|
MITOMYCIN 5 MG INJ
|
Facility
|
OP
|
$39.06
|
|
|
Service Code
|
HCPCS J9280
|
| Hospital Charge Code |
41650580
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19.53 |
| Max. Negotiated Rate |
$71.05 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$21.48
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$63.35
|
| Rate for Payer: Aetna Government |
$63.35
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$44.34
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$44.34
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$44.34
|
| Rate for Payer: Brighton Health Commercial |
$23.44
|
| Rate for Payer: Cash Price |
$63.35
|
| Rate for Payer: Cash Price |
$63.35
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$63.35
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$19.53
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$22.46
|
| Rate for Payer: Elderplan Medicare Advantage |
$63.35
|
| Rate for Payer: EmblemHealth Commercial |
$63.35
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$63.35
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$63.35
|
| Rate for Payer: Fidelis Essential Plan QHP |
$66.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$63.35
|
| Rate for Payer: Fidelis Qualified Health Plan |
$66.52
|
| Rate for Payer: Group Health Inc Commercial |
$63.35
|
| Rate for Payer: Group Health Inc Medicare |
$63.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$19.53
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$19.53
|
| Rate for Payer: Healthfirst Medicare Advantage |
$53.85
|
| Rate for Payer: Healthfirst QHP |
$63.35
|
| Rate for Payer: Humana Medicare |
$64.61
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$63.35
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$71.05
|
| Rate for Payer: SOMOS Essential |
$71.05
|
| Rate for Payer: United Healthcare Commercial |
$44.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$63.35
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$25.39
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$50.68
|
| Rate for Payer: Wellcare Medicare |
$60.18
|
|
|
MITOMYCIN 5 MG IV SOLR [10632]
|
Facility
|
OP
|
$272.46
|
|
|
Service Code
|
HCPCS J9280
|
| Hospital Charge Code |
16729011505
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$50.68 |
| Max. Negotiated Rate |
$177.10 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$149.85
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$63.35
|
| Rate for Payer: Aetna Government |
$63.35
|
| Rate for Payer: Brighton Health Commercial |
$163.48
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$63.35
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$136.23
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$156.66
|
| Rate for Payer: Elderplan Medicare Advantage |
$63.35
|
| Rate for Payer: EmblemHealth Commercial |
$136.23
|
| Rate for Payer: Fidelis Medicare Advantage |
$63.35
|
| Rate for Payer: Group Health Inc Commercial |
$63.35
|
| Rate for Payer: Group Health Inc Medicare |
$63.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$136.23
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$136.23
|
| Rate for Payer: Healthfirst Medicare Advantage |
$53.85
|
| Rate for Payer: Healthfirst QHP |
$63.35
|
| Rate for Payer: Humana Medicare |
$64.61
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$63.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$63.35
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$177.10
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$50.68
|
|
|
MITOMYCIN 5 MG IV SOLR [10632]
|
Facility
|
IP
|
$272.46
|
|
|
Service Code
|
HCPCS J9280
|
| Hospital Charge Code |
16729011505
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$136.23 |
| Max. Negotiated Rate |
$136.23 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$136.23
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$136.23
|
|
|
MITOXANTRONE 2 MG/ML INJ 10 ML
|
Facility
|
OP
|
$418.00
|
|
|
Service Code
|
HCPCS J9293
|
| Hospital Charge Code |
41644577
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30.50 |
| Max. Negotiated Rate |
$271.70 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$229.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$43.58
|
| Rate for Payer: Aetna Government |
$43.58
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$30.50
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$30.50
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$30.50
|
| Rate for Payer: Brighton Health Commercial |
$250.80
|
| Rate for Payer: Cash Price |
$43.58
|
| Rate for Payer: Cash Price |
$43.58
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$43.58
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$209.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$240.35
|
| Rate for Payer: Elderplan Medicare Advantage |
$43.58
|
| Rate for Payer: EmblemHealth Commercial |
$43.58
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$43.58
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$43.58
|
| Rate for Payer: Fidelis Essential Plan QHP |
$45.76
|
| Rate for Payer: Fidelis Medicare Advantage |
$43.58
|
| Rate for Payer: Fidelis Qualified Health Plan |
$45.76
|
| Rate for Payer: Group Health Inc Commercial |
$43.58
|
| Rate for Payer: Group Health Inc Medicare |
$43.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$209.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$209.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$37.04
|
| Rate for Payer: Healthfirst QHP |
$43.58
|
| Rate for Payer: Humana Medicare |
$44.45
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$43.58
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$45.23
|
| Rate for Payer: SOMOS Essential |
$45.23
|
| Rate for Payer: United Healthcare Commercial |
$54.88
|
| Rate for Payer: United Healthcare Medicare Advantage |
$43.58
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$271.70
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$34.86
|
| Rate for Payer: Wellcare Medicare |
$41.40
|
|
|
MITOXANTRONE 2 MG/ML INJ 10 ML
|
Facility
|
IP
|
$418.00
|
|
|
Service Code
|
HCPCS J9293
|
| Hospital Charge Code |
41644577
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$209.00 |
| Max. Negotiated Rate |
$209.00 |
| Rate for Payer: Cash Price |
$43.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$209.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$209.00
|
|
|
MITOXANTRONE 2 MG/ML INJ 10 ML
|
Facility
|
OP
|
$418.00
|
|
|
Service Code
|
HCPCS J9293
|
| Hospital Charge Code |
41654577
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30.50 |
| Max. Negotiated Rate |
$271.70 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$229.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$43.58
|
| Rate for Payer: Aetna Government |
$43.58
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$30.50
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$30.50
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$30.50
|
| Rate for Payer: Brighton Health Commercial |
$250.80
|
| Rate for Payer: Cash Price |
$43.58
|
| Rate for Payer: Cash Price |
$43.58
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$43.58
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$209.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$240.35
|
| Rate for Payer: Elderplan Medicare Advantage |
$43.58
|
| Rate for Payer: EmblemHealth Commercial |
$43.58
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$43.58
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$43.58
|
| Rate for Payer: Fidelis Essential Plan QHP |
$45.76
|
| Rate for Payer: Fidelis Medicare Advantage |
$43.58
|
| Rate for Payer: Fidelis Qualified Health Plan |
$45.76
|
| Rate for Payer: Group Health Inc Commercial |
$43.58
|
| Rate for Payer: Group Health Inc Medicare |
$43.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$209.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$209.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$37.04
|
| Rate for Payer: Healthfirst QHP |
$43.58
|
| Rate for Payer: Humana Medicare |
$44.45
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$43.58
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$45.23
|
| Rate for Payer: SOMOS Essential |
$45.23
|
| Rate for Payer: United Healthcare Commercial |
$54.88
|
| Rate for Payer: United Healthcare Medicare Advantage |
$43.58
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$271.70
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$34.86
|
| Rate for Payer: Wellcare Medicare |
$41.40
|
|
|
MITOXANTRONE 2 MG/ML INJ 10 ML
|
Facility
|
IP
|
$418.00
|
|
|
Service Code
|
HCPCS J9293
|
| Hospital Charge Code |
41654577
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$209.00 |
| Max. Negotiated Rate |
$209.00 |
| Rate for Payer: Cash Price |
$43.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$209.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$209.00
|
|
|
MITOXANTRONE HCL 20 MG/10ML IV CONC [93748]
|
Facility
|
IP
|
$20.40
|
|
|
Service Code
|
HCPCS J9293
|
| Hospital Charge Code |
00703468501
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10.20 |
| Max. Negotiated Rate |
$10.20 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$10.20
|
|
|
MITOXANTRONE HCL 20 MG/10ML IV CONC [93748]
|
Facility
|
OP
|
$20.40
|
|
|
Service Code
|
HCPCS J9293
|
| Hospital Charge Code |
00703468501
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10.20 |
| Max. Negotiated Rate |
$44.45 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$11.22
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$43.58
|
| Rate for Payer: Aetna Government |
$43.58
|
| Rate for Payer: Brighton Health Commercial |
$12.24
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$43.58
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$10.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$11.73
|
| Rate for Payer: Elderplan Medicare Advantage |
$43.58
|
| Rate for Payer: EmblemHealth Commercial |
$10.20
|
| Rate for Payer: Fidelis Medicare Advantage |
$43.58
|
| Rate for Payer: Group Health Inc Commercial |
$43.58
|
| Rate for Payer: Group Health Inc Medicare |
$43.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$10.20
|
| Rate for Payer: Healthfirst Medicare Advantage |
$37.04
|
| Rate for Payer: Healthfirst QHP |
$43.58
|
| Rate for Payer: Humana Medicare |
$44.45
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$43.58
|
| Rate for Payer: United Healthcare Medicare Advantage |
$43.58
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$13.26
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$34.86
|
|
|
MITTEN FLEXIBLE PALM COTTON MED
|
Facility
|
OP
|
$779.79
|
|
| Hospital Charge Code |
64901062
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$272.93 |
| Max. Negotiated Rate |
$623.83 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$428.88
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$389.90
|
| Rate for Payer: Aetna Government |
$389.90
|
| Rate for Payer: Brighton Health Commercial |
$584.84
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$623.83
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$530.26
|
| Rate for Payer: Group Health Inc Commercial |
$389.90
|
| Rate for Payer: Group Health Inc Medicare |
$272.93
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$389.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$389.90
|
|
|
MIX EVAC III
|
Facility
|
OP
|
$166.10
|
|
| Hospital Charge Code |
64903965
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$58.14 |
| Max. Negotiated Rate |
$132.88 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$91.36
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$83.05
|
| Rate for Payer: Aetna Government |
$83.05
|
| Rate for Payer: Brighton Health Commercial |
$124.58
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$132.88
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$112.95
|
| Rate for Payer: Group Health Inc Commercial |
$83.05
|
| Rate for Payer: Group Health Inc Medicare |
$58.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$83.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$83.05
|
|
|
MIXING STUDY
|
Facility
|
IP
|
$29.63
|
|
|
Service Code
|
HCPCS 85300
|
| Hospital Charge Code |
40621577
|
|
Hospital Revenue Code
|
305
|
| Rate for Payer: Cash Price |
$11.85
|
|
|
MIXING STUDY
|
Facility
|
OP
|
$29.63
|
|
|
Service Code
|
HCPCS 85300
|
| Hospital Charge Code |
40621577
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$8.30 |
| Max. Negotiated Rate |
$22.22 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$16.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$11.85
|
| Rate for Payer: Aetna Government |
$11.85
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$8.30
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$8.30
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$8.30
|
| Rate for Payer: Brighton Health Commercial |
$22.22
|
| Rate for Payer: Cash Price |
$11.85
|
| Rate for Payer: Cash Price |
$11.85
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$11.85
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$18.84
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$15.94
|
| Rate for Payer: Elderplan Medicare Advantage |
$11.85
|
| Rate for Payer: EmblemHealth Commercial |
$11.85
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$10.07
|
| Rate for Payer: Fidelis Essential Plan QHP |
$10.55
|
| Rate for Payer: Fidelis Medicare Advantage |
$11.85
|
| Rate for Payer: Fidelis Qualified Health Plan |
$10.55
|
| Rate for Payer: Group Health Inc Commercial |
$11.85
|
| Rate for Payer: Group Health Inc Medicare |
$11.85
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$11.85
|
| Rate for Payer: Healthfirst Medicare Advantage |
$11.85
|
| Rate for Payer: Healthfirst QHP |
$11.85
|
| Rate for Payer: Humana Medicare |
$12.09
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$11.85
|
| Rate for Payer: United Healthcare Commercial |
$15.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.85
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$11.85
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$9.48
|
| Rate for Payer: Wellcare Medicare |
$10.66
|
|
|
MMD ACCUCHECK
|
Facility
|
OP
|
$25.00
|
|
| Hospital Charge Code |
46359020
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$12.50 |
| Max. Negotiated Rate |
$874.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$694.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12.50
|
| Rate for Payer: Aetna Government |
$12.50
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$747.30
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$635.21
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Group Health Inc Commercial |
$525.00
|
| Rate for Payer: Group Health Inc Medicare |
$525.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.50
|
| Rate for Payer: United Healthcare Commercial |
$50.00
|
|
|
MMD ACEWRAPS
|
Facility
|
OP
|
$5.00
|
|
| Hospital Charge Code |
46359050
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$2.50 |
| Max. Negotiated Rate |
$874.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$694.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.50
|
| Rate for Payer: Aetna Government |
$2.50
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$747.30
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$635.21
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Group Health Inc Commercial |
$525.00
|
| Rate for Payer: Group Health Inc Medicare |
$525.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.50
|
| Rate for Payer: United Healthcare Commercial |
$50.00
|
|
|
MMD ANKLE AIRCAST
|
Facility
|
OP
|
$50.00
|
|
| Hospital Charge Code |
46359051
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$25.00 |
| Max. Negotiated Rate |
$874.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$694.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$25.00
|
| Rate for Payer: Aetna Government |
$25.00
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$747.30
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$635.21
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Group Health Inc Commercial |
$525.00
|
| Rate for Payer: Group Health Inc Medicare |
$525.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$25.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$25.00
|
| Rate for Payer: United Healthcare Commercial |
$50.00
|
|
|
MMD ARM SLINGS
|
Facility
|
OP
|
$10.00
|
|
| Hospital Charge Code |
46359052
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$874.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$694.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.00
|
| Rate for Payer: Aetna Government |
$5.00
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$747.30
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$635.21
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Group Health Inc Commercial |
$525.00
|
| Rate for Payer: Group Health Inc Medicare |
$525.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.00
|
| Rate for Payer: United Healthcare Commercial |
$50.00
|
|
|
MMD BASIC EMPLOYMENT/STUDENT
|
Facility
|
OP
|
$65.00
|
|
| Hospital Charge Code |
46359046
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$32.50 |
| Max. Negotiated Rate |
$874.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$694.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$32.50
|
| Rate for Payer: Aetna Government |
$32.50
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$747.30
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$635.21
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Group Health Inc Commercial |
$525.00
|
| Rate for Payer: Group Health Inc Medicare |
$525.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$32.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$32.50
|
| Rate for Payer: United Healthcare Commercial |
$50.00
|
|
|
MMD BENADRYL 50MG
|
Facility
|
OP
|
$99.00
|
|
| Hospital Charge Code |
46359007
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$49.50 |
| Max. Negotiated Rate |
$874.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$694.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$49.50
|
| Rate for Payer: Aetna Government |
$49.50
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$747.30
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$635.21
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Group Health Inc Commercial |
$525.00
|
| Rate for Payer: Group Health Inc Medicare |
$525.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$49.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$49.50
|
| Rate for Payer: United Healthcare Commercial |
$50.00
|
|
|
MMD CERVICAL COLLAR
|
Facility
|
OP
|
$25.00
|
|
| Hospital Charge Code |
46359053
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$12.50 |
| Max. Negotiated Rate |
$874.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$694.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12.50
|
| Rate for Payer: Aetna Government |
$12.50
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$747.30
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$635.21
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Group Health Inc Commercial |
$525.00
|
| Rate for Payer: Group Health Inc Medicare |
$525.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.50
|
| Rate for Payer: United Healthcare Commercial |
$50.00
|
|
|
MMD COMPLEX
|
Facility
|
OP
|
$150.00
|
|
| Hospital Charge Code |
46359037
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$50.00 |
| Max. Negotiated Rate |
$874.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$694.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$75.00
|
| Rate for Payer: Aetna Government |
$75.00
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$747.30
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$635.21
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Group Health Inc Commercial |
$525.00
|
| Rate for Payer: Group Health Inc Medicare |
$525.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$75.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$75.00
|
| Rate for Payer: United Healthcare Commercial |
$50.00
|
|
|
MMD COMPLEX (FB)
|
Facility
|
OP
|
$150.00
|
|
| Hospital Charge Code |
46359029
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$50.00 |
| Max. Negotiated Rate |
$874.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$694.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$75.00
|
| Rate for Payer: Aetna Government |
$75.00
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$747.30
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$635.21
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Group Health Inc Commercial |
$525.00
|
| Rate for Payer: Group Health Inc Medicare |
$525.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$75.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$75.00
|
| Rate for Payer: United Healthcare Commercial |
$50.00
|
|
|
MMD CONJUNCTIVAL (FB)
|
Facility
|
OP
|
$50.00
|
|
| Hospital Charge Code |
46359030
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$25.00 |
| Max. Negotiated Rate |
$874.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$694.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$25.00
|
| Rate for Payer: Aetna Government |
$25.00
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$747.30
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$635.21
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Group Health Inc Commercial |
$525.00
|
| Rate for Payer: Group Health Inc Medicare |
$525.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$25.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$25.00
|
| Rate for Payer: United Healthcare Commercial |
$50.00
|
|
|
MMD COVID ANTIBODY VISIT
|
Facility
|
OP
|
$75.00
|
|
| Hospital Charge Code |
46359003
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$37.50 |
| Max. Negotiated Rate |
$874.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$694.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$37.50
|
| Rate for Payer: Aetna Government |
$37.50
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$747.30
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$635.21
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Group Health Inc Commercial |
$525.00
|
| Rate for Payer: Group Health Inc Medicare |
$525.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$37.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$37.50
|
| Rate for Payer: United Healthcare Commercial |
$50.00
|
|
|
MMD COVID ANTIGEN TEST VISIT
|
Facility
|
OP
|
$124.00
|
|
| Hospital Charge Code |
46359005
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$50.00 |
| Max. Negotiated Rate |
$874.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$694.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$62.00
|
| Rate for Payer: Aetna Government |
$62.00
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$747.30
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$635.21
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Group Health Inc Commercial |
$525.00
|
| Rate for Payer: Group Health Inc Medicare |
$525.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$62.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$62.00
|
| Rate for Payer: United Healthcare Commercial |
$50.00
|
|
