|
MONTELUKAST SODIUM 5 MG PO CHEW
|
Facility
|
OP
|
$5.03
|
|
|
Service Code
|
NDC 5723721330
|
| Hospital Charge Code |
5723721330
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.76 |
| Max. Negotiated Rate |
$4.02 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.77
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.51
|
| Rate for Payer: Aetna Government |
$2.51
|
| Rate for Payer: Brighton Health Commercial |
$3.77
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.02
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.42
|
| Rate for Payer: EmblemHealth Commercial |
$2.51
|
| Rate for Payer: Group Health Inc Commercial |
$2.51
|
| Rate for Payer: Group Health Inc Medicare |
$1.76
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.51
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.51
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.27
|
|
|
MONTELUKAST SODIUM 5 MG PO CHEW
|
Facility
|
IP
|
$5.03
|
|
|
Service Code
|
NDC 5723721330
|
| Hospital Charge Code |
5723721330
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.51 |
| Max. Negotiated Rate |
$2.51 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.51
|
|
|
MONTELUKAST SODIUM 5 MG PO CHEW
|
Facility
|
OP
|
$4.11
|
|
|
Service Code
|
NDC 5026857415
|
| Hospital Charge Code |
5026857415
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.44 |
| Max. Negotiated Rate |
$3.28 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.26
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.05
|
| Rate for Payer: Aetna Government |
$2.05
|
| Rate for Payer: Brighton Health Commercial |
$3.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.28
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.79
|
| Rate for Payer: EmblemHealth Commercial |
$2.05
|
| Rate for Payer: Group Health Inc Commercial |
$2.05
|
| Rate for Payer: Group Health Inc Medicare |
$1.44
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.67
|
|
|
MORPHINE PCA 100 MG/100 ML D5W (PREMIX)
|
Facility
|
IP
|
$0.18
|
|
|
Service Code
|
NDC 9999099999
|
| Hospital Charge Code |
9999099999
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.09 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.09
|
|
|
MORPHINE PCA 100 MG/100 ML D5W (PREMIX)
|
Facility
|
OP
|
$0.18
|
|
|
Service Code
|
NDC 9999099999
|
| Hospital Charge Code |
9999099999
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.15 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.09
|
| Rate for Payer: Aetna Government |
$0.09
|
| Rate for Payer: Brighton Health Commercial |
$0.14
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.15
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.12
|
| Rate for Payer: EmblemHealth Commercial |
$0.09
|
| Rate for Payer: Group Health Inc Commercial |
$0.09
|
| Rate for Payer: Group Health Inc Medicare |
$0.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.12
|
|
|
MORPHINE SULFATE 0.3MG/0.75 ML PO SOLN (NEO)
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
NDC 9999123406
|
| Hospital Charge Code |
9999123406
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.40 |
| Max. Negotiated Rate |
$3.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.20
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.00
|
| Rate for Payer: Aetna Government |
$2.00
|
| Rate for Payer: Brighton Health Commercial |
$3.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.72
|
| Rate for Payer: EmblemHealth Commercial |
$2.00
|
| Rate for Payer: Group Health Inc Commercial |
$2.00
|
| Rate for Payer: Group Health Inc Medicare |
$1.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.60
|
|
|
MORPHINE SULFATE 0.3MG/0.75 ML PO SOLN (NEO)
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
NDC 9999123406
|
| Hospital Charge Code |
9999123406
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$2.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.00
|
|
|
MORPHINE SULFATE 10 MG/5ML PO SOLN
|
Facility
|
OP
|
$0.33
|
|
|
Service Code
|
NDC 6809400159
|
| Hospital Charge Code |
6809400159
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.26 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.18
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.16
|
| Rate for Payer: Aetna Government |
$0.16
|
| Rate for Payer: Brighton Health Commercial |
$0.24
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.26
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.22
|
| Rate for Payer: EmblemHealth Commercial |
$0.16
|
| 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: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.21
|
|
|
MORPHINE SULFATE 10 MG/5ML PO SOLN
|
Facility
|
IP
|
$0.33
|
|
|
Service Code
|
NDC 6809400162
|
| Hospital Charge Code |
6809400162
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$0.16 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.16
|
|
|
MORPHINE SULFATE 10 MG/5ML PO SOLN
|
Facility
|
OP
|
$0.09
|
|
|
Service Code
|
NDC 0054023763
|
| Hospital Charge Code |
0054023763
|
|
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
|
|
|
MORPHINE SULFATE 10 MG/5ML PO SOLN
|
Facility
|
IP
|
$0.33
|
|
|
Service Code
|
NDC 6809400159
|
| Hospital Charge Code |
6809400159
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$0.16 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.16
|
|
|
MORPHINE SULFATE 10 MG/5ML PO SOLN
|
Facility
|
OP
|
$0.33
|
|
|
Service Code
|
NDC 6809400162
|
| Hospital Charge Code |
6809400162
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.26 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.18
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.16
|
| Rate for Payer: Aetna Government |
$0.16
|
| Rate for Payer: Brighton Health Commercial |
$0.24
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.26
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.22
|
| Rate for Payer: EmblemHealth Commercial |
$0.16
|
| 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: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.21
|
|
|
MORPHINE SULFATE 10 MG/5ML PO SOLN
|
Facility
|
IP
|
$0.09
|
|
|
Service Code
|
NDC 0054023763
|
| Hospital Charge Code |
0054023763
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.04 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.04
|
|
|
MORPHINE SULFATE 10 MG/5ML PO SOLN
|
Facility
|
IP
|
$0.12
|
|
|
Service Code
|
NDC 0054023749
|
| Hospital Charge Code |
0054023749
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.06 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.06
|
|
|
MORPHINE SULFATE 10 MG/5ML PO SOLN
|
Facility
|
OP
|
$0.12
|
|
|
Service Code
|
NDC 0054023749
|
| Hospital Charge Code |
0054023749
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.10 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.07
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.06
|
| Rate for Payer: Aetna Government |
$0.06
|
| Rate for Payer: Brighton Health Commercial |
$0.09
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.10
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.08
|
| Rate for Payer: EmblemHealth Commercial |
$0.06
|
| Rate for Payer: Group Health Inc Commercial |
$0.06
|
| Rate for Payer: Group Health Inc Medicare |
$0.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.08
|
|
|
MORPHINE SULFATE 15 MG PO TABS
|
Facility
|
OP
|
$0.52
|
|
|
Service Code
|
NDC 0054023525
|
| Hospital Charge Code |
0054023525
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$0.42 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.29
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.26
|
| Rate for Payer: Aetna Government |
$0.26
|
| Rate for Payer: Brighton Health Commercial |
$0.39
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.42
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.35
|
| Rate for Payer: EmblemHealth Commercial |
$0.26
|
| Rate for Payer: Group Health Inc Commercial |
$0.26
|
| Rate for Payer: Group Health Inc Medicare |
$0.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.26
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.34
|
|
|
MORPHINE SULFATE 15 MG PO TABS
|
Facility
|
IP
|
$0.52
|
|
|
Service Code
|
NDC 0054023525
|
| Hospital Charge Code |
0054023525
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$0.26 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.26
|
|
|
MORPHINE SULFATE 15 MG PO TABS
|
Facility
|
OP
|
$0.91
|
|
|
Service Code
|
NDC 0054023524
|
| Hospital Charge Code |
0054023524
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$0.73 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.45
|
| Rate for Payer: Aetna Government |
$0.45
|
| Rate for Payer: Brighton Health Commercial |
$0.68
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.73
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.62
|
| Rate for Payer: EmblemHealth Commercial |
$0.45
|
| Rate for Payer: Group Health Inc Commercial |
$0.45
|
| Rate for Payer: Group Health Inc Medicare |
$0.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.45
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.45
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.59
|
|
|
MORPHINE SULFATE 15 MG PO TABS
|
Facility
|
IP
|
$0.91
|
|
|
Service Code
|
NDC 0054023524
|
| Hospital Charge Code |
0054023524
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$0.45 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.45
|
|
|
MORPHINE SULFATE 2 MG/ML IJ SOLN
|
Facility
|
IP
|
$3.44
|
|
|
Service Code
|
HCPCS J2270
|
| Hospital Charge Code |
7604500401
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.72 |
| Max. Negotiated Rate |
$1.72 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.72
|
|
|
MORPHINE SULFATE 2 MG/ML IJ SOLN
|
Facility
|
OP
|
$3.44
|
|
|
Service Code
|
HCPCS J2270
|
| Hospital Charge Code |
7604500401
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.21 |
| Max. Negotiated Rate |
$3.39 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.89
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.39
|
| Rate for Payer: Aetna Government |
$3.39
|
| Rate for Payer: Brighton Health Commercial |
$2.58
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.76
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.34
|
| Rate for Payer: EmblemHealth Commercial |
$1.72
|
| Rate for Payer: Group Health Inc Commercial |
$1.72
|
| Rate for Payer: Group Health Inc Medicare |
$1.21
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.72
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2.18
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.24
|
|
|
MORPHINE SULFATE 2 MG/ML IJ SOLN
|
Facility
|
OP
|
$3.44
|
|
|
Service Code
|
HCPCS J2270
|
| Hospital Charge Code |
7604500411
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.21 |
| Max. Negotiated Rate |
$3.39 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.89
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.39
|
| Rate for Payer: Aetna Government |
$3.39
|
| Rate for Payer: Brighton Health Commercial |
$2.58
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.76
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.34
|
| Rate for Payer: EmblemHealth Commercial |
$1.72
|
| Rate for Payer: Group Health Inc Commercial |
$1.72
|
| Rate for Payer: Group Health Inc Medicare |
$1.21
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.72
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2.18
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.24
|
|
|
MORPHINE SULFATE 2 MG/ML IJ SOLN
|
Facility
|
IP
|
$3.44
|
|
|
Service Code
|
HCPCS J2270
|
| Hospital Charge Code |
7604500411
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.72 |
| Max. Negotiated Rate |
$1.72 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.72
|
|
|
MORPHINE SULFATE 30 MG PO TABS
|
Facility
|
OP
|
$1.54
|
|
|
Service Code
|
NDC 0054023624
|
| Hospital Charge Code |
0054023624
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.54 |
| Max. Negotiated Rate |
$1.24 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.85
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.77
|
| Rate for Payer: Aetna Government |
$0.77
|
| Rate for Payer: Brighton Health Commercial |
$1.16
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.24
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.05
|
| Rate for Payer: EmblemHealth Commercial |
$0.77
|
| Rate for Payer: Group Health Inc Commercial |
$0.77
|
| Rate for Payer: Group Health Inc Medicare |
$0.54
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.77
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.77
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.00
|
|
|
MORPHINE SULFATE 30 MG PO TABS
|
Facility
|
IP
|
$1.54
|
|
|
Service Code
|
NDC 0054023624
|
| Hospital Charge Code |
0054023624
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.77 |
| Max. Negotiated Rate |
$0.77 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.77
|
|
