|
MEASLES, MUMPS & RUBELLA VAC IJ SOLR [168883]
|
Facility
|
OP
|
$110.54
|
|
|
Service Code
|
HCPCS 90710
|
| Hospital Charge Code |
00006468101
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$55.27 |
| Max. Negotiated Rate |
$164.27 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$60.80
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$161.05
|
| Rate for Payer: Aetna Government |
$161.05
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$112.74
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$112.74
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$112.74
|
| Rate for Payer: Brighton Health Commercial |
$82.91
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$161.05
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$88.43
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$75.17
|
| Rate for Payer: Elderplan Medicare Advantage |
$161.05
|
| Rate for Payer: EmblemHealth Commercial |
$161.05
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$136.89
|
| Rate for Payer: Fidelis Essential Plan QHP |
$143.33
|
| Rate for Payer: Fidelis Medicare Advantage |
$161.05
|
| Rate for Payer: Fidelis Qualified Health Plan |
$143.33
|
| Rate for Payer: Group Health Inc Commercial |
$161.05
|
| Rate for Payer: Group Health Inc Medicare |
$161.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$55.27
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$161.05
|
| Rate for Payer: Healthfirst Medicare Advantage |
$136.89
|
| Rate for Payer: Healthfirst QHP |
$161.05
|
| Rate for Payer: Humana Medicare |
$164.27
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$161.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$161.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$71.85
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$128.84
|
| Rate for Payer: Wellcare Medicare |
$153.00
|
|
|
MEASLES, MUMPS & RUBELLA VAC IJ SOLR [168883]
|
Facility
|
OP
|
$110.54
|
|
|
Service Code
|
HCPCS 90710
|
| Hospital Charge Code |
00006468100
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$55.27 |
| Max. Negotiated Rate |
$164.27 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$60.80
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$161.05
|
| Rate for Payer: Aetna Government |
$161.05
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$112.74
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$112.74
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$112.74
|
| Rate for Payer: Brighton Health Commercial |
$82.91
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$161.05
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$88.43
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$75.17
|
| Rate for Payer: Elderplan Medicare Advantage |
$161.05
|
| Rate for Payer: EmblemHealth Commercial |
$161.05
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$136.89
|
| Rate for Payer: Fidelis Essential Plan QHP |
$143.33
|
| Rate for Payer: Fidelis Medicare Advantage |
$161.05
|
| Rate for Payer: Fidelis Qualified Health Plan |
$143.33
|
| Rate for Payer: Group Health Inc Commercial |
$161.05
|
| Rate for Payer: Group Health Inc Medicare |
$161.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$55.27
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$161.05
|
| Rate for Payer: Healthfirst Medicare Advantage |
$136.89
|
| Rate for Payer: Healthfirst QHP |
$161.05
|
| Rate for Payer: Humana Medicare |
$164.27
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$161.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$161.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$71.85
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$128.84
|
| Rate for Payer: Wellcare Medicare |
$153.00
|
|
|
MEASLES-MUMPS-RUBELLA-VARICELL SC SUSR [162637]
|
Facility
|
OP
|
$323.58
|
|
|
Service Code
|
NDC 00006417100
|
| Hospital Charge Code |
00006417100
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$113.25 |
| Max. Negotiated Rate |
$258.86 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$177.97
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$161.79
|
| Rate for Payer: Aetna Government |
$161.79
|
| Rate for Payer: Brighton Health Commercial |
$242.68
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$258.86
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$220.03
|
| Rate for Payer: Group Health Inc Commercial |
$161.79
|
| Rate for Payer: Group Health Inc Medicare |
$113.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$161.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$161.79
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$210.33
|
|
|
MEASURE BLOOD OXYGEN LEVEL
|
Facility
|
OP
|
$63.79
|
|
|
Service Code
|
HCPCS 94760
|
| Hospital Charge Code |
30300150
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$3.02 |
| Max. Negotiated Rate |
$51.03 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$35.08
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.02
|
| Rate for Payer: Aetna Government |
$3.02
|
| Rate for Payer: Brighton Health Commercial |
$47.84
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$51.03
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$43.38
|
| Rate for Payer: Group Health Inc Commercial |
$31.90
|
| Rate for Payer: Group Health Inc Medicare |
$22.33
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$31.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$31.90
|
| Rate for Payer: United Healthcare Commercial |
$31.90
|
|
|
MEASURE BLOOD OXYGEN LEVEL
|
Facility
|
OP
|
$354.37
|
|
|
Service Code
|
HCPCS 94760
|
| Hospital Charge Code |
30306634
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$3.02 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$194.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.02
|
| Rate for Payer: Aetna Government |
$3.02
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$204.58
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$173.89
|
| Rate for Payer: Group Health Inc Commercial |
$250.00
|
| Rate for Payer: Group Health Inc Medicare |
$250.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$177.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$177.18
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
|
|
Mechanical removal of obstructive material from gastrostomy, duodenostomy, jejunostomy, gastro-jejunostomy, or cecostomy (or other colonic) tube, any method, under fluoroscopic guidance including contrast injection(s), if performed, image documentation and report
|
Facility
|
OP
|
$2,915.00
|
|
|
Service Code
|
CPT 49460
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$733.80 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$780.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,048.28
|
| Rate for Payer: Aetna Government |
$1,048.28
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$733.80
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$733.80
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$733.80
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,048.28
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$1,048.28
|
| Rate for Payer: EmblemHealth Commercial |
$1,048.28
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$891.04
|
| Rate for Payer: Fidelis Essential Plan QHP |
$932.97
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,048.28
|
| Rate for Payer: Fidelis Qualified Health Plan |
$932.97
|
| Rate for Payer: Group Health Inc Commercial |
$1,048.28
|
| Rate for Payer: Group Health Inc Medicare |
$1,048.28
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,048.28
|
| Rate for Payer: Healthfirst Medicare Advantage |
$891.04
|
| Rate for Payer: Healthfirst QHP |
$1,048.28
|
| Rate for Payer: Humana Medicare |
$1,069.25
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,048.28
|
| Rate for Payer: United Healthcare Commercial |
$1,409.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,048.28
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,048.28
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$838.62
|
| Rate for Payer: Wellcare Medicare |
$995.87
|
|
|
MECH REMOV TUNNELED CV CATH
|
Facility
|
IP
|
$4,940.28
|
|
|
Service Code
|
HCPCS 36596
|
| Hospital Charge Code |
40034365
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$1,852.05
|
|
|
MECH REMOV TUNNELED CV CATH
|
Facility
|
OP
|
$4,940.28
|
|
|
Service Code
|
HCPCS 36596
|
| Hospital Charge Code |
40034365
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,188.00 |
| Max. Negotiated Rate |
$3,705.21 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,852.05
|
| Rate for Payer: Aetna Government |
$1,852.05
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1,296.44
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,296.44
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,296.44
|
| Rate for Payer: Brighton Health Commercial |
$3,705.21
|
| Rate for Payer: Cash Price |
$1,852.05
|
| Rate for Payer: Cash Price |
$1,852.05
|
| Rate for Payer: Cash Price |
$1,852.05
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,852.05
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$1,852.05
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,574.24
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,648.32
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,852.05
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,648.32
|
| Rate for Payer: Group Health Inc Commercial |
$1,852.05
|
| Rate for Payer: Group Health Inc Medicare |
$1,852.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,470.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,852.05
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,574.24
|
| Rate for Payer: Healthfirst QHP |
$1,852.05
|
| Rate for Payer: Humana Medicare |
$1,889.09
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,852.05
|
| Rate for Payer: United Healthcare Commercial |
$1,188.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,852.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,852.05
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,481.64
|
| Rate for Payer: Wellcare Medicare |
$1,759.45
|
|
|
MECLIZINE 12.5 MG TAB
|
Facility
|
OP
|
$1.00
|
|
| Hospital Charge Code |
41650861
|
|
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
|
|
|
MECLIZINE 12.5 MG TAB
|
Facility
|
OP
|
$1.00
|
|
| Hospital Charge Code |
41640861
|
|
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
|
|
|
MECLIZINE 25 MG TAB
|
Facility
|
OP
|
$1.00
|
|
| Hospital Charge Code |
41640874
|
|
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
|
|
|
MECLIZINE 25 MG TAB
|
Facility
|
OP
|
$1.00
|
|
| Hospital Charge Code |
41650874
|
|
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
|
|
|
MECLIZINE HCL 12.5 MG PO TABS [12024]
|
Facility
|
OP
|
$0.33
|
|
|
Service Code
|
NDC 65162044110
|
| Hospital Charge Code |
65162044110
|
|
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: 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
|
|
|
MECLIZINE HCL 12.5 MG PO TABS [12024]
|
Facility
|
OP
|
$0.84
|
|
|
Service Code
|
NDC 00904651661
|
| Hospital Charge Code |
00904651661
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.30 |
| Max. Negotiated Rate |
$0.67 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.46
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.42
|
| Rate for Payer: Aetna Government |
$0.42
|
| Rate for Payer: Brighton Health Commercial |
$0.63
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.67
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.57
|
| Rate for Payer: Group Health Inc Commercial |
$0.42
|
| Rate for Payer: Group Health Inc Medicare |
$0.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.42
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.55
|
|
|
MECLIZINE HCL 25 MG PO TABS [12025]
|
Facility
|
OP
|
$0.40
|
|
|
Service Code
|
NDC 70710116201
|
| Hospital Charge Code |
70710116201
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.32 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.22
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.20
|
| Rate for Payer: Aetna Government |
$0.20
|
| Rate for Payer: Brighton Health Commercial |
$0.30
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.32
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.27
|
| Rate for Payer: Group Health Inc Commercial |
$0.20
|
| Rate for Payer: Group Health Inc Medicare |
$0.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.26
|
|
|
MECLIZINE HCL 25 MG PO TABS [12025]
|
Facility
|
OP
|
$0.87
|
|
|
Service Code
|
NDC 00904651761
|
| Hospital Charge Code |
00904651761
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.30 |
| Max. Negotiated Rate |
$0.70 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.48
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.43
|
| Rate for Payer: Aetna Government |
$0.43
|
| Rate for Payer: Brighton Health Commercial |
$0.65
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.70
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.59
|
| Rate for Payer: Group Health Inc Commercial |
$0.43
|
| Rate for Payer: Group Health Inc Medicare |
$0.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.43
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.43
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.56
|
|
|
MECLIZINE HCL 25 MG PO TABS [12025]
|
Facility
|
OP
|
$0.84
|
|
|
Service Code
|
NDC 50268052311
|
| Hospital Charge Code |
50268052311
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.30 |
| Max. Negotiated Rate |
$0.67 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.46
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.42
|
| Rate for Payer: Aetna Government |
$0.42
|
| Rate for Payer: Brighton Health Commercial |
$0.63
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.67
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.57
|
| Rate for Payer: Group Health Inc Commercial |
$0.42
|
| Rate for Payer: Group Health Inc Medicare |
$0.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.42
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.55
|
|
|
MECLIZINE HCL 25 MG PO TABS [12025]
|
Facility
|
OP
|
$0.40
|
|
|
Service Code
|
NDC 65162044210
|
| Hospital Charge Code |
65162044210
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.32 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.22
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.20
|
| Rate for Payer: Aetna Government |
$0.20
|
| Rate for Payer: Brighton Health Commercial |
$0.30
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.32
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.27
|
| Rate for Payer: Group Health Inc Commercial |
$0.20
|
| Rate for Payer: Group Health Inc Medicare |
$0.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.26
|
|
|
MECLIZINE HCL 25 MG PO TABS [12025]
|
Facility
|
OP
|
$0.84
|
|
|
Service Code
|
NDC 50268052315
|
| Hospital Charge Code |
50268052315
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.30 |
| Max. Negotiated Rate |
$0.67 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.46
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.42
|
| Rate for Payer: Aetna Government |
$0.42
|
| Rate for Payer: Brighton Health Commercial |
$0.63
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.67
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.57
|
| Rate for Payer: Group Health Inc Commercial |
$0.42
|
| Rate for Payer: Group Health Inc Medicare |
$0.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.42
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.55
|
|
|
MED 34-36 A-C MAS KIT W
|
Facility
|
OP
|
$74.88
|
|
| Hospital Charge Code |
64905843
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$26.21 |
| Max. Negotiated Rate |
$59.90 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$41.18
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$37.44
|
| Rate for Payer: Aetna Government |
$37.44
|
| Rate for Payer: Brighton Health Commercial |
$56.16
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$59.90
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$50.92
|
| Rate for Payer: Group Health Inc Commercial |
$37.44
|
| Rate for Payer: Group Health Inc Medicare |
$26.21
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$37.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$37.44
|
|
|
MED ARTIS B LCK SCRW 2.5
|
Facility
|
OP
|
$345.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40208179
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$120.75 |
| Max. Negotiated Rate |
$362.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$189.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$339.17
|
| Rate for Payer: Aetna Government |
$339.17
|
| Rate for Payer: Brighton Health Commercial |
$207.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$172.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$198.38
|
| Rate for Payer: EmblemHealth Commercial |
$172.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$362.25
|
| Rate for Payer: Group Health Inc Commercial |
$172.50
|
| Rate for Payer: Group Health Inc Medicare |
$120.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$172.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$172.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$224.25
|
|
|
MED ARTIS B LCK SCRW 2.5
|
Facility
|
IP
|
$345.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40208179
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$172.50 |
| Max. Negotiated Rate |
$172.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$172.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$172.50
|
|
|
MED ARTIS GOLD NON-LCKNG SCRW 2.5
|
Facility
|
OP
|
$140.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40208139
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$49.00 |
| Max. Negotiated Rate |
$339.17 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$77.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$339.17
|
| Rate for Payer: Aetna Government |
$339.17
|
| Rate for Payer: Brighton Health Commercial |
$84.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$70.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$80.50
|
| Rate for Payer: EmblemHealth Commercial |
$70.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$147.00
|
| Rate for Payer: Group Health Inc Commercial |
$70.00
|
| Rate for Payer: Group Health Inc Medicare |
$49.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$70.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$70.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$91.00
|
|
|
MED ARTIS GOLD NON-LCKNG SCRW 2.5
|
Facility
|
IP
|
$140.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40208139
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$70.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$70.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$70.00
|
|
|
MED ARTIS K-WIRE 01.6MMX150MM
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40208140
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$17.50 |
| Max. Negotiated Rate |
$339.17 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$27.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$339.17
|
| Rate for Payer: Aetna Government |
$339.17
|
| Rate for Payer: Brighton Health Commercial |
$30.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$25.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$28.75
|
| Rate for Payer: EmblemHealth Commercial |
$25.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$52.50
|
| Rate for Payer: Group Health Inc Commercial |
$25.00
|
| Rate for Payer: Group Health Inc Medicare |
$17.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$25.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$25.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$32.50
|
|
