|
METHYLPREDNISOLONE SODIUM SUCC 1000 MG IJ SOLR (WRAPPED)
|
Facility
|
IP
|
$82.70
|
|
|
Service Code
|
HCPCS J2919
|
| Hospital Charge Code |
0009001820
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$41.35 |
| Max. Negotiated Rate |
$41.35 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$41.35
|
|
|
METHYLPREDNISOLONE SODIUM SUCC 1000 MG IJ SOLR (WRAPPED)
|
Facility
|
OP
|
$82.70
|
|
|
Service Code
|
HCPCS J2919
|
| Hospital Charge Code |
0009001820
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$66.16 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$45.48
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.21
|
| Rate for Payer: Aetna Government |
$0.21
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$0.15
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$0.15
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$0.15
|
| Rate for Payer: Brighton Health Commercial |
$62.02
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$0.21
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$66.16
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$56.24
|
| Rate for Payer: Elderplan Medicare Advantage |
$0.21
|
| Rate for Payer: EmblemHealth Commercial |
$0.21
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$0.19
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$0.18
|
| Rate for Payer: Fidelis Essential Plan QHP |
$0.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$0.21
|
| Rate for Payer: Fidelis Qualified Health Plan |
$0.19
|
| Rate for Payer: Group Health Inc Commercial |
$0.21
|
| Rate for Payer: Group Health Inc Medicare |
$0.21
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.21
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.21
|
| Rate for Payer: Healthfirst Medicare Advantage |
$0.18
|
| Rate for Payer: Healthfirst QHP |
$0.21
|
| Rate for Payer: Humana Medicare |
$0.21
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$0.21
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.21
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$53.76
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$0.20
|
| Rate for Payer: Wellcare Medicare |
$0.20
|
|
|
METHYLPREDNISOLONE SODIUM SUCC 1000 MG IJ SOLR (WRAPPED)
|
Facility
|
IP
|
$50.27
|
|
|
Service Code
|
HCPCS J2919
|
| Hospital Charge Code |
0143985101
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$25.14 |
| Max. Negotiated Rate |
$25.14 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$25.14
|
|
|
METHYLPREDNISOLONE SODIUM SUCC 1000 MG IJ SOLR (WRAPPED)
|
Facility
|
IP
|
$52.78
|
|
|
Service Code
|
HCPCS J2919
|
| Hospital Charge Code |
0009069801
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$26.39 |
| Max. Negotiated Rate |
$26.39 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$26.39
|
|
|
METHYLPREDNISOLONE SODIUM SUCC 1000 MG IJ SOLR (WRAPPED)
|
Facility
|
OP
|
$39.00
|
|
|
Service Code
|
HCPCS J2919
|
| Hospital Charge Code |
4359813074
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$31.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$21.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.21
|
| Rate for Payer: Aetna Government |
$0.21
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$0.15
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$0.15
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$0.15
|
| Rate for Payer: Brighton Health Commercial |
$29.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$0.21
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$31.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$26.52
|
| Rate for Payer: Elderplan Medicare Advantage |
$0.21
|
| Rate for Payer: EmblemHealth Commercial |
$0.21
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$0.19
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$0.18
|
| Rate for Payer: Fidelis Essential Plan QHP |
$0.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$0.21
|
| Rate for Payer: Fidelis Qualified Health Plan |
$0.19
|
| Rate for Payer: Group Health Inc Commercial |
$0.21
|
| Rate for Payer: Group Health Inc Medicare |
$0.21
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.21
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.21
|
| Rate for Payer: Healthfirst Medicare Advantage |
$0.18
|
| Rate for Payer: Healthfirst QHP |
$0.21
|
| Rate for Payer: Humana Medicare |
$0.21
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$0.21
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.21
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$25.35
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$0.20
|
| Rate for Payer: Wellcare Medicare |
$0.20
|
|
|
METHYLPREDNISOLONE SODIUM SUCC 125 MG IJ SOLR (WRAPPED)
|
Facility
|
IP
|
$12.50
|
|
|
Service Code
|
HCPCS J2919
|
| Hospital Charge Code |
0009004725
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.25 |
| Max. Negotiated Rate |
$6.25 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.25
|
|
|
METHYLPREDNISOLONE SODIUM SUCC 125 MG IJ SOLR (WRAPPED)
|
Facility
|
IP
|
$13.06
|
|
|
Service Code
|
HCPCS J2919
|
| Hospital Charge Code |
0009004704
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.53 |
| Max. Negotiated Rate |
$6.53 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.53
|
|
|
METHYLPREDNISOLONE SODIUM SUCC 125 MG IJ SOLR (WRAPPED)
|
Facility
|
IP
|
$12.50
|
|
|
Service Code
|
HCPCS J2919
|
| Hospital Charge Code |
0009004722
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.25 |
| Max. Negotiated Rate |
$6.25 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.25
|
|
|
METHYLPREDNISOLONE SODIUM SUCC 125 MG IJ SOLR (WRAPPED)
|
Facility
|
OP
|
$13.06
|
|
|
Service Code
|
HCPCS J2919
|
| Hospital Charge Code |
0009004704
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$10.45 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.18
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.21
|
| Rate for Payer: Aetna Government |
$0.21
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$0.15
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$0.15
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$0.15
|
| Rate for Payer: Brighton Health Commercial |
$9.80
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$0.21
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$10.45
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$8.88
|
| Rate for Payer: Elderplan Medicare Advantage |
$0.21
|
| Rate for Payer: EmblemHealth Commercial |
$0.21
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$0.19
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$0.18
|
| Rate for Payer: Fidelis Essential Plan QHP |
$0.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$0.21
|
| Rate for Payer: Fidelis Qualified Health Plan |
$0.19
|
| Rate for Payer: Group Health Inc Commercial |
$0.21
|
| Rate for Payer: Group Health Inc Medicare |
$0.21
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.21
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.21
|
| Rate for Payer: Healthfirst Medicare Advantage |
$0.18
|
| Rate for Payer: Healthfirst QHP |
$0.21
|
| Rate for Payer: Humana Medicare |
$0.21
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$0.21
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.21
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8.49
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$0.20
|
| Rate for Payer: Wellcare Medicare |
$0.20
|
|
|
METHYLPREDNISOLONE SODIUM SUCC 125 MG IJ SOLR (WRAPPED)
|
Facility
|
OP
|
$12.50
|
|
|
Service Code
|
HCPCS J2919
|
| Hospital Charge Code |
0009004722
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$10.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.88
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.21
|
| Rate for Payer: Aetna Government |
$0.21
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$0.15
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$0.15
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$0.15
|
| Rate for Payer: Brighton Health Commercial |
$9.38
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$0.21
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$10.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$8.50
|
| Rate for Payer: Elderplan Medicare Advantage |
$0.21
|
| Rate for Payer: EmblemHealth Commercial |
$0.21
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$0.19
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$0.18
|
| Rate for Payer: Fidelis Essential Plan QHP |
$0.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$0.21
|
| Rate for Payer: Fidelis Qualified Health Plan |
$0.19
|
| Rate for Payer: Group Health Inc Commercial |
$0.21
|
| Rate for Payer: Group Health Inc Medicare |
$0.21
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.21
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.21
|
| Rate for Payer: Healthfirst Medicare Advantage |
$0.18
|
| Rate for Payer: Healthfirst QHP |
$0.21
|
| Rate for Payer: Humana Medicare |
$0.21
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$0.21
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.21
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8.13
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$0.20
|
| Rate for Payer: Wellcare Medicare |
$0.20
|
|
|
METHYLPREDNISOLONE SODIUM SUCC 125 MG IJ SOLR (WRAPPED)
|
Facility
|
OP
|
$12.50
|
|
|
Service Code
|
HCPCS J2919
|
| Hospital Charge Code |
0009004725
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$10.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.88
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.21
|
| Rate for Payer: Aetna Government |
$0.21
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$0.15
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$0.15
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$0.15
|
| Rate for Payer: Brighton Health Commercial |
$9.38
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$0.21
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$10.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$8.50
|
| Rate for Payer: Elderplan Medicare Advantage |
$0.21
|
| Rate for Payer: EmblemHealth Commercial |
$0.21
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$0.19
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$0.18
|
| Rate for Payer: Fidelis Essential Plan QHP |
$0.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$0.21
|
| Rate for Payer: Fidelis Qualified Health Plan |
$0.19
|
| Rate for Payer: Group Health Inc Commercial |
$0.21
|
| Rate for Payer: Group Health Inc Medicare |
$0.21
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.21
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.21
|
| Rate for Payer: Healthfirst Medicare Advantage |
$0.18
|
| Rate for Payer: Healthfirst QHP |
$0.21
|
| Rate for Payer: Humana Medicare |
$0.21
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$0.21
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.21
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8.12
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$0.20
|
| Rate for Payer: Wellcare Medicare |
$0.20
|
|
|
METHYLPREDNISOLONE SODIUM SUCC 2000 MG IJ SOLR
|
Facility
|
OP
|
$124.42
|
|
|
Service Code
|
HCPCS J2919
|
| Hospital Charge Code |
0009085001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$99.54 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$68.43
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.21
|
| Rate for Payer: Aetna Government |
$0.21
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$0.15
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$0.15
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$0.15
|
| Rate for Payer: Brighton Health Commercial |
$93.31
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$0.21
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$99.54
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$84.61
|
| Rate for Payer: Elderplan Medicare Advantage |
$0.21
|
| Rate for Payer: EmblemHealth Commercial |
$0.21
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$0.19
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$0.18
|
| Rate for Payer: Fidelis Essential Plan QHP |
$0.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$0.21
|
| Rate for Payer: Fidelis Qualified Health Plan |
$0.19
|
| Rate for Payer: Group Health Inc Commercial |
$0.21
|
| Rate for Payer: Group Health Inc Medicare |
$0.21
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.21
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.21
|
| Rate for Payer: Healthfirst Medicare Advantage |
$0.18
|
| Rate for Payer: Healthfirst QHP |
$0.21
|
| Rate for Payer: Humana Medicare |
$0.21
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$0.21
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.21
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$80.87
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$0.20
|
| Rate for Payer: Wellcare Medicare |
$0.20
|
|
|
METHYLPREDNISOLONE SODIUM SUCC 2000 MG IJ SOLR
|
Facility
|
IP
|
$124.42
|
|
|
Service Code
|
HCPCS J2919
|
| Hospital Charge Code |
0009085001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$62.21 |
| Max. Negotiated Rate |
$62.21 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$62.21
|
|
|
METHYLPREDNISOLONE SODIUM SUCC 40 MG IJ SOLR (WRAPPED)
|
Facility
|
OP
|
$8.11
|
|
|
Service Code
|
HCPCS J2919
|
| Hospital Charge Code |
0009003906
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$6.49 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.46
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.21
|
| Rate for Payer: Aetna Government |
$0.21
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$0.15
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$0.15
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$0.15
|
| Rate for Payer: Brighton Health Commercial |
$6.08
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$0.21
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.49
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.51
|
| Rate for Payer: Elderplan Medicare Advantage |
$0.21
|
| Rate for Payer: EmblemHealth Commercial |
$0.21
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$0.19
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$0.18
|
| Rate for Payer: Fidelis Essential Plan QHP |
$0.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$0.21
|
| Rate for Payer: Fidelis Qualified Health Plan |
$0.19
|
| Rate for Payer: Group Health Inc Commercial |
$0.21
|
| Rate for Payer: Group Health Inc Medicare |
$0.21
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.21
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.21
|
| Rate for Payer: Healthfirst Medicare Advantage |
$0.18
|
| Rate for Payer: Healthfirst QHP |
$0.21
|
| Rate for Payer: Humana Medicare |
$0.21
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$0.21
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.21
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.27
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$0.20
|
| Rate for Payer: Wellcare Medicare |
$0.20
|
|
|
METHYLPREDNISOLONE SODIUM SUCC 40 MG IJ SOLR (WRAPPED)
|
Facility
|
IP
|
$8.11
|
|
|
Service Code
|
HCPCS J2919
|
| Hospital Charge Code |
0009003905
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.05 |
| Max. Negotiated Rate |
$4.05 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.05
|
|
|
METHYLPREDNISOLONE SODIUM SUCC 40 MG IJ SOLR (WRAPPED)
|
Facility
|
IP
|
$7.76
|
|
|
Service Code
|
HCPCS J2919
|
| Hospital Charge Code |
0009003930
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.88 |
| Max. Negotiated Rate |
$3.88 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.88
|
|
|
METHYLPREDNISOLONE SODIUM SUCC 40 MG IJ SOLR (WRAPPED)
|
Facility
|
IP
|
$7.76
|
|
|
Service Code
|
HCPCS J2919
|
| Hospital Charge Code |
0009003928
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.88 |
| Max. Negotiated Rate |
$3.88 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.88
|
|
|
METHYLPREDNISOLONE SODIUM SUCC 40 MG IJ SOLR (WRAPPED)
|
Facility
|
OP
|
$7.76
|
|
|
Service Code
|
HCPCS J2919
|
| Hospital Charge Code |
0009003928
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$6.21 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.27
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.21
|
| Rate for Payer: Aetna Government |
$0.21
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$0.15
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$0.15
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$0.15
|
| Rate for Payer: Brighton Health Commercial |
$5.82
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$0.21
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.21
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.28
|
| Rate for Payer: Elderplan Medicare Advantage |
$0.21
|
| Rate for Payer: EmblemHealth Commercial |
$0.21
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$0.19
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$0.18
|
| Rate for Payer: Fidelis Essential Plan QHP |
$0.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$0.21
|
| Rate for Payer: Fidelis Qualified Health Plan |
$0.19
|
| Rate for Payer: Group Health Inc Commercial |
$0.21
|
| Rate for Payer: Group Health Inc Medicare |
$0.21
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.21
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.21
|
| Rate for Payer: Healthfirst Medicare Advantage |
$0.18
|
| Rate for Payer: Healthfirst QHP |
$0.21
|
| Rate for Payer: Humana Medicare |
$0.21
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$0.21
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.21
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.05
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$0.20
|
| Rate for Payer: Wellcare Medicare |
$0.20
|
|
|
METHYLPREDNISOLONE SODIUM SUCC 40 MG IJ SOLR (WRAPPED)
|
Facility
|
OP
|
$8.11
|
|
|
Service Code
|
HCPCS J2919
|
| Hospital Charge Code |
0009003905
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$6.49 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.46
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.21
|
| Rate for Payer: Aetna Government |
$0.21
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$0.15
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$0.15
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$0.15
|
| Rate for Payer: Brighton Health Commercial |
$6.08
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$0.21
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.49
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.51
|
| Rate for Payer: Elderplan Medicare Advantage |
$0.21
|
| Rate for Payer: EmblemHealth Commercial |
$0.21
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$0.19
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$0.18
|
| Rate for Payer: Fidelis Essential Plan QHP |
$0.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$0.21
|
| Rate for Payer: Fidelis Qualified Health Plan |
$0.19
|
| Rate for Payer: Group Health Inc Commercial |
$0.21
|
| Rate for Payer: Group Health Inc Medicare |
$0.21
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.21
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.21
|
| Rate for Payer: Healthfirst Medicare Advantage |
$0.18
|
| Rate for Payer: Healthfirst QHP |
$0.21
|
| Rate for Payer: Humana Medicare |
$0.21
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$0.21
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.21
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.27
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$0.20
|
| Rate for Payer: Wellcare Medicare |
$0.20
|
|
|
METHYLPREDNISOLONE SODIUM SUCC 40 MG IJ SOLR (WRAPPED)
|
Facility
|
OP
|
$7.76
|
|
|
Service Code
|
HCPCS J2919
|
| Hospital Charge Code |
0009003930
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$6.21 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.27
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.21
|
| Rate for Payer: Aetna Government |
$0.21
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$0.15
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$0.15
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$0.15
|
| Rate for Payer: Brighton Health Commercial |
$5.82
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$0.21
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.21
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.28
|
| Rate for Payer: Elderplan Medicare Advantage |
$0.21
|
| Rate for Payer: EmblemHealth Commercial |
$0.21
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$0.19
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$0.18
|
| Rate for Payer: Fidelis Essential Plan QHP |
$0.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$0.21
|
| Rate for Payer: Fidelis Qualified Health Plan |
$0.19
|
| Rate for Payer: Group Health Inc Commercial |
$0.21
|
| Rate for Payer: Group Health Inc Medicare |
$0.21
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.21
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.21
|
| Rate for Payer: Healthfirst Medicare Advantage |
$0.18
|
| Rate for Payer: Healthfirst QHP |
$0.21
|
| Rate for Payer: Humana Medicare |
$0.21
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$0.21
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.21
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.04
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$0.20
|
| Rate for Payer: Wellcare Medicare |
$0.20
|
|
|
METHYLPREDNISOLONE SODIUM SUCC 40 MG IJ SOLR (WRAPPED)
|
Facility
|
IP
|
$8.11
|
|
|
Service Code
|
HCPCS J2919
|
| Hospital Charge Code |
0009003906
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.05 |
| Max. Negotiated Rate |
$4.05 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.05
|
|
|
METHYLPREDNISOLONE SODIUM SUCC 40 MG IJ SOLR (WRAPPED) (PEDIATRIC)
|
Facility
|
IP
|
$7.76
|
|
|
Service Code
|
HCPCS J2919
|
| Hospital Charge Code |
0009003930
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.88 |
| Max. Negotiated Rate |
$3.88 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.88
|
|
|
METHYLPREDNISOLONE SODIUM SUCC 40 MG IJ SOLR (WRAPPED) (PEDIATRIC)
|
Facility
|
OP
|
$7.76
|
|
|
Service Code
|
HCPCS J2919
|
| Hospital Charge Code |
0009003928
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$6.21 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.27
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.21
|
| Rate for Payer: Aetna Government |
$0.21
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$0.15
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$0.15
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$0.15
|
| Rate for Payer: Brighton Health Commercial |
$5.82
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$0.21
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.21
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.28
|
| Rate for Payer: Elderplan Medicare Advantage |
$0.21
|
| Rate for Payer: EmblemHealth Commercial |
$0.21
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$0.19
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$0.18
|
| Rate for Payer: Fidelis Essential Plan QHP |
$0.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$0.21
|
| Rate for Payer: Fidelis Qualified Health Plan |
$0.19
|
| Rate for Payer: Group Health Inc Commercial |
$0.21
|
| Rate for Payer: Group Health Inc Medicare |
$0.21
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.21
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.21
|
| Rate for Payer: Healthfirst Medicare Advantage |
$0.18
|
| Rate for Payer: Healthfirst QHP |
$0.21
|
| Rate for Payer: Humana Medicare |
$0.21
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$0.21
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.21
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.05
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$0.20
|
| Rate for Payer: Wellcare Medicare |
$0.20
|
|
|
METHYLPREDNISOLONE SODIUM SUCC 40 MG IJ SOLR (WRAPPED) (PEDIATRIC)
|
Facility
|
OP
|
$8.11
|
|
|
Service Code
|
HCPCS J2919
|
| Hospital Charge Code |
0009003905
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$6.49 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.46
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.21
|
| Rate for Payer: Aetna Government |
$0.21
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$0.15
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$0.15
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$0.15
|
| Rate for Payer: Brighton Health Commercial |
$6.08
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$0.21
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.49
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.51
|
| Rate for Payer: Elderplan Medicare Advantage |
$0.21
|
| Rate for Payer: EmblemHealth Commercial |
$0.21
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$0.19
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$0.18
|
| Rate for Payer: Fidelis Essential Plan QHP |
$0.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$0.21
|
| Rate for Payer: Fidelis Qualified Health Plan |
$0.19
|
| Rate for Payer: Group Health Inc Commercial |
$0.21
|
| Rate for Payer: Group Health Inc Medicare |
$0.21
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.21
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.21
|
| Rate for Payer: Healthfirst Medicare Advantage |
$0.18
|
| Rate for Payer: Healthfirst QHP |
$0.21
|
| Rate for Payer: Humana Medicare |
$0.21
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$0.21
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.21
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.27
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$0.20
|
| Rate for Payer: Wellcare Medicare |
$0.20
|
|
|
METHYLPREDNISOLONE SODIUM SUCC 40 MG IJ SOLR (WRAPPED) (PEDIATRIC)
|
Facility
|
OP
|
$7.76
|
|
|
Service Code
|
HCPCS J2919
|
| Hospital Charge Code |
0009003930
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$6.21 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.27
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.21
|
| Rate for Payer: Aetna Government |
$0.21
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$0.15
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$0.15
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$0.15
|
| Rate for Payer: Brighton Health Commercial |
$5.82
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$0.21
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.21
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.28
|
| Rate for Payer: Elderplan Medicare Advantage |
$0.21
|
| Rate for Payer: EmblemHealth Commercial |
$0.21
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$0.19
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$0.18
|
| Rate for Payer: Fidelis Essential Plan QHP |
$0.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$0.21
|
| Rate for Payer: Fidelis Qualified Health Plan |
$0.19
|
| Rate for Payer: Group Health Inc Commercial |
$0.21
|
| Rate for Payer: Group Health Inc Medicare |
$0.21
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.21
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.21
|
| Rate for Payer: Healthfirst Medicare Advantage |
$0.18
|
| Rate for Payer: Healthfirst QHP |
$0.21
|
| Rate for Payer: Humana Medicare |
$0.21
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$0.21
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.21
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.04
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$0.20
|
| Rate for Payer: Wellcare Medicare |
$0.20
|
|
