DEVICE TORQUE (TD01)
|
Facility
OP
|
$29.50
|
|
Hospital Charge Code |
64906323
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$10.32 |
Max. Negotiated Rate |
$23.60 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$16.22
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$14.75
|
Rate for Payer: Aetna Government |
$14.75
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$23.60
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$20.06
|
Rate for Payer: Group Health Inc Commercial |
$14.75
|
Rate for Payer: Group Health Inc Medicare |
$10.32
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.75
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$14.75
|
|
DEVICE TRCHNTRC 4HL 23X232MM
|
Facility
OP
|
$4,408.00
|
|
Hospital Charge Code |
64906268
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$1,542.80 |
Max. Negotiated Rate |
$3,526.40 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,424.40
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,204.00
|
Rate for Payer: Aetna Government |
$2,204.00
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3,526.40
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,997.44
|
Rate for Payer: Group Health Inc Commercial |
$2,204.00
|
Rate for Payer: Group Health Inc Medicare |
$1,542.80
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,204.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$2,204.00
|
|
DEVICE, VASC CLOSE 6F-7F MYNX
|
Facility
OP
|
$1,000.00
|
|
Hospital Charge Code |
64906107
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$350.00 |
Max. Negotiated Rate |
$800.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$550.00
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$500.00
|
Rate for Payer: Aetna Government |
$500.00
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$800.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$680.00
|
Rate for Payer: Group Health Inc Commercial |
$500.00
|
Rate for Payer: Group Health Inc Medicare |
$350.00
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$500.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$500.00
|
|
DEVICE, WOUND CLOSR, MYNX 5F GR
|
Facility
OP
|
$1,000.00
|
|
Hospital Charge Code |
64906097
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$350.00 |
Max. Negotiated Rate |
$800.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$550.00
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$500.00
|
Rate for Payer: Aetna Government |
$500.00
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$800.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$680.00
|
Rate for Payer: Group Health Inc Commercial |
$500.00
|
Rate for Payer: Group Health Inc Medicare |
$350.00
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$500.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$500.00
|
|
DEWRAP COMPRESSION DRESSING
|
Facility
OP
|
$38.72
|
|
Hospital Charge Code |
41709550
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$13.55 |
Max. Negotiated Rate |
$30.98 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$21.30
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$19.36
|
Rate for Payer: Aetna Government |
$19.36
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$30.98
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$26.33
|
Rate for Payer: Group Health Inc Commercial |
$19.36
|
Rate for Payer: Group Health Inc Medicare |
$13.55
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$19.36
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$19.36
|
|
DEWRAP COMPRESSION DRESSING
|
Facility
OP
|
$38.72
|
|
Hospital Charge Code |
41809550
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$13.55 |
Max. Negotiated Rate |
$30.98 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$21.30
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$19.36
|
Rate for Payer: Aetna Government |
$19.36
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$30.98
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$26.33
|
Rate for Payer: Group Health Inc Commercial |
$19.36
|
Rate for Payer: Group Health Inc Medicare |
$13.55
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$19.36
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$19.36
|
|
DEXAMETHASONE 0.1 MG/ML SOLN
|
Facility
OP
|
$1.00
|
|
Hospital Charge Code |
41642026
|
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
|
|
DEXAMETHASONE 0.1 MG/ML SOLN
|
Facility
OP
|
$1.00
|
|
Hospital Charge Code |
41652026
|
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
|
|
DEXAMETHASONE 0.1% OPHTHALMIC SOLN
|
Facility
OP
|
$32.26
|
|
Hospital Charge Code |
41653414
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$11.29 |
Max. Negotiated Rate |
$25.81 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$17.74
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$16.13
|
Rate for Payer: Aetna Government |
$16.13
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$25.81
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$21.94
|
Rate for Payer: Group Health Inc Commercial |
$16.13
|
Rate for Payer: Group Health Inc Medicare |
$11.29
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.13
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$16.13
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$20.97
|
|
DEXAMETHASONE 0.1% OPHTHALMIC SOLN
|
Facility
OP
|
$32.26
|
|
Hospital Charge Code |
41643414
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$11.29 |
Max. Negotiated Rate |
$25.81 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$17.74
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$16.13
|
Rate for Payer: Aetna Government |
$16.13
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$25.81
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$21.94
|
Rate for Payer: Group Health Inc Commercial |
$16.13
|
Rate for Payer: Group Health Inc Medicare |
$11.29
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.13
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$16.13
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$20.97
|
|
DEXAMETHASONE 0.5 MG TAB
|
Facility
IP
|
$1.00
|
|
Service Code
|
HCPCS J8540
|
Hospital Charge Code |
41651118
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$0.50 |
Max. Negotiated Rate |
$0.50 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$0.50
|
|
DEXAMETHASONE 0.5 MG TAB
|
Facility
OP
|
$1.00
|
|
Service Code
|
HCPCS J8540
|
Hospital Charge Code |
41641118
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$0.07 |
Max. Negotiated Rate |
$0.65 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.55
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.10
|
Rate for Payer: Aetna Government |
$0.10
|
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 |
$0.09
|
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 |
$0.10
|
Rate for Payer: SOMOS CHP/HARP/Medicaid |
$0.07
|
Rate for Payer: SOMOS Essential |
$0.07
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.65
|
|
DEXAMETHASONE 0.5 MG TAB
|
Facility
IP
|
$1.00
|
|
Service Code
|
HCPCS J8540
|
Hospital Charge Code |
41641118
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$0.50 |
Max. Negotiated Rate |
$0.50 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$0.50
|
|
DEXAMETHASONE 0.5 MG TAB
|
Facility
OP
|
$1.00
|
|
Service Code
|
HCPCS J8540
|
Hospital Charge Code |
41651118
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$0.07 |
Max. Negotiated Rate |
$0.65 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.55
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.10
|
Rate for Payer: Aetna Government |
$0.10
|
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 |
$0.09
|
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 |
$0.10
|
Rate for Payer: SOMOS CHP/HARP/Medicaid |
$0.07
|
Rate for Payer: SOMOS Essential |
$0.07
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.65
|
|
DEXAMETHASONE 0.75 MG TAB
|
Facility
OP
|
$1.00
|
|
Service Code
|
HCPCS J8540
|
Hospital Charge Code |
41641126
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$0.07 |
Max. Negotiated Rate |
$0.65 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.55
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.10
|
Rate for Payer: Aetna Government |
$0.10
|
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 |
$0.09
|
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 |
$0.10
|
Rate for Payer: SOMOS CHP/HARP/Medicaid |
$0.07
|
Rate for Payer: SOMOS Essential |
$0.07
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.65
|
|
DEXAMETHASONE 0.75 MG TAB
|
Facility
IP
|
$1.00
|
|
Service Code
|
HCPCS J8540
|
Hospital Charge Code |
41651126
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$0.50 |
Max. Negotiated Rate |
$0.50 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$0.50
|
|
DEXAMETHASONE 0.75 MG TAB
|
Facility
IP
|
$1.00
|
|
Service Code
|
HCPCS J8540
|
Hospital Charge Code |
41641126
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$0.50 |
Max. Negotiated Rate |
$0.50 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$0.50
|
|
DEXAMETHASONE 0.75 MG TAB
|
Facility
OP
|
$1.00
|
|
Service Code
|
HCPCS J8540
|
Hospital Charge Code |
41651126
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$0.07 |
Max. Negotiated Rate |
$0.65 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.55
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.10
|
Rate for Payer: Aetna Government |
$0.10
|
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 |
$0.09
|
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 |
$0.10
|
Rate for Payer: SOMOS CHP/HARP/Medicaid |
$0.07
|
Rate for Payer: SOMOS Essential |
$0.07
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.65
|
|
DEXAMETHASONE 10MG/D5W 50ML
|
Facility
IP
|
$0.31
|
|
Service Code
|
HCPCS J1100
|
Hospital Charge Code |
41655887
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$0.16 |
Max. Negotiated Rate |
$0.16 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.16
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$0.16
|
|
DEXAMETHASONE 10MG/D5W 50ML
|
Facility
OP
|
$0.31
|
|
Service Code
|
HCPCS J1100
|
Hospital Charge Code |
41645887
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$0.11 |
Max. Negotiated Rate |
$0.20 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.17
|
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 |
$0.16
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.18
|
Rate for Payer: Fidelis CHP/HARP/Medicaid |
$0.11
|
Rate for Payer: Group Health Inc Commercial |
$0.16
|
Rate for Payer: Group Health Inc Medicare |
$0.11
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.16
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$0.16
|
Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.12
|
Rate for Payer: SOMOS CHP/HARP/Medicaid |
$0.12
|
Rate for Payer: SOMOS Essential |
$0.12
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.20
|
|
DEXAMETHASONE 10MG/D5W 50ML
|
Facility
OP
|
$0.31
|
|
Service Code
|
HCPCS J1100
|
Hospital Charge Code |
41655887
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$0.11 |
Max. Negotiated Rate |
$0.20 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.17
|
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 |
$0.16
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.18
|
Rate for Payer: Fidelis CHP/HARP/Medicaid |
$0.11
|
Rate for Payer: Group Health Inc Commercial |
$0.16
|
Rate for Payer: Group Health Inc Medicare |
$0.11
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.16
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$0.16
|
Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.12
|
Rate for Payer: SOMOS CHP/HARP/Medicaid |
$0.12
|
Rate for Payer: SOMOS Essential |
$0.12
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.20
|
|
DEXAMETHASONE 10MG/D5W 50ML
|
Facility
IP
|
$0.31
|
|
Service Code
|
HCPCS J1100
|
Hospital Charge Code |
41645887
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$0.16 |
Max. Negotiated Rate |
$0.16 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.16
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$0.16
|
|
DEXAMETHASONE 10MG/ML-.25MG CROUP
|
Facility
OP
|
$1.84
|
|
Service Code
|
HCPCS J8540
|
Hospital Charge Code |
41648042
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$0.07 |
Max. Negotiated Rate |
$1.20 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.01
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.10
|
Rate for Payer: Aetna Government |
$0.10
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.92
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.06
|
Rate for Payer: Fidelis CHP/HARP/Medicaid |
$0.09
|
Rate for Payer: Group Health Inc Commercial |
$0.92
|
Rate for Payer: Group Health Inc Medicare |
$0.64
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.92
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$0.92
|
Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.10
|
Rate for Payer: SOMOS CHP/HARP/Medicaid |
$0.07
|
Rate for Payer: SOMOS Essential |
$0.07
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.20
|
|
DEXAMETHASONE 10MG/ML-.25MG CROUP
|
Facility
OP
|
$1.84
|
|
Service Code
|
HCPCS J8540
|
Hospital Charge Code |
41658042
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$0.07 |
Max. Negotiated Rate |
$1.20 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.01
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.10
|
Rate for Payer: Aetna Government |
$0.10
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.92
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.06
|
Rate for Payer: Fidelis CHP/HARP/Medicaid |
$0.09
|
Rate for Payer: Group Health Inc Commercial |
$0.92
|
Rate for Payer: Group Health Inc Medicare |
$0.64
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.92
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$0.92
|
Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.10
|
Rate for Payer: SOMOS CHP/HARP/Medicaid |
$0.07
|
Rate for Payer: SOMOS Essential |
$0.07
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.20
|
|
DEXAMETHASONE 10MG/ML-.25MG CROUP
|
Facility
IP
|
$1.84
|
|
Service Code
|
HCPCS J8540
|
Hospital Charge Code |
41648042
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$0.92 |
Max. Negotiated Rate |
$0.92 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.92
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$0.92
|
|