|
METHYLNALTREXONE BROMIDE 8 MG/0.4ML SC SOLN
|
Facility
|
IP
|
$480.93
|
|
|
Service Code
|
NDC 6564955204
|
| Hospital Charge Code |
6564955204
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$240.46 |
| Max. Negotiated Rate |
$240.46 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$240.46
|
|
|
METHYLPHENIDATE HCL 5 MG/5ML PO SOLN
|
Facility
|
OP
|
$1.78
|
|
|
Service Code
|
NDC 0121089605
|
| Hospital Charge Code |
0121089605
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$1.42 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.98
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.89
|
| Rate for Payer: Aetna Government |
$0.89
|
| Rate for Payer: Brighton Health Commercial |
$1.33
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.42
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.21
|
| Rate for Payer: EmblemHealth Commercial |
$0.89
|
| Rate for Payer: Group Health Inc Commercial |
$0.89
|
| Rate for Payer: Group Health Inc Medicare |
$0.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.89
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.15
|
|
|
METHYLPHENIDATE HCL 5 MG/5ML PO SOLN
|
Facility
|
IP
|
$1.78
|
|
|
Service Code
|
NDC 0121089605
|
| Hospital Charge Code |
0121089605
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.89 |
| Max. Negotiated Rate |
$0.89 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.89
|
|
|
METHYLPHENIDATE HCL 5 MG PO TABS
|
Facility
|
OP
|
$0.70
|
|
|
Service Code
|
NDC 0115180001
|
| Hospital Charge Code |
0115180001
|
|
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
|
|
|
METHYLPHENIDATE HCL 5 MG PO TABS
|
Facility
|
IP
|
$0.70
|
|
|
Service Code
|
NDC 0115180001
|
| Hospital Charge Code |
0115180001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$0.35 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.35
|
|
|
METHYLPHENIDATE HCL 5 MG PO TABS
|
Facility
|
OP
|
$0.72
|
|
|
Service Code
|
NDC 1070210001
|
| Hospital Charge Code |
1070210001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.25 |
| Max. Negotiated Rate |
$0.58 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.36
|
| Rate for Payer: Aetna Government |
$0.36
|
| Rate for Payer: Brighton Health Commercial |
$0.54
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.58
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.49
|
| Rate for Payer: EmblemHealth Commercial |
$0.36
|
| Rate for Payer: Group Health Inc Commercial |
$0.36
|
| Rate for Payer: Group Health Inc Medicare |
$0.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.36
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.47
|
|
|
METHYLPHENIDATE HCL 5 MG PO TABS
|
Facility
|
IP
|
$0.72
|
|
|
Service Code
|
NDC 1070210001
|
| Hospital Charge Code |
1070210001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$0.36 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.36
|
|
|
METHYLPHENIDATE HCL ER 18 MG PO TB24
|
Facility
|
IP
|
$6.22
|
|
|
Service Code
|
NDC 6217531037
|
| Hospital Charge Code |
6217531037
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.11 |
| Max. Negotiated Rate |
$3.11 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.11
|
|
|
METHYLPHENIDATE HCL ER 18 MG PO TB24
|
Facility
|
OP
|
$6.22
|
|
|
Service Code
|
NDC 6217531037
|
| Hospital Charge Code |
6217531037
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.18 |
| Max. Negotiated Rate |
$4.98 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.42
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.11
|
| Rate for Payer: Aetna Government |
$3.11
|
| Rate for Payer: Brighton Health Commercial |
$4.67
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.98
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.23
|
| Rate for Payer: EmblemHealth Commercial |
$3.11
|
| Rate for Payer: Group Health Inc Commercial |
$3.11
|
| Rate for Payer: Group Health Inc Medicare |
$2.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.11
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.11
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.04
|
|
|
METHYLPHENIDATE HCL ER (OSM) 18 MG PO TBCR
|
Facility
|
OP
|
$7.60
|
|
|
Service Code
|
NDC 6068753221
|
| Hospital Charge Code |
6068753221
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.66 |
| Max. Negotiated Rate |
$6.08 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.18
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.80
|
| Rate for Payer: Aetna Government |
$3.80
|
| Rate for Payer: Brighton Health Commercial |
$5.70
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.08
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.17
|
| Rate for Payer: EmblemHealth Commercial |
$3.80
|
| Rate for Payer: Group Health Inc Commercial |
$3.80
|
| Rate for Payer: Group Health Inc Medicare |
$2.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.80
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.94
|
|
|
METHYLPHENIDATE HCL ER (OSM) 18 MG PO TBCR
|
Facility
|
IP
|
$13.21
|
|
|
Service Code
|
NDC 3172295201
|
| Hospital Charge Code |
3172295201
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.60 |
| Max. Negotiated Rate |
$6.60 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.60
|
|
|
METHYLPHENIDATE HCL ER (OSM) 18 MG PO TBCR
|
Facility
|
OP
|
$13.21
|
|
|
Service Code
|
NDC 3172295201
|
| Hospital Charge Code |
3172295201
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.62 |
| Max. Negotiated Rate |
$10.57 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.26
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.60
|
| Rate for Payer: Aetna Government |
$6.60
|
| Rate for Payer: Brighton Health Commercial |
$9.91
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$10.57
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$8.98
|
| Rate for Payer: EmblemHealth Commercial |
$6.60
|
| Rate for Payer: Group Health Inc Commercial |
$6.60
|
| Rate for Payer: Group Health Inc Medicare |
$4.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.60
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8.59
|
|
|
METHYLPHENIDATE HCL ER (OSM) 18 MG PO TBCR
|
Facility
|
IP
|
$7.60
|
|
|
Service Code
|
NDC 6068753211
|
| Hospital Charge Code |
6068753211
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.80 |
| Max. Negotiated Rate |
$3.80 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.80
|
|
|
METHYLPHENIDATE HCL ER (OSM) 18 MG PO TBCR
|
Facility
|
IP
|
$7.60
|
|
|
Service Code
|
NDC 6068753221
|
| Hospital Charge Code |
6068753221
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.80 |
| Max. Negotiated Rate |
$3.80 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.80
|
|
|
METHYLPHENIDATE HCL ER (OSM) 18 MG PO TBCR
|
Facility
|
OP
|
$7.60
|
|
|
Service Code
|
NDC 6068753211
|
| Hospital Charge Code |
6068753211
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.66 |
| Max. Negotiated Rate |
$6.08 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.18
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.80
|
| Rate for Payer: Aetna Government |
$3.80
|
| Rate for Payer: Brighton Health Commercial |
$5.70
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.08
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.17
|
| Rate for Payer: EmblemHealth Commercial |
$3.80
|
| Rate for Payer: Group Health Inc Commercial |
$3.80
|
| Rate for Payer: Group Health Inc Medicare |
$2.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.80
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.94
|
|
|
METHYLPREDNISOLONE 16 MG PO TABS
|
Facility
|
IP
|
$3.54
|
|
|
Service Code
|
HCPCS J7509
|
| Hospital Charge Code |
5976200501
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.77 |
| Max. Negotiated Rate |
$1.77 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.77
|
|
|
METHYLPREDNISOLONE 16 MG PO TABS
|
Facility
|
OP
|
$3.54
|
|
|
Service Code
|
HCPCS J7509
|
| Hospital Charge Code |
5976200501
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$2.83 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.26
|
| Rate for Payer: Aetna Government |
$0.26
|
| Rate for Payer: Brighton Health Commercial |
$2.66
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.83
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.41
|
| Rate for Payer: EmblemHealth Commercial |
$1.77
|
| 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: Healthfirst CHP/FHP/Medicaid |
$0.11
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.30
|
|
|
METHYLPREDNISOLONE 32 MG PO TABS
|
Facility
|
IP
|
$5.18
|
|
|
Service Code
|
HCPCS J7509
|
| Hospital Charge Code |
5976200511
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.59 |
| Max. Negotiated Rate |
$2.59 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.59
|
|
|
METHYLPREDNISOLONE 32 MG PO TABS
|
Facility
|
OP
|
$5.18
|
|
|
Service Code
|
HCPCS J7509
|
| Hospital Charge Code |
5976200511
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$4.14 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.85
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.26
|
| Rate for Payer: Aetna Government |
$0.26
|
| Rate for Payer: Brighton Health Commercial |
$3.88
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.14
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.52
|
| Rate for Payer: EmblemHealth Commercial |
$2.59
|
| Rate for Payer: Group Health Inc Commercial |
$2.59
|
| Rate for Payer: Group Health Inc Medicare |
$1.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.59
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.11
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.37
|
|
|
METHYLPREDNISOLONE 4 MG PO TABS
|
Facility
|
OP
|
$2.23
|
|
|
Service Code
|
HCPCS J7509
|
| Hospital Charge Code |
0904691461
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$1.78 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.22
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.26
|
| Rate for Payer: Aetna Government |
$0.26
|
| Rate for Payer: Brighton Health Commercial |
$1.67
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.78
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.51
|
| Rate for Payer: EmblemHealth Commercial |
$1.11
|
| Rate for Payer: Group Health Inc Commercial |
$1.11
|
| Rate for Payer: Group Health Inc Medicare |
$0.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.11
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.11
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.11
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.45
|
|
|
METHYLPREDNISOLONE 4 MG PO TABS
|
Facility
|
IP
|
$1.43
|
|
|
Service Code
|
HCPCS J7509
|
| Hospital Charge Code |
0603459321
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.71 |
| Max. Negotiated Rate |
$0.71 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.71
|
|
|
METHYLPREDNISOLONE 4 MG PO TABS
|
Facility
|
IP
|
$1.65
|
|
|
Service Code
|
HCPCS J7509
|
| Hospital Charge Code |
5974600106
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.83 |
| Max. Negotiated Rate |
$0.83 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.83
|
|
|
METHYLPREDNISOLONE 4 MG PO TABS
|
Facility
|
OP
|
$1.43
|
|
|
Service Code
|
HCPCS J7509
|
| Hospital Charge Code |
0603459321
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$1.14 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.79
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.26
|
| Rate for Payer: Aetna Government |
$0.26
|
| Rate for Payer: Brighton Health Commercial |
$1.07
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.14
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.97
|
| Rate for Payer: EmblemHealth Commercial |
$0.71
|
| Rate for Payer: Group Health Inc Commercial |
$0.71
|
| Rate for Payer: Group Health Inc Medicare |
$0.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.71
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.71
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.11
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.93
|
|
|
METHYLPREDNISOLONE 4 MG PO TABS
|
Facility
|
IP
|
$2.23
|
|
|
Service Code
|
HCPCS J7509
|
| Hospital Charge Code |
0904691461
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.11 |
| Max. Negotiated Rate |
$1.11 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.11
|
|
|
METHYLPREDNISOLONE 4 MG PO TABS
|
Facility
|
OP
|
$1.65
|
|
|
Service Code
|
HCPCS J7509
|
| Hospital Charge Code |
5974600106
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$1.32 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.91
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.26
|
| Rate for Payer: Aetna Government |
$0.26
|
| Rate for Payer: Brighton Health Commercial |
$1.24
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.32
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.12
|
| Rate for Payer: EmblemHealth Commercial |
$0.83
|
| Rate for Payer: Group Health Inc Commercial |
$0.83
|
| Rate for Payer: Group Health Inc Medicare |
$0.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.83
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.83
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.11
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.07
|
|
