|
METHOTREXATE SODIUM (PF) 50 MG/2ML IJ SOLN [117030]
|
Facility
|
OP
|
$2.45
|
|
|
Service Code
|
HCPCS J9250
|
| Hospital Charge Code |
16729027730
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$1.96 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.35
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.22
|
| Rate for Payer: Aetna Government |
$0.22
|
| Rate for Payer: Brighton Health Commercial |
$1.84
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.96
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.67
|
| Rate for Payer: Group Health Inc Commercial |
$1.22
|
| Rate for Payer: Group Health Inc Medicare |
$0.86
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.59
|
|
|
METHOTREXATE SODIUM (PF) 50 MG/2ML IJ SOLN [117030]
|
Facility
|
OP
|
$6.21
|
|
|
Service Code
|
HCPCS J9250
|
| Hospital Charge Code |
00703367101
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$4.97 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.42
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.22
|
| Rate for Payer: Aetna Government |
$0.22
|
| Rate for Payer: Brighton Health Commercial |
$4.66
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.97
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.22
|
| Rate for Payer: Group Health Inc Commercial |
$3.10
|
| Rate for Payer: Group Health Inc Medicare |
$2.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.04
|
|
|
METHOTREXATE SODIUM (PF) 50 MG/2ML IJ SOLN [117030]
|
Facility
|
OP
|
$2.02
|
|
|
Service Code
|
HCPCS J9250
|
| Hospital Charge Code |
00143951901
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$1.61 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.11
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.22
|
| Rate for Payer: Aetna Government |
$0.22
|
| Rate for Payer: Brighton Health Commercial |
$1.51
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.61
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.37
|
| Rate for Payer: Group Health Inc Commercial |
$1.01
|
| Rate for Payer: Group Health Inc Medicare |
$0.71
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.31
|
|
|
METHYLDOPA 250 MG TAB
|
Facility
|
OP
|
$1.00
|
|
| Hospital Charge Code |
41651205
|
|
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
|
|
|
METHYLDOPA 250 MG TAB
|
Facility
|
OP
|
$1.00
|
|
| Hospital Charge Code |
41641205
|
|
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
|
|
|
METHYLDOPATE 50 MG/ML INJ
|
Facility
|
IP
|
$77.50
|
|
|
Service Code
|
HCPCS J0210
|
| Hospital Charge Code |
41641241
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$38.75 |
| Max. Negotiated Rate |
$38.75 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$38.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$38.75
|
|
|
METHYLDOPATE 50 MG/ML INJ
|
Facility
|
OP
|
$77.50
|
|
|
Service Code
|
HCPCS J0210
|
| Hospital Charge Code |
41641241
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$27.12 |
| Max. Negotiated Rate |
$50.38 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$42.62
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$33.12
|
| Rate for Payer: Aetna Government |
$33.12
|
| Rate for Payer: Brighton Health Commercial |
$46.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$38.75
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$44.56
|
| Rate for Payer: Group Health Inc Commercial |
$38.75
|
| Rate for Payer: Group Health Inc Medicare |
$27.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$38.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$38.75
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$50.38
|
|
|
METHYLDOPATE 50 MG/ML INJ
|
Facility
|
OP
|
$77.50
|
|
|
Service Code
|
HCPCS J0210
|
| Hospital Charge Code |
41651241
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$27.12 |
| Max. Negotiated Rate |
$50.38 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$42.62
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$33.12
|
| Rate for Payer: Aetna Government |
$33.12
|
| Rate for Payer: Brighton Health Commercial |
$46.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$38.75
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$44.56
|
| Rate for Payer: Group Health Inc Commercial |
$38.75
|
| Rate for Payer: Group Health Inc Medicare |
$27.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$38.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$38.75
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$50.38
|
|
|
METHYLDOPATE 50 MG/ML INJ
|
Facility
|
IP
|
$77.50
|
|
|
Service Code
|
HCPCS J0210
|
| Hospital Charge Code |
41651241
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$38.75 |
| Max. Negotiated Rate |
$38.75 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$38.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$38.75
|
|
|
METHYLENE BLUE 1% INJ
|
Facility
|
OP
|
$13.55
|
|
| Hospital Charge Code |
41651304
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.74 |
| Max. Negotiated Rate |
$10.84 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.78
|
| Rate for Payer: Aetna Government |
$6.78
|
| Rate for Payer: Brighton Health Commercial |
$10.16
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$10.84
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$9.21
|
| Rate for Payer: Group Health Inc Commercial |
$6.78
|
| Rate for Payer: Group Health Inc Medicare |
$4.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.78
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8.81
|
|
|
METHYLENE BLUE 1% INJ
|
Facility
|
OP
|
$13.55
|
|
| Hospital Charge Code |
41641304
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.74 |
| Max. Negotiated Rate |
$10.84 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.78
|
| Rate for Payer: Aetna Government |
$6.78
|
| Rate for Payer: Brighton Health Commercial |
$10.16
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$10.84
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$9.21
|
| Rate for Payer: Group Health Inc Commercial |
$6.78
|
| Rate for Payer: Group Health Inc Medicare |
$4.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.78
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8.81
|
|
|
METHYLENE BLUE 50MG INJ, PER 1 MG
|
Facility
|
IP
|
$7.62
|
|
|
Service Code
|
HCPCS Q9968
|
| Hospital Charge Code |
41659590
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.81 |
| Max. Negotiated Rate |
$3.81 |
| Rate for Payer: Cash Price |
$7.95
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.81
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.81
|
|
|
METHYLENE BLUE 50MG INJ, PER 1 MG
|
Facility
|
OP
|
$7.62
|
|
|
Service Code
|
HCPCS Q9968
|
| Hospital Charge Code |
41659590
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.81 |
| Max. Negotiated Rate |
$8.35 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.19
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$7.95
|
| Rate for Payer: Aetna Government |
$7.95
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$5.56
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$5.56
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$5.56
|
| Rate for Payer: Brighton Health Commercial |
$4.57
|
| Rate for Payer: Cash Price |
$7.95
|
| Rate for Payer: Cash Price |
$7.95
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$7.95
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.81
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.38
|
| Rate for Payer: Elderplan Medicare Advantage |
$7.95
|
| Rate for Payer: EmblemHealth Commercial |
$7.95
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$7.95
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$7.95
|
| Rate for Payer: Fidelis Essential Plan QHP |
$8.35
|
| Rate for Payer: Fidelis Medicare Advantage |
$7.95
|
| Rate for Payer: Fidelis Qualified Health Plan |
$8.35
|
| Rate for Payer: Group Health Inc Commercial |
$7.95
|
| Rate for Payer: Group Health Inc Medicare |
$7.95
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.81
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.81
|
| Rate for Payer: Healthfirst Medicare Advantage |
$6.76
|
| Rate for Payer: Healthfirst QHP |
$7.95
|
| Rate for Payer: Humana Medicare |
$8.11
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$7.95
|
| Rate for Payer: United Healthcare Commercial |
$7.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7.95
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.95
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$6.36
|
| Rate for Payer: Wellcare Medicare |
$7.55
|
|
|
METHYLENE BLUE 50MG INJ, PER 1 MG
|
Facility
|
IP
|
$7.62
|
|
|
Service Code
|
HCPCS Q9968
|
| Hospital Charge Code |
41649590
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.81 |
| Max. Negotiated Rate |
$3.81 |
| Rate for Payer: Cash Price |
$7.95
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.81
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.81
|
|
|
METHYLENE BLUE 50MG INJ, PER 1 MG
|
Facility
|
OP
|
$7.62
|
|
|
Service Code
|
HCPCS Q9968
|
| Hospital Charge Code |
41649590
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.81 |
| Max. Negotiated Rate |
$8.35 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.19
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$7.95
|
| Rate for Payer: Aetna Government |
$7.95
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$5.56
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$5.56
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$5.56
|
| Rate for Payer: Brighton Health Commercial |
$4.57
|
| Rate for Payer: Cash Price |
$7.95
|
| Rate for Payer: Cash Price |
$7.95
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$7.95
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.81
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.38
|
| Rate for Payer: Elderplan Medicare Advantage |
$7.95
|
| Rate for Payer: EmblemHealth Commercial |
$7.95
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$7.95
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$7.95
|
| Rate for Payer: Fidelis Essential Plan QHP |
$8.35
|
| Rate for Payer: Fidelis Medicare Advantage |
$7.95
|
| Rate for Payer: Fidelis Qualified Health Plan |
$8.35
|
| Rate for Payer: Group Health Inc Commercial |
$7.95
|
| Rate for Payer: Group Health Inc Medicare |
$7.95
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.81
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.81
|
| Rate for Payer: Healthfirst Medicare Advantage |
$6.76
|
| Rate for Payer: Healthfirst QHP |
$7.95
|
| Rate for Payer: Humana Medicare |
$8.11
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$7.95
|
| Rate for Payer: United Healthcare Commercial |
$7.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7.95
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.95
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$6.36
|
| Rate for Payer: Wellcare Medicare |
$7.55
|
|
|
METHYLENE BLUE (ANTIDOTE) 1 % IV SOLN [188015]
|
Facility
|
IP
|
$25.00
|
|
|
Service Code
|
NDC 54288014701
|
| Hospital Charge Code |
54288014701
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12.50 |
| Max. Negotiated Rate |
$12.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.50
|
|
|
METHYLENE BLUE (ANTIDOTE) 1 % IV SOLN [188015]
|
Facility
|
OP
|
$25.00
|
|
|
Service Code
|
NDC 54288014701
|
| Hospital Charge Code |
54288014701
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8.75 |
| Max. Negotiated Rate |
$26.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$13.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12.50
|
| Rate for Payer: Aetna Government |
$12.50
|
| Rate for Payer: Brighton Health Commercial |
$15.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$12.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$14.38
|
| Rate for Payer: EmblemHealth Commercial |
$12.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$26.25
|
| Rate for Payer: Group Health Inc Commercial |
$12.50
|
| Rate for Payer: Group Health Inc Medicare |
$8.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$16.25
|
|
|
METHYLENE BLUE (ANTIDOTE) 50 MG/10ML IV SOLN [134059]
|
Facility
|
IP
|
$31.25
|
|
|
Service Code
|
HCPCS Q9968
|
| Hospital Charge Code |
00517037405
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$15.63 |
| Max. Negotiated Rate |
$15.63 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15.63
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$15.63
|
|
|
METHYLENE BLUE (ANTIDOTE) 50 MG/10ML IV SOLN [134059]
|
Facility
|
OP
|
$31.25
|
|
|
Service Code
|
HCPCS Q9968
|
| Hospital Charge Code |
00517037401
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.36 |
| Max. Negotiated Rate |
$20.31 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$17.19
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$7.95
|
| Rate for Payer: Aetna Government |
$7.95
|
| Rate for Payer: Brighton Health Commercial |
$18.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$7.95
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$15.63
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$17.97
|
| Rate for Payer: Elderplan Medicare Advantage |
$7.95
|
| Rate for Payer: EmblemHealth Commercial |
$15.63
|
| Rate for Payer: Fidelis Medicare Advantage |
$7.95
|
| Rate for Payer: Group Health Inc Commercial |
$7.95
|
| Rate for Payer: Group Health Inc Medicare |
$7.95
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15.63
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$15.63
|
| Rate for Payer: Healthfirst Medicare Advantage |
$6.76
|
| Rate for Payer: Healthfirst QHP |
$7.95
|
| Rate for Payer: Humana Medicare |
$8.11
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$7.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7.95
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$20.31
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$6.36
|
|
|
METHYLENE BLUE (ANTIDOTE) 50 MG/10ML IV SOLN [134059]
|
Facility
|
IP
|
$43.75
|
|
|
Service Code
|
NDC 00517038101
|
| Hospital Charge Code |
00517038101
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$21.88 |
| Max. Negotiated Rate |
$21.88 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$21.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$21.88
|
|
|
METHYLENE BLUE (ANTIDOTE) 50 MG/10ML IV SOLN [134059]
|
Facility
|
IP
|
$31.25
|
|
|
Service Code
|
HCPCS Q9968
|
| Hospital Charge Code |
00517037401
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$15.63 |
| Max. Negotiated Rate |
$15.63 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15.63
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$15.63
|
|
|
METHYLENE BLUE (ANTIDOTE) 50 MG/10ML IV SOLN [134059]
|
Facility
|
OP
|
$31.25
|
|
|
Service Code
|
HCPCS Q9968
|
| Hospital Charge Code |
00517037405
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.36 |
| Max. Negotiated Rate |
$20.31 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$17.19
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$7.95
|
| Rate for Payer: Aetna Government |
$7.95
|
| Rate for Payer: Brighton Health Commercial |
$18.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$7.95
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$15.63
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$17.97
|
| Rate for Payer: Elderplan Medicare Advantage |
$7.95
|
| Rate for Payer: EmblemHealth Commercial |
$15.63
|
| Rate for Payer: Fidelis Medicare Advantage |
$7.95
|
| Rate for Payer: Group Health Inc Commercial |
$7.95
|
| Rate for Payer: Group Health Inc Medicare |
$7.95
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15.63
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$15.63
|
| Rate for Payer: Healthfirst Medicare Advantage |
$6.76
|
| Rate for Payer: Healthfirst QHP |
$7.95
|
| Rate for Payer: Humana Medicare |
$8.11
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$7.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7.95
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$20.31
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$6.36
|
|
|
METHYLENE BLUE (ANTIDOTE) 50 MG/10ML IV SOLN [134059]
|
Facility
|
OP
|
$43.75
|
|
|
Service Code
|
NDC 00517038101
|
| Hospital Charge Code |
00517038101
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$15.31 |
| Max. Negotiated Rate |
$45.94 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$24.06
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$21.88
|
| Rate for Payer: Aetna Government |
$21.88
|
| Rate for Payer: Brighton Health Commercial |
$26.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$21.88
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$25.16
|
| Rate for Payer: EmblemHealth Commercial |
$21.88
|
| Rate for Payer: Fidelis Medicare Advantage |
$45.94
|
| Rate for Payer: Group Health Inc Commercial |
$21.88
|
| Rate for Payer: Group Health Inc Medicare |
$15.31
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$21.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$21.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$28.44
|
|
|
METHYLERGONOVINE 0.2 MG/ML INJ
|
Facility
|
IP
|
$7.18
|
|
|
Service Code
|
HCPCS J2210
|
| Hospital Charge Code |
41644110
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.59 |
| Max. Negotiated Rate |
$3.59 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.59
|
|
|
METHYLERGONOVINE 0.2 MG/ML INJ
|
Facility
|
OP
|
$7.18
|
|
|
Service Code
|
HCPCS J2210
|
| Hospital Charge Code |
41654110
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.51 |
| Max. Negotiated Rate |
$22.12 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$19.62
|
| Rate for Payer: Aetna Government |
$19.62
|
| Rate for Payer: Brighton Health Commercial |
$4.31
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.59
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.13
|
| Rate for Payer: Group Health Inc Commercial |
$3.59
|
| Rate for Payer: Group Health Inc Medicare |
$2.51
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.59
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$22.12
|
| Rate for Payer: SOMOS Essential |
$22.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.67
|
|
