|
METHOTREXATE SODIUM 2.5 MG PO TABS
|
Facility
|
IP
|
$3.58
|
|
|
Service Code
|
HCPCS J8610
|
| Hospital Charge Code |
0904714110
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.79 |
| Max. Negotiated Rate |
$1.79 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.79
|
|
|
METHOTREXATE SODIUM 2.5 MG PO TABS
|
Facility
|
IP
|
$4.05
|
|
|
Service Code
|
HCPCS J8610
|
| Hospital Charge Code |
6923814231
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.02 |
| Max. Negotiated Rate |
$2.02 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.02
|
|
|
METHOTREXATE SODIUM 2.5 MG PO TABS
|
Facility
|
OP
|
$6.24
|
|
|
Service Code
|
HCPCS J8610
|
| Hospital Charge Code |
5107967001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.19 |
| Max. Negotiated Rate |
$4.99 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.43
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.42
|
| Rate for Payer: Aetna Government |
$0.42
|
| Rate for Payer: Brighton Health Commercial |
$4.68
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.99
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.24
|
| Rate for Payer: EmblemHealth Commercial |
$3.12
|
| Rate for Payer: Group Health Inc Commercial |
$3.12
|
| Rate for Payer: Group Health Inc Medicare |
$2.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.06
|
|
|
METHOTREXATE SODIUM 2.5 MG PO TABS
|
Facility
|
IP
|
$3.56
|
|
|
Service Code
|
HCPCS J8610
|
| Hospital Charge Code |
6838277501
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.78 |
| Max. Negotiated Rate |
$1.78 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.78
|
|
|
METHOTREXATE SODIUM 2.5 MG PO TABS
|
Facility
|
OP
|
$6.24
|
|
|
Service Code
|
HCPCS J8610
|
| Hospital Charge Code |
5107967005
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.19 |
| Max. Negotiated Rate |
$4.99 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.43
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.42
|
| Rate for Payer: Aetna Government |
$0.42
|
| Rate for Payer: Brighton Health Commercial |
$4.68
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.99
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.24
|
| Rate for Payer: EmblemHealth Commercial |
$3.12
|
| Rate for Payer: Group Health Inc Commercial |
$3.12
|
| Rate for Payer: Group Health Inc Medicare |
$2.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.05
|
|
|
METHOTREXATE SODIUM 50 MG/2ML IJ SOLN
|
Facility
|
IP
|
$4.36
|
|
|
Service Code
|
HCPCS J9260
|
| Hospital Charge Code |
6170335037
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.18 |
| Max. Negotiated Rate |
$2.18 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.18
|
|
|
METHOTREXATE SODIUM 50 MG/2ML IJ SOLN
|
Facility
|
OP
|
$4.36
|
|
|
Service Code
|
HCPCS J9260
|
| Hospital Charge Code |
6170335037
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.53 |
| Max. Negotiated Rate |
$3.49 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.16
|
| Rate for Payer: Aetna Government |
$2.16
|
| Rate for Payer: Brighton Health Commercial |
$3.27
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.49
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.96
|
| Rate for Payer: EmblemHealth Commercial |
$2.18
|
| Rate for Payer: Group Health Inc Commercial |
$2.18
|
| Rate for Payer: Group Health Inc Medicare |
$1.53
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.18
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2.82
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.83
|
|
|
METHOTREXATE SODIUM 50 MG/2ML IJ SOLN
|
Facility
|
OP
|
$4.36
|
|
|
Service Code
|
HCPCS J9260
|
| Hospital Charge Code |
6170335038
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.53 |
| Max. Negotiated Rate |
$3.49 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.16
|
| Rate for Payer: Aetna Government |
$2.16
|
| Rate for Payer: Brighton Health Commercial |
$3.27
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.49
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.97
|
| Rate for Payer: EmblemHealth Commercial |
$2.18
|
| Rate for Payer: Group Health Inc Commercial |
$2.18
|
| Rate for Payer: Group Health Inc Medicare |
$1.53
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.18
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2.82
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.83
|
|
|
METHOTREXATE SODIUM 50 MG/2ML IJ SOLN
|
Facility
|
IP
|
$4.36
|
|
|
Service Code
|
HCPCS J9260
|
| Hospital Charge Code |
6170335038
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.18 |
| Max. Negotiated Rate |
$2.18 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.18
|
|
|
METHOTREXATE SODIUM (PF) 1 GM/40ML IJ SOLN
|
Facility
|
OP
|
$1.10
|
|
|
Service Code
|
HCPCS J9260
|
| Hospital Charge Code |
6170340841
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.39 |
| Max. Negotiated Rate |
$2.82 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.61
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.16
|
| Rate for Payer: Aetna Government |
$2.16
|
| Rate for Payer: Brighton Health Commercial |
$0.83
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.88
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.75
|
| Rate for Payer: EmblemHealth Commercial |
$0.55
|
| Rate for Payer: Group Health Inc Commercial |
$0.55
|
| Rate for Payer: Group Health Inc Medicare |
$0.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.55
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.55
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2.82
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.72
|
|
|
METHOTREXATE SODIUM (PF) 1 GM/40ML IJ SOLN
|
Facility
|
IP
|
$1.10
|
|
|
Service Code
|
HCPCS J9260
|
| Hospital Charge Code |
6170340841
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.55 |
| Max. Negotiated Rate |
$0.55 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.55
|
|
|
METHOTREXATE SODIUM (PF) 50 MG/2ML IJ SOLN
|
Facility
|
OP
|
$6.21
|
|
|
Service Code
|
HCPCS J9260
|
| Hospital Charge Code |
0703367101
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.16 |
| Max. Negotiated Rate |
$4.97 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.42
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.16
|
| Rate for Payer: Aetna Government |
$2.16
|
| Rate for Payer: Brighton Health Commercial |
$4.66
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.97
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.22
|
| Rate for Payer: EmblemHealth Commercial |
$3.10
|
| Rate for Payer: Group Health Inc Commercial |
$3.10
|
| Rate for Payer: Group Health Inc Medicare |
$2.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.10
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2.82
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.04
|
|
|
METHOTREXATE SODIUM (PF) 50 MG/2ML IJ SOLN
|
Facility
|
IP
|
$2.02
|
|
|
Service Code
|
HCPCS J9260
|
| Hospital Charge Code |
0143951910
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.01 |
| Max. Negotiated Rate |
$1.01 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.01
|
|
|
METHOTREXATE SODIUM (PF) 50 MG/2ML IJ SOLN
|
Facility
|
OP
|
$2.45
|
|
|
Service Code
|
HCPCS J9260
|
| Hospital Charge Code |
1672927730
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.86 |
| Max. Negotiated Rate |
$2.82 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.35
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.16
|
| Rate for Payer: Aetna Government |
$2.16
|
| Rate for Payer: Brighton Health Commercial |
$1.84
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.96
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.67
|
| Rate for Payer: EmblemHealth Commercial |
$1.23
|
| Rate for Payer: Group Health Inc Commercial |
$1.23
|
| Rate for Payer: Group Health Inc Medicare |
$0.86
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.23
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.23
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2.82
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.59
|
|
|
METHOTREXATE SODIUM (PF) 50 MG/2ML IJ SOLN
|
Facility
|
IP
|
$2.02
|
|
|
Service Code
|
HCPCS J9260
|
| Hospital Charge Code |
0143951901
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.01 |
| Max. Negotiated Rate |
$1.01 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.01
|
|
|
METHOTREXATE SODIUM (PF) 50 MG/2ML IJ SOLN
|
Facility
|
IP
|
$2.45
|
|
|
Service Code
|
HCPCS J9260
|
| Hospital Charge Code |
1672927730
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.23 |
| Max. Negotiated Rate |
$1.23 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.23
|
|
|
METHOTREXATE SODIUM (PF) 50 MG/2ML IJ SOLN
|
Facility
|
IP
|
$6.21
|
|
|
Service Code
|
HCPCS J9260
|
| Hospital Charge Code |
0703367101
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.10 |
| Max. Negotiated Rate |
$3.10 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.10
|
|
|
METHOTREXATE SODIUM (PF) 50 MG/2ML IJ SOLN
|
Facility
|
OP
|
$2.02
|
|
|
Service Code
|
HCPCS J9260
|
| Hospital Charge Code |
0143951910
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.71 |
| Max. Negotiated Rate |
$2.82 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.11
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.16
|
| Rate for Payer: Aetna Government |
$2.16
|
| Rate for Payer: Brighton Health Commercial |
$1.51
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.61
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.37
|
| Rate for Payer: EmblemHealth Commercial |
$1.01
|
| Rate for Payer: Group Health Inc Commercial |
$1.01
|
| Rate for Payer: Group Health Inc Medicare |
$0.71
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.01
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2.82
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.31
|
|
|
METHOTREXATE SODIUM (PF) 50 MG/2ML IJ SOLN
|
Facility
|
OP
|
$2.02
|
|
|
Service Code
|
HCPCS J9260
|
| Hospital Charge Code |
0143951901
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.71 |
| Max. Negotiated Rate |
$2.82 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.11
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.16
|
| Rate for Payer: Aetna Government |
$2.16
|
| Rate for Payer: Brighton Health Commercial |
$1.51
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.61
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.37
|
| Rate for Payer: EmblemHealth Commercial |
$1.01
|
| Rate for Payer: Group Health Inc Commercial |
$1.01
|
| Rate for Payer: Group Health Inc Medicare |
$0.71
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.01
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2.82
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.31
|
|
|
METHYLENE BLUE (ANTIDOTE) 1 % IV SOLN
|
Facility
|
IP
|
$25.00
|
|
|
Service Code
|
NDC 5428814701
|
| Hospital Charge Code |
5428814701
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$12.50 |
| Max. Negotiated Rate |
$12.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.50
|
|
|
METHYLENE BLUE (ANTIDOTE) 1 % IV SOLN
|
Facility
|
OP
|
$25.00
|
|
|
Service Code
|
NDC 5428814701
|
| Hospital Charge Code |
5428814701
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$8.75 |
| Max. Negotiated Rate |
$20.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$13.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12.50
|
| Rate for Payer: Aetna Government |
$12.50
|
| Rate for Payer: Brighton Health Commercial |
$18.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$20.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$17.00
|
| Rate for Payer: EmblemHealth Commercial |
$12.50
|
| Rate for Payer: Group Health Inc Commercial |
$12.50
|
| Rate for Payer: Group Health Inc Medicare |
$8.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$16.25
|
|
|
METHYLENE BLUE (ANTIDOTE) 50 MG/10ML IV SOLN
|
Facility
|
IP
|
$31.25
|
|
|
Service Code
|
HCPCS Q9968
|
| Hospital Charge Code |
0517037401
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$15.63 |
| Max. Negotiated Rate |
$15.63 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15.63
|
|
|
METHYLENE BLUE (ANTIDOTE) 50 MG/10ML IV SOLN
|
Facility
|
IP
|
$31.25
|
|
|
Service Code
|
HCPCS Q9968
|
| Hospital Charge Code |
0517037405
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$15.63 |
| Max. Negotiated Rate |
$15.63 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15.63
|
|
|
METHYLENE BLUE (ANTIDOTE) 50 MG/10ML IV SOLN
|
Facility
|
OP
|
$31.25
|
|
|
Service Code
|
HCPCS Q9968
|
| Hospital Charge Code |
0517037405
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$6.11 |
| Max. Negotiated Rate |
$25.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$17.19
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8.73
|
| Rate for Payer: Aetna Government |
$8.73
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$6.11
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$6.11
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$6.11
|
| Rate for Payer: Brighton Health Commercial |
$23.44
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$8.73
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$25.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$21.25
|
| Rate for Payer: Elderplan Medicare Advantage |
$8.73
|
| Rate for Payer: EmblemHealth Commercial |
$8.73
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$7.86
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$7.42
|
| Rate for Payer: Fidelis Essential Plan QHP |
$7.77
|
| Rate for Payer: Fidelis Medicare Advantage |
$8.73
|
| Rate for Payer: Fidelis Qualified Health Plan |
$7.77
|
| Rate for Payer: Group Health Inc Commercial |
$8.73
|
| Rate for Payer: Group Health Inc Medicare |
$8.73
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.73
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.73
|
| Rate for Payer: Healthfirst Medicare Advantage |
$7.42
|
| Rate for Payer: Healthfirst QHP |
$8.73
|
| Rate for Payer: Humana Medicare |
$8.90
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$8.73
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.73
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$20.31
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$8.29
|
| Rate for Payer: Wellcare Medicare |
$8.29
|
|
|
METHYLENE BLUE (ANTIDOTE) 50 MG/10ML IV SOLN
|
Facility
|
IP
|
$43.75
|
|
|
Service Code
|
NDC 0517038101
|
| Hospital Charge Code |
0517038101
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$21.88 |
| Max. Negotiated Rate |
$21.88 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$21.88
|
|
