|
BUPIVACAINE HCL 0.25 % IJ SOLN [1222]
|
Facility
|
OP
|
$0.09
|
|
|
Service Code
|
HCPCS J0665
|
| Hospital Charge Code |
00409116001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.07 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.05
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.01
|
| Rate for Payer: Aetna Government |
$0.01
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$0.01
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$0.01
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$0.01
|
| Rate for Payer: Brighton Health Commercial |
$0.06
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$0.01
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.07
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.06
|
| Rate for Payer: Elderplan Medicare Advantage |
$0.01
|
| Rate for Payer: EmblemHealth Commercial |
$0.01
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$0.01
|
| Rate for Payer: Fidelis Essential Plan QHP |
$0.01
|
| Rate for Payer: Fidelis Medicare Advantage |
$0.01
|
| Rate for Payer: Fidelis Qualified Health Plan |
$0.01
|
| Rate for Payer: Group Health Inc Commercial |
$0.01
|
| Rate for Payer: Group Health Inc Medicare |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
| Rate for Payer: Healthfirst Medicare Advantage |
$0.01
|
| Rate for Payer: Healthfirst QHP |
$0.01
|
| Rate for Payer: Humana Medicare |
$0.01
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$0.02
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$0.02
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$0.02
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$0.02
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$0.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.06
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$0.01
|
| Rate for Payer: Wellcare Medicare |
$0.01
|
|
|
BUPIVACAINE HCL (PF) 0.25 % IJ SOLN [105639]
|
Facility
|
OP
|
$0.08
|
|
|
Service Code
|
HCPCS J0665
|
| Hospital Charge Code |
00409115919
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.06 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.04
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.01
|
| Rate for Payer: Aetna Government |
$0.01
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$0.01
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$0.01
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$0.01
|
| Rate for Payer: Brighton Health Commercial |
$0.06
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$0.01
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.06
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.06
|
| Rate for Payer: Elderplan Medicare Advantage |
$0.01
|
| Rate for Payer: EmblemHealth Commercial |
$0.01
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$0.01
|
| Rate for Payer: Fidelis Essential Plan QHP |
$0.01
|
| Rate for Payer: Fidelis Medicare Advantage |
$0.01
|
| Rate for Payer: Fidelis Qualified Health Plan |
$0.01
|
| Rate for Payer: Group Health Inc Commercial |
$0.01
|
| Rate for Payer: Group Health Inc Medicare |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
| Rate for Payer: Healthfirst Medicare Advantage |
$0.01
|
| Rate for Payer: Healthfirst QHP |
$0.01
|
| Rate for Payer: Humana Medicare |
$0.01
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$0.02
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$0.02
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$0.02
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$0.02
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$0.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.05
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$0.01
|
| Rate for Payer: Wellcare Medicare |
$0.01
|
|
|
BUPIVACAINE HCL (PF) 0.25 % IJ SOLN [105639]
|
Facility
|
OP
|
$0.19
|
|
|
Service Code
|
HCPCS J0665
|
| Hospital Charge Code |
63323046408
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.15 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.01
|
| Rate for Payer: Aetna Government |
$0.01
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$0.01
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$0.01
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$0.01
|
| Rate for Payer: Brighton Health Commercial |
$0.14
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$0.01
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.15
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.13
|
| Rate for Payer: Elderplan Medicare Advantage |
$0.01
|
| Rate for Payer: EmblemHealth Commercial |
$0.01
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$0.01
|
| Rate for Payer: Fidelis Essential Plan QHP |
$0.01
|
| Rate for Payer: Fidelis Medicare Advantage |
$0.01
|
| Rate for Payer: Fidelis Qualified Health Plan |
$0.01
|
| Rate for Payer: Group Health Inc Commercial |
$0.01
|
| Rate for Payer: Group Health Inc Medicare |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
| Rate for Payer: Healthfirst Medicare Advantage |
$0.01
|
| Rate for Payer: Healthfirst QHP |
$0.01
|
| Rate for Payer: Humana Medicare |
$0.01
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$0.02
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$0.02
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$0.02
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$0.02
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$0.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.12
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$0.01
|
| Rate for Payer: Wellcare Medicare |
$0.01
|
|
|
BUPIVACAINE HCL (PF) 0.25 % IJ SOLN [105639]
|
Facility
|
OP
|
$0.79
|
|
|
Service Code
|
HCPCS J0665
|
| Hospital Charge Code |
63323046417
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.63 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.43
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.01
|
| Rate for Payer: Aetna Government |
$0.01
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$0.01
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$0.01
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$0.01
|
| Rate for Payer: Brighton Health Commercial |
$0.59
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$0.01
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.63
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.54
|
| Rate for Payer: Elderplan Medicare Advantage |
$0.01
|
| Rate for Payer: EmblemHealth Commercial |
$0.01
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$0.01
|
| Rate for Payer: Fidelis Essential Plan QHP |
$0.01
|
| Rate for Payer: Fidelis Medicare Advantage |
$0.01
|
| Rate for Payer: Fidelis Qualified Health Plan |
$0.01
|
| Rate for Payer: Group Health Inc Commercial |
$0.01
|
| Rate for Payer: Group Health Inc Medicare |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
| Rate for Payer: Healthfirst Medicare Advantage |
$0.01
|
| Rate for Payer: Healthfirst QHP |
$0.01
|
| Rate for Payer: Humana Medicare |
$0.01
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$0.02
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$0.02
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$0.02
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$0.02
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$0.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.51
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$0.01
|
| Rate for Payer: Wellcare Medicare |
$0.01
|
|
|
BUPIVACAINE HCL (PF) 0.25 % IJ SOLN [105639]
|
Facility
|
OP
|
$0.25
|
|
|
Service Code
|
HCPCS J0665
|
| Hospital Charge Code |
00143933010
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.14
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.01
|
| Rate for Payer: Aetna Government |
$0.01
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$0.01
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$0.01
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$0.01
|
| Rate for Payer: Brighton Health Commercial |
$0.19
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$0.01
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.17
|
| Rate for Payer: Elderplan Medicare Advantage |
$0.01
|
| Rate for Payer: EmblemHealth Commercial |
$0.01
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$0.01
|
| Rate for Payer: Fidelis Essential Plan QHP |
$0.01
|
| Rate for Payer: Fidelis Medicare Advantage |
$0.01
|
| Rate for Payer: Fidelis Qualified Health Plan |
$0.01
|
| Rate for Payer: Group Health Inc Commercial |
$0.01
|
| Rate for Payer: Group Health Inc Medicare |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.13
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
| Rate for Payer: Healthfirst Medicare Advantage |
$0.01
|
| Rate for Payer: Healthfirst QHP |
$0.01
|
| Rate for Payer: Humana Medicare |
$0.01
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$0.02
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$0.02
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$0.02
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$0.02
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$0.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.16
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$0.01
|
| Rate for Payer: Wellcare Medicare |
$0.01
|
|
|
BUPIVACAINE HCL (PF) 0.25 % IJ SOLN [105639]
|
Facility
|
OP
|
$0.31
|
|
|
Service Code
|
HCPCS J0665
|
| Hospital Charge Code |
55150016710
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.17
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.01
|
| Rate for Payer: Aetna Government |
$0.01
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$0.01
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$0.01
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$0.01
|
| Rate for Payer: Brighton Health Commercial |
$0.23
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$0.01
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.25
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.21
|
| Rate for Payer: Elderplan Medicare Advantage |
$0.01
|
| Rate for Payer: EmblemHealth Commercial |
$0.01
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$0.01
|
| Rate for Payer: Fidelis Essential Plan QHP |
$0.01
|
| Rate for Payer: Fidelis Medicare Advantage |
$0.01
|
| Rate for Payer: Fidelis Qualified Health Plan |
$0.01
|
| Rate for Payer: Group Health Inc Commercial |
$0.01
|
| Rate for Payer: Group Health Inc Medicare |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
| Rate for Payer: Healthfirst Medicare Advantage |
$0.01
|
| Rate for Payer: Healthfirst QHP |
$0.01
|
| Rate for Payer: Humana Medicare |
$0.01
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$0.02
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$0.02
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$0.02
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$0.02
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$0.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.20
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$0.01
|
| Rate for Payer: Wellcare Medicare |
$0.01
|
|
|
BUPIVACAINE HCL (PF) 0.25 % IJ SOLN [105639]
|
Facility
|
OP
|
$0.08
|
|
|
Service Code
|
HCPCS J0665
|
| Hospital Charge Code |
00409115902
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.06 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.04
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.01
|
| Rate for Payer: Aetna Government |
$0.01
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$0.01
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$0.01
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$0.01
|
| Rate for Payer: Brighton Health Commercial |
$0.06
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$0.01
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.06
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.06
|
| Rate for Payer: Elderplan Medicare Advantage |
$0.01
|
| Rate for Payer: EmblemHealth Commercial |
$0.01
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$0.01
|
| Rate for Payer: Fidelis Essential Plan QHP |
$0.01
|
| Rate for Payer: Fidelis Medicare Advantage |
$0.01
|
| Rate for Payer: Fidelis Qualified Health Plan |
$0.01
|
| Rate for Payer: Group Health Inc Commercial |
$0.01
|
| Rate for Payer: Group Health Inc Medicare |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
| Rate for Payer: Healthfirst Medicare Advantage |
$0.01
|
| Rate for Payer: Healthfirst QHP |
$0.01
|
| Rate for Payer: Humana Medicare |
$0.01
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$0.02
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$0.02
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$0.02
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$0.02
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$0.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.05
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$0.01
|
| Rate for Payer: Wellcare Medicare |
$0.01
|
|
|
BUPIVACAINE HCL (PF) 0.25 % IJ SOLN [105639]
|
Facility
|
OP
|
$0.24
|
|
|
Service Code
|
HCPCS J0665
|
| Hospital Charge Code |
00409115901
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.19 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.13
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.01
|
| Rate for Payer: Aetna Government |
$0.01
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$0.01
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$0.01
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$0.01
|
| Rate for Payer: Brighton Health Commercial |
$0.18
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$0.01
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.19
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.16
|
| Rate for Payer: Elderplan Medicare Advantage |
$0.01
|
| Rate for Payer: EmblemHealth Commercial |
$0.01
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$0.01
|
| Rate for Payer: Fidelis Essential Plan QHP |
$0.01
|
| Rate for Payer: Fidelis Medicare Advantage |
$0.01
|
| Rate for Payer: Fidelis Qualified Health Plan |
$0.01
|
| Rate for Payer: Group Health Inc Commercial |
$0.01
|
| Rate for Payer: Group Health Inc Medicare |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
| Rate for Payer: Healthfirst Medicare Advantage |
$0.01
|
| Rate for Payer: Healthfirst QHP |
$0.01
|
| Rate for Payer: Humana Medicare |
$0.01
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$0.02
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$0.02
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$0.02
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$0.02
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$0.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.15
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$0.01
|
| Rate for Payer: Wellcare Medicare |
$0.01
|
|
|
BUPIVACAINE HCL (PF) 0.25 % IJ SOLN [105639]
|
Facility
|
OP
|
$0.09
|
|
|
Service Code
|
HCPCS J0665
|
| Hospital Charge Code |
63323046409
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.07 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.05
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.01
|
| Rate for Payer: Aetna Government |
$0.01
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$0.01
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$0.01
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$0.01
|
| Rate for Payer: Brighton Health Commercial |
$0.07
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$0.01
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.07
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.06
|
| Rate for Payer: Elderplan Medicare Advantage |
$0.01
|
| Rate for Payer: EmblemHealth Commercial |
$0.01
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$0.01
|
| Rate for Payer: Fidelis Essential Plan QHP |
$0.01
|
| Rate for Payer: Fidelis Medicare Advantage |
$0.01
|
| Rate for Payer: Fidelis Qualified Health Plan |
$0.01
|
| Rate for Payer: Group Health Inc Commercial |
$0.01
|
| Rate for Payer: Group Health Inc Medicare |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
| Rate for Payer: Healthfirst Medicare Advantage |
$0.01
|
| Rate for Payer: Healthfirst QHP |
$0.01
|
| Rate for Payer: Humana Medicare |
$0.01
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$0.02
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$0.02
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$0.02
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$0.02
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$0.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.06
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$0.01
|
| Rate for Payer: Wellcare Medicare |
$0.01
|
|
|
BUPIVACAINE HCL (PF) 0.25 % IJ SOLN [105639]
|
Facility
|
OP
|
$0.30
|
|
|
Service Code
|
HCPCS J0665
|
| Hospital Charge Code |
63323046437
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.24 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.17
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.01
|
| Rate for Payer: Aetna Government |
$0.01
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$0.01
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$0.01
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$0.01
|
| Rate for Payer: Brighton Health Commercial |
$0.23
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$0.01
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.24
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.20
|
| Rate for Payer: Elderplan Medicare Advantage |
$0.01
|
| Rate for Payer: EmblemHealth Commercial |
$0.01
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$0.01
|
| Rate for Payer: Fidelis Essential Plan QHP |
$0.01
|
| Rate for Payer: Fidelis Medicare Advantage |
$0.01
|
| Rate for Payer: Fidelis Qualified Health Plan |
$0.01
|
| Rate for Payer: Group Health Inc Commercial |
$0.01
|
| Rate for Payer: Group Health Inc Medicare |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.15
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
| Rate for Payer: Healthfirst Medicare Advantage |
$0.01
|
| Rate for Payer: Healthfirst QHP |
$0.01
|
| Rate for Payer: Humana Medicare |
$0.01
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$0.02
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$0.02
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$0.02
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$0.02
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$0.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.20
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$0.01
|
| Rate for Payer: Wellcare Medicare |
$0.01
|
|
|
BUPIVACAINE HCL (PF) 0.25 % IJ SOLN [105639]
|
Facility
|
OP
|
$0.79
|
|
|
Service Code
|
HCPCS J0665
|
| Hospital Charge Code |
63323046401
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.63 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.43
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.01
|
| Rate for Payer: Aetna Government |
$0.01
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$0.01
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$0.01
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$0.01
|
| Rate for Payer: Brighton Health Commercial |
$0.59
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$0.01
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.63
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.54
|
| Rate for Payer: Elderplan Medicare Advantage |
$0.01
|
| Rate for Payer: EmblemHealth Commercial |
$0.01
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$0.01
|
| Rate for Payer: Fidelis Essential Plan QHP |
$0.01
|
| Rate for Payer: Fidelis Medicare Advantage |
$0.01
|
| Rate for Payer: Fidelis Qualified Health Plan |
$0.01
|
| Rate for Payer: Group Health Inc Commercial |
$0.01
|
| Rate for Payer: Group Health Inc Medicare |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
| Rate for Payer: Healthfirst Medicare Advantage |
$0.01
|
| Rate for Payer: Healthfirst QHP |
$0.01
|
| Rate for Payer: Humana Medicare |
$0.01
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$0.02
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$0.02
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$0.02
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$0.02
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$0.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.51
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$0.01
|
| Rate for Payer: Wellcare Medicare |
$0.01
|
|
|
BUPIVACAINE HCL (PF) 0.5 % IJ SOLN [105640]
|
Facility
|
OP
|
$0.28
|
|
|
Service Code
|
NDC 00409116201
|
| Hospital Charge Code |
00409116201
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.22 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.15
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.14
|
| Rate for Payer: Aetna Government |
$0.14
|
| Rate for Payer: Brighton Health Commercial |
$0.21
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.22
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.19
|
| Rate for Payer: Group Health Inc Commercial |
$0.14
|
| Rate for Payer: Group Health Inc Medicare |
$0.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.18
|
|
|
BUPIVACAINE HCL (PF) 0.5 % IJ SOLN [105640]
|
Facility
|
OP
|
$0.09
|
|
|
Service Code
|
HCPCS J0665
|
| Hospital Charge Code |
00409116202
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.07 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.05
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.01
|
| Rate for Payer: Aetna Government |
$0.01
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$0.01
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$0.01
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$0.01
|
| Rate for Payer: Brighton Health Commercial |
$0.07
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$0.01
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.07
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.06
|
| Rate for Payer: Elderplan Medicare Advantage |
$0.01
|
| Rate for Payer: EmblemHealth Commercial |
$0.01
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$0.01
|
| Rate for Payer: Fidelis Essential Plan QHP |
$0.01
|
| Rate for Payer: Fidelis Medicare Advantage |
$0.01
|
| Rate for Payer: Fidelis Qualified Health Plan |
$0.01
|
| Rate for Payer: Group Health Inc Commercial |
$0.01
|
| Rate for Payer: Group Health Inc Medicare |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
| Rate for Payer: Healthfirst Medicare Advantage |
$0.01
|
| Rate for Payer: Healthfirst QHP |
$0.01
|
| Rate for Payer: Humana Medicare |
$0.01
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$0.02
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$0.02
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$0.02
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$0.02
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$0.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.06
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$0.01
|
| Rate for Payer: Wellcare Medicare |
$0.01
|
|
|
BUPIVACAINE HCL (PF) 0.5 % IJ SOLN [105640]
|
Facility
|
OP
|
$0.63
|
|
|
Service Code
|
NDC 63323046617
|
| Hospital Charge Code |
63323046617
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$0.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.35
|
| 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
|
|
|
BUPIVACAINE HCL (PF) 0.5 % IJ SOLN [105640]
|
Facility
|
OP
|
$0.20
|
|
|
Service Code
|
HCPCS J0665
|
| Hospital Charge Code |
00409156029
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.16 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.11
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.01
|
| Rate for Payer: Aetna Government |
$0.01
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$0.01
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$0.01
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$0.01
|
| Rate for Payer: Brighton Health Commercial |
$0.15
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$0.01
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.16
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.13
|
| Rate for Payer: Elderplan Medicare Advantage |
$0.01
|
| Rate for Payer: EmblemHealth Commercial |
$0.01
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$0.01
|
| Rate for Payer: Fidelis Essential Plan QHP |
$0.01
|
| Rate for Payer: Fidelis Medicare Advantage |
$0.01
|
| Rate for Payer: Fidelis Qualified Health Plan |
$0.01
|
| Rate for Payer: Group Health Inc Commercial |
$0.01
|
| Rate for Payer: Group Health Inc Medicare |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
| Rate for Payer: Healthfirst Medicare Advantage |
$0.01
|
| Rate for Payer: Healthfirst QHP |
$0.01
|
| Rate for Payer: Humana Medicare |
$0.01
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$0.02
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$0.02
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$0.02
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$0.02
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$0.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.13
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$0.01
|
| Rate for Payer: Wellcare Medicare |
$0.01
|
|
|
BUPIVACAINE HCL (PF) 0.5 % IJ SOLN [105640]
|
Facility
|
OP
|
$0.29
|
|
|
Service Code
|
HCPCS J0665
|
| Hospital Charge Code |
63323046601
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.23 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.16
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.01
|
| Rate for Payer: Aetna Government |
$0.01
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$0.01
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$0.01
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$0.01
|
| Rate for Payer: Brighton Health Commercial |
$0.22
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$0.01
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.23
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.20
|
| Rate for Payer: Elderplan Medicare Advantage |
$0.01
|
| Rate for Payer: EmblemHealth Commercial |
$0.01
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$0.01
|
| Rate for Payer: Fidelis Essential Plan QHP |
$0.01
|
| Rate for Payer: Fidelis Medicare Advantage |
$0.01
|
| Rate for Payer: Fidelis Qualified Health Plan |
$0.01
|
| Rate for Payer: Group Health Inc Commercial |
$0.01
|
| Rate for Payer: Group Health Inc Medicare |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.15
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
| Rate for Payer: Healthfirst Medicare Advantage |
$0.01
|
| Rate for Payer: Healthfirst QHP |
$0.01
|
| Rate for Payer: Humana Medicare |
$0.01
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$0.02
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$0.02
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$0.02
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$0.02
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$0.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.19
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$0.01
|
| Rate for Payer: Wellcare Medicare |
$0.01
|
|
|
BUPIVACAINE HCL (PF) 0.5 % IJ SOLN [105640]
|
Facility
|
OP
|
$0.29
|
|
|
Service Code
|
HCPCS J0665
|
| Hospital Charge Code |
63323046637
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.23 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.16
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.01
|
| Rate for Payer: Aetna Government |
$0.01
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$0.01
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$0.01
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$0.01
|
| Rate for Payer: Brighton Health Commercial |
$0.22
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$0.01
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.23
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.20
|
| Rate for Payer: Elderplan Medicare Advantage |
$0.01
|
| Rate for Payer: EmblemHealth Commercial |
$0.01
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$0.01
|
| Rate for Payer: Fidelis Essential Plan QHP |
$0.01
|
| Rate for Payer: Fidelis Medicare Advantage |
$0.01
|
| Rate for Payer: Fidelis Qualified Health Plan |
$0.01
|
| Rate for Payer: Group Health Inc Commercial |
$0.01
|
| Rate for Payer: Group Health Inc Medicare |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.15
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
| Rate for Payer: Healthfirst Medicare Advantage |
$0.01
|
| Rate for Payer: Healthfirst QHP |
$0.01
|
| Rate for Payer: Humana Medicare |
$0.01
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$0.02
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$0.02
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$0.02
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$0.02
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$0.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.19
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$0.01
|
| Rate for Payer: Wellcare Medicare |
$0.01
|
|
|
BUPIVACAINE HCL (PF) 0.5 % IJ SOLN [105640]
|
Facility
|
OP
|
$0.36
|
|
|
Service Code
|
NDC 55150016910
|
| Hospital Charge Code |
55150016910
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.29 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.20
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.18
|
| Rate for Payer: Aetna Government |
$0.18
|
| Rate for Payer: Brighton Health Commercial |
$0.27
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.29
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.24
|
| Rate for Payer: Group Health Inc Commercial |
$0.18
|
| Rate for Payer: Group Health Inc Medicare |
$0.13
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.18
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.23
|
|
|
BUPIVACAINE HCL (PF) 0.5 % IJ SOLN [105640]
|
Facility
|
OP
|
$0.09
|
|
|
Service Code
|
HCPCS J0665
|
| Hospital Charge Code |
00409116219
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.07 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.05
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.01
|
| Rate for Payer: Aetna Government |
$0.01
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$0.01
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$0.01
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$0.01
|
| Rate for Payer: Brighton Health Commercial |
$0.07
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$0.01
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.07
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.06
|
| Rate for Payer: Elderplan Medicare Advantage |
$0.01
|
| Rate for Payer: EmblemHealth Commercial |
$0.01
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$0.01
|
| Rate for Payer: Fidelis Essential Plan QHP |
$0.01
|
| Rate for Payer: Fidelis Medicare Advantage |
$0.01
|
| Rate for Payer: Fidelis Qualified Health Plan |
$0.01
|
| Rate for Payer: Group Health Inc Commercial |
$0.01
|
| Rate for Payer: Group Health Inc Medicare |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
| Rate for Payer: Healthfirst Medicare Advantage |
$0.01
|
| Rate for Payer: Healthfirst QHP |
$0.01
|
| Rate for Payer: Humana Medicare |
$0.01
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$0.02
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$0.02
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$0.02
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$0.02
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$0.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.06
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$0.01
|
| Rate for Payer: Wellcare Medicare |
$0.01
|
|
|
BUPIVACAINE HCL (PF) 0.75 % IJ SOLN [122185]
|
Facility
|
OP
|
$0.30
|
|
|
Service Code
|
NDC 63323047237
|
| Hospital Charge Code |
63323047237
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.24 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.17
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.15
|
| Rate for Payer: Aetna Government |
$0.15
|
| Rate for Payer: Brighton Health Commercial |
$0.23
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.24
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.20
|
| Rate for Payer: Group Health Inc Commercial |
$0.15
|
| Rate for Payer: Group Health Inc Medicare |
$0.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.15
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.20
|
|
|
BUPIVACAINE HCL (PF) 0.75 % IJ SOLN [122185]
|
Facility
|
OP
|
$0.16
|
|
|
Service Code
|
NDC 00409116519
|
| Hospital Charge Code |
00409116519
|
|
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
|
|
|
BUPIVACAINE IN DEXTROSE 0.75-8.25 % IT SOLN [9316]
|
Facility
|
OP
|
$3.29
|
|
|
Service Code
|
HCPCS J0665
|
| Hospital Charge Code |
00409176110
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$2.63 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.81
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.01
|
| Rate for Payer: Aetna Government |
$0.01
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$0.01
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$0.01
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$0.01
|
| Rate for Payer: Brighton Health Commercial |
$2.47
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$0.01
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.63
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.24
|
| Rate for Payer: Elderplan Medicare Advantage |
$0.01
|
| Rate for Payer: EmblemHealth Commercial |
$0.01
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$0.01
|
| Rate for Payer: Fidelis Essential Plan QHP |
$0.01
|
| Rate for Payer: Fidelis Medicare Advantage |
$0.01
|
| Rate for Payer: Fidelis Qualified Health Plan |
$0.01
|
| Rate for Payer: Group Health Inc Commercial |
$0.01
|
| Rate for Payer: Group Health Inc Medicare |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.65
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
| Rate for Payer: Healthfirst Medicare Advantage |
$0.01
|
| Rate for Payer: Healthfirst QHP |
$0.01
|
| Rate for Payer: Humana Medicare |
$0.01
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$0.02
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$0.02
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$0.02
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$0.02
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$0.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.14
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$0.01
|
| Rate for Payer: Wellcare Medicare |
$0.01
|
|
|
BUPIVACAINE IN DEXTROSE 0.75-8.25 % IT SOLN [9316]
|
Facility
|
OP
|
$1.71
|
|
|
Service Code
|
HCPCS J0665
|
| Hospital Charge Code |
00409361301
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$1.37 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.94
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.01
|
| Rate for Payer: Aetna Government |
$0.01
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$0.01
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$0.01
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$0.01
|
| Rate for Payer: Brighton Health Commercial |
$1.28
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$0.01
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.37
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.16
|
| Rate for Payer: Elderplan Medicare Advantage |
$0.01
|
| Rate for Payer: EmblemHealth Commercial |
$0.01
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$0.01
|
| Rate for Payer: Fidelis Essential Plan QHP |
$0.01
|
| Rate for Payer: Fidelis Medicare Advantage |
$0.01
|
| Rate for Payer: Fidelis Qualified Health Plan |
$0.01
|
| Rate for Payer: Group Health Inc Commercial |
$0.01
|
| Rate for Payer: Group Health Inc Medicare |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
| Rate for Payer: Healthfirst Medicare Advantage |
$0.01
|
| Rate for Payer: Healthfirst QHP |
$0.01
|
| Rate for Payer: Humana Medicare |
$0.01
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$0.02
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$0.02
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$0.02
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$0.02
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$0.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.11
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$0.01
|
| Rate for Payer: Wellcare Medicare |
$0.01
|
|
|
BUPIVACAINE IN DEXTROSE 0.75-8.25 % IT SOLN [9316]
|
Facility
|
OP
|
$1.71
|
|
|
Service Code
|
HCPCS J0665
|
| Hospital Charge Code |
00409361311
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$1.37 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.94
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.01
|
| Rate for Payer: Aetna Government |
$0.01
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$0.01
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$0.01
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$0.01
|
| Rate for Payer: Brighton Health Commercial |
$1.28
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$0.01
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.37
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.16
|
| Rate for Payer: Elderplan Medicare Advantage |
$0.01
|
| Rate for Payer: EmblemHealth Commercial |
$0.01
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$0.01
|
| Rate for Payer: Fidelis Essential Plan QHP |
$0.01
|
| Rate for Payer: Fidelis Medicare Advantage |
$0.01
|
| Rate for Payer: Fidelis Qualified Health Plan |
$0.01
|
| Rate for Payer: Group Health Inc Commercial |
$0.01
|
| Rate for Payer: Group Health Inc Medicare |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
| Rate for Payer: Healthfirst Medicare Advantage |
$0.01
|
| Rate for Payer: Healthfirst QHP |
$0.01
|
| Rate for Payer: Humana Medicare |
$0.01
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$0.02
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$0.02
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$0.02
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$0.02
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$0.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.11
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$0.01
|
| Rate for Payer: Wellcare Medicare |
$0.01
|
|
|
BUPIVACAINE PF 0.5% 10ML INJ
|
Facility
|
OP
|
$0.33
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
41647821
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.21 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.18
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.17
|
| Rate for Payer: Aetna Government |
$0.17
|
| Rate for Payer: Brighton Health Commercial |
$0.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.17
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.19
|
| Rate for Payer: Group Health Inc Commercial |
$0.17
|
| Rate for Payer: Group Health Inc Medicare |
$0.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.17
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.17
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.21
|
|
