|
MINI PLT, 6 HOLES
|
Facility
|
OP
|
$208.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
40209739
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$69.35 |
| Max. Negotiated Rate |
$218.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$114.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$69.35
|
| Rate for Payer: Aetna Government |
$69.35
|
| Rate for Payer: Brighton Health Commercial |
$124.80
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$104.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$119.60
|
| Rate for Payer: EmblemHealth Commercial |
$104.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$218.40
|
| Rate for Payer: Group Health Inc Commercial |
$104.00
|
| Rate for Payer: Group Health Inc Medicare |
$72.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$104.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$104.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$135.20
|
|
|
MINI PLT, 6 HOLES
|
Facility
|
IP
|
$208.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
40209739
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$104.00 |
| Max. Negotiated Rate |
$104.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$104.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$104.00
|
|
|
MINOCYCLINE 100MG CAP
|
Facility
|
OP
|
$1.00
|
|
| Hospital Charge Code |
41649583
|
|
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
|
|
|
MINOCYCLINE 100MG CAP
|
Facility
|
OP
|
$1.00
|
|
| Hospital Charge Code |
41659583
|
|
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
|
|
|
MINOCYCLINE 100MG IV - 1MG
|
Facility
|
IP
|
$2.20
|
|
|
Service Code
|
HCPCS J2265
|
| Hospital Charge Code |
41659587
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.10 |
| Max. Negotiated Rate |
$1.10 |
| Rate for Payer: Cash Price |
$2.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.10
|
|
|
MINOCYCLINE 100MG IV - 1MG
|
Facility
|
OP
|
$2.20
|
|
|
Service Code
|
HCPCS J2265
|
| Hospital Charge Code |
41659587
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.10 |
| Max. Negotiated Rate |
$2.59 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.21
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.46
|
| Rate for Payer: Aetna Government |
$2.46
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1.73
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1.73
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1.73
|
| Rate for Payer: Brighton Health Commercial |
$1.32
|
| Rate for Payer: Cash Price |
$2.47
|
| Rate for Payer: Cash Price |
$2.47
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2.46
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.10
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.26
|
| Rate for Payer: Elderplan Medicare Advantage |
$2.46
|
| Rate for Payer: EmblemHealth Commercial |
$2.46
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2.46
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2.46
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2.59
|
| Rate for Payer: Fidelis Medicare Advantage |
$2.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2.59
|
| Rate for Payer: Group Health Inc Commercial |
$2.46
|
| Rate for Payer: Group Health Inc Medicare |
$2.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.10
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2.10
|
| Rate for Payer: Healthfirst QHP |
$2.46
|
| Rate for Payer: Humana Medicare |
$2.51
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2.46
|
| Rate for Payer: United Healthcare Commercial |
$2.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2.46
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.43
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1.97
|
| Rate for Payer: Wellcare Medicare |
$2.34
|
|
|
MINOCYCLINE 100MG IV - 1MG
|
Facility
|
IP
|
$2.20
|
|
|
Service Code
|
HCPCS J2265
|
| Hospital Charge Code |
41649587
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.10 |
| Max. Negotiated Rate |
$1.10 |
| Rate for Payer: Cash Price |
$2.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.10
|
|
|
MINOCYCLINE 100MG IV - 1MG
|
Facility
|
OP
|
$2.20
|
|
|
Service Code
|
HCPCS J2265
|
| Hospital Charge Code |
41649587
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.10 |
| Max. Negotiated Rate |
$2.59 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.21
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.46
|
| Rate for Payer: Aetna Government |
$2.46
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1.73
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1.73
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1.73
|
| Rate for Payer: Brighton Health Commercial |
$1.32
|
| Rate for Payer: Cash Price |
$2.47
|
| Rate for Payer: Cash Price |
$2.47
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2.46
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.10
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.26
|
| Rate for Payer: Elderplan Medicare Advantage |
$2.46
|
| Rate for Payer: EmblemHealth Commercial |
$2.46
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2.46
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2.46
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2.59
|
| Rate for Payer: Fidelis Medicare Advantage |
$2.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2.59
|
| Rate for Payer: Group Health Inc Commercial |
$2.46
|
| Rate for Payer: Group Health Inc Medicare |
$2.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.10
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2.10
|
| Rate for Payer: Healthfirst QHP |
$2.46
|
| Rate for Payer: Humana Medicare |
$2.51
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2.46
|
| Rate for Payer: United Healthcare Commercial |
$2.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2.46
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.43
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1.97
|
| Rate for Payer: Wellcare Medicare |
$2.34
|
|
|
MINOCYCLINE 200MG/D5W 500ML
|
Facility
|
OP
|
$2.21
|
|
|
Service Code
|
HCPCS J2265
|
| Hospital Charge Code |
41647923
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.10 |
| Max. Negotiated Rate |
$2.59 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.22
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.46
|
| Rate for Payer: Aetna Government |
$2.46
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1.73
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1.73
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1.73
|
| Rate for Payer: Brighton Health Commercial |
$1.33
|
| Rate for Payer: Cash Price |
$2.47
|
| Rate for Payer: Cash Price |
$2.47
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2.46
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.10
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.27
|
| Rate for Payer: Elderplan Medicare Advantage |
$2.46
|
| Rate for Payer: EmblemHealth Commercial |
$2.46
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2.46
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2.46
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2.59
|
| Rate for Payer: Fidelis Medicare Advantage |
$2.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2.59
|
| Rate for Payer: Group Health Inc Commercial |
$2.46
|
| Rate for Payer: Group Health Inc Medicare |
$2.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.10
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2.10
|
| Rate for Payer: Healthfirst QHP |
$2.46
|
| Rate for Payer: Humana Medicare |
$2.51
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2.46
|
| Rate for Payer: United Healthcare Commercial |
$2.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2.46
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.44
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1.97
|
| Rate for Payer: Wellcare Medicare |
$2.34
|
|
|
MINOCYCLINE 200MG/D5W 500ML
|
Facility
|
IP
|
$2.21
|
|
|
Service Code
|
HCPCS J2265
|
| Hospital Charge Code |
41657923
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.10 |
| Max. Negotiated Rate |
$1.10 |
| Rate for Payer: Cash Price |
$2.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.10
|
|
|
MINOCYCLINE 200MG/D5W 500ML
|
Facility
|
IP
|
$2.21
|
|
|
Service Code
|
HCPCS J2265
|
| Hospital Charge Code |
41647923
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.10 |
| Max. Negotiated Rate |
$1.10 |
| Rate for Payer: Cash Price |
$2.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.10
|
|
|
MINOCYCLINE 200MG/D5W 500ML
|
Facility
|
OP
|
$2.21
|
|
|
Service Code
|
HCPCS J2265
|
| Hospital Charge Code |
41657923
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.10 |
| Max. Negotiated Rate |
$2.59 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.22
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.46
|
| Rate for Payer: Aetna Government |
$2.46
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1.73
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1.73
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1.73
|
| Rate for Payer: Brighton Health Commercial |
$1.33
|
| Rate for Payer: Cash Price |
$2.47
|
| Rate for Payer: Cash Price |
$2.47
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2.46
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.10
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.27
|
| Rate for Payer: Elderplan Medicare Advantage |
$2.46
|
| Rate for Payer: EmblemHealth Commercial |
$2.46
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2.46
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2.46
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2.59
|
| Rate for Payer: Fidelis Medicare Advantage |
$2.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2.59
|
| Rate for Payer: Group Health Inc Commercial |
$2.46
|
| Rate for Payer: Group Health Inc Medicare |
$2.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.10
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2.10
|
| Rate for Payer: Healthfirst QHP |
$2.46
|
| Rate for Payer: Humana Medicare |
$2.51
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2.46
|
| Rate for Payer: United Healthcare Commercial |
$2.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2.46
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.44
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1.97
|
| Rate for Payer: Wellcare Medicare |
$2.34
|
|
|
MINOCYCLINE 200MG/NS 500ML
|
Facility
|
IP
|
$2.21
|
|
|
Service Code
|
HCPCS J2265
|
| Hospital Charge Code |
41647921
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.10 |
| Max. Negotiated Rate |
$1.10 |
| Rate for Payer: Cash Price |
$2.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.10
|
|
|
MINOCYCLINE 200MG/NS 500ML
|
Facility
|
OP
|
$2.21
|
|
|
Service Code
|
HCPCS J2265
|
| Hospital Charge Code |
41657921
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.10 |
| Max. Negotiated Rate |
$2.59 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.22
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.46
|
| Rate for Payer: Aetna Government |
$2.46
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1.73
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1.73
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1.73
|
| Rate for Payer: Brighton Health Commercial |
$1.33
|
| Rate for Payer: Cash Price |
$2.47
|
| Rate for Payer: Cash Price |
$2.47
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2.46
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.10
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.27
|
| Rate for Payer: Elderplan Medicare Advantage |
$2.46
|
| Rate for Payer: EmblemHealth Commercial |
$2.46
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2.46
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2.46
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2.59
|
| Rate for Payer: Fidelis Medicare Advantage |
$2.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2.59
|
| Rate for Payer: Group Health Inc Commercial |
$2.46
|
| Rate for Payer: Group Health Inc Medicare |
$2.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.10
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2.10
|
| Rate for Payer: Healthfirst QHP |
$2.46
|
| Rate for Payer: Humana Medicare |
$2.51
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2.46
|
| Rate for Payer: United Healthcare Commercial |
$2.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2.46
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.44
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1.97
|
| Rate for Payer: Wellcare Medicare |
$2.34
|
|
|
MINOCYCLINE 200MG/NS 500ML
|
Facility
|
IP
|
$2.21
|
|
|
Service Code
|
HCPCS J2265
|
| Hospital Charge Code |
41657921
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.10 |
| Max. Negotiated Rate |
$1.10 |
| Rate for Payer: Cash Price |
$2.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.10
|
|
|
MINOCYCLINE 200MG/NS 500ML
|
Facility
|
OP
|
$2.21
|
|
|
Service Code
|
HCPCS J2265
|
| Hospital Charge Code |
41647921
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.10 |
| Max. Negotiated Rate |
$2.59 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.22
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.46
|
| Rate for Payer: Aetna Government |
$2.46
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1.73
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1.73
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1.73
|
| Rate for Payer: Brighton Health Commercial |
$1.33
|
| Rate for Payer: Cash Price |
$2.47
|
| Rate for Payer: Cash Price |
$2.47
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2.46
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.10
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.27
|
| Rate for Payer: Elderplan Medicare Advantage |
$2.46
|
| Rate for Payer: EmblemHealth Commercial |
$2.46
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2.46
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2.46
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2.59
|
| Rate for Payer: Fidelis Medicare Advantage |
$2.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2.59
|
| Rate for Payer: Group Health Inc Commercial |
$2.46
|
| Rate for Payer: Group Health Inc Medicare |
$2.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.10
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2.10
|
| Rate for Payer: Healthfirst QHP |
$2.46
|
| Rate for Payer: Humana Medicare |
$2.51
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2.46
|
| Rate for Payer: United Healthcare Commercial |
$2.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2.46
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.44
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1.97
|
| Rate for Payer: Wellcare Medicare |
$2.34
|
|
|
MINOCYCLINE HCL 100 MG IV SOLR [10612]
|
Facility
|
IP
|
$301.08
|
|
|
Service Code
|
NDC 70842016010
|
| Hospital Charge Code |
70842016010
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$150.54 |
| Max. Negotiated Rate |
$150.54 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$150.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$150.54
|
|
|
MINOCYCLINE HCL 100 MG IV SOLR [10612]
|
Facility
|
OP
|
$301.08
|
|
|
Service Code
|
NDC 70842016001
|
| Hospital Charge Code |
70842016001
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$105.38 |
| Max. Negotiated Rate |
$316.13 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$165.59
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$150.54
|
| Rate for Payer: Aetna Government |
$150.54
|
| Rate for Payer: Brighton Health Commercial |
$180.65
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$150.54
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$173.12
|
| Rate for Payer: EmblemHealth Commercial |
$150.54
|
| Rate for Payer: Fidelis Medicare Advantage |
$316.13
|
| Rate for Payer: Group Health Inc Commercial |
$150.54
|
| Rate for Payer: Group Health Inc Medicare |
$105.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$150.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$150.54
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$195.70
|
|
|
MINOCYCLINE HCL 100 MG IV SOLR [10612]
|
Facility
|
IP
|
$301.08
|
|
|
Service Code
|
NDC 70842016001
|
| Hospital Charge Code |
70842016001
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$150.54 |
| Max. Negotiated Rate |
$150.54 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$150.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$150.54
|
|
|
MINOCYCLINE HCL 100 MG IV SOLR [10612]
|
Facility
|
OP
|
$301.08
|
|
|
Service Code
|
NDC 70842016010
|
| Hospital Charge Code |
70842016010
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$105.38 |
| Max. Negotiated Rate |
$316.13 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$165.59
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$150.54
|
| Rate for Payer: Aetna Government |
$150.54
|
| Rate for Payer: Brighton Health Commercial |
$180.65
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$150.54
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$173.12
|
| Rate for Payer: EmblemHealth Commercial |
$150.54
|
| Rate for Payer: Fidelis Medicare Advantage |
$316.13
|
| Rate for Payer: Group Health Inc Commercial |
$150.54
|
| Rate for Payer: Group Health Inc Medicare |
$105.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$150.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$150.54
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$195.70
|
|
|
MINOCYCLINE HCL 100 MG PO CAPS [5110]
|
Facility
|
OP
|
$3.40
|
|
|
Service Code
|
NDC 68382031818
|
| Hospital Charge Code |
68382031818
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.19 |
| Max. Negotiated Rate |
$2.72 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.87
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.70
|
| Rate for Payer: Aetna Government |
$1.70
|
| Rate for Payer: Brighton Health Commercial |
$2.55
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.72
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.31
|
| Rate for Payer: Group Health Inc Commercial |
$1.70
|
| Rate for Payer: Group Health Inc Medicare |
$1.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.70
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.70
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.21
|
|
|
MINOCYCLINE HCL 100 MG PO CAPS [5110]
|
Facility
|
OP
|
$3.40
|
|
|
Service Code
|
NDC 00591569550
|
| Hospital Charge Code |
00591569550
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.19 |
| Max. Negotiated Rate |
$2.72 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.87
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.70
|
| Rate for Payer: Aetna Government |
$1.70
|
| Rate for Payer: Brighton Health Commercial |
$2.55
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.72
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.31
|
| Rate for Payer: Group Health Inc Commercial |
$1.70
|
| Rate for Payer: Group Health Inc Medicare |
$1.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.70
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.70
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.21
|
|
|
MINOR BLADDER PROCEDURES WITH CC
|
Facility
|
IP
|
$37,895.50
|
|
|
Service Code
|
MSDRG 663
|
| Min. Negotiated Rate |
$12,510.90 |
| Max. Negotiated Rate |
$37,895.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$21,512.96
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$27,560.36
|
| Rate for Payer: Aetna Government |
$27,560.36
|
| Rate for Payer: Brighton Health Commercial |
$21,155.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$28,111.57
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$25,195.47
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$20,792.38
|
| Rate for Payer: Elderplan Medicare Advantage |
$26,182.34
|
| Rate for Payer: EmblemHealth Commercial |
$12,510.90
|
| Rate for Payer: Fidelis Medicare Advantage |
$27,560.36
|
| Rate for Payer: Group Health Inc Commercial |
$27,560.36
|
| Rate for Payer: Group Health Inc Medicare |
$27,560.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$27,560.36
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12,815.57
|
| Rate for Payer: Humana Medicare |
$37,895.50
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$27,560.36
|
| Rate for Payer: United Healthcare Commercial |
$29,015.13
|
| Rate for Payer: United Healthcare Medicare Advantage |
$27,560.36
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$27,560.36
|
| Rate for Payer: Wellcare Medicare |
$26,182.34
|
|
|
MINOR BLADDER PROCEDURES WITH MCC
|
Facility
|
IP
|
$67,215.82
|
|
|
Service Code
|
MSDRG 662
|
| Min. Negotiated Rate |
$22,731.17 |
| Max. Negotiated Rate |
$67,215.82 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$44,186.34
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$48,884.23
|
| Rate for Payer: Aetna Government |
$48,884.23
|
| Rate for Payer: Brighton Health Commercial |
$43,452.15
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$49,861.91
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$51,750.01
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$42,706.33
|
| Rate for Payer: Elderplan Medicare Advantage |
$46,440.02
|
| Rate for Payer: EmblemHealth Commercial |
$25,696.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$48,884.23
|
| Rate for Payer: Group Health Inc Commercial |
$48,884.23
|
| Rate for Payer: Group Health Inc Medicare |
$48,884.23
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$48,884.23
|
| Rate for Payer: Healthfirst Medicare Advantage |
$22,731.17
|
| Rate for Payer: Humana Medicare |
$67,215.82
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$48,884.23
|
| Rate for Payer: United Healthcare Commercial |
$59,595.37
|
| Rate for Payer: United Healthcare Medicare Advantage |
$48,884.23
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$48,884.23
|
| Rate for Payer: Wellcare Medicare |
$46,440.02
|
|
|
MINOR BLADDER PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$30,318.02
|
|
|
Service Code
|
MSDRG 664
|
| Min. Negotiated Rate |
$9,103.22 |
| Max. Negotiated Rate |
$30,318.02 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$15,653.29
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$22,049.47
|
| Rate for Payer: Aetna Government |
$22,049.47
|
| Rate for Payer: Brighton Health Commercial |
$15,393.20
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$22,490.46
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$18,332.77
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$15,128.99
|
| Rate for Payer: Elderplan Medicare Advantage |
$20,947.00
|
| Rate for Payer: EmblemHealth Commercial |
$9,103.22
|
| Rate for Payer: Fidelis Medicare Advantage |
$22,049.47
|
| Rate for Payer: Group Health Inc Commercial |
$22,049.47
|
| Rate for Payer: Group Health Inc Medicare |
$22,049.47
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$22,049.47
|
| Rate for Payer: Healthfirst Medicare Advantage |
$10,253.00
|
| Rate for Payer: Humana Medicare |
$30,318.02
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$22,049.47
|
| Rate for Payer: United Healthcare Commercial |
$21,112.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$22,049.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$22,049.47
|
| Rate for Payer: Wellcare Medicare |
$20,947.00
|
|
