METRONIDAZOLE IV SYRINGE (NEO/PED) [40840043]
|
Facility
|
IP
|
$0.03
|
|
Service Code
|
NDC 09999123474
|
Hospital Charge Code |
00338105548
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$0.01 |
Max. Negotiated Rate |
$0.01 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
|
METRONIDAZOLE VAGINAL GEL
|
Facility
|
OP
|
$42.78
|
|
Hospital Charge Code |
41644900
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$14.97 |
Max. Negotiated Rate |
$34.22 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$23.53
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$21.39
|
Rate for Payer: Aetna Government |
$21.39
|
Rate for Payer: Brighton Health Commercial |
$32.08
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$34.22
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$29.09
|
Rate for Payer: Group Health Inc Commercial |
$21.39
|
Rate for Payer: Group Health Inc Medicare |
$14.97
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$21.39
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$21.39
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$27.81
|
|
METRONIDAZOLE VAGINAL GEL
|
Facility
|
OP
|
$42.78
|
|
Hospital Charge Code |
41654900
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$14.97 |
Max. Negotiated Rate |
$34.22 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$23.53
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$21.39
|
Rate for Payer: Aetna Government |
$21.39
|
Rate for Payer: Brighton Health Commercial |
$32.08
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$34.22
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$29.09
|
Rate for Payer: Group Health Inc Commercial |
$21.39
|
Rate for Payer: Group Health Inc Medicare |
$14.97
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$21.39
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$21.39
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$27.81
|
|
MEXILETINE 150MG CAP
|
Facility
|
OP
|
$1.00
|
|
Hospital Charge Code |
41644044
|
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
|
|
MEXILETINE 150MG CAP
|
Facility
|
OP
|
$1.00
|
|
Hospital Charge Code |
41654044
|
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
|
|
MEXILETINE 200MG CAP
|
Facility
|
OP
|
$1.00
|
|
Hospital Charge Code |
41644045
|
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
|
|
MEXILETINE 200MG CAP
|
Facility
|
OP
|
$1.00
|
|
Hospital Charge Code |
41654045
|
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
|
|
MEXILETINE HCL 150 MG PO CAPS [10595]
|
Facility
|
OP
|
$2.54
|
|
Service Code
|
NDC 00093873901
|
Hospital Charge Code |
00093873901
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$0.89 |
Max. Negotiated Rate |
$2.03 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.39
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.27
|
Rate for Payer: Aetna Government |
$1.27
|
Rate for Payer: Brighton Health Commercial |
$1.90
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.03
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.72
|
Rate for Payer: Group Health Inc Commercial |
$1.27
|
Rate for Payer: Group Health Inc Medicare |
$0.89
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.27
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1.27
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.65
|
|
MEXILETINE HCL 200 MG PO CAPS [10596]
|
Facility
|
OP
|
$3.03
|
|
Service Code
|
NDC 00093874001
|
Hospital Charge Code |
00093874001
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$1.06 |
Max. Negotiated Rate |
$2.42 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.66
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.51
|
Rate for Payer: Aetna Government |
$1.51
|
Rate for Payer: Brighton Health Commercial |
$2.27
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.42
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.06
|
Rate for Payer: Group Health Inc Commercial |
$1.51
|
Rate for Payer: Group Health Inc Medicare |
$1.06
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.51
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1.51
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.97
|
|
MGMNT OF EQUIPT REMOTLY 1ST 20MIN
|
Facility
|
OP
|
$0.01
|
|
Service Code
|
HCPCS 99457
|
Hospital Charge Code |
30302524
|
Hospital Revenue Code
|
988
|
Max. Negotiated Rate |
$23.85 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.01
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$23.85
|
Rate for Payer: Aetna Government |
$23.85
|
Rate for Payer: Brighton Health Commercial |
$0.01
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.01
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.01
|
Rate for Payer: Group Health Inc Commercial |
$0.01
|
Rate for Payer: Group Health Inc Medicare |
$0.00
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
|
MHA-TP (FTA)
|
Facility
|
OP
|
$33.10
|
|
Service Code
|
HCPCS 86780
|
Hospital Charge Code |
40721320
|
Hospital Revenue Code
|
302
|
Min. Negotiated Rate |
$9.27 |
Max. Negotiated Rate |
$24.82 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$18.20
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$13.24
|
Rate for Payer: Aetna Government |
$13.24
|
Rate for Payer: Affinity Essential Plan 1&2 |
$9.27
|
Rate for Payer: Affinity Essential Plan 3&4 |
$9.27
|
Rate for Payer: Affinity Medicaid/CHP/HARP |
$9.27
|
Rate for Payer: Brighton Health Commercial |
$24.82
|
Rate for Payer: Cash Price |
$13.24
|
Rate for Payer: Cash Price |
$13.24
|
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$13.24
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$21.05
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$17.81
|
Rate for Payer: Elderplan Medicare Advantage |
$13.24
|
Rate for Payer: EmblemHealth Commercial |
$13.24
|
Rate for Payer: Fidelis Essential Plan Aliesa |
$11.25
|
Rate for Payer: Fidelis Essential Plan QHP |
$11.78
|
Rate for Payer: Fidelis Medicare Advantage |
$13.24
|
Rate for Payer: Fidelis Qualified Health Plan |
$11.78
|
Rate for Payer: Group Health Inc Commercial |
$13.24
|
Rate for Payer: Group Health Inc Medicare |
$13.24
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.55
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$13.24
|
Rate for Payer: Healthfirst Medicare Advantage |
$13.24
|
Rate for Payer: Healthfirst QHP |
$13.24
|
Rate for Payer: Humana Medicare |
$13.50
|
Rate for Payer: Senior Whole Health Medicare Advantage |
$13.24
|
Rate for Payer: United Healthcare Commercial |
$16.77
|
Rate for Payer: United Healthcare Medicare Advantage |
$13.24
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$13.24
|
Rate for Payer: Wellcare CHP/FHP/Medicaid |
$10.59
|
Rate for Payer: Wellcare Medicare |
$11.92
|
|
MHA-TP (FTA)
|
Facility
|
IP
|
$33.10
|
|
Service Code
|
HCPCS 86780
|
Hospital Charge Code |
40721320
|
Hospital Revenue Code
|
302
|
Rate for Payer: Cash Price |
$13.24
|
|
MICAFUNGIN INJ 100MG/10ML
|
Facility
|
OP
|
$1.89
|
|
Hospital Charge Code |
41646082
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$0.66 |
Max. Negotiated Rate |
$1.51 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.04
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.95
|
Rate for Payer: Aetna Government |
$0.95
|
Rate for Payer: Brighton Health Commercial |
$1.42
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.51
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.29
|
Rate for Payer: Group Health Inc Commercial |
$0.95
|
Rate for Payer: Group Health Inc Medicare |
$0.66
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.95
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$0.95
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.23
|
|
MICAFUNGIN INJ 50MG/10ML
|
Facility
|
OP
|
$1.89
|
|
Hospital Charge Code |
41646081
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$0.66 |
Max. Negotiated Rate |
$1.51 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.04
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.95
|
Rate for Payer: Aetna Government |
$0.95
|
Rate for Payer: Brighton Health Commercial |
$1.42
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.51
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.29
|
Rate for Payer: Group Health Inc Commercial |
$0.95
|
Rate for Payer: Group Health Inc Medicare |
$0.66
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.95
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$0.95
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.23
|
|
MICAFUNGIN SODIUM 100 MG IV SOLR [77685]
|
Facility
|
IP
|
$57.60
|
|
Service Code
|
HCPCS J2248
|
Hospital Charge Code |
63323072901
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$28.80 |
Max. Negotiated Rate |
$28.80 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$28.80
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$28.80
|
|
MICAFUNGIN SODIUM 100 MG IV SOLR [77685]
|
Facility
|
OP
|
$57.60
|
|
Service Code
|
HCPCS J2248
|
Hospital Charge Code |
63323072910
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$0.97 |
Max. Negotiated Rate |
$60.48 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$31.68
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.97
|
Rate for Payer: Aetna Government |
$0.97
|
Rate for Payer: Brighton Health Commercial |
$34.56
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$28.80
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$33.12
|
Rate for Payer: EmblemHealth Commercial |
$28.80
|
Rate for Payer: Fidelis Medicare Advantage |
$60.48
|
Rate for Payer: Group Health Inc Commercial |
$28.80
|
Rate for Payer: Group Health Inc Medicare |
$20.16
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$28.80
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$28.80
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$37.44
|
|
MICAFUNGIN SODIUM 100 MG IV SOLR [77685]
|
Facility
|
IP
|
$179.52
|
|
Service Code
|
HCPCS J2248
|
Hospital Charge Code |
42023023010
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$89.76 |
Max. Negotiated Rate |
$89.76 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$89.76
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$89.76
|
|
MICAFUNGIN SODIUM 100 MG IV SOLR [77685]
|
Facility
|
IP
|
$57.60
|
|
Service Code
|
HCPCS J2248
|
Hospital Charge Code |
63323072910
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$28.80 |
Max. Negotiated Rate |
$28.80 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$28.80
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$28.80
|
|
MICAFUNGIN SODIUM 100 MG IV SOLR [77685]
|
Facility
|
OP
|
$57.60
|
|
Service Code
|
HCPCS J2248
|
Hospital Charge Code |
63323072901
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$0.97 |
Max. Negotiated Rate |
$60.48 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$31.68
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.97
|
Rate for Payer: Aetna Government |
$0.97
|
Rate for Payer: Brighton Health Commercial |
$34.56
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$28.80
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$33.12
|
Rate for Payer: EmblemHealth Commercial |
$28.80
|
Rate for Payer: Fidelis Medicare Advantage |
$60.48
|
Rate for Payer: Group Health Inc Commercial |
$28.80
|
Rate for Payer: Group Health Inc Medicare |
$20.16
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$28.80
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$28.80
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$37.44
|
|
MICAFUNGIN SODIUM 100 MG IV SOLR [77685]
|
Facility
|
OP
|
$179.52
|
|
Service Code
|
HCPCS J2248
|
Hospital Charge Code |
42023023010
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$0.97 |
Max. Negotiated Rate |
$188.50 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$98.74
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.97
|
Rate for Payer: Aetna Government |
$0.97
|
Rate for Payer: Brighton Health Commercial |
$107.71
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$89.76
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$103.22
|
Rate for Payer: EmblemHealth Commercial |
$89.76
|
Rate for Payer: Fidelis Medicare Advantage |
$188.50
|
Rate for Payer: Group Health Inc Commercial |
$89.76
|
Rate for Payer: Group Health Inc Medicare |
$62.83
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$89.76
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$89.76
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$116.69
|
|
MICAFUNGIN SODIUM 50 MG IV SOLR [41144]
|
Facility
|
IP
|
$89.76
|
|
Service Code
|
HCPCS J2248
|
Hospital Charge Code |
42023022910
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$44.88 |
Max. Negotiated Rate |
$44.88 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$44.88
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$44.88
|
|
MICAFUNGIN SODIUM 50 MG IV SOLR [41144]
|
Facility
|
IP
|
$89.76
|
|
Service Code
|
HCPCS J2248
|
Hospital Charge Code |
42023022901
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$44.88 |
Max. Negotiated Rate |
$44.88 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$44.88
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$44.88
|
|
MICAFUNGIN SODIUM 50 MG IV SOLR [41144]
|
Facility
|
OP
|
$89.76
|
|
Service Code
|
HCPCS J2248
|
Hospital Charge Code |
42023022910
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$0.97 |
Max. Negotiated Rate |
$94.25 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$49.37
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.97
|
Rate for Payer: Aetna Government |
$0.97
|
Rate for Payer: Brighton Health Commercial |
$53.86
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$44.88
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$51.61
|
Rate for Payer: EmblemHealth Commercial |
$44.88
|
Rate for Payer: Fidelis Medicare Advantage |
$94.25
|
Rate for Payer: Group Health Inc Commercial |
$44.88
|
Rate for Payer: Group Health Inc Medicare |
$31.42
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$44.88
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$44.88
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$58.34
|
|
MICAFUNGIN SODIUM 50 MG IV SOLR [41144]
|
Facility
|
OP
|
$89.76
|
|
Service Code
|
HCPCS J2248
|
Hospital Charge Code |
42023022901
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$0.97 |
Max. Negotiated Rate |
$94.25 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$49.37
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.97
|
Rate for Payer: Aetna Government |
$0.97
|
Rate for Payer: Brighton Health Commercial |
$53.86
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$44.88
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$51.61
|
Rate for Payer: EmblemHealth Commercial |
$44.88
|
Rate for Payer: Fidelis Medicare Advantage |
$94.25
|
Rate for Payer: Group Health Inc Commercial |
$44.88
|
Rate for Payer: Group Health Inc Medicare |
$31.42
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$44.88
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$44.88
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$58.34
|
|
MICONAZOLE 2% VAGINAL CREAM
|
Facility
|
OP
|
$5.16
|
|
Hospital Charge Code |
41641264
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$1.81 |
Max. Negotiated Rate |
$4.13 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.84
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.58
|
Rate for Payer: Aetna Government |
$2.58
|
Rate for Payer: Brighton Health Commercial |
$3.87
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.13
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.51
|
Rate for Payer: Group Health Inc Commercial |
$2.58
|
Rate for Payer: Group Health Inc Medicare |
$1.81
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.58
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$2.58
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.35
|
|