|
METOPROLOL TARTRATE 1MG/ML AMPS 12X5ML
|
Facility
OP
|
$9.50
|
|
| Hospital Charge Code |
4400508
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.23 |
| Max. Negotiated Rate |
$7.65 |
| Rate for Payer: Aetna of NY Commercial |
$6.65
|
| Rate for Payer: Aetna of NY Medicare |
$4.37
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$7.12
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$7.12
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$3.52
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$4.75
|
| Rate for Payer: Cash Price |
$7.12
|
| Rate for Payer: CDPHP Commercial |
$7.65
|
| Rate for Payer: CDPHP Medicare |
$3.52
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$7.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$7.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$7.60
|
| Rate for Payer: EmblemHealth Medicaid |
$7.60
|
| Rate for Payer: EmblemHealth Medicare |
$3.23
|
| Rate for Payer: EmblemHealth Select Care |
$6.84
|
| Rate for Payer: Fidelis Medicare |
$3.62
|
| Rate for Payer: Galaxy Health Commercial |
$6.18
|
| Rate for Payer: Hamaspik Choice Medicare |
$3.52
|
| Rate for Payer: Humana Medicare |
$3.52
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$6.65
|
| Rate for Payer: Local 1199SEIU Medicare |
$4.37
|
| Rate for Payer: MVP Health Care of NY Commercial |
$7.12
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$5.35
|
| Rate for Payer: MVP Health Care of NY Medicare |
$3.69
|
| Rate for Payer: United Healthcare Medicare |
$3.52
|
| Rate for Payer: WellCare Medicare |
$5.22
|
|
|
METOPROLOL TARTRATE 25MG TABS 10X10EA
|
Facility
OP
|
$6.18
|
|
| Hospital Charge Code |
4400510
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.10 |
| Max. Negotiated Rate |
$4.97 |
| Rate for Payer: Aetna of NY Commercial |
$4.33
|
| Rate for Payer: Aetna of NY Medicare |
$2.84
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$4.64
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$4.64
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2.29
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$3.09
|
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: CDPHP Commercial |
$4.97
|
| Rate for Payer: CDPHP Medicare |
$2.29
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$4.94
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$4.94
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$4.94
|
| Rate for Payer: EmblemHealth Medicaid |
$4.94
|
| Rate for Payer: EmblemHealth Medicare |
$2.10
|
| Rate for Payer: EmblemHealth Select Care |
$4.45
|
| Rate for Payer: Fidelis Medicare |
$2.36
|
| Rate for Payer: Galaxy Health Commercial |
$4.02
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.29
|
| Rate for Payer: Humana Medicare |
$2.29
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$4.33
|
| Rate for Payer: Local 1199SEIU Medicare |
$2.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4.64
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3.48
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2.40
|
| Rate for Payer: United Healthcare Medicare |
$2.29
|
| Rate for Payer: WellCare Medicare |
$3.40
|
|
|
METOPROLOL TARTRATE 50MG TABS 100 EA
|
Facility
OP
|
$6.18
|
|
| Hospital Charge Code |
4400511
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.10 |
| Max. Negotiated Rate |
$4.97 |
| Rate for Payer: Aetna of NY Commercial |
$4.33
|
| Rate for Payer: Aetna of NY Medicare |
$2.84
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$4.64
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$4.64
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2.29
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$3.09
|
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: CDPHP Commercial |
$4.97
|
| Rate for Payer: CDPHP Medicare |
$2.29
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$4.94
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$4.94
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$4.94
|
| Rate for Payer: EmblemHealth Medicaid |
$4.94
|
| Rate for Payer: EmblemHealth Medicare |
$2.10
|
| Rate for Payer: EmblemHealth Select Care |
$4.45
|
| Rate for Payer: Fidelis Medicare |
$2.36
|
| Rate for Payer: Galaxy Health Commercial |
$4.02
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.29
|
| Rate for Payer: Humana Medicare |
$2.29
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$4.33
|
| Rate for Payer: Local 1199SEIU Medicare |
$2.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4.64
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3.48
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2.40
|
| Rate for Payer: United Healthcare Medicare |
$2.29
|
| Rate for Payer: WellCare Medicare |
$3.40
|
|
|
METRONIDAZOLE 250MG TABS 100 EA
|
Facility
OP
|
$6.18
|
|
| Hospital Charge Code |
4400512
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.10 |
| Max. Negotiated Rate |
$4.97 |
| Rate for Payer: Aetna of NY Commercial |
$4.33
|
| Rate for Payer: Aetna of NY Medicare |
$2.84
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$4.64
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$4.64
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2.29
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$3.09
|
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: CDPHP Commercial |
$4.97
|
| Rate for Payer: CDPHP Medicare |
$2.29
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$4.94
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$4.94
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$4.94
|
| Rate for Payer: EmblemHealth Medicaid |
$4.94
|
| Rate for Payer: EmblemHealth Medicare |
$2.10
|
| Rate for Payer: EmblemHealth Select Care |
$4.45
|
| Rate for Payer: Fidelis Medicare |
$2.36
|
| Rate for Payer: Galaxy Health Commercial |
$4.02
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.29
|
| Rate for Payer: Humana Medicare |
$2.29
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$4.33
|
| Rate for Payer: Local 1199SEIU Medicare |
$2.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4.64
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3.48
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2.40
|
| Rate for Payer: United Healthcare Medicare |
$2.29
|
| Rate for Payer: WellCare Medicare |
$3.40
|
|
|
METRONIDAZOLE 500 MG INJ
|
Facility
OP
|
$12.00
|
|
|
Service Code
|
HCPCS S0030
|
| Hospital Charge Code |
4408963
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.08 |
| Max. Negotiated Rate |
$9.66 |
| Rate for Payer: Aetna of NY Commercial |
$6.60
|
| Rate for Payer: Aetna of NY Medicare |
$5.52
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$5.40
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$5.40
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$4.44
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$6.00
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: CDPHP Commercial |
$9.66
|
| Rate for Payer: CDPHP Medicare |
$4.44
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$9.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$9.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$9.60
|
| Rate for Payer: EmblemHealth Medicaid |
$9.60
|
| Rate for Payer: EmblemHealth Medicare |
$4.08
|
| Rate for Payer: EmblemHealth Select Care |
$8.64
|
| Rate for Payer: Fidelis Medicare |
$4.57
|
| Rate for Payer: Galaxy Health Commercial |
$7.80
|
| Rate for Payer: Hamaspik Choice Medicare |
$4.44
|
| Rate for Payer: Humana Medicare |
$4.44
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$6.60
|
| Rate for Payer: Local 1199SEIU Medicare |
$5.52
|
| Rate for Payer: MVP Health Care of NY Commercial |
$9.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$6.76
|
| Rate for Payer: MVP Health Care of NY Medicare |
$4.66
|
| Rate for Payer: United Healthcare Medicare |
$4.44
|
| Rate for Payer: WellCare Medicare |
$6.60
|
|
|
METRONIDAZOLE 500MG TABS 100 EA
|
Facility
OP
|
$6.18
|
|
| Hospital Charge Code |
4400513
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.10 |
| Max. Negotiated Rate |
$4.97 |
| Rate for Payer: Aetna of NY Commercial |
$4.33
|
| Rate for Payer: Aetna of NY Medicare |
$2.84
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$4.64
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$4.64
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2.29
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$3.09
|
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: CDPHP Commercial |
$4.97
|
| Rate for Payer: CDPHP Medicare |
$2.29
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$4.94
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$4.94
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$4.94
|
| Rate for Payer: EmblemHealth Medicaid |
$4.94
|
| Rate for Payer: EmblemHealth Medicare |
$2.10
|
| Rate for Payer: EmblemHealth Select Care |
$4.45
|
| Rate for Payer: Fidelis Medicare |
$2.36
|
| Rate for Payer: Galaxy Health Commercial |
$4.02
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.29
|
| Rate for Payer: Humana Medicare |
$2.29
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$4.33
|
| Rate for Payer: Local 1199SEIU Medicare |
$2.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4.64
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3.48
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2.40
|
| Rate for Payer: United Healthcare Medicare |
$2.29
|
| Rate for Payer: WellCare Medicare |
$3.40
|
|
|
MEXILETINE 150 MG CAPSULE
|
Facility
OP
|
$7.73
|
|
| Hospital Charge Code |
4400838
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.63 |
| Max. Negotiated Rate |
$6.22 |
| Rate for Payer: Aetna of NY Commercial |
$5.41
|
| Rate for Payer: Aetna of NY Medicare |
$3.56
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$5.80
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$5.80
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2.86
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$3.86
|
| Rate for Payer: Cash Price |
$5.80
|
| Rate for Payer: CDPHP Commercial |
$6.22
|
| Rate for Payer: CDPHP Medicare |
$2.86
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$6.18
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$6.18
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$6.18
|
| Rate for Payer: EmblemHealth Medicaid |
$6.18
|
| Rate for Payer: EmblemHealth Medicare |
$2.63
|
| Rate for Payer: EmblemHealth Select Care |
$5.57
|
| Rate for Payer: Fidelis Medicare |
$2.95
|
| Rate for Payer: Galaxy Health Commercial |
$5.02
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.86
|
| Rate for Payer: Humana Medicare |
$2.86
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$5.41
|
| Rate for Payer: Local 1199SEIU Medicare |
$3.56
|
| Rate for Payer: MVP Health Care of NY Commercial |
$5.80
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$4.35
|
| Rate for Payer: MVP Health Care of NY Medicare |
$3.00
|
| Rate for Payer: United Healthcare Medicare |
$2.86
|
| Rate for Payer: WellCare Medicare |
$4.25
|
|
|
MICROALBUMIN URINE
|
Facility
OP
|
$22.00
|
|
|
Service Code
|
HCPCS 82043
|
| Hospital Charge Code |
4300563
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.08 |
| Max. Negotiated Rate |
$17.71 |
| Rate for Payer: Aetna of NY Commercial |
$14.30
|
| Rate for Payer: Aetna of NY Medicare |
$10.12
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$16.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$16.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$8.14
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$11.00
|
| Rate for Payer: Cash Price |
$16.50
|
| Rate for Payer: Cash Price |
$16.50
|
| Rate for Payer: CDPHP Commercial |
$17.71
|
| Rate for Payer: CDPHP Medicare |
$8.14
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$17.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$17.60
|
| Rate for Payer: EmblemHealth Medicaid |
$17.60
|
| Rate for Payer: EmblemHealth Medicare |
$7.48
|
| Rate for Payer: Fidelis Medicare |
$8.38
|
| Rate for Payer: Galaxy Health Commercial |
$14.30
|
| Rate for Payer: Hamaspik Choice Medicare |
$8.14
|
| Rate for Payer: Humana Medicare |
$8.14
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$14.30
|
| Rate for Payer: Local 1199SEIU Medicare |
$10.12
|
| Rate for Payer: MVP Health Care of NY Commercial |
$16.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$12.39
|
| Rate for Payer: MVP Health Care of NY Medicare |
$8.55
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$16.50
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$5.08
|
| Rate for Payer: United Healthcare Commercial |
$16.50
|
| Rate for Payer: United Healthcare Medicare |
$8.14
|
| Rate for Payer: WellCare Medicare |
$12.10
|
|
|
MICROPUNCTURE INTRODUCER SET
|
Facility
OP
|
$135.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
4471876
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$45.90 |
| Max. Negotiated Rate |
$108.68 |
| Rate for Payer: Aetna of NY Commercial |
$94.50
|
| Rate for Payer: Aetna of NY Medicare |
$62.10
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$101.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$101.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$49.95
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$67.50
|
| Rate for Payer: Cash Price |
$101.25
|
| Rate for Payer: CDPHP Commercial |
$108.68
|
| Rate for Payer: CDPHP Medicare |
$49.95
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$108.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$108.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$108.00
|
| Rate for Payer: EmblemHealth Medicaid |
$108.00
|
| Rate for Payer: EmblemHealth Medicare |
$45.90
|
| Rate for Payer: EmblemHealth Select Care |
$97.20
|
| Rate for Payer: Fidelis Medicare |
$51.45
|
| Rate for Payer: Galaxy Health Commercial |
$87.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$49.95
|
| Rate for Payer: Humana Medicare |
$49.95
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$94.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$62.10
|
| Rate for Payer: MVP Health Care of NY Commercial |
$101.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$76.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$52.45
|
| Rate for Payer: United Healthcare Medicare |
$49.95
|
| Rate for Payer: WellCare Medicare |
$74.25
|
|
|
MIDAZOLAM HYDROCHLORIDE INJ, PER 1 MG
|
Facility
OP
|
$6.18
|
|
|
Service Code
|
HCPCS J2250
|
| Hospital Charge Code |
4400515
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$4.97 |
| Rate for Payer: Aetna of NY Commercial |
$3.40
|
| Rate for Payer: Aetna of NY Medicare |
$2.84
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$0.14
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$0.14
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2.29
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$3.09
|
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: CDPHP Commercial |
$4.97
|
| Rate for Payer: CDPHP Medicare |
$2.29
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.14
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$4.94
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$4.94
|
| Rate for Payer: EmblemHealth Medicaid |
$4.94
|
| Rate for Payer: EmblemHealth Medicare |
$2.10
|
| Rate for Payer: EmblemHealth Select Care |
$0.14
|
| Rate for Payer: Fidelis Medicare |
$2.36
|
| Rate for Payer: Galaxy Health Commercial |
$4.02
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.29
|
| Rate for Payer: Humana Medicare |
$2.29
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$3.40
|
| Rate for Payer: Local 1199SEIU Medicare |
$2.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4.64
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3.48
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2.40
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$0.23
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$0.14
|
| Rate for Payer: United Healthcare Commercial |
$0.23
|
| Rate for Payer: United Healthcare Medicare |
$2.29
|
| Rate for Payer: WellCare Medicare |
$3.40
|
|
|
MIDAZOLAM HYDROCHLORIDE INJ, PER 1 MG
|
Facility
OP
|
$6.18
|
|
|
Service Code
|
HCPCS J2250
|
| Hospital Charge Code |
4400517
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$4.97 |
| Rate for Payer: Aetna of NY Commercial |
$3.40
|
| Rate for Payer: Aetna of NY Medicare |
$2.84
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$0.14
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$0.14
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2.29
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$3.09
|
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: CDPHP Commercial |
$4.97
|
| Rate for Payer: CDPHP Medicare |
$2.29
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.14
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$4.94
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$4.94
|
| Rate for Payer: EmblemHealth Medicaid |
$4.94
|
| Rate for Payer: EmblemHealth Medicare |
$2.10
|
| Rate for Payer: EmblemHealth Select Care |
$0.14
|
| Rate for Payer: Fidelis Medicare |
$2.36
|
| Rate for Payer: Galaxy Health Commercial |
$4.02
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.29
|
| Rate for Payer: Humana Medicare |
$2.29
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$3.40
|
| Rate for Payer: Local 1199SEIU Medicare |
$2.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4.64
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3.48
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2.40
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$0.23
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$0.14
|
| Rate for Payer: United Healthcare Commercial |
$0.23
|
| Rate for Payer: United Healthcare Medicare |
$2.29
|
| Rate for Payer: WellCare Medicare |
$3.40
|
|
|
MIDODRINE 5 MG TAB, NDC 50268-0565-15
|
Facility
OP
|
$12.10
|
|
| Hospital Charge Code |
4409227
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.11 |
| Max. Negotiated Rate |
$9.74 |
| Rate for Payer: Aetna of NY Commercial |
$8.47
|
| Rate for Payer: Aetna of NY Medicare |
$5.57
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$9.08
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$9.08
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$4.48
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$6.05
|
| Rate for Payer: Cash Price |
$9.07
|
| Rate for Payer: CDPHP Commercial |
$9.74
|
| Rate for Payer: CDPHP Medicare |
$4.48
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$9.68
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$9.68
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$9.68
|
| Rate for Payer: EmblemHealth Medicaid |
$9.68
|
| Rate for Payer: EmblemHealth Medicare |
$4.11
|
| Rate for Payer: EmblemHealth Select Care |
$8.71
|
| Rate for Payer: Fidelis Medicare |
$4.61
|
| Rate for Payer: Galaxy Health Commercial |
$7.86
|
| Rate for Payer: Hamaspik Choice Medicare |
$4.48
|
| Rate for Payer: Humana Medicare |
$4.48
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$8.47
|
| Rate for Payer: Local 1199SEIU Medicare |
$5.57
|
| Rate for Payer: MVP Health Care of NY Commercial |
$9.08
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$6.81
|
| Rate for Payer: MVP Health Care of NY Medicare |
$4.70
|
| Rate for Payer: United Healthcare Medicare |
$4.48
|
| Rate for Payer: WellCare Medicare |
$6.66
|
|
|
MILD KIT
|
Facility
OP
|
$8,808.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
4473019
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,994.72 |
| Max. Negotiated Rate |
$7,090.44 |
| Rate for Payer: Aetna of NY Commercial |
$6,165.60
|
| Rate for Payer: Aetna of NY Medicare |
$4,051.68
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$6,606.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$6,606.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$3,258.96
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$4,404.00
|
| Rate for Payer: Cash Price |
$6,606.00
|
| Rate for Payer: CDPHP Commercial |
$7,090.44
|
| Rate for Payer: CDPHP Medicare |
$3,258.96
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$7,046.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$7,046.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$7,046.40
|
| Rate for Payer: EmblemHealth Medicaid |
$7,046.40
|
| Rate for Payer: EmblemHealth Medicare |
$2,994.72
|
| Rate for Payer: EmblemHealth Select Care |
$6,341.76
|
| Rate for Payer: Fidelis Medicare |
$3,356.73
|
| Rate for Payer: Galaxy Health Commercial |
$5,725.20
|
| Rate for Payer: Hamaspik Choice Medicare |
$3,258.96
|
| Rate for Payer: Humana Medicare |
$3,258.96
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$6,165.60
|
| Rate for Payer: Local 1199SEIU Medicare |
$4,051.68
|
| Rate for Payer: MVP Health Care of NY Commercial |
$6,606.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$4,958.90
|
| Rate for Payer: MVP Health Care of NY Medicare |
$3,421.91
|
| Rate for Payer: United Healthcare Medicare |
$3,258.96
|
| Rate for Payer: WellCare Medicare |
$4,844.40
|
|
|
MILRINONE LACT 50 MG/50 ML VL 5 mg, 50 mL
|
Facility
OP
|
$66.00
|
|
|
Service Code
|
HCPCS J2260
|
| Hospital Charge Code |
4401380
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.55 |
| Max. Negotiated Rate |
$53.13 |
| Rate for Payer: Aetna of NY Commercial |
$36.30
|
| Rate for Payer: Aetna of NY Medicare |
$30.36
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1.55
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1.55
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$24.42
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$33.00
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: CDPHP Commercial |
$53.13
|
| Rate for Payer: CDPHP Medicare |
$24.42
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1.55
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$52.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$52.80
|
| Rate for Payer: EmblemHealth Medicaid |
$52.80
|
| Rate for Payer: EmblemHealth Medicare |
$22.44
|
| Rate for Payer: EmblemHealth Select Care |
$1.55
|
| Rate for Payer: Fidelis Medicare |
$25.15
|
| Rate for Payer: Galaxy Health Commercial |
$42.90
|
| Rate for Payer: Hamaspik Choice Medicare |
$24.42
|
| Rate for Payer: Humana Medicare |
$24.42
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$36.30
|
| Rate for Payer: Local 1199SEIU Medicare |
$30.36
|
| Rate for Payer: MVP Health Care of NY Commercial |
$49.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$37.16
|
| Rate for Payer: MVP Health Care of NY Medicare |
$25.64
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$3.09
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1.55
|
| Rate for Payer: United Healthcare Commercial |
$3.09
|
| Rate for Payer: United Healthcare Medicare |
$24.42
|
| Rate for Payer: WellCare Medicare |
$36.30
|
|
|
MILRINONE LACT, 5 MG
|
Facility
OP
|
$67.00
|
|
|
Service Code
|
HCPCS J2260
|
| Hospital Charge Code |
4402268
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.55 |
| Max. Negotiated Rate |
$53.94 |
| Rate for Payer: Aetna of NY Commercial |
$36.85
|
| Rate for Payer: Aetna of NY Medicare |
$30.82
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1.55
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1.55
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$24.79
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$33.50
|
| Rate for Payer: Cash Price |
$50.25
|
| Rate for Payer: Cash Price |
$50.25
|
| Rate for Payer: CDPHP Commercial |
$53.94
|
| Rate for Payer: CDPHP Medicare |
$24.79
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1.55
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$53.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$53.60
|
| Rate for Payer: EmblemHealth Medicaid |
$53.60
|
| Rate for Payer: EmblemHealth Medicare |
$22.78
|
| Rate for Payer: EmblemHealth Select Care |
$1.55
|
| Rate for Payer: Fidelis Medicare |
$25.53
|
| Rate for Payer: Galaxy Health Commercial |
$43.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$24.79
|
| Rate for Payer: Humana Medicare |
$24.79
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$36.85
|
| Rate for Payer: Local 1199SEIU Medicare |
$30.82
|
| Rate for Payer: MVP Health Care of NY Commercial |
$50.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$37.72
|
| Rate for Payer: MVP Health Care of NY Medicare |
$26.03
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$3.09
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1.55
|
| Rate for Payer: United Healthcare Commercial |
$3.09
|
| Rate for Payer: United Healthcare Medicare |
$24.79
|
| Rate for Payer: WellCare Medicare |
$36.85
|
|
|
MILRINONE THERAPY, ALL SUPPLIES/EQUIPMENT
|
Facility
OP
|
$256.00
|
|
| Hospital Charge Code |
1050105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$87.04 |
| Max. Negotiated Rate |
$206.08 |
| Rate for Payer: Aetna of NY Commercial |
$179.20
|
| Rate for Payer: Aetna of NY Medicare |
$117.76
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$192.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$192.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$94.72
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$128.00
|
| Rate for Payer: Cash Price |
$192.00
|
| Rate for Payer: CDPHP Commercial |
$206.08
|
| Rate for Payer: CDPHP Medicare |
$94.72
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$204.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$204.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$204.80
|
| Rate for Payer: EmblemHealth Medicaid |
$204.80
|
| Rate for Payer: EmblemHealth Medicare |
$87.04
|
| Rate for Payer: EmblemHealth Select Care |
$184.32
|
| Rate for Payer: Fidelis Medicare |
$97.56
|
| Rate for Payer: Galaxy Health Commercial |
$166.40
|
| Rate for Payer: Hamaspik Choice Medicare |
$94.72
|
| Rate for Payer: Humana Medicare |
$94.72
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$179.20
|
| Rate for Payer: Local 1199SEIU Medicare |
$117.76
|
| Rate for Payer: MVP Health Care of NY Commercial |
$192.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$144.13
|
| Rate for Payer: MVP Health Care of NY Medicare |
$99.46
|
| Rate for Payer: United Healthcare Medicare |
$94.72
|
| Rate for Payer: WellCare Medicare |
$140.80
|
|
|
MIRTAZAPINE 15 MG TAB
|
Facility
OP
|
$10.56
|
|
| Hospital Charge Code |
4409046
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.59 |
| Max. Negotiated Rate |
$8.50 |
| Rate for Payer: Aetna of NY Commercial |
$7.39
|
| Rate for Payer: Aetna of NY Medicare |
$4.86
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$7.92
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$7.92
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$3.91
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$5.28
|
| Rate for Payer: Cash Price |
$7.92
|
| Rate for Payer: CDPHP Commercial |
$8.50
|
| Rate for Payer: CDPHP Medicare |
$3.91
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$8.45
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$8.45
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$8.45
|
| Rate for Payer: EmblemHealth Medicaid |
$8.45
|
| Rate for Payer: EmblemHealth Medicare |
$3.59
|
| Rate for Payer: EmblemHealth Select Care |
$7.60
|
| Rate for Payer: Fidelis Medicare |
$4.02
|
| Rate for Payer: Galaxy Health Commercial |
$6.86
|
| Rate for Payer: Hamaspik Choice Medicare |
$3.91
|
| Rate for Payer: Humana Medicare |
$3.91
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$7.39
|
| Rate for Payer: Local 1199SEIU Medicare |
$4.86
|
| Rate for Payer: MVP Health Care of NY Commercial |
$7.92
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$5.95
|
| Rate for Payer: MVP Health Care of NY Medicare |
$4.10
|
| Rate for Payer: United Healthcare Medicare |
$3.91
|
| Rate for Payer: WellCare Medicare |
$5.81
|
|
|
MISCELLANEOUS INSTRUMENTS
|
Facility
OP
|
$314.00
|
|
| Hospital Charge Code |
4472236
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$106.76 |
| Max. Negotiated Rate |
$252.77 |
| Rate for Payer: Aetna of NY Commercial |
$219.80
|
| Rate for Payer: Aetna of NY Medicare |
$144.44
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$235.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$235.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$116.18
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$157.00
|
| Rate for Payer: Cash Price |
$235.50
|
| Rate for Payer: CDPHP Commercial |
$252.77
|
| Rate for Payer: CDPHP Medicare |
$116.18
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$251.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$251.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$251.20
|
| Rate for Payer: EmblemHealth Medicaid |
$251.20
|
| Rate for Payer: EmblemHealth Medicare |
$106.76
|
| Rate for Payer: EmblemHealth Select Care |
$226.08
|
| Rate for Payer: Fidelis Medicare |
$119.67
|
| Rate for Payer: Galaxy Health Commercial |
$204.10
|
| Rate for Payer: Hamaspik Choice Medicare |
$116.18
|
| Rate for Payer: Humana Medicare |
$116.18
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$219.80
|
| Rate for Payer: Local 1199SEIU Medicare |
$144.44
|
| Rate for Payer: MVP Health Care of NY Commercial |
$235.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$176.78
|
| Rate for Payer: MVP Health Care of NY Medicare |
$121.99
|
| Rate for Payer: United Healthcare Medicare |
$116.18
|
| Rate for Payer: WellCare Medicare |
$172.70
|
|
|
MISC PHARMACY
|
Facility
OP
|
$6.18
|
|
| Hospital Charge Code |
4409153
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.10 |
| Max. Negotiated Rate |
$4.97 |
| Rate for Payer: Aetna of NY Commercial |
$4.33
|
| Rate for Payer: Aetna of NY Medicare |
$2.84
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$4.64
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$4.64
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2.29
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$3.09
|
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: CDPHP Commercial |
$4.97
|
| Rate for Payer: CDPHP Medicare |
$2.29
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$4.94
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$4.94
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$4.94
|
| Rate for Payer: EmblemHealth Medicaid |
$4.94
|
| Rate for Payer: EmblemHealth Medicare |
$2.10
|
| Rate for Payer: EmblemHealth Select Care |
$4.45
|
| Rate for Payer: Fidelis Medicare |
$2.36
|
| Rate for Payer: Galaxy Health Commercial |
$4.02
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.29
|
| Rate for Payer: Humana Medicare |
$2.29
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$4.33
|
| Rate for Payer: Local 1199SEIU Medicare |
$2.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4.64
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3.48
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2.40
|
| Rate for Payer: United Healthcare Medicare |
$2.29
|
| Rate for Payer: WellCare Medicare |
$3.40
|
|
|
MISOPROSTOL 100 MCG TABLET
|
Facility
OP
|
$6.18
|
|
| Hospital Charge Code |
4400837
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.10 |
| Max. Negotiated Rate |
$4.97 |
| Rate for Payer: Aetna of NY Commercial |
$4.33
|
| Rate for Payer: Aetna of NY Medicare |
$2.84
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$4.64
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$4.64
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2.29
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$3.09
|
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: CDPHP Commercial |
$4.97
|
| Rate for Payer: CDPHP Medicare |
$2.29
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$4.94
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$4.94
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$4.94
|
| Rate for Payer: EmblemHealth Medicaid |
$4.94
|
| Rate for Payer: EmblemHealth Medicare |
$2.10
|
| Rate for Payer: EmblemHealth Select Care |
$4.45
|
| Rate for Payer: Fidelis Medicare |
$2.36
|
| Rate for Payer: Galaxy Health Commercial |
$4.02
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.29
|
| Rate for Payer: Humana Medicare |
$2.29
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$4.33
|
| Rate for Payer: Local 1199SEIU Medicare |
$2.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4.64
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3.48
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2.40
|
| Rate for Payer: United Healthcare Medicare |
$2.29
|
| Rate for Payer: WellCare Medicare |
$3.40
|
|
|
M-M-R II
|
Facility
OP
|
$268.80
|
|
| Hospital Charge Code |
4408943
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$91.39 |
| Max. Negotiated Rate |
$216.38 |
| Rate for Payer: Aetna of NY Commercial |
$188.16
|
| Rate for Payer: Aetna of NY Medicare |
$123.65
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$201.60
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$201.60
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$99.46
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$134.40
|
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: CDPHP Commercial |
$216.38
|
| Rate for Payer: CDPHP Medicare |
$99.46
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$215.04
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$215.04
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$215.04
|
| Rate for Payer: EmblemHealth Medicaid |
$215.04
|
| Rate for Payer: EmblemHealth Medicare |
$91.39
|
| Rate for Payer: EmblemHealth Select Care |
$193.54
|
| Rate for Payer: Fidelis Medicare |
$102.44
|
| Rate for Payer: Galaxy Health Commercial |
$174.72
|
| Rate for Payer: Hamaspik Choice Medicare |
$99.46
|
| Rate for Payer: Humana Medicare |
$99.46
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$188.16
|
| Rate for Payer: Local 1199SEIU Medicare |
$123.65
|
| Rate for Payer: MVP Health Care of NY Commercial |
$201.60
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$151.33
|
| Rate for Payer: MVP Health Care of NY Medicare |
$104.43
|
| Rate for Payer: United Healthcare Medicare |
$99.46
|
| Rate for Payer: WellCare Medicare |
$147.84
|
|
|
MODAFINIL 100 MG TABLET 100 mg, 30 eaches
|
Facility
OP
|
$80.00
|
|
| Hospital Charge Code |
4401928
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$27.20 |
| Max. Negotiated Rate |
$64.40 |
| Rate for Payer: Aetna of NY Commercial |
$56.00
|
| Rate for Payer: Aetna of NY Medicare |
$36.80
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$60.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$60.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$29.60
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$40.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: CDPHP Commercial |
$64.40
|
| Rate for Payer: CDPHP Medicare |
$29.60
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$64.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$64.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$64.00
|
| Rate for Payer: EmblemHealth Medicaid |
$64.00
|
| Rate for Payer: EmblemHealth Medicare |
$27.20
|
| Rate for Payer: EmblemHealth Select Care |
$57.60
|
| Rate for Payer: Fidelis Medicare |
$30.49
|
| Rate for Payer: Galaxy Health Commercial |
$52.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$29.60
|
| Rate for Payer: Humana Medicare |
$29.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$56.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$36.80
|
| Rate for Payer: MVP Health Care of NY Commercial |
$60.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$45.04
|
| Rate for Payer: MVP Health Care of NY Medicare |
$31.08
|
| Rate for Payer: United Healthcare Medicare |
$29.60
|
| Rate for Payer: WellCare Medicare |
$44.00
|
|
|
MODERNA COVID VACCINE 25 MCG/0.25 ML 6 MO - 11Y
|
Facility
OP
|
$0.01
|
|
|
Service Code
|
HCPCS 91321
|
| Hospital Charge Code |
4403004
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$145.92 |
| Rate for Payer: Aetna of NY Commercial |
$0.01
|
| Rate for Payer: Aetna of NY Medicare |
$0.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$145.92
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$145.92
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$0.00
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: CDPHP Commercial |
$0.01
|
| Rate for Payer: CDPHP Medicare |
$0.00
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$145.92
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$0.01
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$0.01
|
| Rate for Payer: EmblemHealth Medicaid |
$0.01
|
| Rate for Payer: EmblemHealth Medicare |
$0.00
|
| Rate for Payer: EmblemHealth Select Care |
$145.92
|
| Rate for Payer: Fidelis Medicare |
$0.00
|
| Rate for Payer: Galaxy Health Commercial |
$0.01
|
| Rate for Payer: Hamaspik Choice Medicare |
$0.00
|
| Rate for Payer: Humana Medicare |
$0.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$0.01
|
| Rate for Payer: Local 1199SEIU Medicare |
$0.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.01
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$0.01
|
| Rate for Payer: MVP Health Care of NY Medicare |
$0.00
|
| Rate for Payer: United Healthcare Medicare |
$0.00
|
| Rate for Payer: WellCare Medicare |
$0.01
|
|
|
MODERNA COVID VACCINE 50 MCG/0.5 ML 12 Y OLDER
|
Facility
OP
|
$0.01
|
|
|
Service Code
|
HCPCS 91322
|
| Hospital Charge Code |
4403005
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$145.92 |
| Rate for Payer: Aetna of NY Commercial |
$0.01
|
| Rate for Payer: Aetna of NY Medicare |
$0.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$145.92
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$145.92
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$0.00
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: CDPHP Commercial |
$0.01
|
| Rate for Payer: CDPHP Medicare |
$0.00
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$145.92
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$0.01
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$0.01
|
| Rate for Payer: EmblemHealth Medicaid |
$0.01
|
| Rate for Payer: EmblemHealth Medicare |
$0.00
|
| Rate for Payer: EmblemHealth Select Care |
$145.92
|
| Rate for Payer: Fidelis Medicare |
$0.00
|
| Rate for Payer: Galaxy Health Commercial |
$0.01
|
| Rate for Payer: Hamaspik Choice Medicare |
$0.00
|
| Rate for Payer: Humana Medicare |
$0.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$0.01
|
| Rate for Payer: Local 1199SEIU Medicare |
$0.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.01
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$0.01
|
| Rate for Payer: MVP Health Care of NY Medicare |
$0.00
|
| Rate for Payer: United Healthcare Medicare |
$0.00
|
| Rate for Payer: WellCare Medicare |
$0.01
|
|
|
MOD SEDATION OTHER PHYS/QHP EA
|
Facility
OP
|
$224.00
|
|
|
Service Code
|
HCPCS 99157
|
| Hospital Charge Code |
4601194
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$58.59 |
| Max. Negotiated Rate |
$1,189.18 |
| Rate for Payer: Aetna of NY Commercial |
$955.00
|
| Rate for Payer: Aetna of NY Medicare |
$103.04
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$950.93
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,189.18
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$82.88
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$112.00
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: CDPHP Commercial |
$180.32
|
| Rate for Payer: CDPHP Medicare |
$82.88
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,182.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$179.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$179.20
|
| Rate for Payer: EmblemHealth Medicaid |
$179.20
|
| Rate for Payer: EmblemHealth Medicare |
$76.16
|
| Rate for Payer: EmblemHealth Select Care |
$1,064.00
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$250.00
|
| Rate for Payer: Fidelis Medicare |
$85.37
|
| Rate for Payer: Galaxy Health Commercial |
$145.60
|
| Rate for Payer: Hamaspik Choice Medicare |
$82.88
|
| Rate for Payer: Humana Medicare |
$82.88
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$955.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$103.04
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,174.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$881.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$87.02
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$980.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$58.59
|
| Rate for Payer: United Healthcare Commercial |
$980.00
|
| Rate for Payer: United Healthcare Medicare |
$82.88
|
| Rate for Payer: WellCare Medicare |
$123.20
|
|
