|
LYRICA CAP 75 MG
|
Facility
|
IP
|
$23.43
|
|
|
Service Code
|
NDC 00071101441
|
| Hospital Charge Code |
4409232
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.89 |
| Max. Negotiated Rate |
$15.23 |
| Rate for Payer: Cash Price |
$17.57
|
| Rate for Payer: Galaxy Health Commercial |
$15.23
|
| Rate for Payer: WellCare Medicare |
$12.89
|
|
|
LYRICA CAP 75 MG
|
Facility
|
OP
|
$23.43
|
|
|
Service Code
|
NDC 00071101441
|
| Hospital Charge Code |
4409232
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.97 |
| Max. Negotiated Rate |
$18.86 |
| Rate for Payer: Aetna of NY Commercial |
$16.40
|
| Rate for Payer: Aetna of NY Medicare |
$10.78
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$17.57
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$17.57
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$8.67
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$11.72
|
| Rate for Payer: Cash Price |
$17.57
|
| Rate for Payer: CDPHP Commercial |
$18.86
|
| Rate for Payer: CDPHP Medicare |
$8.67
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$18.74
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$18.74
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$18.74
|
| Rate for Payer: EmblemHealth Medicaid |
$18.74
|
| Rate for Payer: EmblemHealth Medicare |
$7.97
|
| Rate for Payer: EmblemHealth Select Care |
$16.87
|
| Rate for Payer: Fidelis Medicare |
$8.93
|
| Rate for Payer: Galaxy Health Commercial |
$15.23
|
| Rate for Payer: Hamaspik Choice Medicare |
$8.67
|
| Rate for Payer: Humana Medicare |
$8.67
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$16.40
|
| Rate for Payer: Local 1199SEIU Medicare |
$10.78
|
| Rate for Payer: MVP Health Care of NY Commercial |
$17.57
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$13.19
|
| Rate for Payer: MVP Health Care of NY Medicare |
$9.10
|
| Rate for Payer: United Healthcare Medicare |
$8.67
|
| Rate for Payer: WellCare Medicare |
$12.89
|
|
|
LYRICA CAPSULES 100 MG
|
Facility
|
IP
|
$23.43
|
|
|
Service Code
|
NDC 00071101541
|
| Hospital Charge Code |
4409214
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.89 |
| Max. Negotiated Rate |
$15.23 |
| Rate for Payer: Cash Price |
$17.57
|
| Rate for Payer: Galaxy Health Commercial |
$15.23
|
| Rate for Payer: WellCare Medicare |
$12.89
|
|
|
LYRICA CAPSULES 100 MG
|
Facility
|
OP
|
$23.43
|
|
|
Service Code
|
NDC 00071101541
|
| Hospital Charge Code |
4409214
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.97 |
| Max. Negotiated Rate |
$18.86 |
| Rate for Payer: Aetna of NY Commercial |
$16.40
|
| Rate for Payer: Aetna of NY Medicare |
$10.78
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$17.57
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$17.57
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$8.67
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$11.72
|
| Rate for Payer: Cash Price |
$17.57
|
| Rate for Payer: CDPHP Commercial |
$18.86
|
| Rate for Payer: CDPHP Medicare |
$8.67
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$18.74
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$18.74
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$18.74
|
| Rate for Payer: EmblemHealth Medicaid |
$18.74
|
| Rate for Payer: EmblemHealth Medicare |
$7.97
|
| Rate for Payer: EmblemHealth Select Care |
$16.87
|
| Rate for Payer: Fidelis Medicare |
$8.93
|
| Rate for Payer: Galaxy Health Commercial |
$15.23
|
| Rate for Payer: Hamaspik Choice Medicare |
$8.67
|
| Rate for Payer: Humana Medicare |
$8.67
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$16.40
|
| Rate for Payer: Local 1199SEIU Medicare |
$10.78
|
| Rate for Payer: MVP Health Care of NY Commercial |
$17.57
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$13.19
|
| Rate for Payer: MVP Health Care of NY Medicare |
$9.10
|
| Rate for Payer: United Healthcare Medicare |
$8.67
|
| Rate for Payer: WellCare Medicare |
$12.89
|
|
|
MACROSCOPIC EXAM PARASITE
|
Facility
|
IP
|
$54.00
|
|
|
Service Code
|
HCPCS 87169
|
| Hospital Charge Code |
4301253
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$35.10 |
| Max. Negotiated Rate |
$35.10 |
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Galaxy Health Commercial |
$35.10
|
|
|
MACROSCOPIC EXAM PARASITE
|
Facility
|
OP
|
$54.00
|
|
|
Service Code
|
HCPCS 87169
|
| Hospital Charge Code |
4301253
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$2.02 |
| Max. Negotiated Rate |
$43.47 |
| Rate for Payer: Aetna of NY Commercial |
$35.10
|
| 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: 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 |
$32.40
|
| 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 |
$32.40
|
| 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 |
$35.10
|
| 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: Oxford Health Plans Freedom/Liberty/Metro |
$40.50
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$2.02
|
| Rate for Payer: United Healthcare Commercial |
$40.50
|
| Rate for Payer: United Healthcare Medicare |
$19.98
|
| Rate for Payer: WellCare Medicare |
$29.70
|
|
|
MAG AL PLUS XS 30 ML UNIT DOSE CONTAIN
|
Facility
|
IP
|
$6.70
|
|
|
Service Code
|
NDC 00121176230
|
| Hospital Charge Code |
4409175
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.68 |
| Max. Negotiated Rate |
$4.36 |
| Rate for Payer: Cash Price |
$5.03
|
| Rate for Payer: Galaxy Health Commercial |
$4.36
|
| Rate for Payer: WellCare Medicare |
$3.68
|
|
|
MAG AL PLUS XS 30 ML UNIT DOSE CONTAIN
|
Facility
|
OP
|
$6.70
|
|
|
Service Code
|
NDC 00121176230
|
| Hospital Charge Code |
4409175
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.28 |
| Max. Negotiated Rate |
$5.39 |
| Rate for Payer: Aetna of NY Commercial |
$4.69
|
| Rate for Payer: Aetna of NY Medicare |
$3.08
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$5.02
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$5.02
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2.48
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$3.35
|
| Rate for Payer: Cash Price |
$5.03
|
| Rate for Payer: CDPHP Commercial |
$5.39
|
| Rate for Payer: CDPHP Medicare |
$2.48
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$5.36
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$5.36
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$5.36
|
| Rate for Payer: EmblemHealth Medicaid |
$5.36
|
| Rate for Payer: EmblemHealth Medicare |
$2.28
|
| Rate for Payer: EmblemHealth Select Care |
$4.82
|
| Rate for Payer: Fidelis Medicare |
$2.55
|
| Rate for Payer: Galaxy Health Commercial |
$4.36
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.48
|
| Rate for Payer: Humana Medicare |
$2.48
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$4.69
|
| Rate for Payer: Local 1199SEIU Medicare |
$3.08
|
| Rate for Payer: MVP Health Care of NY Commercial |
$5.02
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3.77
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2.60
|
| Rate for Payer: United Healthcare Medicare |
$2.48
|
| Rate for Payer: WellCare Medicare |
$3.68
|
|
|
MAGNESIUM
|
Facility
|
IP
|
$38.00
|
|
|
Service Code
|
HCPCS 83735
|
| Hospital Charge Code |
4300547
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$24.70 |
| Max. Negotiated Rate |
$24.70 |
| Rate for Payer: Cash Price |
$28.50
|
| Rate for Payer: Galaxy Health Commercial |
$24.70
|
|
|
MAGNESIUM
|
Facility
|
OP
|
$38.00
|
|
|
Service Code
|
HCPCS 83735
|
| Hospital Charge Code |
4300547
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.08 |
| Max. Negotiated Rate |
$30.59 |
| Rate for Payer: Aetna of NY Commercial |
$24.70
|
| Rate for Payer: Aetna of NY Medicare |
$17.48
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$28.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$28.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$14.06
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$19.00
|
| Rate for Payer: Cash Price |
$28.50
|
| Rate for Payer: Cash Price |
$28.50
|
| Rate for Payer: CDPHP Commercial |
$30.59
|
| Rate for Payer: CDPHP Medicare |
$14.06
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$22.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$30.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$30.40
|
| Rate for Payer: EmblemHealth Medicaid |
$30.40
|
| Rate for Payer: EmblemHealth Medicare |
$12.92
|
| Rate for Payer: EmblemHealth Select Care |
$22.80
|
| Rate for Payer: Fidelis Medicare |
$14.48
|
| Rate for Payer: Galaxy Health Commercial |
$24.70
|
| Rate for Payer: Hamaspik Choice Medicare |
$14.06
|
| Rate for Payer: Humana Medicare |
$14.06
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$24.70
|
| Rate for Payer: Local 1199SEIU Medicare |
$17.48
|
| Rate for Payer: MVP Health Care of NY Commercial |
$28.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$21.39
|
| Rate for Payer: MVP Health Care of NY Medicare |
$14.76
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$28.50
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$5.08
|
| Rate for Payer: United Healthcare Commercial |
$28.50
|
| Rate for Payer: United Healthcare Medicare |
$14.06
|
| Rate for Payer: WellCare Medicare |
$20.90
|
|
|
MAGNESIUM CITRATE SOLN 10 OZ
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 37205036238
|
| Hospital Charge Code |
4400168
|
|
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
|
|
|
MAGNESIUM CITRATE SOLN 10 OZ
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
NDC 37205036238
|
| Hospital Charge Code |
4400168
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.40 |
| Max. Negotiated Rate |
$4.02 |
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: Galaxy Health Commercial |
$4.02
|
| Rate for Payer: WellCare Medicare |
$3.40
|
|
|
MAGNESIUM HYDROX/AL HYDROX/SIM SUSP 360
|
Facility
|
OP
|
$17.00
|
|
| Hospital Charge Code |
4400478
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.78 |
| Max. Negotiated Rate |
$13.68 |
| Rate for Payer: Aetna of NY Commercial |
$11.90
|
| Rate for Payer: Aetna of NY Medicare |
$7.82
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$12.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$12.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$6.29
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$8.50
|
| Rate for Payer: Cash Price |
$12.75
|
| Rate for Payer: CDPHP Commercial |
$13.68
|
| Rate for Payer: CDPHP Medicare |
$6.29
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$13.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$13.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$13.60
|
| Rate for Payer: EmblemHealth Medicaid |
$13.60
|
| Rate for Payer: EmblemHealth Medicare |
$5.78
|
| Rate for Payer: EmblemHealth Select Care |
$12.24
|
| Rate for Payer: Fidelis Medicare |
$6.48
|
| Rate for Payer: Galaxy Health Commercial |
$11.05
|
| Rate for Payer: Hamaspik Choice Medicare |
$6.29
|
| Rate for Payer: Humana Medicare |
$6.29
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$11.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$7.82
|
| Rate for Payer: MVP Health Care of NY Commercial |
$12.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$9.57
|
| Rate for Payer: MVP Health Care of NY Medicare |
$6.60
|
| Rate for Payer: United Healthcare Medicare |
$6.29
|
| Rate for Payer: WellCare Medicare |
$9.35
|
|
|
MAGNESIUM HYDROX/AL HYDROX/SIM SUSP 360
|
Facility
|
IP
|
$17.00
|
|
| Hospital Charge Code |
4400478
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.35 |
| Max. Negotiated Rate |
$11.05 |
| Rate for Payer: Cash Price |
$12.75
|
| Rate for Payer: Galaxy Health Commercial |
$11.05
|
| Rate for Payer: WellCare Medicare |
$9.35
|
|
|
MAGNESIUM HYDROXIDE 400MG/5ML SUSP 100X3
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 00121043130
|
| Hospital Charge Code |
4400519
|
|
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
|
|
|
MAGNESIUM HYDROXIDE 400MG/5ML SUSP 100X3
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
NDC 00121043130
|
| Hospital Charge Code |
4400519
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.40 |
| Max. Negotiated Rate |
$4.02 |
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: Galaxy Health Commercial |
$4.02
|
| Rate for Payer: WellCare Medicare |
$3.40
|
|
|
MAGNESIUM OXIDE 400MG TABS 10X10EA
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
NDC 63739035401
|
| Hospital Charge Code |
4400479
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.40 |
| Max. Negotiated Rate |
$4.02 |
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: Galaxy Health Commercial |
$4.02
|
| Rate for Payer: WellCare Medicare |
$3.40
|
|
|
MAGNESIUM OXIDE 400MG TABS 10X10EA
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 63739035401
|
| Hospital Charge Code |
4400479
|
|
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
|
|
|
MAGNESIUM SULFATE 4MEQ/ML SDV 25X2ML
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
HCPCS J3475
|
| Hospital Charge Code |
4400482
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.64 |
| Max. Negotiated Rate |
$4.02 |
| Rate for Payer: Aetna of NY Commercial |
$3.40
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$0.64
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$0.64
|
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.64
|
| Rate for Payer: EmblemHealth Select Care |
$0.64
|
| Rate for Payer: Galaxy Health Commercial |
$4.02
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$3.40
|
| Rate for Payer: WellCare Medicare |
$3.40
|
|
|
MAGNESIUM SULFATE 4MEQ/ML SDV 25X2ML
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
HCPCS J3475
|
| Hospital Charge Code |
4400482
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.64 |
| 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 |
$0.64
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$0.64
|
| 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: 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 |
$0.64
|
| 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 |
$0.64
|
| 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 |
$1.53
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$0.64
|
| Rate for Payer: United Healthcare Commercial |
$1.53
|
| Rate for Payer: United Healthcare Medicare |
$2.29
|
| Rate for Payer: WellCare Medicare |
$3.40
|
|
|
MAGNESIUM SULFATE INJ, 500 MG
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
HCPCS J3475
|
| Hospital Charge Code |
4400481
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.64 |
| Max. Negotiated Rate |
$4.02 |
| Rate for Payer: Aetna of NY Commercial |
$3.40
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$0.64
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$0.64
|
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.64
|
| Rate for Payer: EmblemHealth Select Care |
$0.64
|
| Rate for Payer: Galaxy Health Commercial |
$4.02
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$3.40
|
| Rate for Payer: WellCare Medicare |
$3.40
|
|
|
MAGNESIUM SULFATE INJ, 500 MG
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
HCPCS J3475
|
| Hospital Charge Code |
4400481
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.64 |
| 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 |
$0.64
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$0.64
|
| 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: 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 |
$0.64
|
| 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 |
$0.64
|
| 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 |
$1.53
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$0.64
|
| Rate for Payer: United Healthcare Commercial |
$1.53
|
| Rate for Payer: United Healthcare Medicare |
$2.29
|
| Rate for Payer: WellCare Medicare |
$3.40
|
|
|
MAGNETIC RESONANCE SPECTROSCOPY
|
Facility
|
OP
|
$2,393.00
|
|
|
Service Code
|
HCPCS 76390
|
| Hospital Charge Code |
4230066
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$86.58 |
| Max. Negotiated Rate |
$2,260.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,738.00
|
| Rate for Payer: Aetna of NY Medicare |
$1,100.78
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1,794.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,794.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$885.41
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$794.00
|
| Rate for Payer: Cash Price |
$1,794.75
|
| Rate for Payer: Cash Price |
$1,794.75
|
| Rate for Payer: Cash Price |
$1,794.75
|
| Rate for Payer: CDPHP Commercial |
$1,926.36
|
| Rate for Payer: CDPHP Medicare |
$885.41
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,675.10
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,914.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,914.40
|
| Rate for Payer: EmblemHealth Medicaid |
$1,914.40
|
| Rate for Payer: EmblemHealth Medicare |
$813.62
|
| Rate for Payer: EmblemHealth Select Care |
$1,555.45
|
| Rate for Payer: Fidelis Medicare |
$911.97
|
| Rate for Payer: Galaxy Health Commercial |
$1,555.45
|
| Rate for Payer: Hamaspik Choice Medicare |
$885.41
|
| Rate for Payer: Humana Medicare |
$885.41
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,738.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,100.78
|
| 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 |
$929.68
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$2,260.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$86.58
|
| Rate for Payer: United Healthcare Commercial |
$2,260.00
|
| Rate for Payer: United Healthcare Medicare |
$885.41
|
| Rate for Payer: WellCare Medicare |
$1,316.15
|
|
|
MAGNETIC RESONANCE SPECTROSCOPY
|
Facility
|
IP
|
$2,393.00
|
|
|
Service Code
|
HCPCS 76390
|
| Hospital Charge Code |
4230066
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,555.45 |
| Max. Negotiated Rate |
$1,555.45 |
| Rate for Payer: Cash Price |
$1,794.75
|
| Rate for Payer: Galaxy Health Commercial |
$1,555.45
|
|
|
MAMMOTOME - 13G PROBE
|
Facility
|
OP
|
$858.00
|
|
| Hospital Charge Code |
4470950
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$291.72 |
| Max. Negotiated Rate |
$690.69 |
| Rate for Payer: Aetna of NY Commercial |
$600.60
|
| Rate for Payer: Aetna of NY Medicare |
$394.68
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$643.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$643.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$317.46
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$429.00
|
| Rate for Payer: Cash Price |
$643.50
|
| Rate for Payer: CDPHP Commercial |
$690.69
|
| Rate for Payer: CDPHP Medicare |
$317.46
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$686.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$686.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$686.40
|
| Rate for Payer: EmblemHealth Medicaid |
$686.40
|
| Rate for Payer: EmblemHealth Medicare |
$291.72
|
| Rate for Payer: EmblemHealth Select Care |
$617.76
|
| Rate for Payer: Fidelis Medicare |
$326.98
|
| Rate for Payer: Galaxy Health Commercial |
$557.70
|
| Rate for Payer: Hamaspik Choice Medicare |
$317.46
|
| Rate for Payer: Humana Medicare |
$317.46
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$600.60
|
| Rate for Payer: Local 1199SEIU Medicare |
$394.68
|
| Rate for Payer: MVP Health Care of NY Commercial |
$643.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$483.05
|
| Rate for Payer: MVP Health Care of NY Medicare |
$333.33
|
| Rate for Payer: United Healthcare Medicare |
$317.46
|
| Rate for Payer: WellCare Medicare |
$471.90
|
|
