|
MEDROXYPROGESTERONE ACETATE 150 MG/ML IM SUSP
|
Facility
|
OP
|
$43.97
|
|
|
Service Code
|
HCPCS J1050
|
| Hospital Charge Code |
5515032901
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$35.18 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$24.18
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.57
|
| Rate for Payer: Aetna Government |
$0.57
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$0.72
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$0.72
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$0.32
|
| Rate for Payer: Amida Care Medicaid |
$0.32
|
| Rate for Payer: Brighton Health Commercial |
$32.98
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$35.18
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$29.90
|
| Rate for Payer: EmblemHealth Commercial |
$21.98
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$0.72
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$0.32
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$0.32
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$0.72
|
| Rate for Payer: Fidelis Essential Plan QHP |
$0.72
|
| Rate for Payer: Fidelis Qualified Health Plan |
$0.34
|
| Rate for Payer: Group Health Inc Commercial |
$21.98
|
| Rate for Payer: Group Health Inc Medicare |
$15.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$21.98
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$32.00
|
| Rate for Payer: Healthfirst Essential Plan |
$0.72
|
| Rate for Payer: Healthfirst QHP |
$0.52
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$0.32
|
| Rate for Payer: SOMOS Essential |
$0.72
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$0.72
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$0.35
|
| Rate for Payer: United Healthcare Medicaid |
$0.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$28.58
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$0.32
|
|
|
MEDROXYPROGESTERONE ACETATE 150 MG/ML IM SUSP
|
Facility
|
IP
|
$97.85
|
|
|
Service Code
|
HCPCS J1050
|
| Hospital Charge Code |
6275609040
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$48.92 |
| Max. Negotiated Rate |
$48.92 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$48.92
|
|
|
MEDROXYPROGESTERONE ACETATE 150 MG/ML IM SUSP
|
Facility
|
IP
|
$41.27
|
|
|
Service Code
|
HCPCS J1050
|
| Hospital Charge Code |
6745788701
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$20.64 |
| Max. Negotiated Rate |
$20.64 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$20.64
|
|
|
MEDROXYPROGESTERONE ACETATE 150 MG/ML IM SUSP
|
Facility
|
OP
|
$41.27
|
|
|
Service Code
|
HCPCS J1050
|
| Hospital Charge Code |
6745788701
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$33.02 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$22.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.57
|
| Rate for Payer: Aetna Government |
$0.57
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$0.72
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$0.72
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$0.32
|
| Rate for Payer: Amida Care Medicaid |
$0.32
|
| Rate for Payer: Brighton Health Commercial |
$30.96
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$33.02
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$28.07
|
| Rate for Payer: EmblemHealth Commercial |
$20.64
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$0.72
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$0.32
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$0.32
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$0.72
|
| Rate for Payer: Fidelis Essential Plan QHP |
$0.72
|
| Rate for Payer: Fidelis Qualified Health Plan |
$0.34
|
| Rate for Payer: Group Health Inc Commercial |
$20.64
|
| Rate for Payer: Group Health Inc Medicare |
$14.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$20.64
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$32.00
|
| Rate for Payer: Healthfirst Essential Plan |
$0.72
|
| Rate for Payer: Healthfirst QHP |
$0.52
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$0.32
|
| Rate for Payer: SOMOS Essential |
$0.72
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$0.72
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$0.35
|
| Rate for Payer: United Healthcare Medicaid |
$0.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$26.83
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$0.32
|
|
|
MEDROXYPROGESTERONE ACETATE 150 MG/ML IM SUSP
|
Facility
|
OP
|
$97.75
|
|
|
Service Code
|
HCPCS J1050
|
| Hospital Charge Code |
6699337025
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$78.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$53.76
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.57
|
| Rate for Payer: Aetna Government |
$0.57
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$0.72
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$0.72
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$0.32
|
| Rate for Payer: Amida Care Medicaid |
$0.32
|
| Rate for Payer: Brighton Health Commercial |
$73.31
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$78.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$66.47
|
| Rate for Payer: EmblemHealth Commercial |
$48.87
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$0.72
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$0.32
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$0.32
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$0.72
|
| Rate for Payer: Fidelis Essential Plan QHP |
$0.72
|
| Rate for Payer: Fidelis Qualified Health Plan |
$0.34
|
| Rate for Payer: Group Health Inc Commercial |
$48.87
|
| Rate for Payer: Group Health Inc Medicare |
$34.21
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$48.87
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$32.00
|
| Rate for Payer: Healthfirst Essential Plan |
$0.72
|
| Rate for Payer: Healthfirst QHP |
$0.52
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$0.32
|
| Rate for Payer: SOMOS Essential |
$0.72
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$0.72
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$0.35
|
| Rate for Payer: United Healthcare Medicaid |
$0.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$63.53
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$0.32
|
|
|
MEDROXYPROGESTERONE ACETATE 150 MG/ML IM SUSP
|
Facility
|
IP
|
$43.97
|
|
|
Service Code
|
HCPCS J1050
|
| Hospital Charge Code |
5515032901
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$21.98 |
| Max. Negotiated Rate |
$21.98 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$21.98
|
|
|
MEDROXYPROGESTERONE ACETATE 150 MG/ML IM SUSP
|
Facility
|
OP
|
$41.27
|
|
|
Service Code
|
HCPCS J1050
|
| Hospital Charge Code |
6745788799
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$33.02 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$22.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.57
|
| Rate for Payer: Aetna Government |
$0.57
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$0.72
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$0.72
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$0.32
|
| Rate for Payer: Amida Care Medicaid |
$0.32
|
| Rate for Payer: Brighton Health Commercial |
$30.95
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$33.02
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$28.06
|
| Rate for Payer: EmblemHealth Commercial |
$20.64
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$0.72
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$0.32
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$0.32
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$0.72
|
| Rate for Payer: Fidelis Essential Plan QHP |
$0.72
|
| Rate for Payer: Fidelis Qualified Health Plan |
$0.34
|
| Rate for Payer: Group Health Inc Commercial |
$20.64
|
| Rate for Payer: Group Health Inc Medicare |
$14.44
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$20.64
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$32.00
|
| Rate for Payer: Healthfirst Essential Plan |
$0.72
|
| Rate for Payer: Healthfirst QHP |
$0.52
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$0.32
|
| Rate for Payer: SOMOS Essential |
$0.72
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$0.72
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$0.35
|
| Rate for Payer: United Healthcare Medicaid |
$0.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$26.83
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$0.32
|
|
|
MEDROXYPROGESTERONE ACETATE 150 MG/ML IM SUSP
|
Facility
|
IP
|
$41.27
|
|
|
Service Code
|
HCPCS J1050
|
| Hospital Charge Code |
6745788700
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$20.64 |
| Max. Negotiated Rate |
$20.64 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$20.64
|
|
|
MEDROXYPROGESTERONE ACETATE 150 MG/ML IM SUSP
|
Facility
|
IP
|
$97.75
|
|
|
Service Code
|
HCPCS J1050
|
| Hospital Charge Code |
6699337025
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$48.87 |
| Max. Negotiated Rate |
$48.87 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$48.87
|
|
|
MEDROXYPROGESTERONE ACETATE 150 MG/ML IM SUSP
|
Facility
|
OP
|
$97.85
|
|
|
Service Code
|
HCPCS J1050
|
| Hospital Charge Code |
6699337083
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$78.28 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$53.82
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.57
|
| Rate for Payer: Aetna Government |
$0.57
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$0.72
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$0.72
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$0.32
|
| Rate for Payer: Amida Care Medicaid |
$0.32
|
| Rate for Payer: Brighton Health Commercial |
$73.39
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$78.28
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$66.54
|
| Rate for Payer: EmblemHealth Commercial |
$48.92
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$0.72
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$0.32
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$0.32
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$0.72
|
| Rate for Payer: Fidelis Essential Plan QHP |
$0.72
|
| Rate for Payer: Fidelis Qualified Health Plan |
$0.34
|
| Rate for Payer: Group Health Inc Commercial |
$48.92
|
| Rate for Payer: Group Health Inc Medicare |
$34.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$48.92
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$32.00
|
| Rate for Payer: Healthfirst Essential Plan |
$0.72
|
| Rate for Payer: Healthfirst QHP |
$0.52
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$0.32
|
| Rate for Payer: SOMOS Essential |
$0.72
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$0.72
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$0.35
|
| Rate for Payer: United Healthcare Medicaid |
$0.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$63.60
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$0.32
|
|
|
MEDROXYPROGESTERONE ACETATE 150 MG/ML IM SUSP
|
Facility
|
OP
|
$41.27
|
|
|
Service Code
|
HCPCS J1050
|
| Hospital Charge Code |
6745788700
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$33.02 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$22.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.57
|
| Rate for Payer: Aetna Government |
$0.57
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$0.72
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$0.72
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$0.32
|
| Rate for Payer: Amida Care Medicaid |
$0.32
|
| Rate for Payer: Brighton Health Commercial |
$30.95
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$33.02
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$28.06
|
| Rate for Payer: EmblemHealth Commercial |
$20.64
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$0.72
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$0.32
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$0.32
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$0.72
|
| Rate for Payer: Fidelis Essential Plan QHP |
$0.72
|
| Rate for Payer: Fidelis Qualified Health Plan |
$0.34
|
| Rate for Payer: Group Health Inc Commercial |
$20.64
|
| Rate for Payer: Group Health Inc Medicare |
$14.44
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$20.64
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$32.00
|
| Rate for Payer: Healthfirst Essential Plan |
$0.72
|
| Rate for Payer: Healthfirst QHP |
$0.52
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$0.32
|
| Rate for Payer: SOMOS Essential |
$0.72
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$0.72
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$0.35
|
| Rate for Payer: United Healthcare Medicaid |
$0.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$26.83
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$0.32
|
|
|
MEDROXYPROGESTERONE ACETATE 150 MG/ML IM SUSY
|
Facility
|
OP
|
$66.00
|
|
|
Service Code
|
HCPCS J1050
|
| Hospital Charge Code |
0548570100
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$52.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$36.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.57
|
| Rate for Payer: Aetna Government |
$0.57
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$0.72
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$0.72
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$0.32
|
| Rate for Payer: Amida Care Medicaid |
$0.32
|
| Rate for Payer: Brighton Health Commercial |
$49.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$52.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$44.88
|
| Rate for Payer: EmblemHealth Commercial |
$33.00
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$0.72
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$0.32
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$0.32
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$0.72
|
| Rate for Payer: Fidelis Essential Plan QHP |
$0.72
|
| Rate for Payer: Fidelis Qualified Health Plan |
$0.34
|
| Rate for Payer: Group Health Inc Commercial |
$33.00
|
| Rate for Payer: Group Health Inc Medicare |
$23.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$33.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$32.00
|
| Rate for Payer: Healthfirst Essential Plan |
$0.72
|
| Rate for Payer: Healthfirst QHP |
$0.52
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$0.32
|
| Rate for Payer: SOMOS Essential |
$0.72
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$0.72
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$0.35
|
| Rate for Payer: United Healthcare Medicaid |
$0.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$42.90
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$0.32
|
|
|
MEDROXYPROGESTERONE ACETATE 150 MG/ML IM SUSY
|
Facility
|
IP
|
$66.00
|
|
|
Service Code
|
HCPCS J1050
|
| Hospital Charge Code |
0548570100
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$33.00 |
| Max. Negotiated Rate |
$33.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$33.00
|
|
|
MEDROXYPROGESTERONE ACETATE 2.5 MG PO TABS
|
Facility
|
OP
|
$0.31
|
|
|
Service Code
|
NDC 0555087202
|
| Hospital Charge Code |
0555087202
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.17
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.16
|
| Rate for Payer: Aetna Government |
$0.16
|
| Rate for Payer: Brighton Health Commercial |
$0.23
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.25
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.21
|
| Rate for Payer: EmblemHealth Commercial |
$0.16
|
| Rate for Payer: Group Health Inc Commercial |
$0.16
|
| Rate for Payer: Group Health Inc Medicare |
$0.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.16
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.20
|
|
|
MEDROXYPROGESTERONE ACETATE 2.5 MG PO TABS
|
Facility
|
IP
|
$0.31
|
|
|
Service Code
|
NDC 0555087202
|
| Hospital Charge Code |
0555087202
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$0.16 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.16
|
|
|
MEFLOQUINE HCL 250 MG PO TABS
|
Facility
|
IP
|
$10.59
|
|
|
Service Code
|
NDC 0555017178
|
| Hospital Charge Code |
0555017178
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.29 |
| Max. Negotiated Rate |
$5.29 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.29
|
|
|
MEFLOQUINE HCL 250 MG PO TABS
|
Facility
|
OP
|
$10.59
|
|
|
Service Code
|
NDC 0555017178
|
| Hospital Charge Code |
0555017178
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.71 |
| Max. Negotiated Rate |
$8.47 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.82
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.29
|
| Rate for Payer: Aetna Government |
$5.29
|
| Rate for Payer: Brighton Health Commercial |
$7.94
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.47
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7.20
|
| Rate for Payer: EmblemHealth Commercial |
$5.29
|
| Rate for Payer: Group Health Inc Commercial |
$5.29
|
| Rate for Payer: Group Health Inc Medicare |
$3.71
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.29
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6.88
|
|
|
MEGESTROL ACETATE 20 MG PO TABS
|
Facility
|
OP
|
$0.69
|
|
|
Service Code
|
NDC 6438015801
|
| Hospital Charge Code |
6438015801
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$0.55 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.38
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.35
|
| Rate for Payer: Aetna Government |
$0.35
|
| Rate for Payer: Brighton Health Commercial |
$0.52
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.55
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.47
|
| Rate for Payer: EmblemHealth Commercial |
$0.35
|
| Rate for Payer: Group Health Inc Commercial |
$0.35
|
| Rate for Payer: Group Health Inc Medicare |
$0.24
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.35
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.45
|
|
|
MEGESTROL ACETATE 20 MG PO TABS
|
Facility
|
IP
|
$0.69
|
|
|
Service Code
|
NDC 6438015801
|
| Hospital Charge Code |
6438015801
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$0.35 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.35
|
|
|
MEGESTROL ACETATE 40 MG/ML PO SUSP
|
Facility
|
OP
|
$0.55
|
|
|
Service Code
|
NDC 6809417459
|
| Hospital Charge Code |
6809417459
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.19 |
| Max. Negotiated Rate |
$0.44 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.28
|
| Rate for Payer: Aetna Government |
$0.28
|
| Rate for Payer: Brighton Health Commercial |
$0.41
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.44
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.38
|
| Rate for Payer: EmblemHealth Commercial |
$0.28
|
| Rate for Payer: Group Health Inc Commercial |
$0.28
|
| Rate for Payer: Group Health Inc Medicare |
$0.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.28
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.28
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.36
|
|
|
MEGESTROL ACETATE 40 MG/ML PO SUSP
|
Facility
|
IP
|
$0.55
|
|
|
Service Code
|
NDC 6809417459
|
| Hospital Charge Code |
6809417459
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.28 |
| Max. Negotiated Rate |
$0.28 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.28
|
|
|
MEGESTROL ACETATE 40 MG PO TABS
|
Facility
|
IP
|
$1.71
|
|
|
Service Code
|
NDC 0555060702
|
| Hospital Charge Code |
0555060702
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.85 |
| Max. Negotiated Rate |
$0.85 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.85
|
|
|
MEGESTROL ACETATE 40 MG PO TABS
|
Facility
|
OP
|
$1.71
|
|
|
Service Code
|
NDC 0555060702
|
| Hospital Charge Code |
0555060702
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$1.37 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.94
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.85
|
| Rate for Payer: Aetna Government |
$0.85
|
| Rate for Payer: Brighton Health Commercial |
$1.28
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.37
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.16
|
| Rate for Payer: EmblemHealth Commercial |
$0.85
|
| Rate for Payer: Group Health Inc Commercial |
$0.85
|
| Rate for Payer: Group Health Inc Medicare |
$0.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.85
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.85
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.11
|
|
|
MEGESTROL ACETATE 40 MG PO TABS
|
Facility
|
IP
|
$0.28
|
|
|
Service Code
|
NDC 0904723661
|
| Hospital Charge Code |
0904723661
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.14 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.14
|
|
|
MEGESTROL ACETATE 40 MG PO TABS
|
Facility
|
OP
|
$0.28
|
|
|
Service Code
|
NDC 0904723661
|
| Hospital Charge Code |
0904723661
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.22 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.15
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.14
|
| Rate for Payer: Aetna Government |
$0.14
|
| Rate for Payer: Brighton Health Commercial |
$0.21
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.22
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.19
|
| Rate for Payer: EmblemHealth Commercial |
$0.14
|
| Rate for Payer: Group Health Inc Commercial |
$0.14
|
| Rate for Payer: Group Health Inc Medicare |
$0.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.18
|
|
