|
MRI PELVIS W/DYE
|
Facility
OP
|
$3,779.00
|
|
|
Service Code
|
HCPCS 72196
|
| Hospital Charge Code |
4230006
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$505.00 |
| Max. Negotiated Rate |
$3,042.10 |
| Rate for Payer: Aetna of NY Commercial |
$1,738.00
|
| Rate for Payer: Aetna of NY Medicare |
$1,738.34
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$2,834.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$2,834.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1,398.23
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$794.00
|
| Rate for Payer: Cash Price |
$2,834.25
|
| Rate for Payer: Cash Price |
$2,834.25
|
| Rate for Payer: Cash Price |
$2,834.25
|
| Rate for Payer: CDPHP Commercial |
$3,042.10
|
| Rate for Payer: CDPHP Medicare |
$1,398.23
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$3,023.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$3,023.20
|
| Rate for Payer: EmblemHealth Medicaid |
$3,023.20
|
| Rate for Payer: EmblemHealth Medicare |
$1,284.86
|
| Rate for Payer: Fidelis Medicare |
$1,440.18
|
| Rate for Payer: Galaxy Health Commercial |
$2,456.35
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,398.23
|
| Rate for Payer: Humana Medicare |
$1,398.23
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,738.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,738.34
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,270.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$918.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1,468.14
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$2,260.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$505.00
|
| Rate for Payer: United Healthcare Commercial |
$2,260.00
|
| Rate for Payer: United Healthcare Medicare |
$1,398.23
|
| Rate for Payer: WellCare Medicare |
$2,078.45
|
|
|
MRI PELVIS W/O DYE
|
Facility
OP
|
$2,278.00
|
|
|
Service Code
|
HCPCS 72195
|
| Hospital Charge Code |
4230005
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$505.00 |
| Max. Negotiated Rate |
$2,260.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,738.00
|
| Rate for Payer: Aetna of NY Medicare |
$1,047.88
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1,708.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,708.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$842.86
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$794.00
|
| Rate for Payer: Cash Price |
$1,708.50
|
| Rate for Payer: Cash Price |
$1,708.50
|
| Rate for Payer: Cash Price |
$1,708.50
|
| Rate for Payer: CDPHP Commercial |
$1,833.79
|
| Rate for Payer: CDPHP Medicare |
$842.86
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,822.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,822.40
|
| Rate for Payer: EmblemHealth Medicaid |
$1,822.40
|
| Rate for Payer: EmblemHealth Medicare |
$774.52
|
| Rate for Payer: Fidelis Medicare |
$868.15
|
| Rate for Payer: Galaxy Health Commercial |
$1,480.70
|
| Rate for Payer: Hamaspik Choice Medicare |
$842.86
|
| Rate for Payer: Humana Medicare |
$842.86
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,738.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,047.88
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,270.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$918.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$885.00
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$2,260.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$505.00
|
| Rate for Payer: United Healthcare Commercial |
$2,260.00
|
| Rate for Payer: United Healthcare Medicare |
$842.86
|
| Rate for Payer: WellCare Medicare |
$1,252.90
|
|
|
MRI PELVIS W/O & W/DYE
|
Facility
OP
|
$3,882.00
|
|
|
Service Code
|
HCPCS 72197
|
| Hospital Charge Code |
4230007
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$505.00 |
| Max. Negotiated Rate |
$3,125.01 |
| Rate for Payer: Aetna of NY Commercial |
$1,738.00
|
| Rate for Payer: Aetna of NY Medicare |
$1,785.72
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$2,911.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$2,911.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1,436.34
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$794.00
|
| Rate for Payer: Cash Price |
$2,911.50
|
| Rate for Payer: Cash Price |
$2,911.50
|
| Rate for Payer: Cash Price |
$2,911.50
|
| Rate for Payer: CDPHP Commercial |
$3,125.01
|
| Rate for Payer: CDPHP Medicare |
$1,436.34
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$3,105.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$3,105.60
|
| Rate for Payer: EmblemHealth Medicaid |
$3,105.60
|
| Rate for Payer: EmblemHealth Medicare |
$1,319.88
|
| Rate for Payer: Fidelis Medicare |
$1,479.43
|
| Rate for Payer: Galaxy Health Commercial |
$2,523.30
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,436.34
|
| Rate for Payer: Humana Medicare |
$1,436.34
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,738.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,785.72
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,270.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$918.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1,508.16
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$2,260.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$505.00
|
| Rate for Payer: United Healthcare Commercial |
$2,260.00
|
| Rate for Payer: United Healthcare Medicare |
$1,436.34
|
| Rate for Payer: WellCare Medicare |
$2,135.10
|
|
|
MRI THORACIC SPINE W/DYE
|
Facility
OP
|
$4,348.00
|
|
|
Service Code
|
HCPCS 72147
|
| Hospital Charge Code |
4230031
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$505.00 |
| Max. Negotiated Rate |
$3,500.14 |
| Rate for Payer: Aetna of NY Commercial |
$1,738.00
|
| Rate for Payer: Aetna of NY Medicare |
$2,000.08
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$3,261.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$3,261.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1,608.76
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$794.00
|
| Rate for Payer: Cash Price |
$3,261.00
|
| Rate for Payer: Cash Price |
$3,261.00
|
| Rate for Payer: Cash Price |
$3,261.00
|
| Rate for Payer: CDPHP Commercial |
$3,500.14
|
| Rate for Payer: CDPHP Medicare |
$1,608.76
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$3,478.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$3,478.40
|
| Rate for Payer: EmblemHealth Medicaid |
$3,478.40
|
| Rate for Payer: EmblemHealth Medicare |
$1,478.32
|
| Rate for Payer: Fidelis Medicare |
$1,657.02
|
| Rate for Payer: Galaxy Health Commercial |
$2,826.20
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,608.76
|
| Rate for Payer: Humana Medicare |
$1,608.76
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,738.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$2,000.08
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,270.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$918.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1,689.20
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$2,260.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$505.00
|
| Rate for Payer: United Healthcare Commercial |
$2,260.00
|
| Rate for Payer: United Healthcare Medicare |
$1,608.76
|
| Rate for Payer: WellCare Medicare |
$2,391.40
|
|
|
MRI THORACIC SPINE W/O DYE
|
Facility
OP
|
$2,278.00
|
|
|
Service Code
|
HCPCS 72146
|
| Hospital Charge Code |
4230012
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$505.00 |
| Max. Negotiated Rate |
$2,260.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,738.00
|
| Rate for Payer: Aetna of NY Medicare |
$1,047.88
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1,708.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,708.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$842.86
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$794.00
|
| Rate for Payer: Cash Price |
$1,708.50
|
| Rate for Payer: Cash Price |
$1,708.50
|
| Rate for Payer: Cash Price |
$1,708.50
|
| Rate for Payer: CDPHP Commercial |
$1,833.79
|
| Rate for Payer: CDPHP Medicare |
$842.86
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,822.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,822.40
|
| Rate for Payer: EmblemHealth Medicaid |
$1,822.40
|
| Rate for Payer: EmblemHealth Medicare |
$774.52
|
| Rate for Payer: Fidelis Medicare |
$868.15
|
| Rate for Payer: Galaxy Health Commercial |
$1,480.70
|
| Rate for Payer: Hamaspik Choice Medicare |
$842.86
|
| Rate for Payer: Humana Medicare |
$842.86
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,738.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,047.88
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,270.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$918.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$885.00
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$2,260.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$505.00
|
| Rate for Payer: United Healthcare Commercial |
$2,260.00
|
| Rate for Payer: United Healthcare Medicare |
$842.86
|
| Rate for Payer: WellCare Medicare |
$1,252.90
|
|
|
MRI THORACIC SPINE W/O & W/DYE
|
Facility
OP
|
$3,986.00
|
|
|
Service Code
|
HCPCS 72157
|
| Hospital Charge Code |
4230013
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$505.00 |
| Max. Negotiated Rate |
$3,208.73 |
| Rate for Payer: Aetna of NY Commercial |
$1,738.00
|
| Rate for Payer: Aetna of NY Medicare |
$1,833.56
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$2,989.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$2,989.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1,474.82
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$794.00
|
| Rate for Payer: Cash Price |
$2,989.50
|
| Rate for Payer: Cash Price |
$2,989.50
|
| Rate for Payer: Cash Price |
$2,989.50
|
| Rate for Payer: CDPHP Commercial |
$3,208.73
|
| Rate for Payer: CDPHP Medicare |
$1,474.82
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$3,188.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$3,188.80
|
| Rate for Payer: EmblemHealth Medicaid |
$3,188.80
|
| Rate for Payer: EmblemHealth Medicare |
$1,355.24
|
| Rate for Payer: Fidelis Medicare |
$1,519.06
|
| Rate for Payer: Galaxy Health Commercial |
$2,590.90
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,474.82
|
| Rate for Payer: Humana Medicare |
$1,474.82
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,738.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,833.56
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,270.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$918.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1,548.56
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$2,260.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$505.00
|
| Rate for Payer: United Healthcare Commercial |
$2,260.00
|
| Rate for Payer: United Healthcare Medicare |
$1,474.82
|
| Rate for Payer: WellCare Medicare |
$2,192.30
|
|
|
MRI UPPER EXT; ANY JOINT W DYE
|
Facility
OP
|
$3,572.00
|
|
|
Service Code
|
HCPCS 73222
|
| Hospital Charge Code |
4230022
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$505.00 |
| Max. Negotiated Rate |
$2,875.46 |
| Rate for Payer: Aetna of NY Commercial |
$1,738.00
|
| Rate for Payer: Aetna of NY Medicare |
$1,643.12
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$2,679.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$2,679.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1,321.64
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$794.00
|
| Rate for Payer: Cash Price |
$2,679.00
|
| Rate for Payer: Cash Price |
$2,679.00
|
| Rate for Payer: Cash Price |
$2,679.00
|
| Rate for Payer: CDPHP Commercial |
$2,875.46
|
| Rate for Payer: CDPHP Medicare |
$1,321.64
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2,857.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$2,857.60
|
| Rate for Payer: EmblemHealth Medicaid |
$2,857.60
|
| Rate for Payer: EmblemHealth Medicare |
$1,214.48
|
| Rate for Payer: Fidelis Medicare |
$1,361.29
|
| Rate for Payer: Galaxy Health Commercial |
$2,321.80
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,321.64
|
| Rate for Payer: Humana Medicare |
$1,321.64
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,738.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,643.12
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,270.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$918.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1,387.72
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$2,260.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$505.00
|
| Rate for Payer: United Healthcare Commercial |
$2,260.00
|
| Rate for Payer: United Healthcare Medicare |
$1,321.64
|
| Rate for Payer: WellCare Medicare |
$1,964.60
|
|
|
MRI UPPER EXT; ANY JOINT W/O DYE
|
Facility
OP
|
$2,240.00
|
|
|
Service Code
|
HCPCS 73221 TC
|
| Hospital Charge Code |
4230021
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$761.60 |
| Max. Negotiated Rate |
$2,260.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,738.00
|
| Rate for Payer: Aetna of NY Medicare |
$1,030.40
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1,680.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,680.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$828.80
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$794.00
|
| Rate for Payer: Cash Price |
$1,680.00
|
| Rate for Payer: Cash Price |
$1,680.00
|
| Rate for Payer: Cash Price |
$1,680.00
|
| Rate for Payer: CDPHP Commercial |
$1,803.20
|
| Rate for Payer: CDPHP Medicare |
$828.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,792.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,792.00
|
| Rate for Payer: EmblemHealth Medicaid |
$1,792.00
|
| Rate for Payer: EmblemHealth Medicare |
$761.60
|
| Rate for Payer: Fidelis Medicare |
$853.66
|
| Rate for Payer: Galaxy Health Commercial |
$1,456.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$828.80
|
| Rate for Payer: Humana Medicare |
$828.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,738.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,030.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,270.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$918.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$870.24
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$2,260.00
|
| Rate for Payer: United Healthcare Commercial |
$2,260.00
|
| Rate for Payer: United Healthcare Medicare |
$828.80
|
| Rate for Payer: WellCare Medicare |
$1,232.00
|
|
|
MRI UPPER EXT; ANY JOINT W/O & W/DYE
|
Facility
OP
|
$4,400.00
|
|
|
Service Code
|
HCPCS 73223
|
| Hospital Charge Code |
4230023
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$505.00 |
| Max. Negotiated Rate |
$3,542.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,738.00
|
| Rate for Payer: Aetna of NY Medicare |
$2,024.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$3,300.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$3,300.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1,628.00
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$794.00
|
| Rate for Payer: Cash Price |
$3,300.00
|
| Rate for Payer: Cash Price |
$3,300.00
|
| Rate for Payer: Cash Price |
$3,300.00
|
| Rate for Payer: CDPHP Commercial |
$3,542.00
|
| Rate for Payer: CDPHP Medicare |
$1,628.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$3,520.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$3,520.00
|
| Rate for Payer: EmblemHealth Medicaid |
$3,520.00
|
| Rate for Payer: EmblemHealth Medicare |
$1,496.00
|
| Rate for Payer: Fidelis Medicare |
$1,676.84
|
| Rate for Payer: Galaxy Health Commercial |
$2,860.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,628.00
|
| Rate for Payer: Humana Medicare |
$1,628.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,738.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$2,024.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,270.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$918.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1,709.40
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$2,260.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$505.00
|
| Rate for Payer: United Healthcare Commercial |
$2,260.00
|
| Rate for Payer: United Healthcare Medicare |
$1,628.00
|
| Rate for Payer: WellCare Medicare |
$2,420.00
|
|
|
MRI UPPER EXT; NON JOINT W/ DYE
|
Facility
OP
|
$3,209.00
|
|
|
Service Code
|
HCPCS 73219
|
| Hospital Charge Code |
4230025
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$505.00 |
| Max. Negotiated Rate |
$2,583.24 |
| Rate for Payer: Aetna of NY Commercial |
$1,738.00
|
| Rate for Payer: Aetna of NY Medicare |
$1,476.14
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$2,406.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$2,406.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1,187.33
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$794.00
|
| Rate for Payer: Cash Price |
$2,406.75
|
| Rate for Payer: Cash Price |
$2,406.75
|
| Rate for Payer: Cash Price |
$2,406.75
|
| Rate for Payer: CDPHP Commercial |
$2,583.24
|
| Rate for Payer: CDPHP Medicare |
$1,187.33
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2,567.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$2,567.20
|
| Rate for Payer: EmblemHealth Medicaid |
$2,567.20
|
| Rate for Payer: EmblemHealth Medicare |
$1,091.06
|
| Rate for Payer: Fidelis Medicare |
$1,222.95
|
| Rate for Payer: Galaxy Health Commercial |
$2,085.85
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,187.33
|
| Rate for Payer: Humana Medicare |
$1,187.33
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,738.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,476.14
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,270.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$918.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1,246.70
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$2,260.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$505.00
|
| Rate for Payer: United Healthcare Commercial |
$2,260.00
|
| Rate for Payer: United Healthcare Medicare |
$1,187.33
|
| Rate for Payer: WellCare Medicare |
$1,764.95
|
|
|
MRI UPPER EXT; NON JOINT W/O DYE
|
Facility
OP
|
$3,427.00
|
|
|
Service Code
|
HCPCS 73218
|
| Hospital Charge Code |
4230024
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$505.00 |
| Max. Negotiated Rate |
$2,758.74 |
| Rate for Payer: Aetna of NY Commercial |
$1,738.00
|
| Rate for Payer: Aetna of NY Medicare |
$1,576.42
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$2,570.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$2,570.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1,267.99
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$794.00
|
| Rate for Payer: Cash Price |
$2,570.25
|
| Rate for Payer: Cash Price |
$2,570.25
|
| Rate for Payer: Cash Price |
$2,570.25
|
| Rate for Payer: CDPHP Commercial |
$2,758.74
|
| Rate for Payer: CDPHP Medicare |
$1,267.99
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2,741.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$2,741.60
|
| Rate for Payer: EmblemHealth Medicaid |
$2,741.60
|
| Rate for Payer: EmblemHealth Medicare |
$1,165.18
|
| Rate for Payer: Fidelis Medicare |
$1,306.03
|
| Rate for Payer: Galaxy Health Commercial |
$2,227.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,267.99
|
| Rate for Payer: Humana Medicare |
$1,267.99
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,738.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,576.42
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,270.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$918.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1,331.39
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$2,260.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$505.00
|
| Rate for Payer: United Healthcare Commercial |
$2,260.00
|
| Rate for Payer: United Healthcare Medicare |
$1,267.99
|
| Rate for Payer: WellCare Medicare |
$1,884.85
|
|
|
MRI UPPER EXT; NON JOINT W/O & W/DYE
|
Facility
OP
|
$4,400.00
|
|
|
Service Code
|
HCPCS 73220
|
| Hospital Charge Code |
4230026
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$505.00 |
| Max. Negotiated Rate |
$3,542.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,738.00
|
| Rate for Payer: Aetna of NY Medicare |
$2,024.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$3,300.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$3,300.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1,628.00
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$794.00
|
| Rate for Payer: Cash Price |
$3,300.00
|
| Rate for Payer: Cash Price |
$3,300.00
|
| Rate for Payer: Cash Price |
$3,300.00
|
| Rate for Payer: CDPHP Commercial |
$3,542.00
|
| Rate for Payer: CDPHP Medicare |
$1,628.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$3,520.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$3,520.00
|
| Rate for Payer: EmblemHealth Medicaid |
$3,520.00
|
| Rate for Payer: EmblemHealth Medicare |
$1,496.00
|
| Rate for Payer: Fidelis Medicare |
$1,676.84
|
| Rate for Payer: Galaxy Health Commercial |
$2,860.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,628.00
|
| Rate for Payer: Humana Medicare |
$1,628.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,738.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$2,024.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,270.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$918.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1,709.40
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$2,260.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$505.00
|
| Rate for Payer: United Healthcare Commercial |
$2,260.00
|
| Rate for Payer: United Healthcare Medicare |
$1,628.00
|
| Rate for Payer: WellCare Medicare |
$2,420.00
|
|
|
MUGA; MULTI W WM & EF
|
Facility
OP
|
$1,180.00
|
|
|
Service Code
|
HCPCS 78473
|
| Hospital Charge Code |
4210098
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$151.50 |
| Max. Negotiated Rate |
$1,500.00 |
| Rate for Payer: Aetna of NY Commercial |
$826.00
|
| Rate for Payer: Aetna of NY Medicare |
$542.80
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$885.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$885.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$436.60
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$590.00
|
| Rate for Payer: Cash Price |
$885.00
|
| Rate for Payer: Cash Price |
$885.00
|
| Rate for Payer: CDPHP Commercial |
$949.90
|
| Rate for Payer: CDPHP Medicare |
$436.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$944.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$944.00
|
| Rate for Payer: EmblemHealth Medicaid |
$944.00
|
| Rate for Payer: EmblemHealth Medicare |
$401.20
|
| Rate for Payer: Fidelis Medicare |
$449.70
|
| Rate for Payer: Galaxy Health Commercial |
$767.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$436.60
|
| Rate for Payer: Humana Medicare |
$436.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$826.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$542.80
|
| Rate for Payer: MVP Health Care of NY Commercial |
$885.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$664.34
|
| Rate for Payer: MVP Health Care of NY Medicare |
$458.43
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,500.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$151.50
|
| Rate for Payer: United Healthcare Commercial |
$1,500.00
|
| Rate for Payer: United Healthcare Medicare |
$436.60
|
| Rate for Payer: WellCare Medicare |
$649.00
|
|
|
MUGA SGL W RV EF BY 1ST PASS
|
Facility
OP
|
$379.00
|
|
|
Service Code
|
HCPCS 78496
|
| Hospital Charge Code |
4210082
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$128.86 |
| Max. Negotiated Rate |
$1,500.00 |
| Rate for Payer: Aetna of NY Commercial |
$265.30
|
| Rate for Payer: Aetna of NY Medicare |
$174.34
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$284.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$284.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$140.23
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$189.50
|
| Rate for Payer: Cash Price |
$284.25
|
| Rate for Payer: Cash Price |
$284.25
|
| Rate for Payer: CDPHP Commercial |
$305.10
|
| Rate for Payer: CDPHP Medicare |
$140.23
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$303.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$303.20
|
| Rate for Payer: EmblemHealth Medicaid |
$303.20
|
| Rate for Payer: EmblemHealth Medicare |
$128.86
|
| Rate for Payer: Fidelis Medicare |
$144.44
|
| Rate for Payer: Galaxy Health Commercial |
$246.35
|
| Rate for Payer: Hamaspik Choice Medicare |
$140.23
|
| Rate for Payer: Humana Medicare |
$140.23
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$265.30
|
| Rate for Payer: Local 1199SEIU Medicare |
$174.34
|
| Rate for Payer: MVP Health Care of NY Commercial |
$284.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$213.38
|
| Rate for Payer: MVP Health Care of NY Medicare |
$147.24
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,500.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$167.66
|
| Rate for Payer: United Healthcare Commercial |
$1,500.00
|
| Rate for Payer: United Healthcare Medicare |
$140.23
|
| Rate for Payer: WellCare Medicare |
$208.45
|
|
|
MUGA; SGL W WM & EF
|
Facility
OP
|
$1,180.00
|
|
|
Service Code
|
HCPCS 78472
|
| Hospital Charge Code |
4211249
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$151.50 |
| Max. Negotiated Rate |
$1,500.00 |
| Rate for Payer: Aetna of NY Commercial |
$826.00
|
| Rate for Payer: Aetna of NY Medicare |
$542.80
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$885.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$885.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$436.60
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$590.00
|
| Rate for Payer: Cash Price |
$885.00
|
| Rate for Payer: Cash Price |
$885.00
|
| Rate for Payer: CDPHP Commercial |
$949.90
|
| Rate for Payer: CDPHP Medicare |
$436.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$944.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$944.00
|
| Rate for Payer: EmblemHealth Medicaid |
$944.00
|
| Rate for Payer: EmblemHealth Medicare |
$401.20
|
| Rate for Payer: Fidelis Medicare |
$449.70
|
| Rate for Payer: Galaxy Health Commercial |
$767.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$436.60
|
| Rate for Payer: Humana Medicare |
$436.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$826.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$542.80
|
| Rate for Payer: MVP Health Care of NY Commercial |
$885.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$664.34
|
| Rate for Payer: MVP Health Care of NY Medicare |
$458.43
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,500.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$151.50
|
| Rate for Payer: United Healthcare Commercial |
$1,500.00
|
| Rate for Payer: United Healthcare Medicare |
$436.60
|
| Rate for Payer: WellCare Medicare |
$649.00
|
|
|
MULTIPLE AREA STATIC BONE
|
Facility
OP
|
$1,180.00
|
|
|
Service Code
|
HCPCS 78305
|
| Hospital Charge Code |
4210003
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$60.60 |
| Max. Negotiated Rate |
$1,500.00 |
| Rate for Payer: Aetna of NY Commercial |
$826.00
|
| Rate for Payer: Aetna of NY Medicare |
$542.80
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$885.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$885.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$436.60
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$590.00
|
| Rate for Payer: Cash Price |
$885.00
|
| Rate for Payer: Cash Price |
$885.00
|
| Rate for Payer: CDPHP Commercial |
$949.90
|
| Rate for Payer: CDPHP Medicare |
$436.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$944.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$944.00
|
| Rate for Payer: EmblemHealth Medicaid |
$944.00
|
| Rate for Payer: EmblemHealth Medicare |
$401.20
|
| Rate for Payer: Fidelis Medicare |
$449.70
|
| Rate for Payer: Galaxy Health Commercial |
$767.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$436.60
|
| Rate for Payer: Humana Medicare |
$436.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$826.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$542.80
|
| Rate for Payer: MVP Health Care of NY Commercial |
$885.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$664.34
|
| Rate for Payer: MVP Health Care of NY Medicare |
$458.43
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,500.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$60.60
|
| Rate for Payer: United Healthcare Commercial |
$1,500.00
|
| Rate for Payer: United Healthcare Medicare |
$436.60
|
| Rate for Payer: WellCare Medicare |
$649.00
|
|
|
MUMPS SCREEN IGG
|
Facility
OP
|
$56.00
|
|
|
Service Code
|
HCPCS 86735
|
| Hospital Charge Code |
4300570
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.11 |
| Max. Negotiated Rate |
$45.08 |
| Rate for Payer: Aetna of NY Commercial |
$36.40
|
| Rate for Payer: Aetna of NY Medicare |
$25.76
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$42.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$42.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$20.72
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$28.00
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: CDPHP Commercial |
$45.08
|
| Rate for Payer: CDPHP Medicare |
$20.72
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$44.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$44.80
|
| Rate for Payer: EmblemHealth Medicaid |
$44.80
|
| Rate for Payer: EmblemHealth Medicare |
$19.04
|
| Rate for Payer: Fidelis Medicare |
$21.34
|
| Rate for Payer: Galaxy Health Commercial |
$36.40
|
| Rate for Payer: Hamaspik Choice Medicare |
$20.72
|
| Rate for Payer: Humana Medicare |
$20.72
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$36.40
|
| Rate for Payer: Local 1199SEIU Medicare |
$25.76
|
| Rate for Payer: MVP Health Care of NY Commercial |
$42.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$31.53
|
| Rate for Payer: MVP Health Care of NY Medicare |
$21.76
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$42.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$8.11
|
| Rate for Payer: United Healthcare Commercial |
$42.00
|
| Rate for Payer: United Healthcare Medicare |
$20.72
|
| Rate for Payer: WellCare Medicare |
$30.80
|
|
|
MUPIROCIN 0.02 OINT 22 GM
|
Facility
OP
|
$75.00
|
|
| Hospital Charge Code |
4400531
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$25.50 |
| Max. Negotiated Rate |
$60.38 |
| Rate for Payer: Aetna of NY Commercial |
$52.50
|
| Rate for Payer: Aetna of NY Medicare |
$34.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$56.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$56.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$27.75
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$37.50
|
| Rate for Payer: Cash Price |
$56.25
|
| Rate for Payer: CDPHP Commercial |
$60.38
|
| Rate for Payer: CDPHP Medicare |
$27.75
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$60.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$60.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$60.00
|
| Rate for Payer: EmblemHealth Medicaid |
$60.00
|
| Rate for Payer: EmblemHealth Medicare |
$25.50
|
| Rate for Payer: EmblemHealth Select Care |
$54.00
|
| Rate for Payer: Fidelis Medicare |
$28.58
|
| Rate for Payer: Galaxy Health Commercial |
$48.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$27.75
|
| Rate for Payer: Humana Medicare |
$27.75
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$52.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$34.50
|
| Rate for Payer: MVP Health Care of NY Commercial |
$56.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$42.22
|
| Rate for Payer: MVP Health Care of NY Medicare |
$29.14
|
| Rate for Payer: United Healthcare Medicare |
$27.75
|
| Rate for Payer: WellCare Medicare |
$41.25
|
|
|
mycophenolate 250 MG CAPSULE 250 mg, 100 eaches
|
Facility
OP
|
$6.00
|
|
| Hospital Charge Code |
4401523
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.04 |
| Max. Negotiated Rate |
$4.83 |
| Rate for Payer: Aetna of NY Commercial |
$4.20
|
| Rate for Payer: Aetna of NY Medicare |
$2.76
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$4.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$4.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2.22
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$3.00
|
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: CDPHP Commercial |
$4.83
|
| Rate for Payer: CDPHP Medicare |
$2.22
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$4.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$4.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$4.80
|
| Rate for Payer: EmblemHealth Medicaid |
$4.80
|
| Rate for Payer: EmblemHealth Medicare |
$2.04
|
| Rate for Payer: EmblemHealth Select Care |
$4.32
|
| Rate for Payer: Fidelis Medicare |
$2.29
|
| Rate for Payer: Galaxy Health Commercial |
$3.90
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.22
|
| Rate for Payer: Humana Medicare |
$2.22
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$4.20
|
| Rate for Payer: Local 1199SEIU Medicare |
$2.76
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3.38
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2.33
|
| Rate for Payer: United Healthcare Medicare |
$2.22
|
| Rate for Payer: WellCare Medicare |
$3.30
|
|
|
MYCOPLASMA PNEUMONIA AB
|
Facility
OP
|
$87.00
|
|
|
Service Code
|
HCPCS 86738
|
| Hospital Charge Code |
4300573
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.24 |
| Max. Negotiated Rate |
$70.04 |
| Rate for Payer: Aetna of NY Commercial |
$56.55
|
| Rate for Payer: Aetna of NY Medicare |
$40.02
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$65.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$65.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$32.19
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$43.50
|
| Rate for Payer: Cash Price |
$65.25
|
| Rate for Payer: Cash Price |
$65.25
|
| Rate for Payer: CDPHP Commercial |
$70.04
|
| Rate for Payer: CDPHP Medicare |
$32.19
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$69.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$69.60
|
| Rate for Payer: EmblemHealth Medicaid |
$69.60
|
| Rate for Payer: EmblemHealth Medicare |
$29.58
|
| Rate for Payer: Fidelis Medicare |
$33.16
|
| Rate for Payer: Galaxy Health Commercial |
$56.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$32.19
|
| Rate for Payer: Humana Medicare |
$32.19
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$56.55
|
| Rate for Payer: Local 1199SEIU Medicare |
$40.02
|
| Rate for Payer: MVP Health Care of NY Commercial |
$65.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$48.98
|
| Rate for Payer: MVP Health Care of NY Medicare |
$33.80
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$65.25
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$13.24
|
| Rate for Payer: United Healthcare Commercial |
$65.25
|
| Rate for Payer: United Healthcare Medicare |
$32.19
|
| Rate for Payer: WellCare Medicare |
$47.85
|
|
|
MYELIN BASIC PROTEIN CSF
|
Facility
OP
|
$146.00
|
|
|
Service Code
|
HCPCS 83873
|
| Hospital Charge Code |
4300574
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.20 |
| Max. Negotiated Rate |
$117.53 |
| Rate for Payer: Aetna of NY Commercial |
$94.90
|
| Rate for Payer: Aetna of NY Medicare |
$67.16
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$109.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$109.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$54.02
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$73.00
|
| Rate for Payer: Cash Price |
$109.50
|
| Rate for Payer: Cash Price |
$109.50
|
| Rate for Payer: CDPHP Commercial |
$117.53
|
| Rate for Payer: CDPHP Medicare |
$54.02
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$116.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$116.80
|
| Rate for Payer: EmblemHealth Medicaid |
$116.80
|
| Rate for Payer: EmblemHealth Medicare |
$49.64
|
| Rate for Payer: Fidelis Medicare |
$55.64
|
| Rate for Payer: Galaxy Health Commercial |
$94.90
|
| Rate for Payer: Hamaspik Choice Medicare |
$54.02
|
| Rate for Payer: Humana Medicare |
$54.02
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$94.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$67.16
|
| Rate for Payer: MVP Health Care of NY Commercial |
$109.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$82.20
|
| Rate for Payer: MVP Health Care of NY Medicare |
$56.72
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$109.50
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$17.20
|
| Rate for Payer: United Healthcare Commercial |
$109.50
|
| Rate for Payer: United Healthcare Medicare |
$54.02
|
| Rate for Payer: WellCare Medicare |
$80.30
|
|
|
MYOGLOBIN-URINE QUALITA
|
Facility
OP
|
$98.00
|
|
|
Service Code
|
HCPCS 83874
|
| Hospital Charge Code |
4300576
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.92 |
| Max. Negotiated Rate |
$78.89 |
| Rate for Payer: Aetna of NY Commercial |
$63.70
|
| Rate for Payer: Aetna of NY Medicare |
$45.08
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$73.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$73.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$36.26
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$49.00
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: CDPHP Commercial |
$78.89
|
| Rate for Payer: CDPHP Medicare |
$36.26
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$78.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$78.40
|
| Rate for Payer: EmblemHealth Medicaid |
$78.40
|
| Rate for Payer: EmblemHealth Medicare |
$33.32
|
| Rate for Payer: Fidelis Medicare |
$37.35
|
| Rate for Payer: Galaxy Health Commercial |
$63.70
|
| Rate for Payer: Hamaspik Choice Medicare |
$36.26
|
| Rate for Payer: Humana Medicare |
$36.26
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$63.70
|
| Rate for Payer: Local 1199SEIU Medicare |
$45.08
|
| Rate for Payer: MVP Health Care of NY Commercial |
$73.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$55.17
|
| Rate for Payer: MVP Health Care of NY Medicare |
$38.07
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$73.50
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$12.92
|
| Rate for Payer: United Healthcare Commercial |
$73.50
|
| Rate for Payer: United Healthcare Medicare |
$36.26
|
| Rate for Payer: WellCare Medicare |
$53.90
|
|
|
MYRBETRIQ ER 25 MG TABLET 25 mg, 30 eaches
|
Facility
OP
|
$54.00
|
|
| Hospital Charge Code |
4401549
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$18.36 |
| Max. Negotiated Rate |
$43.47 |
| Rate for Payer: Aetna of NY Commercial |
$37.80
|
| Rate for Payer: Aetna of NY Medicare |
$24.84
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$40.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$40.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$19.98
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$27.00
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: CDPHP Commercial |
$43.47
|
| Rate for Payer: CDPHP Medicare |
$19.98
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$43.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$43.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$43.20
|
| Rate for Payer: EmblemHealth Medicaid |
$43.20
|
| Rate for Payer: EmblemHealth Medicare |
$18.36
|
| Rate for Payer: EmblemHealth Select Care |
$38.88
|
| Rate for Payer: Fidelis Medicare |
$20.58
|
| Rate for Payer: Galaxy Health Commercial |
$35.10
|
| Rate for Payer: Hamaspik Choice Medicare |
$19.98
|
| Rate for Payer: Humana Medicare |
$19.98
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$37.80
|
| Rate for Payer: Local 1199SEIU Medicare |
$24.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$40.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$30.40
|
| Rate for Payer: MVP Health Care of NY Medicare |
$20.98
|
| Rate for Payer: United Healthcare Medicare |
$19.98
|
| Rate for Payer: WellCare Medicare |
$29.70
|
|
|
MYRBETRIQ ER 50 MG TABLET 50 mg, 30 eaches
|
Facility
OP
|
$61.00
|
|
| Hospital Charge Code |
4401464
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$20.74 |
| Max. Negotiated Rate |
$49.10 |
| Rate for Payer: Aetna of NY Commercial |
$42.70
|
| Rate for Payer: Aetna of NY Medicare |
$28.06
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$45.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$45.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$22.57
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$30.50
|
| Rate for Payer: Cash Price |
$45.75
|
| Rate for Payer: CDPHP Commercial |
$49.10
|
| Rate for Payer: CDPHP Medicare |
$22.57
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$48.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$48.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$48.80
|
| Rate for Payer: EmblemHealth Medicaid |
$48.80
|
| Rate for Payer: EmblemHealth Medicare |
$20.74
|
| Rate for Payer: EmblemHealth Select Care |
$43.92
|
| Rate for Payer: Fidelis Medicare |
$23.25
|
| Rate for Payer: Galaxy Health Commercial |
$39.65
|
| Rate for Payer: Hamaspik Choice Medicare |
$22.57
|
| Rate for Payer: Humana Medicare |
$22.57
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$42.70
|
| Rate for Payer: Local 1199SEIU Medicare |
$28.06
|
| Rate for Payer: MVP Health Care of NY Commercial |
$45.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$34.34
|
| Rate for Payer: MVP Health Care of NY Medicare |
$23.70
|
| Rate for Payer: United Healthcare Medicare |
$22.57
|
| Rate for Payer: WellCare Medicare |
$33.55
|
|
|
MYXREDLIN 100 UNIT/100 ML BAG 100 unit, 100 mL
|
Facility
OP
|
$157.50
|
|
|
Service Code
|
HCPCS J3590
|
| Hospital Charge Code |
4401917
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$53.55 |
| Max. Negotiated Rate |
$126.79 |
| Rate for Payer: Aetna of NY Commercial |
$86.62
|
| Rate for Payer: Aetna of NY Medicare |
$72.45
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$70.88
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$70.88
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$58.28
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$78.75
|
| Rate for Payer: Cash Price |
$118.12
|
| Rate for Payer: CDPHP Commercial |
$126.79
|
| Rate for Payer: CDPHP Medicare |
$58.28
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$126.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$126.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$126.00
|
| Rate for Payer: EmblemHealth Medicaid |
$126.00
|
| Rate for Payer: EmblemHealth Medicare |
$53.55
|
| Rate for Payer: EmblemHealth Select Care |
$113.40
|
| Rate for Payer: Fidelis Medicare |
$60.02
|
| Rate for Payer: Galaxy Health Commercial |
$102.38
|
| Rate for Payer: Hamaspik Choice Medicare |
$58.28
|
| Rate for Payer: Humana Medicare |
$58.28
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$86.62
|
| Rate for Payer: Local 1199SEIU Medicare |
$72.45
|
| Rate for Payer: MVP Health Care of NY Commercial |
$118.12
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$88.67
|
| Rate for Payer: MVP Health Care of NY Medicare |
$61.19
|
| Rate for Payer: United Healthcare Medicare |
$58.28
|
| Rate for Payer: WellCare Medicare |
$86.62
|
|
