|
Migraine & other headaches
|
Facility
|
IP
|
$42,783.71
|
|
|
Service Code
|
APR-DRG 0542
|
| Min. Negotiated Rate |
$6,674.00 |
| Max. Negotiated Rate |
$42,783.71 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$42,783.71
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$42,783.71
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$19,014.98
|
| Rate for Payer: Amida Care Medicaid |
$19,014.98
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$42,783.71
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$19,014.98
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$19,014.98
|
| Rate for Payer: Fidelis Qualified Health Plan |
$22,817.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$19,014.98
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$19,014.98
|
| Rate for Payer: Healthfirst Commercial |
$11,114.00
|
| Rate for Payer: Healthfirst Essential Plan |
$42,783.71
|
| Rate for Payer: Healthfirst QHP |
$6,674.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$19,014.98
|
| Rate for Payer: SOMOS Essential |
$42,783.71
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$42,783.71
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$42,783.71
|
| Rate for Payer: United Healthcare Medicaid |
$19,014.98
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$19,014.98
|
|
|
MILRINONE LACTATE IN DEXTROSE 20-5 MG/100ML-% IV SOLN
|
Facility
|
IP
|
$0.18
|
|
|
Service Code
|
HCPCS J2260
|
| Hospital Charge Code |
0143971910
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.09 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.09
|
|
|
MILRINONE LACTATE IN DEXTROSE 20-5 MG/100ML-% IV SOLN
|
Facility
|
IP
|
$0.18
|
|
|
Service Code
|
HCPCS J2260
|
| Hospital Charge Code |
2502131382
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.09 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.09
|
|
|
MILRINONE LACTATE IN DEXTROSE 20-5 MG/100ML-% IV SOLN
|
Facility
|
OP
|
$0.18
|
|
|
Service Code
|
HCPCS J2260
|
| Hospital Charge Code |
0143971910
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$1.89 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.89
|
| Rate for Payer: Aetna Government |
$1.89
|
| Rate for Payer: Brighton Health Commercial |
$0.14
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.15
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.12
|
| Rate for Payer: EmblemHealth Commercial |
$0.09
|
| Rate for Payer: Group Health Inc Commercial |
$0.09
|
| Rate for Payer: Group Health Inc Medicare |
$0.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.09
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1.45
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.12
|
|
|
MILRINONE LACTATE IN DEXTROSE 20-5 MG/100ML-% IV SOLN
|
Facility
|
OP
|
$0.18
|
|
|
Service Code
|
HCPCS J2260
|
| Hospital Charge Code |
2502131382
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$1.89 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.89
|
| Rate for Payer: Aetna Government |
$1.89
|
| Rate for Payer: Brighton Health Commercial |
$0.14
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.15
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.12
|
| Rate for Payer: EmblemHealth Commercial |
$0.09
|
| Rate for Payer: Group Health Inc Commercial |
$0.09
|
| Rate for Payer: Group Health Inc Medicare |
$0.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.09
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1.45
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.12
|
|
|
MINERAL OIL LIGHT OIL
|
Facility
|
OP
|
$2.10
|
|
|
Service Code
|
NDC 6332325410
|
| Hospital Charge Code |
6332325410
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.74 |
| Max. Negotiated Rate |
$1.68 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.16
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.05
|
| Rate for Payer: Aetna Government |
$1.05
|
| Rate for Payer: Brighton Health Commercial |
$1.58
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.68
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.43
|
| Rate for Payer: EmblemHealth Commercial |
$1.05
|
| Rate for Payer: Group Health Inc Commercial |
$1.05
|
| Rate for Payer: Group Health Inc Medicare |
$0.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.37
|
|
|
MINERAL OIL LIGHT OIL
|
Facility
|
IP
|
$2.10
|
|
|
Service Code
|
NDC 6332325410
|
| Hospital Charge Code |
6332325410
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.05 |
| Max. Negotiated Rate |
$1.05 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.05
|
|
|
MINERAL OIL PO OIL
|
Facility
|
OP
|
$0.07
|
|
|
Service Code
|
NDC 4843320230
|
| Hospital Charge Code |
4843320230
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.04
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.03
|
| Rate for Payer: Aetna Government |
$0.03
|
| Rate for Payer: Brighton Health Commercial |
$0.05
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.05
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.04
|
| Rate for Payer: EmblemHealth Commercial |
$0.03
|
| Rate for Payer: Group Health Inc Commercial |
$0.03
|
| Rate for Payer: Group Health Inc Medicare |
$0.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.03
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.03
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.04
|
|
|
MINERAL OIL PO OIL
|
Facility
|
IP
|
$0.07
|
|
|
Service Code
|
NDC 4843320230
|
| Hospital Charge Code |
4843320230
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.03
|
|
|
MINERAL OIL RE ENEM
|
Facility
|
IP
|
$0.02
|
|
|
Service Code
|
NDC 7000001091
|
| Hospital Charge Code |
7000001091
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
|
|
MINERAL OIL RE ENEM
|
Facility
|
OP
|
$0.02
|
|
|
Service Code
|
NDC 0132030140
|
| Hospital Charge Code |
0132030140
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.02 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.01
|
| Rate for Payer: Aetna Government |
$0.01
|
| Rate for Payer: Brighton Health Commercial |
$0.02
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.02
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.02
|
| Rate for Payer: EmblemHealth Commercial |
$0.01
|
| Rate for Payer: Group Health Inc Commercial |
$0.01
|
| Rate for Payer: Group Health Inc Medicare |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.02
|
|
|
MINERAL OIL RE ENEM
|
Facility
|
IP
|
$0.02
|
|
|
Service Code
|
NDC 0132030140
|
| Hospital Charge Code |
0132030140
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
|
|
MINERAL OIL RE ENEM
|
Facility
|
OP
|
$0.02
|
|
|
Service Code
|
NDC 7000001091
|
| Hospital Charge Code |
7000001091
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.02 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.01
|
| Rate for Payer: Aetna Government |
$0.01
|
| Rate for Payer: Brighton Health Commercial |
$0.01
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.02
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.01
|
| Rate for Payer: EmblemHealth Commercial |
$0.01
|
| Rate for Payer: Group Health Inc Commercial |
$0.01
|
| Rate for Payer: Group Health Inc Medicare |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.01
|
|
|
MINOCYCLINE HCL 100 MG IV SOLR
|
Facility
|
OP
|
$301.08
|
|
|
Service Code
|
NDC 7084216010
|
| Hospital Charge Code |
7084216010
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$105.38 |
| Max. Negotiated Rate |
$240.86 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$165.59
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$150.54
|
| Rate for Payer: Aetna Government |
$150.54
|
| Rate for Payer: Brighton Health Commercial |
$225.81
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$240.86
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$204.73
|
| Rate for Payer: EmblemHealth Commercial |
$150.54
|
| Rate for Payer: Group Health Inc Commercial |
$150.54
|
| Rate for Payer: Group Health Inc Medicare |
$105.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$150.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$150.54
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$195.70
|
|
|
MINOCYCLINE HCL 100 MG IV SOLR
|
Facility
|
IP
|
$301.08
|
|
|
Service Code
|
NDC 7084216001
|
| Hospital Charge Code |
7084216001
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$150.54 |
| Max. Negotiated Rate |
$150.54 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$150.54
|
|
|
MINOCYCLINE HCL 100 MG IV SOLR
|
Facility
|
IP
|
$301.08
|
|
|
Service Code
|
NDC 7084216010
|
| Hospital Charge Code |
7084216010
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$150.54 |
| Max. Negotiated Rate |
$150.54 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$150.54
|
|
|
MINOCYCLINE HCL 100 MG IV SOLR
|
Facility
|
OP
|
$301.08
|
|
|
Service Code
|
NDC 7084216001
|
| Hospital Charge Code |
7084216001
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$105.38 |
| Max. Negotiated Rate |
$240.86 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$165.59
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$150.54
|
| Rate for Payer: Aetna Government |
$150.54
|
| Rate for Payer: Brighton Health Commercial |
$225.81
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$240.86
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$204.73
|
| Rate for Payer: EmblemHealth Commercial |
$150.54
|
| Rate for Payer: Group Health Inc Commercial |
$150.54
|
| Rate for Payer: Group Health Inc Medicare |
$105.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$150.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$150.54
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$195.70
|
|
|
MINOCYCLINE HCL 100 MG PO CAPS
|
Facility
|
IP
|
$1.38
|
|
|
Service Code
|
NDC 0904688806
|
| Hospital Charge Code |
0904688806
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.69 |
| Max. Negotiated Rate |
$0.69 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.69
|
|
|
MINOCYCLINE HCL 100 MG PO CAPS
|
Facility
|
OP
|
$1.38
|
|
|
Service Code
|
NDC 0904688806
|
| Hospital Charge Code |
0904688806
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.48 |
| Max. Negotiated Rate |
$1.10 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.76
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.69
|
| Rate for Payer: Aetna Government |
$0.69
|
| Rate for Payer: Brighton Health Commercial |
$1.03
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.10
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.94
|
| Rate for Payer: EmblemHealth Commercial |
$0.69
|
| Rate for Payer: Group Health Inc Commercial |
$0.69
|
| Rate for Payer: Group Health Inc Medicare |
$0.48
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.69
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.69
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.90
|
|
|
MINOCYCLINE HCL 100 MG PO CAPS
|
Facility
|
IP
|
$3.40
|
|
|
Service Code
|
NDC 0591569550
|
| Hospital Charge Code |
0591569550
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.70 |
| Max. Negotiated Rate |
$1.70 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.70
|
|
|
MINOCYCLINE HCL 100 MG PO CAPS
|
Facility
|
IP
|
$3.40
|
|
|
Service Code
|
NDC 6838231818
|
| Hospital Charge Code |
6838231818
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.70 |
| Max. Negotiated Rate |
$1.70 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.70
|
|
|
MINOCYCLINE HCL 100 MG PO CAPS
|
Facility
|
OP
|
$3.40
|
|
|
Service Code
|
NDC 0591569550
|
| Hospital Charge Code |
0591569550
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.19 |
| Max. Negotiated Rate |
$2.72 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.87
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.70
|
| Rate for Payer: Aetna Government |
$1.70
|
| Rate for Payer: Brighton Health Commercial |
$2.55
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.72
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.31
|
| Rate for Payer: EmblemHealth Commercial |
$1.70
|
| Rate for Payer: Group Health Inc Commercial |
$1.70
|
| Rate for Payer: Group Health Inc Medicare |
$1.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.70
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.70
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.21
|
|
|
MINOCYCLINE HCL 100 MG PO CAPS
|
Facility
|
OP
|
$3.40
|
|
|
Service Code
|
NDC 6838231818
|
| Hospital Charge Code |
6838231818
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.19 |
| Max. Negotiated Rate |
$2.72 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.87
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.70
|
| Rate for Payer: Aetna Government |
$1.70
|
| Rate for Payer: Brighton Health Commercial |
$2.55
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.72
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.31
|
| Rate for Payer: EmblemHealth Commercial |
$1.70
|
| Rate for Payer: Group Health Inc Commercial |
$1.70
|
| Rate for Payer: Group Health Inc Medicare |
$1.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.70
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.70
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.21
|
|
|
MINOR AUDIOMETRIC TESTS AND SCREENING SERVICES
|
Facility
|
OP
|
$101.83
|
|
|
Service Code
|
EAPG 00229
|
| Min. Negotiated Rate |
$101.83 |
| Max. Negotiated Rate |
$101.83 |
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$101.83
|
|
|
MINOR DERMATOLOGY SERVICES
|
Facility
|
OP
|
$53.23
|
|
|
Service Code
|
EAPG 00177
|
| Min. Negotiated Rate |
$53.23 |
| Max. Negotiated Rate |
$53.23 |
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$53.23
|
|
