|
BUDESONIDE 0.25 MG/2ML IN SUSP
|
Facility
|
IP
|
$4.74
|
|
|
Service Code
|
HCPCS J7626
|
| Hospital Charge Code |
0487960101
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.37 |
| Max. Negotiated Rate |
$2.37 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.37
|
|
|
BUDESONIDE 0.25 MG/2ML IN SUSP
|
Facility
|
OP
|
$4.71
|
|
|
Service Code
|
HCPCS J7626
|
| Hospital Charge Code |
0093681573
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.05 |
| Max. Negotiated Rate |
$3.77 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.59
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.05
|
| Rate for Payer: Aetna Government |
$1.05
|
| Rate for Payer: Brighton Health Commercial |
$3.53
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.77
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.20
|
| Rate for Payer: EmblemHealth Commercial |
$2.35
|
| Rate for Payer: Group Health Inc Commercial |
$2.35
|
| Rate for Payer: Group Health Inc Medicare |
$1.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.35
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1.35
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.06
|
|
|
BUDESONIDE 0.5 MG/2ML IN SUSP
|
Facility
|
OP
|
$5.54
|
|
|
Service Code
|
HCPCS J7626
|
| Hospital Charge Code |
0093681673
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.05 |
| Max. Negotiated Rate |
$4.43 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.05
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.05
|
| Rate for Payer: Aetna Government |
$1.05
|
| Rate for Payer: Brighton Health Commercial |
$4.16
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.43
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.77
|
| Rate for Payer: EmblemHealth Commercial |
$2.77
|
| Rate for Payer: Group Health Inc Commercial |
$2.77
|
| Rate for Payer: Group Health Inc Medicare |
$1.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.77
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.77
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1.35
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.60
|
|
|
BUDESONIDE 0.5 MG/2ML IN SUSP
|
Facility
|
IP
|
$5.54
|
|
|
Service Code
|
HCPCS J7626
|
| Hospital Charge Code |
0093681619
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.77 |
| Max. Negotiated Rate |
$2.77 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.77
|
|
|
BUDESONIDE 0.5 MG/2ML IN SUSP
|
Facility
|
OP
|
$5.54
|
|
|
Service Code
|
HCPCS J7626
|
| Hospital Charge Code |
0093681619
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.05 |
| Max. Negotiated Rate |
$4.43 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.05
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.05
|
| Rate for Payer: Aetna Government |
$1.05
|
| Rate for Payer: Brighton Health Commercial |
$4.16
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.43
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.77
|
| Rate for Payer: EmblemHealth Commercial |
$2.77
|
| Rate for Payer: Group Health Inc Commercial |
$2.77
|
| Rate for Payer: Group Health Inc Medicare |
$1.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.77
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.77
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1.35
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.60
|
|
|
BUDESONIDE 0.5 MG/2ML IN SUSP
|
Facility
|
IP
|
$5.54
|
|
|
Service Code
|
HCPCS J7626
|
| Hospital Charge Code |
0093681673
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.77 |
| Max. Negotiated Rate |
$2.77 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.77
|
|
|
BUDESONIDE 0.5 MG/2ML IN SUSP
|
Facility
|
IP
|
$5.54
|
|
|
Service Code
|
HCPCS J7626
|
| Hospital Charge Code |
0115168974
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.77 |
| Max. Negotiated Rate |
$2.77 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.77
|
|
|
BUDESONIDE 0.5 MG/2ML IN SUSP
|
Facility
|
IP
|
$5.54
|
|
|
Service Code
|
HCPCS J7626
|
| Hospital Charge Code |
0093681655
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.77 |
| Max. Negotiated Rate |
$2.77 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.77
|
|
|
BUDESONIDE 0.5 MG/2ML IN SUSP
|
Facility
|
OP
|
$5.54
|
|
|
Service Code
|
HCPCS J7626
|
| Hospital Charge Code |
0115168974
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.05 |
| Max. Negotiated Rate |
$4.43 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.05
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.05
|
| Rate for Payer: Aetna Government |
$1.05
|
| Rate for Payer: Brighton Health Commercial |
$4.16
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.43
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.77
|
| Rate for Payer: EmblemHealth Commercial |
$2.77
|
| Rate for Payer: Group Health Inc Commercial |
$2.77
|
| Rate for Payer: Group Health Inc Medicare |
$1.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.77
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.77
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1.35
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.60
|
|
|
BUDESONIDE 0.5 MG/2ML IN SUSP
|
Facility
|
OP
|
$5.54
|
|
|
Service Code
|
HCPCS J7626
|
| Hospital Charge Code |
0093681655
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.05 |
| Max. Negotiated Rate |
$4.43 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.05
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.05
|
| Rate for Payer: Aetna Government |
$1.05
|
| Rate for Payer: Brighton Health Commercial |
$4.16
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.43
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.77
|
| Rate for Payer: EmblemHealth Commercial |
$2.77
|
| Rate for Payer: Group Health Inc Commercial |
$2.77
|
| Rate for Payer: Group Health Inc Medicare |
$1.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.77
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.77
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1.35
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.60
|
|
|
BUDESONIDE-FORMOTEROL FUMARATE 160-4.5 MCG/ACT IN AERO
|
Facility
|
OP
|
$31.84
|
|
|
Service Code
|
NDC 0186037028
|
| Hospital Charge Code |
0186037028
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.14 |
| Max. Negotiated Rate |
$25.47 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$17.51
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$15.92
|
| Rate for Payer: Aetna Government |
$15.92
|
| Rate for Payer: Brighton Health Commercial |
$23.88
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$25.47
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$21.65
|
| Rate for Payer: EmblemHealth Commercial |
$15.92
|
| Rate for Payer: Group Health Inc Commercial |
$15.92
|
| Rate for Payer: Group Health Inc Medicare |
$11.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$15.92
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$20.70
|
|
|
BUDESONIDE-FORMOTEROL FUMARATE 160-4.5 MCG/ACT IN AERO
|
Facility
|
IP
|
$31.84
|
|
|
Service Code
|
NDC 0186037028
|
| Hospital Charge Code |
0186037028
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.92 |
| Max. Negotiated Rate |
$15.92 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15.92
|
|
|
BUDESONIDE-FORMOTEROL FUMARATE 160-4.5 MCG/ACT IN AERO
|
Facility
|
OP
|
$39.51
|
|
|
Service Code
|
NDC 0310737020
|
| Hospital Charge Code |
0310737020
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.83 |
| Max. Negotiated Rate |
$31.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$21.73
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$19.75
|
| Rate for Payer: Aetna Government |
$19.75
|
| Rate for Payer: Brighton Health Commercial |
$29.63
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$31.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$26.86
|
| Rate for Payer: EmblemHealth Commercial |
$19.75
|
| Rate for Payer: Group Health Inc Commercial |
$19.75
|
| Rate for Payer: Group Health Inc Medicare |
$13.83
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$19.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$19.75
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$25.68
|
|
|
BUDESONIDE-FORMOTEROL FUMARATE 160-4.5 MCG/ACT IN AERO
|
Facility
|
IP
|
$39.51
|
|
|
Service Code
|
NDC 0310737020
|
| Hospital Charge Code |
0310737020
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$19.75 |
| Max. Negotiated Rate |
$19.75 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$19.75
|
|
|
BUDESONIDE-FORMOTEROL FUMARATE 160-4.5 MCG/ACT IN AERO
|
Facility
|
IP
|
$27.56
|
|
|
Service Code
|
NDC 0186037020
|
| Hospital Charge Code |
0186037020
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.78 |
| Max. Negotiated Rate |
$13.78 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$13.78
|
|
|
BUDESONIDE-FORMOTEROL FUMARATE 160-4.5 MCG/ACT IN AERO
|
Facility
|
OP
|
$27.56
|
|
|
Service Code
|
NDC 0186037020
|
| Hospital Charge Code |
0186037020
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.65 |
| Max. Negotiated Rate |
$22.05 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$15.16
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$13.78
|
| Rate for Payer: Aetna Government |
$13.78
|
| Rate for Payer: Brighton Health Commercial |
$20.67
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$22.05
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$18.74
|
| Rate for Payer: EmblemHealth Commercial |
$13.78
|
| Rate for Payer: Group Health Inc Commercial |
$13.78
|
| Rate for Payer: Group Health Inc Medicare |
$9.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$13.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.78
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$17.92
|
|
|
BUNION PROCEDURES
|
Facility
|
OP
|
$3,912.88
|
|
|
Service Code
|
EAPG 00045
|
| Min. Negotiated Rate |
$2,839.65 |
| Max. Negotiated Rate |
$3,912.88 |
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,839.65
|
| Rate for Payer: Healthfirst Commercial |
$3,912.88
|
|
|
BUPIVACAINE-EPINEPHRINE 0.25% -1:200000 IJ SOLN
|
Facility
|
IP
|
$0.29
|
|
|
Service Code
|
NDC 0409381201
|
| Hospital Charge Code |
0409381201
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$0.15 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.15
|
|
|
BUPIVACAINE-EPINEPHRINE 0.25% -1:200000 IJ SOLN
|
Facility
|
OP
|
$0.29
|
|
|
Service Code
|
NDC 0409381201
|
| Hospital Charge Code |
0409381201
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.24 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.16
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.15
|
| Rate for Payer: Aetna Government |
$0.15
|
| Rate for Payer: Brighton Health Commercial |
$0.22
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.24
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.20
|
| Rate for Payer: EmblemHealth Commercial |
$0.15
|
| Rate for Payer: Group Health Inc Commercial |
$0.15
|
| Rate for Payer: Group Health Inc Medicare |
$0.10
|
| 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 |
$0.19
|
|
|
BUPIVACAINE-EPINEPHRINE 0.5% -1:200000 IJ SOLN
|
Facility
|
IP
|
$0.39
|
|
|
Service Code
|
NDC 0409175550
|
| Hospital Charge Code |
0409175550
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$0.20 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.20
|
|
|
BUPIVACAINE-EPINEPHRINE 0.5% -1:200000 IJ SOLN
|
Facility
|
OP
|
$0.39
|
|
|
Service Code
|
NDC 0409175550
|
| Hospital Charge Code |
0409175550
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.31 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.22
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.20
|
| Rate for Payer: Aetna Government |
$0.20
|
| Rate for Payer: Brighton Health Commercial |
$0.29
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.31
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.27
|
| Rate for Payer: EmblemHealth Commercial |
$0.20
|
| Rate for Payer: Group Health Inc Commercial |
$0.20
|
| Rate for Payer: Group Health Inc Medicare |
$0.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.25
|
|
|
BUPIVACAINE HCL 0.25 % IJ SOLN
|
Facility
|
OP
|
$0.09
|
|
|
Service Code
|
NDC 0409116001
|
| Hospital Charge Code |
0409116001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.07 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.05
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.04
|
| Rate for Payer: Aetna Government |
$0.04
|
| Rate for Payer: Brighton Health Commercial |
$0.06
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.07
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.06
|
| Rate for Payer: EmblemHealth Commercial |
$0.04
|
| Rate for Payer: Group Health Inc Commercial |
$0.04
|
| Rate for Payer: Group Health Inc Medicare |
$0.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.04
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.06
|
|
|
BUPIVACAINE HCL 0.25 % IJ SOLN
|
Facility
|
IP
|
$0.09
|
|
|
Service Code
|
NDC 0409116001
|
| Hospital Charge Code |
0409116001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.04 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.04
|
|
|
BUPIVACAINE HCL 0.5 % IJ SOLN
|
Facility
|
IP
|
$0.07
|
|
|
Service Code
|
HCPCS J0665
|
| Hospital Charge Code |
0409116301
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.04 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.04
|
|
|
BUPIVACAINE HCL 0.5 % IJ SOLN
|
Facility
|
OP
|
$0.07
|
|
|
Service Code
|
HCPCS J0665
|
| Hospital Charge Code |
0409116301
|
|
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 |
$0.04
|
| Rate for Payer: Aetna Government |
$0.04
|
| Rate for Payer: Brighton Health Commercial |
$0.05
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.06
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.05
|
| Rate for Payer: EmblemHealth Commercial |
$0.04
|
| Rate for Payer: Group Health Inc Commercial |
$0.04
|
| Rate for Payer: Group Health Inc Medicare |
$0.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.04
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.05
|
|
