|
MULTIVITAMINS LIQUID 5 ML UDC
|
Facility
|
OP
|
$1.00
|
|
| Hospital Charge Code |
41643197
|
|
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
|
|
|
MULTIVITAMINS LIQUID 5 ML UDC
|
Facility
|
OP
|
$1.00
|
|
| Hospital Charge Code |
41653197
|
|
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
|
|
|
MULTIVITAMINS + MINERALS (AQUADEK) LIQ P
|
Facility
|
OP
|
$0.82
|
|
| Hospital Charge Code |
41655408
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$0.66 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.41
|
| Rate for Payer: Aetna Government |
$0.41
|
| Rate for Payer: Brighton Health Commercial |
$0.62
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.66
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.56
|
| Rate for Payer: Group Health Inc Commercial |
$0.41
|
| Rate for Payer: Group Health Inc Medicare |
$0.29
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.41
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.41
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.53
|
|
|
MULTIVITAMINS + MINERALS (AQUADEK) LIQ P
|
Facility
|
OP
|
$0.82
|
|
| Hospital Charge Code |
41645408
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$0.66 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.41
|
| Rate for Payer: Aetna Government |
$0.41
|
| Rate for Payer: Brighton Health Commercial |
$0.62
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.66
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.56
|
| Rate for Payer: Group Health Inc Commercial |
$0.41
|
| Rate for Payer: Group Health Inc Medicare |
$0.29
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.41
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.41
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.53
|
|
|
MULTIVITAMINS + MINERALS TAB
|
Facility
|
OP
|
$0.08
|
|
| Hospital Charge Code |
41643748
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.06 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.04
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.04
|
| Rate for Payer: Aetna Government |
$0.04
|
| Rate for Payer: Brighton Health Commercial |
$0.06
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.06
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.05
|
| Rate for Payer: Group Health Inc Commercial |
$0.04
|
| Rate for Payer: Group Health Inc Medicare |
$0.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.04
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.05
|
|
|
MULTIVITAMINS + MINERALS TAB
|
Facility
|
OP
|
$0.08
|
|
| Hospital Charge Code |
41653748
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.06 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.04
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.04
|
| Rate for Payer: Aetna Government |
$0.04
|
| Rate for Payer: Brighton Health Commercial |
$0.06
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.06
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.05
|
| Rate for Payer: Group Health Inc Commercial |
$0.04
|
| Rate for Payer: Group Health Inc Medicare |
$0.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.04
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.05
|
|
|
MULTIVITAMINS PRENATAL TAB
|
Facility
|
OP
|
$1.00
|
|
| Hospital Charge Code |
41641858
|
|
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
|
|
|
MULTIVITAMINS PRENATAL TAB
|
Facility
|
OP
|
$1.00
|
|
| Hospital Charge Code |
41651858
|
|
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
|
|
|
MULT LEAD ICD W/REPROGRAM
|
Facility
|
OP
|
$109.80
|
|
|
Service Code
|
HCPCS 93284 TC
|
| Hospital Charge Code |
30305066
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$30.53 |
| Max. Negotiated Rate |
$316.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$60.39
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$43.61
|
| Rate for Payer: Aetna Government |
$43.61
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$30.53
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$30.53
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$30.53
|
| Rate for Payer: Brighton Health Commercial |
$82.35
|
| Rate for Payer: Cash Price |
$43.61
|
| Rate for Payer: Cash Price |
$43.61
|
| Rate for Payer: Cash Price |
$43.61
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$43.61
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$87.84
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$74.66
|
| Rate for Payer: Elderplan Medicare Advantage |
$43.61
|
| Rate for Payer: EmblemHealth Commercial |
$43.61
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$37.07
|
| Rate for Payer: Fidelis Essential Plan QHP |
$38.81
|
| Rate for Payer: Fidelis Medicare Advantage |
$43.61
|
| Rate for Payer: Fidelis Qualified Health Plan |
$38.81
|
| Rate for Payer: Group Health Inc Commercial |
$43.61
|
| Rate for Payer: Group Health Inc Medicare |
$43.61
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$54.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$43.61
|
| Rate for Payer: Healthfirst Medicare Advantage |
$37.07
|
| Rate for Payer: Healthfirst QHP |
$43.61
|
| Rate for Payer: Humana Medicare |
$44.48
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$43.61
|
| Rate for Payer: United Healthcare Commercial |
$316.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$43.61
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$43.61
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$34.89
|
| Rate for Payer: Wellcare Medicare |
$41.43
|
|
|
MULT LEAD ICD W/REPROGRAM
|
Facility
|
IP
|
$109.80
|
|
|
Service Code
|
HCPCS 93284 TC
|
| Hospital Charge Code |
30305066
|
|
Hospital Revenue Code
|
480
|
| Rate for Payer: Cash Price |
$43.61
|
|
|
MULT LEAD PACE W/REPROGRAM
|
Facility
|
OP
|
$109.80
|
|
|
Service Code
|
HCPCS 93281 TC
|
| Hospital Charge Code |
30305063
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$30.53 |
| Max. Negotiated Rate |
$316.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$60.39
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$43.61
|
| Rate for Payer: Aetna Government |
$43.61
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$30.53
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$30.53
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$30.53
|
| Rate for Payer: Brighton Health Commercial |
$82.35
|
| Rate for Payer: Cash Price |
$43.61
|
| Rate for Payer: Cash Price |
$43.61
|
| Rate for Payer: Cash Price |
$43.61
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$43.61
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$87.84
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$74.66
|
| Rate for Payer: Elderplan Medicare Advantage |
$43.61
|
| Rate for Payer: EmblemHealth Commercial |
$43.61
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$37.07
|
| Rate for Payer: Fidelis Essential Plan QHP |
$38.81
|
| Rate for Payer: Fidelis Medicare Advantage |
$43.61
|
| Rate for Payer: Fidelis Qualified Health Plan |
$38.81
|
| Rate for Payer: Group Health Inc Commercial |
$43.61
|
| Rate for Payer: Group Health Inc Medicare |
$43.61
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$54.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$43.61
|
| Rate for Payer: Healthfirst Medicare Advantage |
$37.07
|
| Rate for Payer: Healthfirst QHP |
$43.61
|
| Rate for Payer: Humana Medicare |
$44.48
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$43.61
|
| Rate for Payer: United Healthcare Commercial |
$316.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$43.61
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$43.61
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$34.89
|
| Rate for Payer: Wellcare Medicare |
$41.43
|
|
|
MULT LEAD PACE W/REPROGRAM
|
Facility
|
IP
|
$109.80
|
|
|
Service Code
|
HCPCS 93281 TC
|
| Hospital Charge Code |
30305063
|
|
Hospital Revenue Code
|
480
|
| Rate for Payer: Cash Price |
$43.61
|
|
|
MUMPS ANTIBODIES, IGG
|
Facility
|
IP
|
$32.63
|
|
|
Service Code
|
HCPCS 86735
|
| Hospital Charge Code |
40729374
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$13.05
|
|
|
MUMPS ANTIBODIES, IGG
|
Facility
|
OP
|
$32.63
|
|
|
Service Code
|
HCPCS 86735
|
| Hospital Charge Code |
40729374
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.14 |
| Max. Negotiated Rate |
$24.47 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$17.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$13.05
|
| Rate for Payer: Aetna Government |
$13.05
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$9.14
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$9.14
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$9.14
|
| Rate for Payer: Brighton Health Commercial |
$24.47
|
| Rate for Payer: Cash Price |
$13.05
|
| Rate for Payer: Cash Price |
$13.05
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$13.05
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$20.75
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$17.56
|
| Rate for Payer: Elderplan Medicare Advantage |
$13.05
|
| Rate for Payer: EmblemHealth Commercial |
$13.05
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$11.09
|
| Rate for Payer: Fidelis Essential Plan QHP |
$11.61
|
| Rate for Payer: Fidelis Medicare Advantage |
$13.05
|
| Rate for Payer: Fidelis Qualified Health Plan |
$11.61
|
| Rate for Payer: Group Health Inc Commercial |
$13.05
|
| Rate for Payer: Group Health Inc Medicare |
$13.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.05
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13.05
|
| Rate for Payer: Healthfirst QHP |
$13.05
|
| Rate for Payer: Humana Medicare |
$13.31
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$13.05
|
| Rate for Payer: United Healthcare Commercial |
$16.53
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$13.05
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$10.44
|
| Rate for Payer: Wellcare Medicare |
$11.74
|
|
|
MUMPS ANTIBODIES, IGM
|
Facility
|
OP
|
$32.63
|
|
|
Service Code
|
HCPCS 86735
|
| Hospital Charge Code |
40729375
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.14 |
| Max. Negotiated Rate |
$24.47 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$17.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$13.05
|
| Rate for Payer: Aetna Government |
$13.05
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$9.14
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$9.14
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$9.14
|
| Rate for Payer: Brighton Health Commercial |
$24.47
|
| Rate for Payer: Cash Price |
$13.05
|
| Rate for Payer: Cash Price |
$13.05
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$13.05
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$20.75
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$17.56
|
| Rate for Payer: Elderplan Medicare Advantage |
$13.05
|
| Rate for Payer: EmblemHealth Commercial |
$13.05
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$11.09
|
| Rate for Payer: Fidelis Essential Plan QHP |
$11.61
|
| Rate for Payer: Fidelis Medicare Advantage |
$13.05
|
| Rate for Payer: Fidelis Qualified Health Plan |
$11.61
|
| Rate for Payer: Group Health Inc Commercial |
$13.05
|
| Rate for Payer: Group Health Inc Medicare |
$13.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.05
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13.05
|
| Rate for Payer: Healthfirst QHP |
$13.05
|
| Rate for Payer: Humana Medicare |
$13.31
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$13.05
|
| Rate for Payer: United Healthcare Commercial |
$16.53
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$13.05
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$10.44
|
| Rate for Payer: Wellcare Medicare |
$11.74
|
|
|
MUMPS ANTIBODIES, IGM
|
Facility
|
IP
|
$32.63
|
|
|
Service Code
|
HCPCS 86735
|
| Hospital Charge Code |
40729375
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$13.05
|
|
|
MUMPS VIRUS IGG AB BY EIA, SERUM
|
Facility
|
OP
|
$32.63
|
|
|
Service Code
|
HCPCS 86735
|
| Hospital Charge Code |
40728012
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.14 |
| Max. Negotiated Rate |
$24.47 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$17.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$13.05
|
| Rate for Payer: Aetna Government |
$13.05
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$9.14
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$9.14
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$9.14
|
| Rate for Payer: Brighton Health Commercial |
$24.47
|
| Rate for Payer: Cash Price |
$13.05
|
| Rate for Payer: Cash Price |
$13.05
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$13.05
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$20.75
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$17.56
|
| Rate for Payer: Elderplan Medicare Advantage |
$13.05
|
| Rate for Payer: EmblemHealth Commercial |
$13.05
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$11.09
|
| Rate for Payer: Fidelis Essential Plan QHP |
$11.61
|
| Rate for Payer: Fidelis Medicare Advantage |
$13.05
|
| Rate for Payer: Fidelis Qualified Health Plan |
$11.61
|
| Rate for Payer: Group Health Inc Commercial |
$13.05
|
| Rate for Payer: Group Health Inc Medicare |
$13.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.05
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13.05
|
| Rate for Payer: Healthfirst QHP |
$13.05
|
| Rate for Payer: Humana Medicare |
$13.31
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$13.05
|
| Rate for Payer: United Healthcare Commercial |
$16.53
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$13.05
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$10.44
|
| Rate for Payer: Wellcare Medicare |
$11.74
|
|
|
MUMPS VIRUS IGG AB BY EIA, SERUM
|
Facility
|
IP
|
$32.63
|
|
|
Service Code
|
HCPCS 86735
|
| Hospital Charge Code |
40728012
|
|
Hospital Revenue Code
|
302
|
| Rate for Payer: Cash Price |
$13.05
|
|
|
MUPIROCIN 2 % EX OINT [10674]
|
Facility
|
OP
|
$14.06
|
|
|
Service Code
|
NDC 50436011201
|
| Hospital Charge Code |
50436011201
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.92 |
| Max. Negotiated Rate |
$11.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.73
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$7.03
|
| Rate for Payer: Aetna Government |
$7.03
|
| Rate for Payer: Brighton Health Commercial |
$10.54
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$11.25
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$9.56
|
| Rate for Payer: Group Health Inc Commercial |
$7.03
|
| Rate for Payer: Group Health Inc Medicare |
$4.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.03
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.03
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$9.14
|
|
|
MUPIROCIN 2 % EX OINT [10674]
|
Facility
|
OP
|
$1.94
|
|
|
Service Code
|
NDC 68462018022
|
| Hospital Charge Code |
68462018022
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.68 |
| Max. Negotiated Rate |
$1.55 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.07
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.97
|
| Rate for Payer: Aetna Government |
$0.97
|
| Rate for Payer: Brighton Health Commercial |
$1.46
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.55
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.32
|
| Rate for Payer: Group Health Inc Commercial |
$0.97
|
| Rate for Payer: Group Health Inc Medicare |
$0.68
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.97
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.97
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.26
|
|
|
MUPIROCIN 2 % EX OINT [10674]
|
Facility
|
OP
|
$1.14
|
|
|
Service Code
|
NDC 51672131200
|
| Hospital Charge Code |
51672131200
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$0.91 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.62
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.57
|
| Rate for Payer: Aetna Government |
$0.57
|
| Rate for Payer: Brighton Health Commercial |
$0.85
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.91
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.77
|
| Rate for Payer: Group Health Inc Commercial |
$0.57
|
| Rate for Payer: Group Health Inc Medicare |
$0.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.57
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.57
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.74
|
|
|
MUPIROCIN 2 % EX OINT [10674]
|
Facility
|
OP
|
$3.89
|
|
|
Service Code
|
NDC 00093101042
|
| Hospital Charge Code |
00093101042
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.36 |
| Max. Negotiated Rate |
$3.11 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.14
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.94
|
| Rate for Payer: Aetna Government |
$1.94
|
| Rate for Payer: Brighton Health Commercial |
$2.91
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.11
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.64
|
| Rate for Payer: Group Health Inc Commercial |
$1.94
|
| Rate for Payer: Group Health Inc Medicare |
$1.36
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.53
|
|
|
MUPIROCIN 2 % EX OINT [10674]
|
Facility
|
OP
|
$3.55
|
|
|
Service Code
|
NDC 00904728454
|
| Hospital Charge Code |
00904728454
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.24 |
| Max. Negotiated Rate |
$2.84 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.77
|
| Rate for Payer: Aetna Government |
$1.77
|
| Rate for Payer: Brighton Health Commercial |
$2.66
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.84
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.41
|
| Rate for Payer: Group Health Inc Commercial |
$1.77
|
| Rate for Payer: Group Health Inc Medicare |
$1.24
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.77
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.77
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.31
|
|
|
MUPIROCIN 2 % EX OINT [10674]
|
Facility
|
OP
|
$3.55
|
|
|
Service Code
|
NDC 00904728469
|
| Hospital Charge Code |
00904728469
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.24 |
| Max. Negotiated Rate |
$2.84 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.77
|
| Rate for Payer: Aetna Government |
$1.77
|
| Rate for Payer: Brighton Health Commercial |
$2.66
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.84
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.41
|
| Rate for Payer: Group Health Inc Commercial |
$1.77
|
| Rate for Payer: Group Health Inc Medicare |
$1.24
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.77
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.77
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.31
|
|
|
MUPIROCIN 2% OINT 22 GRAMS
|
Facility
|
OP
|
$19.00
|
|
| Hospital Charge Code |
41642790
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.65 |
| Max. Negotiated Rate |
$15.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$10.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$9.50
|
| Rate for Payer: Aetna Government |
$9.50
|
| Rate for Payer: Brighton Health Commercial |
$14.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$15.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$12.92
|
| Rate for Payer: Group Health Inc Commercial |
$9.50
|
| Rate for Payer: Group Health Inc Medicare |
$6.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12.35
|
|
