|
IPILIMUMAB 200 MG/40ML IV SOLN [108956]
|
Facility
|
OP
|
$1,023.90
|
|
|
Service Code
|
HCPCS J9228
|
| Hospital Charge Code |
00003232822
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$137.94 |
| Max. Negotiated Rate |
$665.53 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$563.14
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$172.42
|
| Rate for Payer: Aetna Government |
$172.42
|
| Rate for Payer: Brighton Health Commercial |
$614.34
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$172.42
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$511.95
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$588.74
|
| Rate for Payer: Elderplan Medicare Advantage |
$172.42
|
| Rate for Payer: EmblemHealth Commercial |
$511.95
|
| Rate for Payer: Fidelis Medicare Advantage |
$172.42
|
| Rate for Payer: Group Health Inc Commercial |
$172.42
|
| Rate for Payer: Group Health Inc Medicare |
$172.42
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$511.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$511.95
|
| Rate for Payer: Healthfirst Medicare Advantage |
$146.56
|
| Rate for Payer: Healthfirst QHP |
$172.42
|
| Rate for Payer: Humana Medicare |
$175.87
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$172.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$172.42
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$665.53
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$137.94
|
|
|
IPILIMUMAB 200 MG/40ML IV SOLN [108956]
|
Facility
|
IP
|
$1,023.90
|
|
|
Service Code
|
HCPCS J9228
|
| Hospital Charge Code |
00003232822
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$511.95 |
| Max. Negotiated Rate |
$511.95 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$511.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$511.95
|
|
|
IPILIMUMAB 50 MG/10ML IV SOLN [108955]
|
Facility
|
OP
|
$1,023.90
|
|
|
Service Code
|
HCPCS J9228
|
| Hospital Charge Code |
00003232711
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$137.94 |
| Max. Negotiated Rate |
$665.53 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$563.14
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$172.42
|
| Rate for Payer: Aetna Government |
$172.42
|
| Rate for Payer: Brighton Health Commercial |
$614.34
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$172.42
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$511.95
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$588.74
|
| Rate for Payer: Elderplan Medicare Advantage |
$172.42
|
| Rate for Payer: EmblemHealth Commercial |
$511.95
|
| Rate for Payer: Fidelis Medicare Advantage |
$172.42
|
| Rate for Payer: Group Health Inc Commercial |
$172.42
|
| Rate for Payer: Group Health Inc Medicare |
$172.42
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$511.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$511.95
|
| Rate for Payer: Healthfirst Medicare Advantage |
$146.56
|
| Rate for Payer: Healthfirst QHP |
$172.42
|
| Rate for Payer: Humana Medicare |
$175.87
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$172.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$172.42
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$665.53
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$137.94
|
|
|
IPILIMUMAB 50 MG/10ML IV SOLN [108955]
|
Facility
|
IP
|
$1,023.90
|
|
|
Service Code
|
HCPCS J9228
|
| Hospital Charge Code |
00003232711
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$511.95 |
| Max. Negotiated Rate |
$511.95 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$511.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$511.95
|
|
|
IPOL .5 ML/DOSE
|
Facility
|
OP
|
$106.00
|
|
| Hospital Charge Code |
41647156
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$37.10 |
| Max. Negotiated Rate |
$84.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$58.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$53.00
|
| Rate for Payer: Aetna Government |
$53.00
|
| Rate for Payer: Brighton Health Commercial |
$79.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$84.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$72.08
|
| Rate for Payer: Group Health Inc Commercial |
$53.00
|
| Rate for Payer: Group Health Inc Medicare |
$37.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$53.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$53.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$68.90
|
|
|
IPOL .5 ML/DOSE
|
Facility
|
OP
|
$106.00
|
|
| Hospital Charge Code |
41657156
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$37.10 |
| Max. Negotiated Rate |
$84.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$58.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$53.00
|
| Rate for Payer: Aetna Government |
$53.00
|
| Rate for Payer: Brighton Health Commercial |
$79.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$84.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$72.08
|
| Rate for Payer: Group Health Inc Commercial |
$53.00
|
| Rate for Payer: Group Health Inc Medicare |
$37.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$53.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$53.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$68.90
|
|
|
IPRATROPIUM 0.5 MG/2.5 ML NEB SOLN
|
Facility
|
OP
|
$0.33
|
|
|
Service Code
|
HCPCS J7644
|
| Hospital Charge Code |
41653718
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.35 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.18
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.20
|
| Rate for Payer: Aetna Government |
$0.20
|
| Rate for Payer: Brighton Health Commercial |
$0.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.17
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.19
|
| 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: SOMOS CHP/HARP/Medicaid |
$0.35
|
| Rate for Payer: SOMOS Essential |
$0.35
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.21
|
|
|
IPRATROPIUM 0.5 MG/2.5 ML NEB SOLN
|
Facility
|
IP
|
$0.33
|
|
|
Service Code
|
HCPCS J7644
|
| Hospital Charge Code |
41643718
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.17 |
| Max. Negotiated Rate |
$0.17 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.17
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.17
|
|
|
IPRATROPIUM 0.5 MG/2.5 ML NEB SOLN
|
Facility
|
OP
|
$0.33
|
|
|
Service Code
|
HCPCS J7644
|
| Hospital Charge Code |
41643718
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.35 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.18
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.20
|
| Rate for Payer: Aetna Government |
$0.20
|
| Rate for Payer: Brighton Health Commercial |
$0.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.17
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.19
|
| 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: SOMOS CHP/HARP/Medicaid |
$0.35
|
| Rate for Payer: SOMOS Essential |
$0.35
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.21
|
|
|
IPRATROPIUM 0.5 MG/2.5 ML NEB SOLN
|
Facility
|
IP
|
$0.33
|
|
|
Service Code
|
HCPCS J7644
|
| Hospital Charge Code |
41653718
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.17 |
| Max. Negotiated Rate |
$0.17 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.17
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.17
|
|
|
IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN [93931]
|
Facility
|
OP
|
$0.73
|
|
|
Service Code
|
HCPCS J7620
|
| Hospital Charge Code |
69097084087
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.58 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.12
|
| Rate for Payer: Aetna Government |
$0.12
|
| Rate for Payer: Brighton Health Commercial |
$0.55
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.58
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.50
|
| Rate for Payer: Group Health Inc Commercial |
$0.37
|
| Rate for Payer: Group Health Inc Medicare |
$0.26
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.37
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.37
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$0.20
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$0.21
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$0.21
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$0.21
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.47
|
|
|
IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN [93931]
|
Facility
|
OP
|
$0.73
|
|
|
Service Code
|
HCPCS J7620
|
| Hospital Charge Code |
69097017353
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.58 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.12
|
| Rate for Payer: Aetna Government |
$0.12
|
| Rate for Payer: Brighton Health Commercial |
$0.55
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.58
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.50
|
| Rate for Payer: Group Health Inc Commercial |
$0.37
|
| Rate for Payer: Group Health Inc Medicare |
$0.26
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.37
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.37
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$0.20
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$0.21
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$0.21
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$0.21
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.47
|
|
|
IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN [93931]
|
Facility
|
OP
|
$0.77
|
|
|
Service Code
|
HCPCS J7620
|
| Hospital Charge Code |
00378967193
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.61 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.42
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.12
|
| Rate for Payer: Aetna Government |
$0.12
|
| Rate for Payer: Brighton Health Commercial |
$0.58
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.61
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.52
|
| Rate for Payer: Group Health Inc Commercial |
$0.38
|
| Rate for Payer: Group Health Inc Medicare |
$0.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.38
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$0.20
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$0.21
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$0.21
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$0.21
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.50
|
|
|
IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN [93931]
|
Facility
|
OP
|
$0.73
|
|
|
Service Code
|
HCPCS J7620
|
| Hospital Charge Code |
47335075649
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.58 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.12
|
| Rate for Payer: Aetna Government |
$0.12
|
| Rate for Payer: Brighton Health Commercial |
$0.55
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.58
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.50
|
| Rate for Payer: Group Health Inc Commercial |
$0.36
|
| Rate for Payer: Group Health Inc Medicare |
$0.26
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.36
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$0.20
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$0.21
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$0.21
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$0.21
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.47
|
|
|
IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN [93931]
|
Facility
|
OP
|
$0.73
|
|
|
Service Code
|
HCPCS J7620
|
| Hospital Charge Code |
76204060060
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.58 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.12
|
| Rate for Payer: Aetna Government |
$0.12
|
| Rate for Payer: Brighton Health Commercial |
$0.55
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.58
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.50
|
| Rate for Payer: Group Health Inc Commercial |
$0.36
|
| Rate for Payer: Group Health Inc Medicare |
$0.26
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.36
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$0.20
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$0.21
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$0.21
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$0.21
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.47
|
|
|
IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN [93931]
|
Facility
|
OP
|
$0.70
|
|
|
Service Code
|
HCPCS J7620
|
| Hospital Charge Code |
69097017364
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.56 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.39
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.12
|
| Rate for Payer: Aetna Government |
$0.12
|
| Rate for Payer: Brighton Health Commercial |
$0.53
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.56
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.48
|
| Rate for Payer: Group Health Inc Commercial |
$0.35
|
| Rate for Payer: Group Health Inc Medicare |
$0.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.35
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$0.20
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$0.21
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$0.21
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$0.21
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.46
|
|
|
IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN [93931]
|
Facility
|
OP
|
$0.26
|
|
|
Service Code
|
HCPCS J7620
|
| Hospital Charge Code |
60687040583
|
|
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 |
$0.12
|
| Rate for Payer: Aetna Government |
$0.12
|
| 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: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$0.20
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$0.21
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$0.21
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$0.21
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.17
|
|
|
IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN [93931]
|
Facility
|
OP
|
$0.77
|
|
|
Service Code
|
HCPCS J7620
|
| Hospital Charge Code |
76204060001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.61 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.42
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.12
|
| Rate for Payer: Aetna Government |
$0.12
|
| Rate for Payer: Brighton Health Commercial |
$0.57
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.61
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.52
|
| Rate for Payer: Group Health Inc Commercial |
$0.38
|
| Rate for Payer: Group Health Inc Medicare |
$0.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.38
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$0.20
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$0.21
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$0.21
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$0.21
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.50
|
|
|
IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN [93931]
|
Facility
|
OP
|
$0.73
|
|
|
Service Code
|
HCPCS J7620
|
| Hospital Charge Code |
76204060030
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.58 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.12
|
| Rate for Payer: Aetna Government |
$0.12
|
| Rate for Payer: Brighton Health Commercial |
$0.55
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.58
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.50
|
| Rate for Payer: Group Health Inc Commercial |
$0.36
|
| Rate for Payer: Group Health Inc Medicare |
$0.26
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.36
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$0.20
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$0.21
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$0.21
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$0.21
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.47
|
|
|
IPRATROPIUM BROMIDE 0.02 % IN SOLN [12580]
|
Facility
|
OP
|
$0.74
|
|
|
Service Code
|
HCPCS J7644
|
| Hospital Charge Code |
76204010001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$0.59 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.41
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.20
|
| Rate for Payer: Aetna Government |
$0.20
|
| Rate for Payer: Brighton Health Commercial |
$0.55
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.59
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.50
|
| Rate for Payer: Group Health Inc Commercial |
$0.37
|
| Rate for Payer: Group Health Inc Medicare |
$0.26
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.37
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.37
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$0.33
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$0.35
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$0.35
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$0.35
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.48
|
|
|
IPRATROPIUM BROMIDE 0.02 % IN SOLN [12580]
|
Facility
|
OP
|
$0.70
|
|
|
Service Code
|
HCPCS J7644
|
| Hospital Charge Code |
76204010030
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$0.56 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.39
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.20
|
| Rate for Payer: Aetna Government |
$0.20
|
| Rate for Payer: Brighton Health Commercial |
$0.53
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.56
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.48
|
| Rate for Payer: Group Health Inc Commercial |
$0.35
|
| Rate for Payer: Group Health Inc Medicare |
$0.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.35
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$0.33
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$0.35
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$0.35
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$0.35
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.46
|
|
|
IPRATROPIUM BROMIDE 0.02 % IN SOLN [12580]
|
Facility
|
OP
|
$0.14
|
|
|
Service Code
|
HCPCS J7644
|
| Hospital Charge Code |
00487980101
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.35 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.08
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.20
|
| Rate for Payer: Aetna Government |
$0.20
|
| Rate for Payer: Brighton Health Commercial |
$0.11
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.12
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.10
|
| Rate for Payer: Group Health Inc Commercial |
$0.07
|
| Rate for Payer: Group Health Inc Medicare |
$0.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.07
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.07
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$0.33
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$0.35
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$0.35
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$0.35
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.09
|
|
|
IPRATROPIUM BROMIDE 0.02 % IN SOLN [12580]
|
Facility
|
OP
|
$0.76
|
|
|
Service Code
|
HCPCS J7644
|
| Hospital Charge Code |
00378797091
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$0.61 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.42
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.20
|
| Rate for Payer: Aetna Government |
$0.20
|
| Rate for Payer: Brighton Health Commercial |
$0.57
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.61
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.52
|
| Rate for Payer: Group Health Inc Commercial |
$0.38
|
| Rate for Payer: Group Health Inc Medicare |
$0.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.38
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$0.33
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$0.35
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$0.35
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$0.35
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.49
|
|
|
IPRATROPIUM BROMIDE 0.02 % IN SOLN [12580]
|
Facility
|
OP
|
$0.76
|
|
|
Service Code
|
HCPCS J7644
|
| Hospital Charge Code |
00378797093
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$0.61 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.42
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.20
|
| Rate for Payer: Aetna Government |
$0.20
|
| Rate for Payer: Brighton Health Commercial |
$0.57
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.61
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.52
|
| Rate for Payer: Group Health Inc Commercial |
$0.38
|
| Rate for Payer: Group Health Inc Medicare |
$0.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.38
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$0.33
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$0.35
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$0.35
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$0.35
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.49
|
|
|
IPRATROPIUM BROMIDE 0.02 % IN SOLN [12580]
|
Facility
|
OP
|
$0.90
|
|
|
Service Code
|
HCPCS J7644
|
| Hospital Charge Code |
00378797055
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$0.72 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.49
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.20
|
| Rate for Payer: Aetna Government |
$0.20
|
| Rate for Payer: Brighton Health Commercial |
$0.67
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.72
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.61
|
| Rate for Payer: Group Health Inc Commercial |
$0.45
|
| Rate for Payer: Group Health Inc Medicare |
$0.31
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.45
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.45
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$0.33
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$0.35
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$0.35
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$0.35
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.58
|
|
