IBUPROFEN 10 MG/ML INJ
|
Facility
|
IP
|
$1,016.00
|
|
Hospital Charge Code |
41654689
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$508.00 |
Max. Negotiated Rate |
$508.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$508.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$508.00
|
|
IBUPROFEN 10 MG/ML INJ
|
Facility
|
OP
|
$1,016.00
|
|
Hospital Charge Code |
41644689
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$355.60 |
Max. Negotiated Rate |
$660.40 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$558.80
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$508.00
|
Rate for Payer: Aetna Government |
$508.00
|
Rate for Payer: Brighton Health Commercial |
$609.60
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$508.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$584.20
|
Rate for Payer: Group Health Inc Commercial |
$508.00
|
Rate for Payer: Group Health Inc Medicare |
$355.60
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$508.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$508.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$660.40
|
|
IBUPROFEN 10 MG/ML INJ
|
Facility
|
IP
|
$1,016.00
|
|
Hospital Charge Code |
41644689
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$508.00 |
Max. Negotiated Rate |
$508.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$508.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$508.00
|
|
IBUPROFEN 10 MG/ML INJ
|
Facility
|
OP
|
$1,016.00
|
|
Hospital Charge Code |
41654689
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$355.60 |
Max. Negotiated Rate |
$660.40 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$558.80
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$508.00
|
Rate for Payer: Aetna Government |
$508.00
|
Rate for Payer: Brighton Health Commercial |
$609.60
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$508.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$584.20
|
Rate for Payer: Group Health Inc Commercial |
$508.00
|
Rate for Payer: Group Health Inc Medicare |
$355.60
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$508.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$508.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$660.40
|
|
IBUPROFEN 400 MG PO TABS [3843]
|
Facility
|
OP
|
$0.22
|
|
Service Code
|
NDC 00904585361
|
Hospital Charge Code |
00904585361
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$0.08 |
Max. Negotiated Rate |
$0.17 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.12
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.11
|
Rate for Payer: Aetna Government |
$0.11
|
Rate for Payer: Brighton Health Commercial |
$0.16
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.17
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.15
|
Rate for Payer: Group Health Inc Commercial |
$0.11
|
Rate for Payer: Group Health Inc Medicare |
$0.08
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.11
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$0.11
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.14
|
|
IBUPROFEN 400 MG PO TABS [3843]
|
Facility
|
OP
|
$0.37
|
|
Service Code
|
NDC 67877031901
|
Hospital Charge Code |
67877031901
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$0.13 |
Max. Negotiated Rate |
$0.29 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.20
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.18
|
Rate for Payer: Aetna Government |
$0.18
|
Rate for Payer: Brighton Health Commercial |
$0.27
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.29
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.25
|
Rate for Payer: Group Health Inc Commercial |
$0.18
|
Rate for Payer: Group Health Inc Medicare |
$0.13
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.18
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$0.18
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.24
|
|
IBUPROFEN 400 MG PO TABS [3843]
|
Facility
|
OP
|
$0.26
|
|
Service Code
|
NDC 60687044611
|
Hospital Charge Code |
60687044611
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$0.09 |
Max. Negotiated Rate |
$0.21 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.14
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.13
|
Rate for Payer: Aetna Government |
$0.13
|
Rate for Payer: Brighton Health Commercial |
$0.20
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.21
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.18
|
Rate for Payer: Group Health Inc Commercial |
$0.13
|
Rate for Payer: Group Health Inc Medicare |
$0.09
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.13
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$0.13
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.17
|
|
IBUPROFEN 400 MG PO TABS [3843]
|
Facility
|
OP
|
$0.34
|
|
Service Code
|
NDC 67877031905
|
Hospital Charge Code |
67877031905
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$0.12 |
Max. Negotiated Rate |
$0.27 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.19
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.17
|
Rate for Payer: Aetna Government |
$0.17
|
Rate for Payer: Brighton Health Commercial |
$0.26
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.27
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.23
|
Rate for Payer: Group Health Inc Commercial |
$0.17
|
Rate for Payer: Group Health Inc Medicare |
$0.12
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.17
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$0.17
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.22
|
|
IBUPROFEN 400 MG PO TABS [3843]
|
Facility
|
OP
|
$0.26
|
|
Service Code
|
NDC 60687044601
|
Hospital Charge Code |
60687044601
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$0.09 |
Max. Negotiated Rate |
$0.21 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.14
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.13
|
Rate for Payer: Aetna Government |
$0.13
|
Rate for Payer: Brighton Health Commercial |
$0.20
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.21
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.18
|
Rate for Payer: Group Health Inc Commercial |
$0.13
|
Rate for Payer: Group Health Inc Medicare |
$0.09
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.13
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$0.13
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.17
|
|
IBUPROFEN 400 MG TAB
|
Facility
|
OP
|
$1.00
|
|
Hospital Charge Code |
41653279
|
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: Brighton Health Commercial |
$0.75
|
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
|
|
IBUPROFEN 400 MG TAB
|
Facility
|
OP
|
$1.00
|
|
Hospital Charge Code |
41643279
|
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: Brighton Health Commercial |
$0.75
|
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
|
|
IBUPROFEN 600 MG PO TABS [3844]
|
Facility
|
OP
|
$0.53
|
|
Service Code
|
NDC 64380080807
|
Hospital Charge Code |
64380080807
|
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 |
$0.40
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.42
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.36
|
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
|
|
IBUPROFEN 600 MG PO TABS [3844]
|
Facility
|
OP
|
$0.31
|
|
Service Code
|
NDC 00904585461
|
Hospital Charge Code |
00904585461
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$0.11 |
Max. Negotiated Rate |
$0.24 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.17
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.15
|
Rate for Payer: Aetna Government |
$0.15
|
Rate for Payer: Brighton Health Commercial |
$0.23
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.24
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.21
|
Rate for Payer: Group Health Inc Commercial |
$0.15
|
Rate for Payer: Group Health Inc Medicare |
$0.11
|
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 |
$0.20
|
|
IBUPROFEN 600 MG PO TABS [3844]
|
Facility
|
OP
|
$0.53
|
|
Service Code
|
NDC 59651036105
|
Hospital Charge Code |
59651036105
|
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 |
$0.40
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.42
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.36
|
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
|
|
IBUPROFEN 600 MG PO TABS [3844]
|
Facility
|
OP
|
$0.52
|
|
Service Code
|
NDC 67877032001
|
Hospital Charge Code |
67877032001
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$0.18 |
Max. Negotiated Rate |
$0.41 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.28
|
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 |
$0.41
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.35
|
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 |
$0.33
|
|
IBUPROFEN 600 MG PO TABS [3844]
|
Facility
|
OP
|
$0.52
|
|
Service Code
|
NDC 67877032005
|
Hospital Charge Code |
67877032005
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$0.18 |
Max. Negotiated Rate |
$0.41 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.28
|
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 |
$0.41
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.35
|
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 |
$0.33
|
|
IBUPROFEN 600 MG PO TABS [3844]
|
Facility
|
OP
|
$0.55
|
|
Service Code
|
NDC 65162046550
|
Hospital Charge Code |
65162046550
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$0.19 |
Max. Negotiated Rate |
$0.44 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.30
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.27
|
Rate for Payer: Aetna Government |
$0.27
|
Rate for Payer: Brighton Health Commercial |
$0.41
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.44
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.37
|
Rate for Payer: Group Health Inc Commercial |
$0.27
|
Rate for Payer: Group Health Inc Medicare |
$0.19
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.27
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$0.27
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.36
|
|
IBUPROFEN 600 MG PO TABS [3844]
|
Facility
|
OP
|
$0.27
|
|
Service Code
|
NDC 00904585460
|
Hospital Charge Code |
00904585460
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$0.10 |
Max. Negotiated Rate |
$0.22 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.15
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.14
|
Rate for Payer: Aetna Government |
$0.14
|
Rate for Payer: Brighton Health Commercial |
$0.21
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.22
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.19
|
Rate for Payer: Group Health Inc Commercial |
$0.14
|
Rate for Payer: Group Health Inc Medicare |
$0.10
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.14
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$0.14
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.18
|
|
IBUPROFEN 600 MG PO TABS [3844]
|
Facility
|
OP
|
$0.36
|
|
Service Code
|
NDC 60687045701
|
Hospital Charge Code |
60687045701
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$0.13 |
Max. Negotiated Rate |
$0.29 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.20
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.18
|
Rate for Payer: Aetna Government |
$0.18
|
Rate for Payer: Brighton Health Commercial |
$0.27
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.29
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.25
|
Rate for Payer: Group Health Inc Commercial |
$0.18
|
Rate for Payer: Group Health Inc Medicare |
$0.13
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.18
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$0.18
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.24
|
|
IBUPROFEN 600 MG TAB
|
Facility
|
OP
|
$1.00
|
|
Hospital Charge Code |
41640276
|
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: Brighton Health Commercial |
$0.75
|
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
|
|
IBUPROFEN 600 MG TAB
|
Facility
|
OP
|
$1.00
|
|
Hospital Charge Code |
41650276
|
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: Brighton Health Commercial |
$0.75
|
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
|
|
IBUPROFEN 800MG/8ML INJ
|
Facility
|
IP
|
$8.14
|
|
Service Code
|
HCPCS J1741
|
Hospital Charge Code |
41657818
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$4.07 |
Max. Negotiated Rate |
$4.07 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.07
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$4.07
|
|
IBUPROFEN 800MG/8ML INJ
|
Facility
|
OP
|
$8.14
|
|
Service Code
|
HCPCS J1741
|
Hospital Charge Code |
41657818
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$1.98 |
Max. Negotiated Rate |
$5.29 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.48
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.98
|
Rate for Payer: Aetna Government |
$1.98
|
Rate for Payer: Brighton Health Commercial |
$4.88
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.07
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.68
|
Rate for Payer: Group Health Inc Commercial |
$4.07
|
Rate for Payer: Group Health Inc Medicare |
$2.85
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.07
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$4.07
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.29
|
|
IBUPROFEN 800 MG/8ML IV SOLN [108068]
|
Facility
|
OP
|
$3.70
|
|
Service Code
|
NDC 66220028708
|
Hospital Charge Code |
66220028708
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1.30 |
Max. Negotiated Rate |
$3.89 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.04
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.85
|
Rate for Payer: Aetna Government |
$1.85
|
Rate for Payer: Brighton Health Commercial |
$2.22
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.85
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.13
|
Rate for Payer: EmblemHealth Commercial |
$1.85
|
Rate for Payer: Fidelis Medicare Advantage |
$3.89
|
Rate for Payer: Group Health Inc Commercial |
$1.85
|
Rate for Payer: Group Health Inc Medicare |
$1.30
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.85
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1.85
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.41
|
|
IBUPROFEN 800 MG/8ML IV SOLN [108068]
|
Facility
|
IP
|
$3.70
|
|
Service Code
|
NDC 66220028708
|
Hospital Charge Code |
66220028708
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1.85 |
Max. Negotiated Rate |
$1.85 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.85
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1.85
|
|