
|
$0.67
|
|
|
Service Code
|
NDC 45802006535
|
| Hospital Charge Code |
45802006535
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$0.54 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.37
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.34
|
| Rate for Payer: Aetna Government |
$0.34
|
| Rate for Payer: Brighton Health Commercial |
$0.51
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.54
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.46
|
| Rate for Payer: Group Health Inc Commercial |
$0.34
|
| Rate for Payer: Group Health Inc Medicare |
$0.24
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.34
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.34
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.44
|
|
|
TRIAMCINOLONE ACETONIDE 0.5 % EX CREA [8114]
|
Facility
|
OP
|
$0.76
|
|
|
Service Code
|
NDC 67877031815
|
| Hospital Charge Code |
67877031815
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$0.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.42
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.38
|
| Rate for Payer: Aetna Government |
$0.38
|
| Rate for Payer: Brighton Health Commercial |
$0.57
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.51
|
| Rate for Payer: Group Health Inc Commercial |
$0.38
|
| Rate for Payer: Group Health Inc Medicare |
$0.26
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.49
|
|
|
TRIAMCINOLONE ACETONIDE 0.5 % EX OINT [8119]
|
Facility
|
OP
|
$0.67
|
|
|
Service Code
|
NDC 45802004935
|
| Hospital Charge Code |
45802004935
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$0.54 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.37
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.34
|
| Rate for Payer: Aetna Government |
$0.34
|
| Rate for Payer: Brighton Health Commercial |
$0.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.54
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.46
|
| Rate for Payer: Group Health Inc Commercial |
$0.34
|
| Rate for Payer: Group Health Inc Medicare |
$0.24
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.34
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.34
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.44
|
|
|
TRIAMCINOLONE ACETONIDE 0.5 % EX OINT [8119]
|
Facility
|
OP
|
$0.67
|
|
|
Service Code
|
NDC 68462079817
|
| Hospital Charge Code |
68462079817
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$0.54 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.37
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.34
|
| Rate for Payer: Aetna Government |
$0.34
|
| Rate for Payer: Brighton Health Commercial |
$0.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.54
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.46
|
| Rate for Payer: Group Health Inc Commercial |
$0.34
|
| Rate for Payer: Group Health Inc Medicare |
$0.24
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.34
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.34
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.44
|
|
|
TRIAMCINOLONE ACETONIDE 10 MG/ML IJ SUSP [11584]
|
Facility
|
OP
|
$2.90
|
|
|
Service Code
|
HCPCS J3301
|
| Hospital Charge Code |
00003049420
|
|
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 |
$1.20
|
| Rate for Payer: Aetna Government |
$1.20
|
| 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: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1.08
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1.15
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1.15
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.89
|
|
|
TRIAMCINOLONE ACETONIDE 40 MG/ML IJ SUSP [8120]
|
Facility
|
OP
|
$11.40
|
|
|
Service Code
|
HCPCS J3301
|
| Hospital Charge Code |
00003029320
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.08 |
| Max. Negotiated Rate |
$9.12 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.27
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.20
|
| Rate for Payer: Aetna Government |
$1.20
|
| Rate for Payer: Brighton Health Commercial |
$8.55
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$9.12
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7.75
|
| Rate for Payer: Group Health Inc Commercial |
$5.70
|
| Rate for Payer: Group Health Inc Medicare |
$3.99
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.70
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.70
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1.08
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1.15
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1.15
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$7.41
|
|
|
TRIAMCINOLONE ACETONIDE 40 MG/ML IJ SUSP [8120]
|
Facility
|
OP
|
$10.20
|
|
|
Service Code
|
HCPCS J3301
|
| Hospital Charge Code |
70121104902
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.08 |
| Max. Negotiated Rate |
$8.16 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.61
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.20
|
| Rate for Payer: Aetna Government |
$1.20
|
| Rate for Payer: Brighton Health Commercial |
$7.65
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.16
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.94
|
| Rate for Payer: Group Health Inc Commercial |
$5.10
|
| Rate for Payer: Group Health Inc Medicare |
$3.57
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.10
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1.08
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1.15
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1.15
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6.63
|
|
|
TRIAMCINOLONE ACETONIDE 40 MG/ML IJ SUSP [8120]
|
Facility
|
OP
|
$11.23
|
|
|
Service Code
|
HCPCS J3301
|
| Hospital Charge Code |
00003029305
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.08 |
| Max. Negotiated Rate |
$8.98 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.18
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.20
|
| Rate for Payer: Aetna Government |
$1.20
|
| Rate for Payer: Brighton Health Commercial |
$8.42
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.98
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7.64
|
| Rate for Payer: Group Health Inc Commercial |
$5.62
|
| Rate for Payer: Group Health Inc Medicare |
$3.93
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.62
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1.08
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1.15
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1.15
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$7.30
|
|
|
TRIAMCINOLONE ACETONIDE 40 MG/ML IJ SUSP [8120]
|
Facility
|
OP
|
$10.20
|
|
|
Service Code
|
HCPCS J3301
|
| Hospital Charge Code |
70121104905
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.08 |
| Max. Negotiated Rate |
$8.16 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.61
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.20
|
| Rate for Payer: Aetna Government |
$1.20
|
| Rate for Payer: Brighton Health Commercial |
$7.65
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.16
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.94
|
| Rate for Payer: Group Health Inc Commercial |
$5.10
|
| Rate for Payer: Group Health Inc Medicare |
$3.57
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.10
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1.08
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1.15
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1.15
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6.63
|
|
|
TRIAMCINOLONE ACETONIDE 40 MG/ML IO SUSP [89128]
|
Facility
|
OP
|
$1,132.80
|
|
|
Service Code
|
HCPCS J3300
|
| Hospital Charge Code |
00065054301
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.88 |
| Max. Negotiated Rate |
$906.24 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$623.04
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.88
|
| Rate for Payer: Aetna Government |
$3.88
|
| Rate for Payer: Brighton Health Commercial |
$849.60
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$906.24
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$770.30
|
| Rate for Payer: Group Health Inc Commercial |
$566.40
|
| Rate for Payer: Group Health Inc Medicare |
$396.48
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$566.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$566.40
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$736.32
|
|
|
TRIAMCINOLONE REPOSITORY 10 MG/ML INJ
|
Facility
|
OP
|
$21.88
|
|
|
Service Code
|
HCPCS J3301
|
| Hospital Charge Code |
41650513
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.15 |
| Max. Negotiated Rate |
$14.22 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$12.03
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.20
|
| Rate for Payer: Aetna Government |
$1.20
|
| Rate for Payer: Brighton Health Commercial |
$13.13
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$10.94
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$12.58
|
| Rate for Payer: Group Health Inc Commercial |
$10.94
|
| Rate for Payer: Group Health Inc Medicare |
$7.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$10.94
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1.15
|
| Rate for Payer: SOMOS Essential |
$1.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$14.22
|
|
|
TRIAMCINOLONE REPOSITORY 10 MG/ML INJ
|
Facility
|
IP
|
$21.88
|
|
|
Service Code
|
HCPCS J3301
|
| Hospital Charge Code |
41650513
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.94 |
| Max. Negotiated Rate |
$10.94 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$10.94
|
|
