|
ACETAMINOPHEN 10MG/ML INJ
|
Facility
OP
|
$1.00
|
|
|
Service Code
|
HCPCS J0131
|
| Hospital Charge Code |
41655659
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.65 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.20
|
| Rate for Payer: Aetna Government |
$0.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.58
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$0.08
|
| Rate for Payer: Group Health Inc Commercial |
$0.50
|
| Rate for Payer: Group Health Inc Medicare |
$0.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.09
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$0.05
|
| Rate for Payer: SOMOS Essential |
$0.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.65
|
|
|
ACETAMINOPHEN 10MG/ML INJ
|
Facility
OP
|
$1.00
|
|
|
Service Code
|
HCPCS J0131
|
| Hospital Charge Code |
41645659
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.65 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.20
|
| Rate for Payer: Aetna Government |
$0.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.58
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$0.08
|
| Rate for Payer: Group Health Inc Commercial |
$0.50
|
| Rate for Payer: Group Health Inc Medicare |
$0.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.09
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$0.05
|
| Rate for Payer: SOMOS Essential |
$0.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.65
|
|
|
ACETAMINOPHEN 120 MG SUPP
|
Facility
OP
|
$1.00
|
|
| Hospital Charge Code |
41654376
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$0.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.50
|
| Rate for Payer: Aetna Government |
$0.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.68
|
| Rate for Payer: Group Health Inc Commercial |
$0.50
|
| Rate for Payer: Group Health Inc Medicare |
$0.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.65
|
|
|
ACETAMINOPHEN 120 MG SUPP
|
Facility
OP
|
$1.00
|
|
| Hospital Charge Code |
41644376
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$0.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.50
|
| Rate for Payer: Aetna Government |
$0.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.68
|
| Rate for Payer: Group Health Inc Commercial |
$0.50
|
| Rate for Payer: Group Health Inc Medicare |
$0.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.65
|
|
|
ACETAMINOPHEN 160MG/5ML UD LIQ
|
Facility
OP
|
$1.68
|
|
| Hospital Charge Code |
41658045
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$1.34 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.92
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.84
|
| Rate for Payer: Aetna Government |
$0.84
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.34
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.14
|
| Rate for Payer: Group Health Inc Commercial |
$0.84
|
| Rate for Payer: Group Health Inc Medicare |
$0.59
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.84
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.09
|
|
|
ACETAMINOPHEN 160MG/5ML UD LIQ
|
Facility
OP
|
$1.68
|
|
| Hospital Charge Code |
41648045
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$1.34 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.92
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.84
|
| Rate for Payer: Aetna Government |
$0.84
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.34
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.14
|
| Rate for Payer: Group Health Inc Commercial |
$0.84
|
| Rate for Payer: Group Health Inc Medicare |
$0.59
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.84
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.09
|
|
|
ACETAMINOPHEN 160MG/5ML UD OS
|
Facility
OP
|
$3.36
|
|
| Hospital Charge Code |
41646566
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.18 |
| Max. Negotiated Rate |
$2.69 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.85
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.68
|
| Rate for Payer: Aetna Government |
$1.68
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.69
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.28
|
| Rate for Payer: Group Health Inc Commercial |
$1.68
|
| Rate for Payer: Group Health Inc Medicare |
$1.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.68
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.18
|
|
|
ACETAMINOPHEN 160MG/5ML UD OS
|
Facility
OP
|
$3.36
|
|
| Hospital Charge Code |
41656566
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.18 |
| Max. Negotiated Rate |
$2.69 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.85
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.68
|
| Rate for Payer: Aetna Government |
$1.68
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.69
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.28
|
| Rate for Payer: Group Health Inc Commercial |
$1.68
|
| Rate for Payer: Group Health Inc Medicare |
$1.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.68
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.18
|
|
|
ACETAMINOPHEN 325MG/10.15ML UD L
|
Facility
OP
|
$1.00
|
|
| Hospital Charge Code |
41657034
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$0.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.50
|
| Rate for Payer: Aetna Government |
$0.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.68
|
| Rate for Payer: Group Health Inc Commercial |
$0.50
|
| Rate for Payer: Group Health Inc Medicare |
$0.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.65
|
|
|
ACETAMINOPHEN 325MG/10.15ML UD L
|
Facility
OP
|
$1.00
|
|
| Hospital Charge Code |
41647034
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$0.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.50
|
| Rate for Payer: Aetna Government |
$0.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.68
|
| Rate for Payer: Group Health Inc Commercial |
$0.50
|
| Rate for Payer: Group Health Inc Medicare |
$0.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.65
|
|
|
ACETAMINOPHEN 325 MG SUPP
|
Facility
OP
|
$0.65
|
|
| Hospital Charge Code |
41654448
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.23 |
| Max. Negotiated Rate |
$0.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.36
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.33
|
| Rate for Payer: Aetna Government |
$0.33
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.44
|
| Rate for Payer: Group Health Inc Commercial |
$0.33
|
| Rate for Payer: Group Health Inc Medicare |
$0.23
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.33
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.33
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.42
|
|
|
ACETAMINOPHEN 325 MG SUPP
|
Facility
OP
|
$0.65
|
|
| Hospital Charge Code |
41644448
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.23 |
| Max. Negotiated Rate |
$0.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.36
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.33
|
| Rate for Payer: Aetna Government |
$0.33
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.44
|
| Rate for Payer: Group Health Inc Commercial |
$0.33
|
| Rate for Payer: Group Health Inc Medicare |
$0.23
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.33
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.33
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.42
|
|
|
ACETAMINOPHEN 325 MG TAB
|
Facility
OP
|
$1.00
|
|
| Hospital Charge Code |
41644490
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$0.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.50
|
| Rate for Payer: Aetna Government |
$0.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.68
|
| Rate for Payer: Group Health Inc Commercial |
$0.50
|
| Rate for Payer: Group Health Inc Medicare |
$0.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.65
|
|
|
ACETAMINOPHEN 325 MG TAB
|
Facility
OP
|
$1.00
|
|
| Hospital Charge Code |
41654490
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$0.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.50
|
| Rate for Payer: Aetna Government |
$0.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.68
|
| Rate for Payer: Group Health Inc Commercial |
$0.50
|
| Rate for Payer: Group Health Inc Medicare |
$0.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.65
|
|
|
ACETAMINOPHEN 650MG / 20.3ML LIQUID
|
Facility
OP
|
$0.92
|
|
| Hospital Charge Code |
41653185
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$0.74 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.51
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.46
|
| Rate for Payer: Aetna Government |
$0.46
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.74
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.63
|
| Rate for Payer: Group Health Inc Commercial |
$0.46
|
| Rate for Payer: Group Health Inc Medicare |
$0.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.46
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.60
|
|
|
ACETAMINOPHEN 650MG / 20.3ML LIQUID
|
Facility
OP
|
$0.92
|
|
| Hospital Charge Code |
41643185
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$0.74 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.51
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.46
|
| Rate for Payer: Aetna Government |
$0.46
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.74
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.63
|
| Rate for Payer: Group Health Inc Commercial |
$0.46
|
| Rate for Payer: Group Health Inc Medicare |
$0.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.46
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.60
|
|
|
ACETAMINOPHEN 650 MG SUPP
|
Facility
OP
|
$2.00
|
|
| Hospital Charge Code |
41653386
|
|
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: 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
|
|
|
ACETAMINOPHEN 650 MG SUPP
|
Facility
OP
|
$2.00
|
|
| Hospital Charge Code |
41643386
|
|
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: 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
|
|
|
ACETAMINOPHEN 80 MG/0.8 ML PEDIATRIC DRO
|
Facility
OP
|
$2.00
|
|
| Hospital Charge Code |
41653603
|
|
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: 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
|
|
|
ACETAMINOPHEN 80 MG/0.8 ML PEDIATRIC DRO
|
Facility
OP
|
$2.00
|
|
| Hospital Charge Code |
41643603
|
|
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: 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
|
|
|
ACETAMINOPHEN 80 MG SUPP
|
Facility
OP
|
$1.39
|
|
| Hospital Charge Code |
41643385
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.49 |
| Max. Negotiated Rate |
$1.11 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.76
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.70
|
| Rate for Payer: Aetna Government |
$0.70
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.11
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.95
|
| Rate for Payer: Group Health Inc Commercial |
$0.70
|
| Rate for Payer: Group Health Inc Medicare |
$0.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.70
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.70
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.90
|
|
|
ACETAMINOPHEN 80 MG SUPP
|
Facility
OP
|
$1.39
|
|
| Hospital Charge Code |
41653385
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.49 |
| Max. Negotiated Rate |
$1.11 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.76
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.70
|
| Rate for Payer: Aetna Government |
$0.70
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.11
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.95
|
| Rate for Payer: Group Health Inc Commercial |
$0.70
|
| Rate for Payer: Group Health Inc Medicare |
$0.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.70
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.70
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.90
|
|
|
ACETAMINOPHEN + BUTALBITAL + CAFFEINE 32
|
Facility
OP
|
$0.24
|
|
| Hospital Charge Code |
41653736
|
|
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: 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
|
|
|
ACETAMINOPHEN + BUTALBITAL + CAFFEINE 32
|
Facility
OP
|
$0.24
|
|
| Hospital Charge Code |
41643736
|
|
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: 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
|
|
|
ACETAMINOPHEN + CODEINE 120 MG-12 MG/5 M
|
Facility
OP
|
$0.88
|
|
| Hospital Charge Code |
41644033
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.31 |
| Max. Negotiated Rate |
$0.70 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.48
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.44
|
| Rate for Payer: Aetna Government |
$0.44
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.70
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.60
|
| Rate for Payer: Group Health Inc Commercial |
$0.44
|
| Rate for Payer: Group Health Inc Medicare |
$0.31
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.44
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.57
|
|
