|
METHYLERGONOVINE 0.2 MG/ML INJ
|
Facility
|
IP
|
$7.18
|
|
|
Service Code
|
HCPCS J2210
|
| Hospital Charge Code |
41654110
|
|
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 |
41644110
|
|
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
|
|
|
METHYLERGONOVINE 0.2 MG TAB
|
Facility
|
OP
|
$2.83
|
|
| Hospital Charge Code |
41654111
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.99 |
| Max. Negotiated Rate |
$2.26 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.56
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.42
|
| Rate for Payer: Aetna Government |
$1.42
|
| Rate for Payer: Brighton Health Commercial |
$2.12
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.26
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.92
|
| Rate for Payer: Group Health Inc Commercial |
$1.42
|
| Rate for Payer: Group Health Inc Medicare |
$0.99
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.42
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.84
|
|
|
METHYLERGONOVINE 0.2 MG TAB
|
Facility
|
OP
|
$2.83
|
|
| Hospital Charge Code |
41644111
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.99 |
| Max. Negotiated Rate |
$2.26 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.56
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.42
|
| Rate for Payer: Aetna Government |
$1.42
|
| Rate for Payer: Brighton Health Commercial |
$2.12
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.26
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.92
|
| Rate for Payer: Group Health Inc Commercial |
$1.42
|
| Rate for Payer: Group Health Inc Medicare |
$0.99
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.42
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.84
|
|
|
METHYLERGONOVINE MALEATE 0.2 MG/ML IJ SOLN [10571]
|
Facility
|
OP
|
$23.71
|
|
|
Service Code
|
HCPCS J2210
|
| Hospital Charge Code |
51991014417
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.30 |
| Max. Negotiated Rate |
$22.12 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$13.04
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$19.62
|
| Rate for Payer: Aetna Government |
$19.62
|
| Rate for Payer: Brighton Health Commercial |
$17.78
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$18.97
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$16.12
|
| Rate for Payer: Group Health Inc Commercial |
$11.86
|
| Rate for Payer: Group Health Inc Medicare |
$8.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$11.86
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$20.87
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$22.12
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$22.12
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$22.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$15.41
|
|
|
METHYLERGONOVINE MALEATE 0.2 MG/ML IJ SOLN [10571]
|
Facility
|
OP
|
$36.44
|
|
|
Service Code
|
HCPCS J2210
|
| Hospital Charge Code |
00517074020
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.76 |
| Max. Negotiated Rate |
$29.16 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$20.04
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$19.62
|
| Rate for Payer: Aetna Government |
$19.62
|
| Rate for Payer: Brighton Health Commercial |
$27.33
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$29.16
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$24.78
|
| Rate for Payer: Group Health Inc Commercial |
$18.22
|
| Rate for Payer: Group Health Inc Medicare |
$12.76
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$18.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$18.22
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$20.87
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$22.12
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$22.12
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$22.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$23.69
|
|
|
METHYLERGONOVINE MALEATE 0.2 MG/ML IJ SOLN [10571]
|
Facility
|
OP
|
$36.44
|
|
|
Service Code
|
HCPCS J2210
|
| Hospital Charge Code |
00517074001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.75 |
| Max. Negotiated Rate |
$29.15 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$20.04
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$19.62
|
| Rate for Payer: Aetna Government |
$19.62
|
| Rate for Payer: Brighton Health Commercial |
$27.33
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$29.15
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$24.78
|
| Rate for Payer: Group Health Inc Commercial |
$18.22
|
| Rate for Payer: Group Health Inc Medicare |
$12.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$18.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$18.22
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$20.87
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$22.12
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$22.12
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$22.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$23.69
|
|
|
METHYLERGONOVINE MALEATE 0.2 MG PO TABS [10572]
|
Facility
|
OP
|
$67.23
|
|
|
Service Code
|
NDC 00054063905
|
| Hospital Charge Code |
00054063905
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$23.53 |
| Max. Negotiated Rate |
$53.78 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$36.98
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$33.61
|
| Rate for Payer: Aetna Government |
$33.61
|
| Rate for Payer: Brighton Health Commercial |
$50.42
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$53.78
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$45.72
|
| Rate for Payer: Group Health Inc Commercial |
$33.61
|
| Rate for Payer: Group Health Inc Medicare |
$23.53
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$33.61
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$33.61
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$43.70
|
|
|
METHYLERGONOVINE MALEATE 0.2 MG PO TABS [10572]
|
Facility
|
OP
|
$66.00
|
|
|
Service Code
|
NDC 60687041094
|
| Hospital Charge Code |
60687041094
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$23.10 |
| Max. Negotiated Rate |
$52.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$36.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$33.00
|
| Rate for Payer: Aetna Government |
$33.00
|
| Rate for Payer: Brighton Health Commercial |
$49.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$52.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$44.88
|
| Rate for Payer: Group Health Inc Commercial |
$33.00
|
| Rate for Payer: Group Health Inc Medicare |
$23.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$33.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$33.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$42.90
|
|
|
METHYLMALONIC ACID, SERUM
|
Facility
|
OP
|
$53.03
|
|
|
Service Code
|
HCPCS 83921
|
| Hospital Charge Code |
40609103
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.85 |
| Max. Negotiated Rate |
$39.77 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$29.17
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$21.21
|
| Rate for Payer: Aetna Government |
$21.21
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$14.85
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$14.85
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$14.85
|
| Rate for Payer: Brighton Health Commercial |
$39.77
|
| Rate for Payer: Cash Price |
$21.21
|
| Rate for Payer: Cash Price |
$21.21
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$21.21
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$26.16
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$22.13
|
| Rate for Payer: Elderplan Medicare Advantage |
$21.21
|
| Rate for Payer: EmblemHealth Commercial |
$21.21
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$18.03
|
| Rate for Payer: Fidelis Essential Plan QHP |
$18.88
|
| Rate for Payer: Fidelis Medicare Advantage |
$21.21
|
| Rate for Payer: Fidelis Qualified Health Plan |
$18.88
|
| Rate for Payer: Group Health Inc Commercial |
$21.21
|
| Rate for Payer: Group Health Inc Medicare |
$21.21
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$26.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$21.21
|
| Rate for Payer: Healthfirst Medicare Advantage |
$21.21
|
| Rate for Payer: Healthfirst QHP |
$21.21
|
| Rate for Payer: Humana Medicare |
$21.63
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$21.21
|
| Rate for Payer: United Healthcare Commercial |
$20.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21.21
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$21.21
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$16.97
|
| Rate for Payer: Wellcare Medicare |
$19.09
|
|
|
METHYLMALONIC ACID, SERUM
|
Facility
|
IP
|
$53.03
|
|
|
Service Code
|
HCPCS 83921
|
| Hospital Charge Code |
40609103
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$21.21
|
|
|
METHYLNALTREXONE BROMIDE 12 MG/0.6ML SC SOLN [91651]
|
Facility
|
OP
|
$320.62
|
|
|
Service Code
|
NDC 65649055102
|
| Hospital Charge Code |
65649055102
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$112.22 |
| Max. Negotiated Rate |
$256.49 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$176.34
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$160.31
|
| Rate for Payer: Aetna Government |
$160.31
|
| Rate for Payer: Brighton Health Commercial |
$240.46
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$256.49
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$218.02
|
| Rate for Payer: Group Health Inc Commercial |
$160.31
|
| Rate for Payer: Group Health Inc Medicare |
$112.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$160.31
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$160.31
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$208.40
|
|
|
METHYLNALTREXONE BROMIDE 12 MG/0.6ML SC SOLN [91651]
|
Facility
|
OP
|
$320.62
|
|
|
Service Code
|
NDC 65649055107
|
| Hospital Charge Code |
65649055107
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$112.22 |
| Max. Negotiated Rate |
$256.49 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$176.34
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$160.31
|
| Rate for Payer: Aetna Government |
$160.31
|
| Rate for Payer: Brighton Health Commercial |
$240.46
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$256.49
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$218.02
|
| Rate for Payer: Group Health Inc Commercial |
$160.31
|
| Rate for Payer: Group Health Inc Medicare |
$112.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$160.31
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$160.31
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$208.40
|
|
|
METHYLNALTREXONE BROMIDE 8 MG/0.4ML SC SOLN [113621]
|
Facility
|
OP
|
$480.93
|
|
|
Service Code
|
NDC 65649055204
|
| Hospital Charge Code |
65649055204
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$168.33 |
| Max. Negotiated Rate |
$384.74 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$264.51
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$240.46
|
| Rate for Payer: Aetna Government |
$240.46
|
| Rate for Payer: Brighton Health Commercial |
$360.70
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$384.74
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$327.03
|
| Rate for Payer: Group Health Inc Commercial |
$240.46
|
| Rate for Payer: Group Health Inc Medicare |
$168.33
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$240.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$240.46
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$312.60
|
|
|
METHYLPHENIDATE 18 MG TAB CR - NF
|
Facility
|
OP
|
$11.88
|
|
| Hospital Charge Code |
41645072
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.16 |
| Max. Negotiated Rate |
$9.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.53
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.94
|
| Rate for Payer: Aetna Government |
$5.94
|
| Rate for Payer: Brighton Health Commercial |
$8.91
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$9.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$8.08
|
| Rate for Payer: Group Health Inc Commercial |
$5.94
|
| Rate for Payer: Group Health Inc Medicare |
$4.16
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$7.72
|
|
|
METHYLPHENIDATE 18 MG TAB CR - NF
|
Facility
|
OP
|
$11.88
|
|
| Hospital Charge Code |
41655072
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.16 |
| Max. Negotiated Rate |
$9.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.53
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.94
|
| Rate for Payer: Aetna Government |
$5.94
|
| Rate for Payer: Brighton Health Commercial |
$8.91
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$9.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$8.08
|
| Rate for Payer: Group Health Inc Commercial |
$5.94
|
| Rate for Payer: Group Health Inc Medicare |
$4.16
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$7.72
|
|
|
METHYLPHENIDATE 1MG/ML 500ML
|
Facility
|
OP
|
$1.70
|
|
| Hospital Charge Code |
41657914
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$1.36 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.94
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.85
|
| Rate for Payer: Aetna Government |
$0.85
|
| Rate for Payer: Brighton Health Commercial |
$1.28
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.36
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.16
|
| Rate for Payer: Group Health Inc Commercial |
$0.85
|
| Rate for Payer: Group Health Inc Medicare |
$0.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.85
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.85
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.10
|
|
|
METHYLPHENIDATE 1MG/ML 500ML
|
Facility
|
OP
|
$1.70
|
|
| Hospital Charge Code |
41647914
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$1.36 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.94
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.85
|
| Rate for Payer: Aetna Government |
$0.85
|
| Rate for Payer: Brighton Health Commercial |
$1.28
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.36
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.16
|
| Rate for Payer: Group Health Inc Commercial |
$0.85
|
| Rate for Payer: Group Health Inc Medicare |
$0.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.85
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.85
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.10
|
|
|
METHYLPHENIDATE 1MG/ML 500ML
|
Facility
|
OP
|
$1.70
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
30307914
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$0.85 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.94
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.85
|
| Rate for Payer: Aetna Government |
$0.85
|
| 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 |
$0.85
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.85
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
|
|
METHYLPHENIDATE 5MG/5ML UD LIQ
|
Facility
|
OP
|
$8.52
|
|
| Hospital Charge Code |
41657915
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.98 |
| Max. Negotiated Rate |
$6.82 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.69
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.26
|
| Rate for Payer: Aetna Government |
$4.26
|
| Rate for Payer: Brighton Health Commercial |
$6.39
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.82
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.79
|
| Rate for Payer: Group Health Inc Commercial |
$4.26
|
| Rate for Payer: Group Health Inc Medicare |
$2.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.26
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.54
|
|
|
METHYLPHENIDATE 5MG/5ML UD LIQ
|
Facility
|
OP
|
$8.52
|
|
| Hospital Charge Code |
41647915
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.98 |
| Max. Negotiated Rate |
$6.82 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.69
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.26
|
| Rate for Payer: Aetna Government |
$4.26
|
| Rate for Payer: Brighton Health Commercial |
$6.39
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.82
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.79
|
| Rate for Payer: Group Health Inc Commercial |
$4.26
|
| Rate for Payer: Group Health Inc Medicare |
$2.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.26
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.54
|
|
|
METHYLPHENIDATE 5 MG TAB
|
Facility
|
OP
|
$1.00
|
|
| Hospital Charge Code |
41654296
|
|
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
|
|
|
METHYLPHENIDATE 5 MG TAB
|
Facility
|
OP
|
$1.00
|
|
| Hospital Charge Code |
41644296
|
|
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
|
|
|
METHYLPHENIDATE HCL 5 MG/5ML PO SOLN [39314]
|
Facility
|
OP
|
$1.78
|
|
|
Service Code
|
NDC 00121089605
|
| Hospital Charge Code |
00121089605
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$1.42 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.98
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.89
|
| Rate for Payer: Aetna Government |
$0.89
|
| Rate for Payer: Brighton Health Commercial |
$1.33
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.42
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.21
|
| Rate for Payer: Group Health Inc Commercial |
$0.89
|
| Rate for Payer: Group Health Inc Medicare |
$0.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.89
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.15
|
|
|
METHYLPHENIDATE HCL 5 MG PO TABS [4988]
|
Facility
|
OP
|
$0.72
|
|
|
Service Code
|
NDC 10702010001
|
| Hospital Charge Code |
10702010001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.25 |
| Max. Negotiated Rate |
$0.58 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.36
|
| Rate for Payer: Aetna Government |
$0.36
|
| Rate for Payer: Brighton Health Commercial |
$0.54
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.58
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.49
|
| Rate for Payer: Group Health Inc Commercial |
$0.36
|
| Rate for Payer: Group Health Inc Medicare |
$0.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.36
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.47
|
|
