INJ MORPHINE PRESERV FREE, 10MG
|
Facility
|
IP
|
$22.00
|
|
Service Code
|
HCPCS J2274
|
Hospital Charge Code |
41643567
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$11.00 |
Max. Negotiated Rate |
$11.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$11.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$11.00
|
|
INJ MORPHINE PRESERV FREE, 10MG
|
Facility
|
IP
|
$14.31
|
|
Service Code
|
HCPCS J2274
|
Hospital Charge Code |
41647074
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$7.16 |
Max. Negotiated Rate |
$7.16 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.16
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$7.16
|
|
INJ MORPHINE PRESERV FREE, 10MG
|
Facility
|
IP
|
$0.50
|
|
Service Code
|
HCPCS J2274
|
Hospital Charge Code |
41658456
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$0.25 |
Max. Negotiated Rate |
$0.25 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.25
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$0.25
|
|
INJ MORPHINE PRESERV FREE, 10MG
|
Facility
|
OP
|
$22.00
|
|
Service Code
|
HCPCS J2274
|
Hospital Charge Code |
41653567
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$7.70 |
Max. Negotiated Rate |
$15.30 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$12.10
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$11.08
|
Rate for Payer: Aetna Government |
$11.08
|
Rate for Payer: Brighton Health Commercial |
$13.20
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$11.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$12.65
|
Rate for Payer: Group Health Inc Commercial |
$11.00
|
Rate for Payer: Group Health Inc Medicare |
$7.70
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$11.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$11.00
|
Rate for Payer: SOMOS CHP/HARP/Medicaid |
$15.30
|
Rate for Payer: SOMOS Essential |
$15.30
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$14.30
|
|
INJ MORPHINE PRESERV FREE, 10MG
|
Facility
|
OP
|
$0.50
|
|
Service Code
|
HCPCS J2274
|
Hospital Charge Code |
41648456
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$0.18 |
Max. Negotiated Rate |
$15.30 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.28
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$11.08
|
Rate for Payer: Aetna Government |
$11.08
|
Rate for Payer: Brighton Health Commercial |
$0.30
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.25
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.29
|
Rate for Payer: Group Health Inc Commercial |
$0.25
|
Rate for Payer: Group Health Inc Medicare |
$0.18
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.25
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$0.25
|
Rate for Payer: SOMOS CHP/HARP/Medicaid |
$15.30
|
Rate for Payer: SOMOS Essential |
$15.30
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.33
|
|
INJ MORPHINE PRESERV FREE, 10MG
|
Facility
|
OP
|
$253.00
|
|
Service Code
|
HCPCS J2274
|
Hospital Charge Code |
41654966
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$11.08 |
Max. Negotiated Rate |
$164.45 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$139.15
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$11.08
|
Rate for Payer: Aetna Government |
$11.08
|
Rate for Payer: Brighton Health Commercial |
$151.80
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$126.50
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$145.48
|
Rate for Payer: Group Health Inc Commercial |
$126.50
|
Rate for Payer: Group Health Inc Medicare |
$88.55
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$126.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$126.50
|
Rate for Payer: SOMOS CHP/HARP/Medicaid |
$15.30
|
Rate for Payer: SOMOS Essential |
$15.30
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$164.45
|
|
INJ MORPHINE PRESERV FREE, 10MG
|
Facility
|
IP
|
$0.08
|
|
Service Code
|
HCPCS J2274
|
Hospital Charge Code |
41655450
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$0.04 |
Max. Negotiated Rate |
$0.04 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.04
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$0.04
|
|
INJ MORPHINE PRESERV FREE, 10MG
|
Facility
|
IP
|
$0.50
|
|
Service Code
|
HCPCS J2274
|
Hospital Charge Code |
41648456
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$0.25 |
Max. Negotiated Rate |
$0.25 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.25
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$0.25
|
|
INJ MORPHINE PRESERV FREE, 10MG
|
Facility
|
OP
|
$21.00
|
|
Service Code
|
HCPCS J2274
|
Hospital Charge Code |
41656025
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$7.35 |
Max. Negotiated Rate |
$15.30 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$11.55
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$11.08
|
Rate for Payer: Aetna Government |
$11.08
|
Rate for Payer: Brighton Health Commercial |
$12.60
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$10.50
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$12.08
|
Rate for Payer: Group Health Inc Commercial |
$10.50
|
Rate for Payer: Group Health Inc Medicare |
$7.35
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$10.50
|
Rate for Payer: SOMOS CHP/HARP/Medicaid |
$15.30
|
Rate for Payer: SOMOS Essential |
$15.30
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$13.65
|
|
INJ MORPHINE PRESERV FREE, 10MG
|
Facility
|
OP
|
$3.00
|
|
Service Code
|
HCPCS J2274
|
Hospital Charge Code |
41657077
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$1.05 |
Max. Negotiated Rate |
$15.30 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.65
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$11.08
|
Rate for Payer: Aetna Government |
$11.08
|
Rate for Payer: Brighton Health Commercial |
$1.80
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.50
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.72
|
Rate for Payer: Group Health Inc Commercial |
$1.50
|
Rate for Payer: Group Health Inc Medicare |
$1.05
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1.50
|
Rate for Payer: SOMOS CHP/HARP/Medicaid |
$15.30
|
Rate for Payer: SOMOS Essential |
$15.30
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.95
|
|
INJ MORPHINE PRESERV FREE, 10MG
|
Facility
|
IP
|
$21.00
|
|
Service Code
|
HCPCS J2274
|
Hospital Charge Code |
41656025
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$10.50 |
Max. Negotiated Rate |
$10.50 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$10.50
|
|
INJ MORPHINE PRESERV FREE, 10MG
|
Facility
|
IP
|
$14.31
|
|
Service Code
|
HCPCS J2274
|
Hospital Charge Code |
41657074
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$7.16 |
Max. Negotiated Rate |
$7.16 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.16
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$7.16
|
|
INJ MORPHINE PRESERV FREE, 10MG
|
Facility
|
OP
|
$14.31
|
|
Service Code
|
HCPCS J2274
|
Hospital Charge Code |
41657074
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$5.01 |
Max. Negotiated Rate |
$15.30 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.87
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$11.08
|
Rate for Payer: Aetna Government |
$11.08
|
Rate for Payer: Brighton Health Commercial |
$8.59
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7.16
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$8.23
|
Rate for Payer: Group Health Inc Commercial |
$7.16
|
Rate for Payer: Group Health Inc Medicare |
$5.01
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.16
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$7.16
|
Rate for Payer: SOMOS CHP/HARP/Medicaid |
$15.30
|
Rate for Payer: SOMOS Essential |
$15.30
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$9.30
|
|
INJ MORPHINE PRSERV FREE, 10MG
|
Facility
|
IP
|
$253.00
|
|
Service Code
|
HCPCS J2274
|
Hospital Charge Code |
41644966
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$126.50 |
Max. Negotiated Rate |
$126.50 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$126.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$126.50
|
|
INJ MORPHINE PRSERV FREE, 10MG
|
Facility
|
OP
|
$0.08
|
|
Service Code
|
HCPCS J2274
|
Hospital Charge Code |
41645450
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$0.03 |
Max. Negotiated Rate |
$15.30 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.04
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$11.08
|
Rate for Payer: Aetna Government |
$11.08
|
Rate for Payer: Brighton Health Commercial |
$0.05
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.04
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.05
|
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: SOMOS CHP/HARP/Medicaid |
$15.30
|
Rate for Payer: SOMOS Essential |
$15.30
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.05
|
|
INJ MORPHINE PRSERV FREE, 10MG
|
Facility
|
OP
|
$253.00
|
|
Service Code
|
HCPCS J2274
|
Hospital Charge Code |
41644966
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$11.08 |
Max. Negotiated Rate |
$164.45 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$139.15
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$11.08
|
Rate for Payer: Aetna Government |
$11.08
|
Rate for Payer: Brighton Health Commercial |
$151.80
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$126.50
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$145.48
|
Rate for Payer: Group Health Inc Commercial |
$126.50
|
Rate for Payer: Group Health Inc Medicare |
$88.55
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$126.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$126.50
|
Rate for Payer: SOMOS CHP/HARP/Medicaid |
$15.30
|
Rate for Payer: SOMOS Essential |
$15.30
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$164.45
|
|
INJ MORPHINE PRSERV FREE, 10MG
|
Facility
|
IP
|
$0.08
|
|
Service Code
|
HCPCS J2274
|
Hospital Charge Code |
41645450
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$0.04 |
Max. Negotiated Rate |
$0.04 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.04
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$0.04
|
|
INJ MORPHINE SULFATE, UP TO 10MG
|
Facility
|
IP
|
$15.00
|
|
Service Code
|
HCPCS J2270
|
Hospital Charge Code |
41655603
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$7.50 |
Max. Negotiated Rate |
$7.50 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$7.50
|
|
INJ MORPHINE SULFATE, UP TO 10MG
|
Facility
|
IP
|
$15.00
|
|
Service Code
|
HCPCS J2270
|
Hospital Charge Code |
41645603
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$7.50 |
Max. Negotiated Rate |
$7.50 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$7.50
|
|
INJ MORPHINE SULFATE, UP TO 10MG
|
Facility
|
OP
|
$15.00
|
|
Service Code
|
HCPCS J2270
|
Hospital Charge Code |
41645603
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$3.39 |
Max. Negotiated Rate |
$9.75 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$8.25
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.39
|
Rate for Payer: Aetna Government |
$3.39
|
Rate for Payer: Brighton Health Commercial |
$9.00
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7.50
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$8.62
|
Rate for Payer: Group Health Inc Commercial |
$7.50
|
Rate for Payer: Group Health Inc Medicare |
$5.25
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$7.50
|
Rate for Payer: SOMOS CHP/HARP/Medicaid |
$4.72
|
Rate for Payer: SOMOS Essential |
$4.72
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$9.75
|
|
INJ MORPHINE SULFATE, UP TO 10MG
|
Facility
|
OP
|
$11.75
|
|
Service Code
|
HCPCS J2270
|
Hospital Charge Code |
41647002
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$3.39 |
Max. Negotiated Rate |
$7.64 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.46
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.39
|
Rate for Payer: Aetna Government |
$3.39
|
Rate for Payer: Brighton Health Commercial |
$7.05
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5.88
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.76
|
Rate for Payer: Group Health Inc Commercial |
$5.88
|
Rate for Payer: Group Health Inc Medicare |
$4.11
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.88
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$5.88
|
Rate for Payer: SOMOS CHP/HARP/Medicaid |
$4.72
|
Rate for Payer: SOMOS Essential |
$4.72
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$7.64
|
|
INJ MORPHINE SULFATE, UP TO 10MG
|
Facility
|
OP
|
$15.00
|
|
Service Code
|
HCPCS J2270
|
Hospital Charge Code |
41655603
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$3.39 |
Max. Negotiated Rate |
$9.75 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$8.25
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.39
|
Rate for Payer: Aetna Government |
$3.39
|
Rate for Payer: Brighton Health Commercial |
$9.00
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7.50
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$8.62
|
Rate for Payer: Group Health Inc Commercial |
$7.50
|
Rate for Payer: Group Health Inc Medicare |
$5.25
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$7.50
|
Rate for Payer: SOMOS CHP/HARP/Medicaid |
$4.72
|
Rate for Payer: SOMOS Essential |
$4.72
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$9.75
|
|
INJ MORPHINE SULFATE, UP TO 10MG
|
Facility
|
IP
|
$11.75
|
|
Service Code
|
HCPCS J2270
|
Hospital Charge Code |
41647002
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$5.88 |
Max. Negotiated Rate |
$5.88 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.88
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$5.88
|
|
INJ PACLITAXEL, 1 MG
|
Facility
|
IP
|
$9.73
|
|
Service Code
|
HCPCS J9267
|
Hospital Charge Code |
41642882
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$4.86 |
Max. Negotiated Rate |
$4.86 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.86
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$4.86
|
|
INJ PACLITAXEL, 1 MG
|
Facility
|
OP
|
$9.73
|
|
Service Code
|
HCPCS J9267
|
Hospital Charge Code |
41642882
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$0.11 |
Max. Negotiated Rate |
$6.32 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.35
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.13
|
Rate for Payer: Aetna Government |
$0.13
|
Rate for Payer: Brighton Health Commercial |
$5.84
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.86
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.59
|
Rate for Payer: Group Health Inc Commercial |
$4.86
|
Rate for Payer: Group Health Inc Medicare |
$3.41
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.86
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$4.86
|
Rate for Payer: SOMOS CHP/HARP/Medicaid |
$0.11
|
Rate for Payer: SOMOS Essential |
$0.11
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6.32
|
|