|
MEPOLIZUMAB 100MG INJECTION
|
Facility
|
OP
|
$66.94
|
|
|
Service Code
|
HCPCS J2182
|
| Hospital Charge Code |
41649600
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.35 |
| Max. Negotiated Rate |
$43.51 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$36.82
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$30.50
|
| Rate for Payer: Aetna Government |
$30.50
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$21.35
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$21.35
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$21.35
|
| Rate for Payer: Brighton Health Commercial |
$40.16
|
| Rate for Payer: Cash Price |
$30.51
|
| Rate for Payer: Cash Price |
$30.51
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$30.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$33.47
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$38.49
|
| Rate for Payer: Elderplan Medicare Advantage |
$30.50
|
| Rate for Payer: EmblemHealth Commercial |
$30.50
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$30.50
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$30.50
|
| Rate for Payer: Fidelis Essential Plan QHP |
$32.03
|
| Rate for Payer: Fidelis Medicare Advantage |
$30.50
|
| Rate for Payer: Fidelis Qualified Health Plan |
$32.03
|
| Rate for Payer: Group Health Inc Commercial |
$30.50
|
| Rate for Payer: Group Health Inc Medicare |
$30.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$33.47
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$33.47
|
| Rate for Payer: Healthfirst Medicare Advantage |
$25.93
|
| Rate for Payer: Healthfirst QHP |
$30.50
|
| Rate for Payer: Humana Medicare |
$31.12
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$30.50
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$32.31
|
| Rate for Payer: SOMOS Essential |
$32.31
|
| Rate for Payer: United Healthcare Commercial |
$29.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$30.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$43.51
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$24.40
|
| Rate for Payer: Wellcare Medicare |
$28.98
|
|
|
MEPOLIZUMAB 100MG INJECTION
|
Facility
|
IP
|
$66.94
|
|
|
Service Code
|
HCPCS J2182
|
| Hospital Charge Code |
41659600
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$33.47 |
| Max. Negotiated Rate |
$33.47 |
| Rate for Payer: Cash Price |
$30.51
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$33.47
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$33.47
|
|
|
MEPOLIZUMAB 100MG INJECTION
|
Facility
|
OP
|
$66.94
|
|
|
Service Code
|
HCPCS J2182
|
| Hospital Charge Code |
41659600
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.35 |
| Max. Negotiated Rate |
$43.51 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$36.82
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$30.50
|
| Rate for Payer: Aetna Government |
$30.50
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$21.35
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$21.35
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$21.35
|
| Rate for Payer: Brighton Health Commercial |
$40.16
|
| Rate for Payer: Cash Price |
$30.51
|
| Rate for Payer: Cash Price |
$30.51
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$30.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$33.47
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$38.49
|
| Rate for Payer: Elderplan Medicare Advantage |
$30.50
|
| Rate for Payer: EmblemHealth Commercial |
$30.50
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$30.50
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$30.50
|
| Rate for Payer: Fidelis Essential Plan QHP |
$32.03
|
| Rate for Payer: Fidelis Medicare Advantage |
$30.50
|
| Rate for Payer: Fidelis Qualified Health Plan |
$32.03
|
| Rate for Payer: Group Health Inc Commercial |
$30.50
|
| Rate for Payer: Group Health Inc Medicare |
$30.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$33.47
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$33.47
|
| Rate for Payer: Healthfirst Medicare Advantage |
$25.93
|
| Rate for Payer: Healthfirst QHP |
$30.50
|
| Rate for Payer: Humana Medicare |
$31.12
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$30.50
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$32.31
|
| Rate for Payer: SOMOS Essential |
$32.31
|
| Rate for Payer: United Healthcare Commercial |
$29.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$30.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$43.51
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$24.40
|
| Rate for Payer: Wellcare Medicare |
$28.98
|
|
|
MEPOLIZUMAB 100MG INJECTION
|
Facility
|
IP
|
$66.94
|
|
|
Service Code
|
HCPCS J2182
|
| Hospital Charge Code |
41649600
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$33.47 |
| Max. Negotiated Rate |
$33.47 |
| Rate for Payer: Cash Price |
$30.51
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$33.47
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$33.47
|
|
|
MEPOLIZUMAB 100 MG SC SOLR [131354]
|
Facility
|
OP
|
$4,094.09
|
|
|
Service Code
|
HCPCS J2182
|
| Hospital Charge Code |
00173088101
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$21.35 |
| Max. Negotiated Rate |
$3,275.27 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,251.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$30.50
|
| Rate for Payer: Aetna Government |
$30.50
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$21.35
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$21.35
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$21.35
|
| Rate for Payer: Brighton Health Commercial |
$3,070.57
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$30.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3,275.27
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,783.98
|
| Rate for Payer: Elderplan Medicare Advantage |
$30.50
|
| Rate for Payer: EmblemHealth Commercial |
$30.50
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$25.93
|
| Rate for Payer: Fidelis Essential Plan QHP |
$27.15
|
| Rate for Payer: Fidelis Medicare Advantage |
$30.50
|
| Rate for Payer: Fidelis Qualified Health Plan |
$27.15
|
| Rate for Payer: Group Health Inc Commercial |
$30.50
|
| Rate for Payer: Group Health Inc Medicare |
$30.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,047.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$30.50
|
| Rate for Payer: Healthfirst Medicare Advantage |
$25.93
|
| Rate for Payer: Healthfirst QHP |
$30.50
|
| Rate for Payer: Humana Medicare |
$31.12
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$30.48
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$32.31
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$32.31
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$32.31
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$30.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$30.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,661.16
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$24.40
|
| Rate for Payer: Wellcare Medicare |
$28.98
|
|
|
MERCAPTOPURINE 50 MG PO TABS [10531]
|
Facility
|
OP
|
$8.19
|
|
|
Service Code
|
NDC 00054458111
|
| Hospital Charge Code |
00054458111
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.86 |
| Max. Negotiated Rate |
$6.55 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.09
|
| Rate for Payer: Aetna Government |
$4.09
|
| Rate for Payer: Brighton Health Commercial |
$6.14
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.55
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.57
|
| Rate for Payer: Group Health Inc Commercial |
$4.09
|
| Rate for Payer: Group Health Inc Medicare |
$2.86
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.32
|
|
|
MERCAPTOPURINE 50 MG TAB
|
Facility
|
OP
|
$2.90
|
|
|
Service Code
|
HCPCS J8999
|
| Hospital Charge Code |
41644171
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.02 |
| Max. Negotiated Rate |
$1.88 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.45
|
| Rate for Payer: Aetna Government |
$1.45
|
| Rate for Payer: Brighton Health Commercial |
$1.74
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.45
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.67
|
| Rate for Payer: Group Health Inc Commercial |
$1.45
|
| Rate for Payer: Group Health Inc Medicare |
$1.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.45
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.45
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.88
|
|
|
MERCAPTOPURINE 50 MG TAB
|
Facility
|
OP
|
$2.90
|
|
|
Service Code
|
HCPCS J8999
|
| Hospital Charge Code |
41654171
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.02 |
| Max. Negotiated Rate |
$1.88 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.45
|
| Rate for Payer: Aetna Government |
$1.45
|
| Rate for Payer: Brighton Health Commercial |
$1.74
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.45
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.67
|
| Rate for Payer: Group Health Inc Commercial |
$1.45
|
| Rate for Payer: Group Health Inc Medicare |
$1.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.45
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.45
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.88
|
|
|
MERCAPTOPURINE 50 MG TAB
|
Facility
|
IP
|
$2.90
|
|
|
Service Code
|
HCPCS J8999
|
| Hospital Charge Code |
41644171
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.45 |
| Max. Negotiated Rate |
$1.45 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.45
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.45
|
|
|
MERCAPTOPURINE 50 MG TAB
|
Facility
|
IP
|
$2.90
|
|
|
Service Code
|
HCPCS J8999
|
| Hospital Charge Code |
41654171
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.45 |
| Max. Negotiated Rate |
$1.45 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.45
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.45
|
|
|
MERCURY BLOOD
|
Facility
|
IP
|
$40.65
|
|
|
Service Code
|
HCPCS 83825
|
| Hospital Charge Code |
40607051
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$16.26
|
|
|
MERCURY BLOOD
|
Facility
|
OP
|
$40.65
|
|
|
Service Code
|
HCPCS 83825
|
| Hospital Charge Code |
40607051
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.38 |
| Max. Negotiated Rate |
$30.49 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$22.36
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$16.26
|
| Rate for Payer: Aetna Government |
$16.26
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$11.38
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$11.38
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$11.38
|
| Rate for Payer: Brighton Health Commercial |
$30.49
|
| Rate for Payer: Cash Price |
$16.26
|
| Rate for Payer: Cash Price |
$16.26
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$16.26
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$25.83
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$21.86
|
| Rate for Payer: Elderplan Medicare Advantage |
$16.26
|
| Rate for Payer: EmblemHealth Commercial |
$16.26
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$13.82
|
| Rate for Payer: Fidelis Essential Plan QHP |
$14.47
|
| Rate for Payer: Fidelis Medicare Advantage |
$16.26
|
| Rate for Payer: Fidelis Qualified Health Plan |
$14.47
|
| Rate for Payer: Group Health Inc Commercial |
$16.26
|
| Rate for Payer: Group Health Inc Medicare |
$16.26
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$20.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.26
|
| Rate for Payer: Healthfirst Medicare Advantage |
$16.26
|
| Rate for Payer: Healthfirst QHP |
$16.26
|
| Rate for Payer: Humana Medicare |
$16.59
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$16.26
|
| Rate for Payer: United Healthcare Commercial |
$20.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.26
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$16.26
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$13.01
|
| Rate for Payer: Wellcare Medicare |
$14.63
|
|
|
MERCURY, BLOOD
|
Facility
|
IP
|
$40.65
|
|
|
Service Code
|
HCPCS 83825
|
| Hospital Charge Code |
40609097
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$16.26
|
|
|
MERCURY, BLOOD
|
Facility
|
OP
|
$40.65
|
|
|
Service Code
|
HCPCS 83825
|
| Hospital Charge Code |
40609097
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.38 |
| Max. Negotiated Rate |
$30.49 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$22.36
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$16.26
|
| Rate for Payer: Aetna Government |
$16.26
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$11.38
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$11.38
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$11.38
|
| Rate for Payer: Brighton Health Commercial |
$30.49
|
| Rate for Payer: Cash Price |
$16.26
|
| Rate for Payer: Cash Price |
$16.26
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$16.26
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$25.83
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$21.86
|
| Rate for Payer: Elderplan Medicare Advantage |
$16.26
|
| Rate for Payer: EmblemHealth Commercial |
$16.26
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$13.82
|
| Rate for Payer: Fidelis Essential Plan QHP |
$14.47
|
| Rate for Payer: Fidelis Medicare Advantage |
$16.26
|
| Rate for Payer: Fidelis Qualified Health Plan |
$14.47
|
| Rate for Payer: Group Health Inc Commercial |
$16.26
|
| Rate for Payer: Group Health Inc Medicare |
$16.26
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$20.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.26
|
| Rate for Payer: Healthfirst Medicare Advantage |
$16.26
|
| Rate for Payer: Healthfirst QHP |
$16.26
|
| Rate for Payer: Humana Medicare |
$16.59
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$16.26
|
| Rate for Payer: United Healthcare Commercial |
$20.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.26
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$16.26
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$13.01
|
| Rate for Payer: Wellcare Medicare |
$14.63
|
|
|
MERCURY, URINE
|
Facility
|
OP
|
$12.95
|
|
|
Service Code
|
HCPCS 82570
|
| Hospital Charge Code |
40609830
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.63 |
| Max. Negotiated Rate |
$9.71 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.12
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.18
|
| Rate for Payer: Aetna Government |
$5.18
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$3.63
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$3.63
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$3.63
|
| Rate for Payer: Brighton Health Commercial |
$9.71
|
| Rate for Payer: Cash Price |
$5.18
|
| Rate for Payer: Cash Price |
$5.18
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$5.18
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.23
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.96
|
| Rate for Payer: Elderplan Medicare Advantage |
$5.18
|
| Rate for Payer: EmblemHealth Commercial |
$5.18
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4.40
|
| Rate for Payer: Fidelis Essential Plan QHP |
$4.61
|
| Rate for Payer: Fidelis Medicare Advantage |
$5.18
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4.61
|
| Rate for Payer: Group Health Inc Commercial |
$5.18
|
| Rate for Payer: Group Health Inc Medicare |
$5.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.48
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.18
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5.18
|
| Rate for Payer: Healthfirst QHP |
$5.18
|
| Rate for Payer: Humana Medicare |
$5.28
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$5.18
|
| Rate for Payer: United Healthcare Commercial |
$6.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.18
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.18
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$4.14
|
| Rate for Payer: Wellcare Medicare |
$4.66
|
|
|
MERCURY, URINE
|
Facility
|
IP
|
$12.95
|
|
|
Service Code
|
HCPCS 82570
|
| Hospital Charge Code |
40609830
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$5.18
|
|
|
MERIT MED CATH PK K12-T05706
|
Facility
|
OP
|
$448.00
|
|
| Hospital Charge Code |
66529928
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$156.80 |
| Max. Negotiated Rate |
$358.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$246.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$224.00
|
| Rate for Payer: Aetna Government |
$224.00
|
| Rate for Payer: Brighton Health Commercial |
$336.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$358.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$304.64
|
| Rate for Payer: Group Health Inc Commercial |
$224.00
|
| Rate for Payer: Group Health Inc Medicare |
$156.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$224.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$224.00
|
|
|
MER KNEE 35 DIA THIK 10 MM
|
Facility
|
IP
|
$3,171.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40009266
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,585.60 |
| Max. Negotiated Rate |
$1,585.60 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,585.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,585.60
|
|
|
MER KNEE 35 DIA THIK 10 MM
|
Facility
|
OP
|
$3,171.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40009266
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.17 |
| Max. Negotiated Rate |
$3,329.76 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,744.16
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$339.17
|
| Rate for Payer: Aetna Government |
$339.17
|
| Rate for Payer: Brighton Health Commercial |
$1,902.72
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,585.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,823.44
|
| Rate for Payer: EmblemHealth Commercial |
$1,585.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,329.76
|
| Rate for Payer: Group Health Inc Commercial |
$1,585.60
|
| Rate for Payer: Group Health Inc Medicare |
$1,109.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,585.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,585.60
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,061.28
|
|
|
MEROPENEM 1000 MG INJ
|
Facility
|
IP
|
$2.06
|
|
|
Service Code
|
HCPCS J2185
|
| Hospital Charge Code |
41651578
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.03 |
| Max. Negotiated Rate |
$1.03 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.03
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.03
|
|
|
MEROPENEM 1000 MG INJ
|
Facility
|
OP
|
$2.06
|
|
|
Service Code
|
HCPCS J2185
|
| Hospital Charge Code |
41641578
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.41 |
| Max. Negotiated Rate |
$1.34 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.13
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.79
|
| Rate for Payer: Aetna Government |
$0.79
|
| Rate for Payer: Brighton Health Commercial |
$1.24
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.03
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.18
|
| Rate for Payer: Group Health Inc Commercial |
$1.03
|
| Rate for Payer: Group Health Inc Medicare |
$0.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.03
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.03
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$0.41
|
| Rate for Payer: SOMOS Essential |
$0.41
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.34
|
|
|
MEROPENEM 1000 MG INJ
|
Facility
|
OP
|
$2.06
|
|
|
Service Code
|
HCPCS J2185
|
| Hospital Charge Code |
41651578
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.41 |
| Max. Negotiated Rate |
$1.34 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.13
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.79
|
| Rate for Payer: Aetna Government |
$0.79
|
| Rate for Payer: Brighton Health Commercial |
$1.24
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.03
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.18
|
| Rate for Payer: Group Health Inc Commercial |
$1.03
|
| Rate for Payer: Group Health Inc Medicare |
$0.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.03
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.03
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$0.41
|
| Rate for Payer: SOMOS Essential |
$0.41
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.34
|
|
|
MEROPENEM 1000 MG INJ
|
Facility
|
IP
|
$2.06
|
|
|
Service Code
|
HCPCS J2185
|
| Hospital Charge Code |
41641578
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.03 |
| Max. Negotiated Rate |
$1.03 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.03
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.03
|
|
|
MEROPENEM 10 MG/ML INJ NEONATAL
|
Facility
|
OP
|
$6.00
|
|
| Hospital Charge Code |
41655017
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.10 |
| Max. Negotiated Rate |
$4.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.00
|
| Rate for Payer: Aetna Government |
$3.00
|
| Rate for Payer: Brighton Health Commercial |
$4.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.08
|
| Rate for Payer: Group Health Inc Commercial |
$3.00
|
| Rate for Payer: Group Health Inc Medicare |
$2.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.90
|
|
|
MEROPENEM 10 MG/ML INJ NEONATAL
|
Facility
|
OP
|
$6.00
|
|
| Hospital Charge Code |
41645017
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.10 |
| Max. Negotiated Rate |
$4.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.00
|
| Rate for Payer: Aetna Government |
$3.00
|
| Rate for Payer: Brighton Health Commercial |
$4.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.08
|
| Rate for Payer: Group Health Inc Commercial |
$3.00
|
| Rate for Payer: Group Health Inc Medicare |
$2.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.90
|
|
