|
MICROALBUMIN URINE
|
Facility
|
IP
|
$22.00
|
|
|
Service Code
|
HCPCS 82043
|
| Hospital Charge Code |
4300563
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.30 |
| Max. Negotiated Rate |
$14.30 |
| Rate for Payer: Cash Price |
$16.50
|
| Rate for Payer: Galaxy Health Commercial |
$14.30
|
|
|
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
|
|
|
MICROPUNCTURE INTRODUCER SET
|
Facility
|
IP
|
$135.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
4471876
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$87.75 |
| Max. Negotiated Rate |
$87.75 |
| Rate for Payer: Cash Price |
$101.25
|
| Rate for Payer: Galaxy Health Commercial |
$87.75
|
|
|
MIDAZOLAM HYDROCHLORIDE INJ, PER 1 MG
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
HCPCS J2250
|
| Hospital Charge Code |
4400515
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.14 |
| 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 |
$0.14
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$0.14
|
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.14
|
| Rate for Payer: EmblemHealth Select Care |
$0.14
|
| 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
|
|
|
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
|
|
|
MIDAZOLAM HYDROCHLORIDE INJ, PER 1 MG
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
HCPCS J2250
|
| Hospital Charge Code |
4400517
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.14 |
| 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 |
$0.14
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$0.14
|
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.14
|
| Rate for Payer: EmblemHealth Select Care |
$0.14
|
| 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
|
|
|
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
|
|
|
MIDODRINE 5 MG TAB, NDC 50268-0565-15
|
Facility
|
IP
|
$12.10
|
|
|
Service Code
|
NDC 00245021211
|
| Hospital Charge Code |
4409227
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.66 |
| Max. Negotiated Rate |
$7.86 |
| Rate for Payer: Cash Price |
$9.08
|
| Rate for Payer: Galaxy Health Commercial |
$7.86
|
| Rate for Payer: WellCare Medicare |
$6.66
|
|
|
MIDODRINE 5 MG TAB, NDC 50268-0565-15
|
Facility
|
OP
|
$12.10
|
|
|
Service Code
|
NDC 00245021211
|
| 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 |
$9.08
|
| 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
|
IP
|
$8,808.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
4473019
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5,725.20 |
| Max. Negotiated Rate |
$5,725.20 |
| Rate for Payer: Cash Price |
$6,606.00
|
| Rate for Payer: Galaxy Health Commercial |
$5,725.20
|
|
|
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
|
IP
|
$66.00
|
|
|
Service Code
|
HCPCS J2260
|
| Hospital Charge Code |
4401380
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.55 |
| Max. Negotiated Rate |
$42.90 |
| Rate for Payer: Aetna of NY Commercial |
$36.30
|
| 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: Cash Price |
$49.50
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1.55
|
| Rate for Payer: EmblemHealth Select Care |
$1.55
|
| Rate for Payer: Galaxy Health Commercial |
$42.90
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$36.30
|
| Rate for Payer: WellCare Medicare |
$36.30
|
|
|
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 LACT, 5 MG
|
Facility
|
IP
|
$67.00
|
|
|
Service Code
|
HCPCS J2260
|
| Hospital Charge Code |
4402268
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.55 |
| Max. Negotiated Rate |
$43.55 |
| Rate for Payer: Aetna of NY Commercial |
$36.85
|
| 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: Cash Price |
$50.25
|
| Rate for Payer: Cash Price |
$50.25
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1.55
|
| Rate for Payer: EmblemHealth Select Care |
$1.55
|
| Rate for Payer: Galaxy Health Commercial |
$43.55
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$36.85
|
| 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
|
|
|
MILRINONE THERAPY, ALL SUPPLIES/EQUIPMENT
|
Facility
|
IP
|
$256.00
|
|
| Hospital Charge Code |
1050105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$140.80 |
| Max. Negotiated Rate |
$166.40 |
| Rate for Payer: Cash Price |
$192.00
|
| Rate for Payer: Galaxy Health Commercial |
$166.40
|
| Rate for Payer: WellCare Medicare |
$140.80
|
|
|
MIRTAZAPINE 15 MG TAB
|
Facility
|
OP
|
$10.56
|
|
|
Service Code
|
NDC 68084011911
|
| 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
|
|
|
MIRTAZAPINE 15 MG TAB
|
Facility
|
IP
|
$10.56
|
|
|
Service Code
|
NDC 68084011911
|
| Hospital Charge Code |
4409046
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.81 |
| Max. Negotiated Rate |
$6.86 |
| Rate for Payer: Cash Price |
$7.92
|
| Rate for Payer: Galaxy Health Commercial |
$6.86
|
| Rate for Payer: WellCare Medicare |
$5.81
|
|
|
MISCELLANEOUS INSTRUMENTS
|
Facility
|
IP
|
$314.00
|
|
| Hospital Charge Code |
4472236
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$204.10 |
| Max. Negotiated Rate |
$204.10 |
| Rate for Payer: Cash Price |
$235.50
|
| Rate for Payer: Galaxy Health Commercial |
$204.10
|
|
|
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
|
IP
|
$6.18
|
|
|
Service Code
|
NDC 51079008320
|
| Hospital Charge Code |
4409153
|
|
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
|
|
|
MISC PHARMACY
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 51079008320
|
| 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
|
|
|
Service Code
|
NDC 68084004001
|
| 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
|
|
|
MISOPROSTOL 100 MCG TABLET
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
NDC 68084004001
|
| Hospital Charge Code |
4400837
|
|
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
|
|
