|
METFORMIN HCL 500 MG PO TABS
|
Facility
|
IP
|
$0.70
|
|
|
Service Code
|
NDC 7001006310
|
| Hospital Charge Code |
7001006310
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$0.35 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.35
|
|
|
METFORMIN HCL 500 MG PO TABS
|
Facility
|
OP
|
$0.70
|
|
|
Service Code
|
NDC 7001006310
|
| Hospital Charge Code |
7001006310
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.25 |
| Max. Negotiated Rate |
$0.56 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.39
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.35
|
| Rate for Payer: Aetna Government |
$0.35
|
| Rate for Payer: Brighton Health Commercial |
$0.53
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.56
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.48
|
| Rate for Payer: EmblemHealth Commercial |
$0.35
|
| Rate for Payer: Group Health Inc Commercial |
$0.35
|
| Rate for Payer: Group Health Inc Medicare |
$0.25
|
| 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 |
$0.46
|
|
|
METFORMIN HCL 500 MG PO TABS
|
Facility
|
OP
|
$0.03
|
|
|
Service Code
|
NDC 2315510210
|
| Hospital Charge Code |
2315510210
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.02
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.02
|
| Rate for Payer: Aetna Government |
$0.02
|
| Rate for Payer: Brighton Health Commercial |
$0.03
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.03
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.02
|
| Rate for Payer: EmblemHealth Commercial |
$0.02
|
| Rate for Payer: Group Health Inc Commercial |
$0.02
|
| Rate for Payer: Group Health Inc Medicare |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.02
|
|
|
METFORMIN HCL 500 MG PO TABS
|
Facility
|
OP
|
$0.71
|
|
|
Service Code
|
NDC 6936718010
|
| Hospital Charge Code |
6936718010
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.25 |
| Max. Negotiated Rate |
$0.56 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.39
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.35
|
| Rate for Payer: Aetna Government |
$0.35
|
| Rate for Payer: Brighton Health Commercial |
$0.53
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.56
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.48
|
| Rate for Payer: EmblemHealth Commercial |
$0.35
|
| Rate for Payer: Group Health Inc Commercial |
$0.35
|
| Rate for Payer: Group Health Inc Medicare |
$0.25
|
| 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 |
$0.46
|
|
|
METFORMIN HCL 500 MG PO TABS
|
Facility
|
IP
|
$0.71
|
|
|
Service Code
|
NDC 6936718010
|
| Hospital Charge Code |
6936718010
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$0.35 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.35
|
|
|
METFORMIN HCL 500 MG PO TABS
|
Facility
|
IP
|
$0.04
|
|
|
Service Code
|
NDC 2315510205
|
| Hospital Charge Code |
2315510205
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.02 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.02
|
|
|
METFORMIN HCL 850 MG PO TABS
|
Facility
|
OP
|
$1.20
|
|
|
Service Code
|
NDC 6068714301
|
| Hospital Charge Code |
6068714301
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.42 |
| Max. Negotiated Rate |
$0.96 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.66
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.60
|
| Rate for Payer: Aetna Government |
$0.60
|
| Rate for Payer: Brighton Health Commercial |
$0.90
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.96
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.82
|
| Rate for Payer: EmblemHealth Commercial |
$0.60
|
| Rate for Payer: Group Health Inc Commercial |
$0.60
|
| Rate for Payer: Group Health Inc Medicare |
$0.42
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.60
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.78
|
|
|
METFORMIN HCL 850 MG PO TABS
|
Facility
|
IP
|
$0.07
|
|
|
Service Code
|
NDC 2315510301
|
| Hospital Charge Code |
2315510301
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.04 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.04
|
|
|
METFORMIN HCL 850 MG PO TABS
|
Facility
|
OP
|
$1.21
|
|
|
Service Code
|
NDC 6787756205
|
| Hospital Charge Code |
6787756205
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.42 |
| Max. Negotiated Rate |
$0.96 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.66
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.60
|
| Rate for Payer: Aetna Government |
$0.60
|
| Rate for Payer: Brighton Health Commercial |
$0.90
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.96
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.82
|
| Rate for Payer: EmblemHealth Commercial |
$0.60
|
| Rate for Payer: Group Health Inc Commercial |
$0.60
|
| Rate for Payer: Group Health Inc Medicare |
$0.42
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.60
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.78
|
|
|
METFORMIN HCL 850 MG PO TABS
|
Facility
|
OP
|
$0.07
|
|
|
Service Code
|
NDC 2315510301
|
| Hospital Charge Code |
2315510301
|
|
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 |
$0.05
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.06
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.05
|
| Rate for Payer: EmblemHealth Commercial |
$0.04
|
| 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
|
|
|
METFORMIN HCL 850 MG PO TABS
|
Facility
|
IP
|
$1.20
|
|
|
Service Code
|
NDC 6068714301
|
| Hospital Charge Code |
6068714301
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$0.60 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.60
|
|
|
METFORMIN HCL 850 MG PO TABS
|
Facility
|
OP
|
$0.25
|
|
|
Service Code
|
NDC 0904716361
|
| Hospital Charge Code |
0904716361
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.14
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.12
|
| Rate for Payer: Aetna Government |
$0.12
|
| Rate for Payer: Brighton Health Commercial |
$0.19
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.17
|
| Rate for Payer: EmblemHealth Commercial |
$0.12
|
| Rate for Payer: Group Health Inc Commercial |
$0.12
|
| Rate for Payer: Group Health Inc Medicare |
$0.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.16
|
|
|
METFORMIN HCL 850 MG PO TABS
|
Facility
|
OP
|
$1.20
|
|
|
Service Code
|
NDC 6586200901
|
| Hospital Charge Code |
6586200901
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.42 |
| Max. Negotiated Rate |
$0.96 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.66
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.60
|
| Rate for Payer: Aetna Government |
$0.60
|
| Rate for Payer: Brighton Health Commercial |
$0.90
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.96
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.82
|
| Rate for Payer: EmblemHealth Commercial |
$0.60
|
| Rate for Payer: Group Health Inc Commercial |
$0.60
|
| Rate for Payer: Group Health Inc Medicare |
$0.42
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.60
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.78
|
|
|
METFORMIN HCL 850 MG PO TABS
|
Facility
|
IP
|
$1.21
|
|
|
Service Code
|
NDC 6787756205
|
| Hospital Charge Code |
6787756205
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$0.60 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.60
|
|
|
METFORMIN HCL 850 MG PO TABS
|
Facility
|
IP
|
$0.25
|
|
|
Service Code
|
NDC 0904716361
|
| Hospital Charge Code |
0904716361
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.12 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.12
|
|
|
METFORMIN HCL 850 MG PO TABS
|
Facility
|
IP
|
$1.20
|
|
|
Service Code
|
NDC 6586200901
|
| Hospital Charge Code |
6586200901
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$0.60 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.60
|
|
|
METHADONE HCL 10 MG/ML IJ SOLN
|
Facility
|
IP
|
$25.65
|
|
|
Service Code
|
HCPCS J1230
|
| Hospital Charge Code |
9999123408
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.82 |
| Max. Negotiated Rate |
$12.82 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.82
|
|
|
METHADONE HCL 10 MG/ML IJ SOLN
|
Facility
|
OP
|
$25.65
|
|
|
Service Code
|
HCPCS J1230
|
| Hospital Charge Code |
5199100298
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.98 |
| Max. Negotiated Rate |
$20.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$14.11
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$17.80
|
| Rate for Payer: Aetna Government |
$17.80
|
| Rate for Payer: Brighton Health Commercial |
$19.24
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$20.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$17.44
|
| Rate for Payer: EmblemHealth Commercial |
$12.82
|
| Rate for Payer: Group Health Inc Commercial |
$12.82
|
| Rate for Payer: Group Health Inc Medicare |
$8.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.82
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$19.33
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$16.67
|
|
|
METHADONE HCL 10 MG/ML IJ SOLN
|
Facility
|
IP
|
$25.65
|
|
|
Service Code
|
HCPCS J1230
|
| Hospital Charge Code |
5199100298
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.82 |
| Max. Negotiated Rate |
$12.82 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.82
|
|
|
METHADONE HCL 10 MG/ML IJ SOLN
|
Facility
|
OP
|
$25.65
|
|
|
Service Code
|
HCPCS J1230
|
| Hospital Charge Code |
9999123408
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.98 |
| Max. Negotiated Rate |
$20.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$14.11
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$17.80
|
| Rate for Payer: Aetna Government |
$17.80
|
| Rate for Payer: Brighton Health Commercial |
$19.24
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$20.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$17.44
|
| Rate for Payer: EmblemHealth Commercial |
$12.82
|
| Rate for Payer: Group Health Inc Commercial |
$12.82
|
| Rate for Payer: Group Health Inc Medicare |
$8.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.82
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$19.33
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$16.67
|
|
|
METHADONE HCL 10 MG/ML IJ SOLN
|
Facility
|
IP
|
$25.65
|
|
|
Service Code
|
HCPCS J1230
|
| Hospital Charge Code |
6745721720
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.82 |
| Max. Negotiated Rate |
$12.82 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.82
|
|
|
METHADONE HCL 10 MG/ML IJ SOLN
|
Facility
|
OP
|
$25.65
|
|
|
Service Code
|
HCPCS J1230
|
| Hospital Charge Code |
6745721720
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.98 |
| Max. Negotiated Rate |
$20.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$14.11
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$17.80
|
| Rate for Payer: Aetna Government |
$17.80
|
| Rate for Payer: Brighton Health Commercial |
$19.24
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$20.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$17.44
|
| Rate for Payer: EmblemHealth Commercial |
$12.82
|
| Rate for Payer: Group Health Inc Commercial |
$12.82
|
| Rate for Payer: Group Health Inc Medicare |
$8.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.82
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$19.33
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$16.67
|
|
|
METHADONE HCL 10 MG PO TABS
|
Facility
|
IP
|
$0.40
|
|
|
Service Code
|
NDC 6668982010
|
| Hospital Charge Code |
6668982010
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$0.20 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.20
|
|
|
METHADONE HCL 10 MG PO TABS
|
Facility
|
OP
|
$0.44
|
|
|
Service Code
|
NDC 0054071020
|
| Hospital Charge Code |
0054071020
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$0.35 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.24
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.22
|
| Rate for Payer: Aetna Government |
$0.22
|
| Rate for Payer: Brighton Health Commercial |
$0.33
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.35
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.30
|
| Rate for Payer: EmblemHealth Commercial |
$0.22
|
| Rate for Payer: Group Health Inc Commercial |
$0.22
|
| Rate for Payer: Group Health Inc Medicare |
$0.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.28
|
|
|
METHADONE HCL 10 MG PO TABS
|
Facility
|
OP
|
$0.40
|
|
|
Service Code
|
NDC 6668982010
|
| Hospital Charge Code |
6668982010
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.32 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.22
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.20
|
| Rate for Payer: Aetna Government |
$0.20
|
| Rate for Payer: Brighton Health Commercial |
$0.30
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.32
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.27
|
| Rate for Payer: EmblemHealth Commercial |
$0.20
|
| Rate for Payer: Group Health Inc Commercial |
$0.20
|
| Rate for Payer: Group Health Inc Medicare |
$0.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.26
|
|
