|
ACETYLCHOLINE 1% OPHTHALMIC INTRAOCULAR
|
Facility
OP
|
$68.74
|
|
| Hospital Charge Code |
41644578
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$24.06 |
| Max. Negotiated Rate |
$54.99 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$37.81
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$34.37
|
| Rate for Payer: Aetna Government |
$34.37
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$54.99
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$46.74
|
| Rate for Payer: Group Health Inc Commercial |
$34.37
|
| Rate for Payer: Group Health Inc Medicare |
$24.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$34.37
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$34.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$44.68
|
|
|
ACETYLCYSTEINE 10% SOLN 10 ML
|
Facility
IP
|
$0.97
|
|
|
Service Code
|
HCPCS J7608
|
| Hospital Charge Code |
41652247
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.49 |
| Max. Negotiated Rate |
$0.49 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.49
|
|
|
ACETYLCYSTEINE 10% SOLN 10 ML
|
Facility
OP
|
$0.97
|
|
|
Service Code
|
HCPCS J7608
|
| Hospital Charge Code |
41652247
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.34 |
| Max. Negotiated Rate |
$9.92 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.53
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.08
|
| Rate for Payer: Aetna Government |
$6.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.49
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.56
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$6.16
|
| Rate for Payer: Group Health Inc Commercial |
$0.49
|
| Rate for Payer: Group Health Inc Medicare |
$0.34
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.49
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$6.84
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$9.92
|
| Rate for Payer: SOMOS Essential |
$9.92
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.63
|
|
|
ACETYLCYSTEINE 10% SOLN 10 ML
|
Facility
IP
|
$0.97
|
|
|
Service Code
|
HCPCS J7608
|
| Hospital Charge Code |
41642247
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.49 |
| Max. Negotiated Rate |
$0.49 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.49
|
|
|
ACETYLCYSTEINE 10% SOLN 10 ML
|
Facility
OP
|
$0.97
|
|
|
Service Code
|
HCPCS J7608
|
| Hospital Charge Code |
41642247
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.34 |
| Max. Negotiated Rate |
$9.92 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.53
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.08
|
| Rate for Payer: Aetna Government |
$6.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.49
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.56
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$6.16
|
| Rate for Payer: Group Health Inc Commercial |
$0.49
|
| Rate for Payer: Group Health Inc Medicare |
$0.34
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.49
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$6.84
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$9.92
|
| Rate for Payer: SOMOS Essential |
$9.92
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.63
|
|
|
ACETYLCYSTEINE 10% SOLN 4 ML
|
Facility
OP
|
$1.49
|
|
|
Service Code
|
HCPCS J7608
|
| Hospital Charge Code |
41643626
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.52 |
| Max. Negotiated Rate |
$9.92 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.82
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.08
|
| Rate for Payer: Aetna Government |
$6.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.75
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.86
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$6.16
|
| Rate for Payer: Group Health Inc Commercial |
$0.75
|
| Rate for Payer: Group Health Inc Medicare |
$0.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.75
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$6.84
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$9.92
|
| Rate for Payer: SOMOS Essential |
$9.92
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.97
|
|
|
ACETYLCYSTEINE 10% SOLN 4 ML
|
Facility
OP
|
$1.49
|
|
|
Service Code
|
HCPCS J7608
|
| Hospital Charge Code |
41653626
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.52 |
| Max. Negotiated Rate |
$9.92 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.82
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.08
|
| Rate for Payer: Aetna Government |
$6.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.75
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.86
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$6.16
|
| Rate for Payer: Group Health Inc Commercial |
$0.75
|
| Rate for Payer: Group Health Inc Medicare |
$0.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.75
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$6.84
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$9.92
|
| Rate for Payer: SOMOS Essential |
$9.92
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.97
|
|
|
ACETYLCYSTEINE 10% SOLN 4 ML
|
Facility
IP
|
$1.49
|
|
|
Service Code
|
HCPCS J7608
|
| Hospital Charge Code |
41653626
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.75 |
| Max. Negotiated Rate |
$0.75 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.75
|
|
|
ACETYLCYSTEINE 10% SOLN 4 ML
|
Facility
IP
|
$1.49
|
|
|
Service Code
|
HCPCS J7608
|
| Hospital Charge Code |
41643626
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.75 |
| Max. Negotiated Rate |
$0.75 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.75
|
|
|
ACETYLCYSTEINE 20% 3ML PER 100MG
|
Facility
OP
|
$6.00
|
|
|
Service Code
|
HCPCS J0132
|
| Hospital Charge Code |
41658039
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.70 |
| Max. Negotiated Rate |
$3.90 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.83
|
| Rate for Payer: Aetna Government |
$0.83
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.45
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$0.70
|
| Rate for Payer: Group Health Inc Commercial |
$3.00
|
| Rate for Payer: Group Health Inc Medicare |
$2.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.78
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$0.82
|
| Rate for Payer: SOMOS Essential |
$0.82
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.90
|
|
|
ACETYLCYSTEINE 20% 3ML PER 100MG
|
Facility
IP
|
$6.00
|
|
|
Service Code
|
HCPCS J0132
|
| Hospital Charge Code |
41648039
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$3.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.00
|
|
|
ACETYLCYSTEINE 20% 3ML PER 100MG
|
Facility
IP
|
$6.00
|
|
|
Service Code
|
HCPCS J0132
|
| Hospital Charge Code |
41658039
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$3.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.00
|
|
|
ACETYLCYSTEINE 20% 3ML PER 100MG
|
Facility
OP
|
$6.00
|
|
|
Service Code
|
HCPCS J0132
|
| Hospital Charge Code |
41648039
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.70 |
| Max. Negotiated Rate |
$3.90 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.83
|
| Rate for Payer: Aetna Government |
$0.83
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.45
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$0.70
|
| Rate for Payer: Group Health Inc Commercial |
$3.00
|
| Rate for Payer: Group Health Inc Medicare |
$2.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.78
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$0.82
|
| Rate for Payer: SOMOS Essential |
$0.82
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.90
|
|
|
ACETYLCYSTEINE 20% INJ
|
Facility
IP
|
$11.00
|
|
|
Service Code
|
HCPCS J7608
|
| Hospital Charge Code |
41653560
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.50 |
| Max. Negotiated Rate |
$5.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.50
|
|
|
ACETYLCYSTEINE 20% INJ
|
Facility
IP
|
$11.00
|
|
|
Service Code
|
HCPCS J7608
|
| Hospital Charge Code |
41643560
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.50 |
| Max. Negotiated Rate |
$5.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.50
|
|
|
ACETYLCYSTEINE 20% INJ
|
Facility
OP
|
$11.00
|
|
|
Service Code
|
HCPCS J7608
|
| Hospital Charge Code |
41643560
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.85 |
| Max. Negotiated Rate |
$9.92 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.05
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.08
|
| Rate for Payer: Aetna Government |
$6.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.32
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$6.16
|
| Rate for Payer: Group Health Inc Commercial |
$5.50
|
| Rate for Payer: Group Health Inc Medicare |
$3.85
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$6.84
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$9.92
|
| Rate for Payer: SOMOS Essential |
$9.92
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$7.15
|
|
|
ACETYLCYSTEINE 20% INJ
|
Facility
OP
|
$11.00
|
|
|
Service Code
|
HCPCS J7608
|
| Hospital Charge Code |
41653560
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.85 |
| Max. Negotiated Rate |
$9.92 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.05
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.08
|
| Rate for Payer: Aetna Government |
$6.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.32
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$6.16
|
| Rate for Payer: Group Health Inc Commercial |
$5.50
|
| Rate for Payer: Group Health Inc Medicare |
$3.85
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$6.84
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$9.92
|
| Rate for Payer: SOMOS Essential |
$9.92
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$7.15
|
|
|
ACETYLCYSTEINE 20% SOLN 10 ML
|
Facility
IP
|
$1.21
|
|
|
Service Code
|
HCPCS J7608
|
| Hospital Charge Code |
41652248
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.61 |
| Max. Negotiated Rate |
$0.61 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.61
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.61
|
|
|
ACETYLCYSTEINE 20% SOLN 10 ML
|
Facility
OP
|
$1.21
|
|
|
Service Code
|
HCPCS J7608
|
| Hospital Charge Code |
41642248
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.42 |
| Max. Negotiated Rate |
$9.92 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.67
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.08
|
| Rate for Payer: Aetna Government |
$6.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.61
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.70
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$6.16
|
| Rate for Payer: Group Health Inc Commercial |
$0.61
|
| Rate for Payer: Group Health Inc Medicare |
$0.42
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.61
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.61
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$6.84
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$9.92
|
| Rate for Payer: SOMOS Essential |
$9.92
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.79
|
|
|
ACETYLCYSTEINE 20% SOLN 10 ML
|
Facility
IP
|
$1.21
|
|
|
Service Code
|
HCPCS J7608
|
| Hospital Charge Code |
41642248
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.61 |
| Max. Negotiated Rate |
$0.61 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.61
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.61
|
|
|
ACETYLCYSTEINE 20% SOLN 10 ML
|
Facility
OP
|
$1.21
|
|
|
Service Code
|
HCPCS J7608
|
| Hospital Charge Code |
41652248
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.42 |
| Max. Negotiated Rate |
$9.92 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.67
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.08
|
| Rate for Payer: Aetna Government |
$6.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.61
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.70
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$6.16
|
| Rate for Payer: Group Health Inc Commercial |
$0.61
|
| Rate for Payer: Group Health Inc Medicare |
$0.42
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.61
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.61
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$6.84
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$9.92
|
| Rate for Payer: SOMOS Essential |
$9.92
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.79
|
|
|
ACETYLCYSTEINE 20% SOLN 30 ML
|
Facility
OP
|
$1.93
|
|
|
Service Code
|
HCPCS J7608
|
| Hospital Charge Code |
41643316
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.68 |
| Max. Negotiated Rate |
$9.92 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.06
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.08
|
| Rate for Payer: Aetna Government |
$6.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.97
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.11
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$6.16
|
| Rate for Payer: Group Health Inc Commercial |
$0.97
|
| Rate for Payer: Group Health Inc Medicare |
$0.68
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.97
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.97
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$6.84
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$9.92
|
| Rate for Payer: SOMOS Essential |
$9.92
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.25
|
|
|
ACETYLCYSTEINE 20% SOLN 30 ML
|
Facility
IP
|
$1.93
|
|
|
Service Code
|
HCPCS J7608
|
| Hospital Charge Code |
41653316
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.97 |
| Max. Negotiated Rate |
$0.97 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.97
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.97
|
|
|
ACETYLCYSTEINE 20% SOLN 30 ML
|
Facility
IP
|
$1.93
|
|
|
Service Code
|
HCPCS J7608
|
| Hospital Charge Code |
41643316
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.97 |
| Max. Negotiated Rate |
$0.97 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.97
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.97
|
|
|
ACETYLCYSTEINE 20% SOLN 30 ML
|
Facility
OP
|
$1.93
|
|
|
Service Code
|
HCPCS J7608
|
| Hospital Charge Code |
41653316
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.68 |
| Max. Negotiated Rate |
$9.92 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.06
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.08
|
| Rate for Payer: Aetna Government |
$6.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.97
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.11
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$6.16
|
| Rate for Payer: Group Health Inc Commercial |
$0.97
|
| Rate for Payer: Group Health Inc Medicare |
$0.68
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.97
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.97
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$6.84
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$9.92
|
| Rate for Payer: SOMOS Essential |
$9.92
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.25
|
|
