|
MORPHINE SULFATE ER 30 MG PO TBCR
|
Facility
|
IP
|
$0.64
|
|
|
Service Code
|
NDC 4285880201
|
| Hospital Charge Code |
4285880201
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$0.32 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.32
|
|
|
MORPHINE SULFATE ER 60 MG PO TBCR
|
Facility
|
OP
|
$3.39
|
|
|
Service Code
|
NDC 0904655961
|
| Hospital Charge Code |
0904655961
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.19 |
| Max. Negotiated Rate |
$2.71 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.87
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.70
|
| Rate for Payer: Aetna Government |
$1.70
|
| Rate for Payer: Brighton Health Commercial |
$2.54
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.71
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.31
|
| Rate for Payer: EmblemHealth Commercial |
$1.70
|
| Rate for Payer: Group Health Inc Commercial |
$1.70
|
| Rate for Payer: Group Health Inc Medicare |
$1.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.70
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.70
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.20
|
|
|
MORPHINE SULFATE ER 60 MG PO TBCR
|
Facility
|
IP
|
$1.05
|
|
|
Service Code
|
NDC 4285880301
|
| Hospital Charge Code |
4285880301
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.52 |
| Max. Negotiated Rate |
$0.52 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.52
|
|
|
MORPHINE SULFATE ER 60 MG PO TBCR
|
Facility
|
IP
|
$3.39
|
|
|
Service Code
|
NDC 0904655961
|
| Hospital Charge Code |
0904655961
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.70 |
| Max. Negotiated Rate |
$1.70 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.70
|
|
|
MORPHINE SULFATE ER 60 MG PO TBCR
|
Facility
|
OP
|
$1.05
|
|
|
Service Code
|
NDC 4285880301
|
| Hospital Charge Code |
4285880301
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.37 |
| Max. Negotiated Rate |
$0.84 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.58
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.52
|
| Rate for Payer: Aetna Government |
$0.52
|
| Rate for Payer: Brighton Health Commercial |
$0.79
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.84
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.71
|
| Rate for Payer: EmblemHealth Commercial |
$0.52
|
| Rate for Payer: Group Health Inc Commercial |
$0.52
|
| Rate for Payer: Group Health Inc Medicare |
$0.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.68
|
|
|
MORPHINE SULFATE-NACL 100-0.9 MG/100ML-% IV SOLN
|
Facility
|
OP
|
$0.18
|
|
|
Service Code
|
NDC 9999123436
|
| Hospital Charge Code |
9999123436
|
|
Hospital Revenue Code
|
258
|
| 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-NACL 100-0.9 MG/100ML-% IV SOLN
|
Facility
|
IP
|
$0.18
|
|
|
Service Code
|
NDC 9999123436
|
| Hospital Charge Code |
9999123436
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.09 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.09
|
|
|
MORPHINE SULFATE PCA 100 MG/100 ML NACL
|
Facility
|
IP
|
$0.18
|
|
|
Service Code
|
NDC 9999123436
|
| Hospital Charge Code |
9999123436
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.09 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.09
|
|
|
MORPHINE SULFATE PCA 100 MG/100 ML NACL
|
Facility
|
OP
|
$0.18
|
|
|
Service Code
|
NDC 9999123436
|
| Hospital Charge Code |
9999123436
|
|
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 PCA 100 MG/100 ML (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 SULFATE PCA 100 MG/100 ML (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 PCA 1 MG/ML - COMPOUNDED
|
Facility
|
OP
|
$4.45
|
|
|
Service Code
|
HCPCS J2270
|
| Hospital Charge Code |
70092113343
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.56 |
| Max. Negotiated Rate |
$3.56 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.44
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.39
|
| Rate for Payer: Aetna Government |
$3.39
|
| Rate for Payer: Brighton Health Commercial |
$3.33
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.56
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.02
|
| Rate for Payer: EmblemHealth Commercial |
$2.22
|
| Rate for Payer: Group Health Inc Commercial |
$2.22
|
| Rate for Payer: Group Health Inc Medicare |
$1.56
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.22
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2.18
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.89
|
|
|
MORPHINE SULFATE PCA 1 MG/ML - COMPOUNDED
|
Facility
|
IP
|
$4.45
|
|
|
Service Code
|
HCPCS J2270
|
| Hospital Charge Code |
70092113343
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.22 |
| Max. Negotiated Rate |
$2.22 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.22
|
|
|
MORPHINE SULFATE (PF) 0.5 MG/ML IJ SOLN
|
Facility
|
OP
|
$0.99
|
|
|
Service Code
|
HCPCS J2274
|
| Hospital Charge Code |
0409381412
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$12.06 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.54
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$11.08
|
| Rate for Payer: Aetna Government |
$11.08
|
| Rate for Payer: Brighton Health Commercial |
$0.74
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.79
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.67
|
| Rate for Payer: EmblemHealth Commercial |
$0.49
|
| Rate for Payer: Group Health Inc Commercial |
$0.49
|
| Rate for Payer: Group Health Inc Medicare |
$0.35
|
| 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 |
$12.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.64
|
|
|
MORPHINE SULFATE (PF) 0.5 MG/ML IJ SOLN
|
Facility
|
OP
|
$0.99
|
|
|
Service Code
|
HCPCS J2274
|
| Hospital Charge Code |
0409381411
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$12.06 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.54
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$11.08
|
| Rate for Payer: Aetna Government |
$11.08
|
| Rate for Payer: Brighton Health Commercial |
$0.74
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.79
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.67
|
| Rate for Payer: EmblemHealth Commercial |
$0.49
|
| Rate for Payer: Group Health Inc Commercial |
$0.49
|
| Rate for Payer: Group Health Inc Medicare |
$0.35
|
| 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 |
$12.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.64
|
|
|
MORPHINE SULFATE (PF) 0.5 MG/ML IJ SOLN
|
Facility
|
IP
|
$0.99
|
|
|
Service Code
|
HCPCS J2274
|
| Hospital Charge Code |
0409381412
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.49 |
| Max. Negotiated Rate |
$0.49 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.49
|
|
|
MORPHINE SULFATE (PF) 0.5 MG/ML IJ SOLN
|
Facility
|
IP
|
$0.99
|
|
|
Service Code
|
HCPCS J2274
|
| Hospital Charge Code |
0409381411
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.49 |
| Max. Negotiated Rate |
$0.49 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.49
|
|
|
MORPHINE SULFATE (PF) 1 MG/ML IJ SOLN
|
Facility
|
OP
|
$1.09
|
|
|
Service Code
|
HCPCS J2274
|
| Hospital Charge Code |
0409381512
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.38 |
| Max. Negotiated Rate |
$12.06 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$11.08
|
| Rate for Payer: Aetna Government |
$11.08
|
| Rate for Payer: Brighton Health Commercial |
$0.82
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.87
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.74
|
| Rate for Payer: EmblemHealth Commercial |
$0.55
|
| Rate for Payer: Group Health Inc Commercial |
$0.55
|
| Rate for Payer: Group Health Inc Medicare |
$0.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.55
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.55
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$12.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.71
|
|
|
MORPHINE SULFATE (PF) 1 MG/ML IJ SOLN
|
Facility
|
IP
|
$1.09
|
|
|
Service Code
|
HCPCS J2274
|
| Hospital Charge Code |
0409381511
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.55 |
| Max. Negotiated Rate |
$0.55 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.55
|
|
|
MORPHINE SULFATE (PF) 1 MG/ML IJ SOLN
|
Facility
|
IP
|
$3.48
|
|
|
Service Code
|
HCPCS J2274
|
| Hospital Charge Code |
0641601901
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.74 |
| Max. Negotiated Rate |
$1.74 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.74
|
|
|
MORPHINE SULFATE (PF) 1 MG/ML IJ SOLN
|
Facility
|
OP
|
$1.09
|
|
|
Service Code
|
HCPCS J2274
|
| Hospital Charge Code |
0409381511
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.38 |
| Max. Negotiated Rate |
$12.06 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$11.08
|
| Rate for Payer: Aetna Government |
$11.08
|
| Rate for Payer: Brighton Health Commercial |
$0.82
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.87
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.74
|
| Rate for Payer: EmblemHealth Commercial |
$0.55
|
| Rate for Payer: Group Health Inc Commercial |
$0.55
|
| Rate for Payer: Group Health Inc Medicare |
$0.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.55
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.55
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$12.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.71
|
|
|
MORPHINE SULFATE (PF) 1 MG/ML IJ SOLN
|
Facility
|
IP
|
$1.09
|
|
|
Service Code
|
HCPCS J2274
|
| Hospital Charge Code |
0409381512
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.55 |
| Max. Negotiated Rate |
$0.55 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.55
|
|
|
MORPHINE SULFATE (PF) 1 MG/ML IJ SOLN
|
Facility
|
OP
|
$3.48
|
|
|
Service Code
|
HCPCS J2274
|
| Hospital Charge Code |
0641601901
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.22 |
| Max. Negotiated Rate |
$12.06 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.91
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$11.08
|
| Rate for Payer: Aetna Government |
$11.08
|
| Rate for Payer: Brighton Health Commercial |
$2.61
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.78
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.36
|
| Rate for Payer: EmblemHealth Commercial |
$1.74
|
| Rate for Payer: Group Health Inc Commercial |
$1.74
|
| Rate for Payer: Group Health Inc Medicare |
$1.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.74
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$12.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.26
|
|
|
MORPHINE SULFATE (PF) 2 MG/ML IV SOLN
|
Facility
|
IP
|
$5.14
|
|
|
Service Code
|
HCPCS J2270
|
| Hospital Charge Code |
0409189023
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$2.57 |
| Max. Negotiated Rate |
$2.57 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.57
|
|
|
MORPHINE SULFATE (PF) 2 MG/ML IV SOLN
|
Facility
|
IP
|
$5.19
|
|
|
Service Code
|
HCPCS J2270
|
| Hospital Charge Code |
0641619110
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$2.59 |
| Max. Negotiated Rate |
$2.59 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.59
|
|
