|
LWR XTR VASC STDY BILAT
|
Facility
|
IP
|
$662.00
|
|
|
Service Code
|
HCPCS 93924
|
| Hospital Charge Code |
4201053
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$430.30 |
| Max. Negotiated Rate |
$430.30 |
| Rate for Payer: Cash Price |
$496.50
|
| Rate for Payer: Galaxy Health Commercial |
$430.30
|
|
|
LWR XTR VASC STDY BILAT
|
Facility
|
OP
|
$662.00
|
|
|
Service Code
|
HCPCS 93924
|
| Hospital Charge Code |
4201053
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$99.30 |
| Max. Negotiated Rate |
$529.60 |
| Rate for Payer: Aetna of NY Commercial |
$430.30
|
| Rate for Payer: Aetna of NY Medicare |
$304.52
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$264.80
|
| Rate for Payer: Cash Price |
$496.50
|
| Rate for Payer: Cash Price |
$496.50
|
| Rate for Payer: CDPHP Medicare |
$244.94
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$463.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$529.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$529.60
|
| Rate for Payer: EmblemHealth Medicaid |
$529.60
|
| Rate for Payer: EmblemHealth Medicare |
$225.08
|
| Rate for Payer: EmblemHealth Select Care |
$430.30
|
| Rate for Payer: Fidelis Medicare |
$264.80
|
| Rate for Payer: Galaxy Health Commercial |
$430.30
|
| Rate for Payer: Hamaspik Choice Medicare |
$264.80
|
| Rate for Payer: Humana Medicare |
$264.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$430.30
|
| Rate for Payer: Local 1199SEIU Medicare |
$304.52
|
| Rate for Payer: MVP Health Care of NY Commercial |
$496.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$372.71
|
| Rate for Payer: MVP Health Care of NY Medicare |
$278.04
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$287.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$99.30
|
| Rate for Payer: United Healthcare Commercial |
$287.00
|
| Rate for Payer: United Healthcare Medicare |
$264.80
|
| Rate for Payer: WellCare Medicare |
$364.10
|
|
|
L XL WRIST W/ABDUCTED THUMB
|
Facility
|
IP
|
$58.71
|
|
| Hospital Charge Code |
4471583
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$38.16 |
| Max. Negotiated Rate |
$38.16 |
| Rate for Payer: Cash Price |
$44.03
|
| Rate for Payer: Galaxy Health Commercial |
$38.16
|
|
|
L XL WRIST W/ABDUCTED THUMB
|
Facility
|
OP
|
$58.71
|
|
| Hospital Charge Code |
4471583
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.81 |
| Max. Negotiated Rate |
$46.97 |
| Rate for Payer: Aetna of NY Commercial |
$41.10
|
| Rate for Payer: Aetna of NY Medicare |
$27.01
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$23.48
|
| Rate for Payer: Cash Price |
$44.03
|
| Rate for Payer: CDPHP Medicare |
$21.72
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$46.97
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$46.97
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$46.97
|
| Rate for Payer: EmblemHealth Medicaid |
$46.97
|
| Rate for Payer: EmblemHealth Medicare |
$19.96
|
| Rate for Payer: EmblemHealth Select Care |
$42.27
|
| Rate for Payer: Fidelis Medicare |
$23.48
|
| Rate for Payer: Galaxy Health Commercial |
$38.16
|
| Rate for Payer: Hamaspik Choice Medicare |
$23.48
|
| Rate for Payer: Humana Medicare |
$23.48
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$41.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$27.01
|
| Rate for Payer: MVP Health Care of NY Commercial |
$44.03
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$33.05
|
| Rate for Payer: MVP Health Care of NY Medicare |
$24.66
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$8.81
|
| Rate for Payer: United Healthcare Medicare |
$23.48
|
| Rate for Payer: WellCare Medicare |
$32.29
|
|
|
L XS WRIST W/ABDUCTED THUMB
|
Facility
|
IP
|
$59.74
|
|
| Hospital Charge Code |
4471579
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$38.83 |
| Max. Negotiated Rate |
$38.83 |
| Rate for Payer: Cash Price |
$44.80
|
| Rate for Payer: Galaxy Health Commercial |
$38.83
|
|
|
L XS WRIST W/ABDUCTED THUMB
|
Facility
|
OP
|
$59.74
|
|
| Hospital Charge Code |
4471579
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.96 |
| Max. Negotiated Rate |
$47.79 |
| Rate for Payer: Aetna of NY Commercial |
$41.82
|
| Rate for Payer: Aetna of NY Medicare |
$27.48
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$23.90
|
| Rate for Payer: Cash Price |
$44.80
|
| Rate for Payer: CDPHP Medicare |
$22.10
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$47.79
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$47.79
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$47.79
|
| Rate for Payer: EmblemHealth Medicaid |
$47.79
|
| Rate for Payer: EmblemHealth Medicare |
$20.31
|
| Rate for Payer: EmblemHealth Select Care |
$43.01
|
| Rate for Payer: Fidelis Medicare |
$23.90
|
| Rate for Payer: Galaxy Health Commercial |
$38.83
|
| Rate for Payer: Hamaspik Choice Medicare |
$23.90
|
| Rate for Payer: Humana Medicare |
$23.90
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$41.82
|
| Rate for Payer: Local 1199SEIU Medicare |
$27.48
|
| Rate for Payer: MVP Health Care of NY Commercial |
$44.80
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$33.63
|
| Rate for Payer: MVP Health Care of NY Medicare |
$25.09
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$8.96
|
| Rate for Payer: United Healthcare Medicare |
$23.90
|
| Rate for Payer: WellCare Medicare |
$32.86
|
|
|
LYME DIS TOT ABS REF BLOT
|
Facility
|
IP
|
$153.00
|
|
|
Service Code
|
HCPCS 86617
|
| Hospital Charge Code |
4300540
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$99.45 |
| Max. Negotiated Rate |
$99.45 |
| Rate for Payer: Cash Price |
$114.75
|
| Rate for Payer: Galaxy Health Commercial |
$99.45
|
|
|
LYME DIS TOT ABS REF BLOT
|
Facility
|
OP
|
$153.00
|
|
|
Service Code
|
HCPCS 86617
|
| Hospital Charge Code |
4300540
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$22.95 |
| Max. Negotiated Rate |
$122.40 |
| Rate for Payer: Aetna of NY Commercial |
$99.45
|
| Rate for Payer: Aetna of NY Medicare |
$70.38
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$61.20
|
| Rate for Payer: Cash Price |
$114.75
|
| Rate for Payer: CDPHP Medicare |
$56.61
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$91.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$122.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$122.40
|
| Rate for Payer: EmblemHealth Medicaid |
$122.40
|
| Rate for Payer: EmblemHealth Medicare |
$52.02
|
| Rate for Payer: EmblemHealth Select Care |
$91.80
|
| Rate for Payer: Fidelis Medicare |
$61.20
|
| Rate for Payer: Galaxy Health Commercial |
$99.45
|
| Rate for Payer: Hamaspik Choice Medicare |
$61.20
|
| Rate for Payer: Humana Medicare |
$61.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$99.45
|
| Rate for Payer: Local 1199SEIU Medicare |
$70.38
|
| Rate for Payer: MVP Health Care of NY Commercial |
$114.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$86.14
|
| Rate for Payer: MVP Health Care of NY Medicare |
$64.26
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$114.75
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$22.95
|
| Rate for Payer: United Healthcare Commercial |
$114.75
|
| Rate for Payer: United Healthcare Medicare |
$61.20
|
| Rate for Payer: WellCare Medicare |
$84.15
|
|
|
LYMES AMPLIFIED NA PROBE
|
Facility
|
OP
|
$105.00
|
|
|
Service Code
|
HCPCS 87476
|
| Hospital Charge Code |
4304880
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$15.75 |
| Max. Negotiated Rate |
$84.00 |
| Rate for Payer: Aetna of NY Commercial |
$68.25
|
| Rate for Payer: Aetna of NY Medicare |
$48.30
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$42.00
|
| Rate for Payer: Cash Price |
$78.75
|
| Rate for Payer: CDPHP Medicare |
$38.85
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$63.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$84.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$84.00
|
| Rate for Payer: EmblemHealth Medicaid |
$84.00
|
| Rate for Payer: EmblemHealth Medicare |
$35.70
|
| Rate for Payer: EmblemHealth Select Care |
$63.00
|
| Rate for Payer: Fidelis Medicare |
$42.00
|
| Rate for Payer: Galaxy Health Commercial |
$68.25
|
| Rate for Payer: Hamaspik Choice Medicare |
$42.00
|
| Rate for Payer: Humana Medicare |
$42.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$68.25
|
| Rate for Payer: Local 1199SEIU Medicare |
$48.30
|
| Rate for Payer: MVP Health Care of NY Commercial |
$78.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$59.12
|
| Rate for Payer: MVP Health Care of NY Medicare |
$44.10
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$78.75
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$15.75
|
| Rate for Payer: United Healthcare Commercial |
$78.75
|
| Rate for Payer: United Healthcare Medicare |
$42.00
|
| Rate for Payer: WellCare Medicare |
$57.75
|
|
|
LYMES AMPLIFIED NA PROBE
|
Facility
|
IP
|
$105.00
|
|
|
Service Code
|
HCPCS 87476
|
| Hospital Charge Code |
4304880
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$68.25 |
| Max. Negotiated Rate |
$68.25 |
| Rate for Payer: Cash Price |
$78.75
|
| Rate for Payer: Galaxy Health Commercial |
$68.25
|
|
|
LYME SCREEN
|
Facility
|
OP
|
$87.00
|
|
|
Service Code
|
HCPCS 86618
|
| Hospital Charge Code |
4301036
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.05 |
| Max. Negotiated Rate |
$69.60 |
| 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) Medicare |
$34.80
|
| Rate for Payer: Cash Price |
$65.25
|
| Rate for Payer: CDPHP Medicare |
$32.19
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$52.20
|
| 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: EmblemHealth Select Care |
$52.20
|
| Rate for Payer: Fidelis Medicare |
$34.80
|
| Rate for Payer: Galaxy Health Commercial |
$56.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$34.80
|
| Rate for Payer: Humana Medicare |
$34.80
|
| 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 |
$36.54
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$65.25
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$13.05
|
| Rate for Payer: United Healthcare Commercial |
$65.25
|
| Rate for Payer: United Healthcare Medicare |
$34.80
|
| Rate for Payer: WellCare Medicare |
$47.85
|
|
|
LYME SCREEN
|
Facility
|
IP
|
$87.00
|
|
|
Service Code
|
HCPCS 86618
|
| Hospital Charge Code |
4301036
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$56.55 |
| Max. Negotiated Rate |
$56.55 |
| Rate for Payer: Cash Price |
$65.25
|
| Rate for Payer: Galaxy Health Commercial |
$56.55
|
|
|
LYMPH SUBSET CD4-CD8
|
Facility
|
IP
|
$141.00
|
|
|
Service Code
|
HCPCS 86360
|
| Hospital Charge Code |
4301048
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$91.65 |
| Max. Negotiated Rate |
$91.65 |
| Rate for Payer: Cash Price |
$105.75
|
| Rate for Payer: Galaxy Health Commercial |
$91.65
|
|
|
LYMPH SUBSET CD4-CD8
|
Facility
|
OP
|
$141.00
|
|
|
Service Code
|
HCPCS 86360
|
| Hospital Charge Code |
4301048
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.15 |
| Max. Negotiated Rate |
$112.80 |
| Rate for Payer: Aetna of NY Commercial |
$91.65
|
| Rate for Payer: Aetna of NY Medicare |
$64.86
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$56.40
|
| Rate for Payer: Cash Price |
$105.75
|
| Rate for Payer: CDPHP Medicare |
$52.17
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$84.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$112.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$112.80
|
| Rate for Payer: EmblemHealth Medicaid |
$112.80
|
| Rate for Payer: EmblemHealth Medicare |
$47.94
|
| Rate for Payer: EmblemHealth Select Care |
$84.60
|
| Rate for Payer: Fidelis Medicare |
$56.40
|
| Rate for Payer: Galaxy Health Commercial |
$91.65
|
| Rate for Payer: Hamaspik Choice Medicare |
$56.40
|
| Rate for Payer: Humana Medicare |
$56.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$91.65
|
| Rate for Payer: Local 1199SEIU Medicare |
$64.86
|
| Rate for Payer: MVP Health Care of NY Commercial |
$105.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$79.38
|
| Rate for Payer: MVP Health Care of NY Medicare |
$59.22
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$105.75
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$21.15
|
| Rate for Payer: United Healthcare Commercial |
$105.75
|
| Rate for Payer: United Healthcare Medicare |
$56.40
|
| Rate for Payer: WellCare Medicare |
$77.55
|
|
|
LYRICA CAP 75 MG
|
Facility
|
OP
|
$23.43
|
|
|
Service Code
|
NDC 71101441
|
| Hospital Charge Code |
4409232
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.51 |
| Max. Negotiated Rate |
$18.74 |
| 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) Medicare |
$9.37
|
| Rate for Payer: Cash Price |
$17.57
|
| 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 |
$9.37
|
| Rate for Payer: Galaxy Health Commercial |
$15.23
|
| Rate for Payer: Hamaspik Choice Medicare |
$9.37
|
| Rate for Payer: Humana Medicare |
$9.37
|
| 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 |
$9.84
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$3.51
|
| Rate for Payer: United Healthcare Medicare |
$9.37
|
| Rate for Payer: WellCare Medicare |
$12.89
|
|
|
LYRICA CAP 75 MG
|
Facility
|
IP
|
$23.43
|
|
|
Service Code
|
NDC 71101441
|
| 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 CAPSULES 100 MG
|
Facility
|
OP
|
$23.43
|
|
|
Service Code
|
NDC 71101541
|
| Hospital Charge Code |
4409214
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.51 |
| Max. Negotiated Rate |
$18.74 |
| 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) Medicare |
$9.37
|
| Rate for Payer: Cash Price |
$17.57
|
| 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 |
$9.37
|
| Rate for Payer: Galaxy Health Commercial |
$15.23
|
| Rate for Payer: Hamaspik Choice Medicare |
$9.37
|
| Rate for Payer: Humana Medicare |
$9.37
|
| 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 |
$9.84
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$3.51
|
| Rate for Payer: United Healthcare Medicare |
$9.37
|
| Rate for Payer: WellCare Medicare |
$12.89
|
|
|
LYRICA CAPSULES 100 MG
|
Facility
|
IP
|
$23.43
|
|
|
Service Code
|
NDC 71101541
|
| 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
|
|
|
MACROSCOPIC EXAM PARASITE
|
Facility
|
OP
|
$13.00
|
|
|
Service Code
|
HCPCS 87169
|
| Hospital Charge Code |
4301253
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$1.95 |
| Max. Negotiated Rate |
$10.40 |
| Rate for Payer: Aetna of NY Commercial |
$8.45
|
| Rate for Payer: Aetna of NY Medicare |
$5.98
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$5.20
|
| Rate for Payer: Cash Price |
$9.75
|
| Rate for Payer: CDPHP Medicare |
$4.81
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$7.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$10.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$10.40
|
| Rate for Payer: EmblemHealth Medicaid |
$10.40
|
| Rate for Payer: EmblemHealth Medicare |
$4.42
|
| Rate for Payer: EmblemHealth Select Care |
$7.80
|
| Rate for Payer: Fidelis Medicare |
$5.20
|
| Rate for Payer: Galaxy Health Commercial |
$8.45
|
| Rate for Payer: Hamaspik Choice Medicare |
$5.20
|
| Rate for Payer: Humana Medicare |
$5.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$8.45
|
| Rate for Payer: Local 1199SEIU Medicare |
$5.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$9.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$7.32
|
| Rate for Payer: MVP Health Care of NY Medicare |
$5.46
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$9.75
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1.95
|
| Rate for Payer: United Healthcare Commercial |
$9.75
|
| Rate for Payer: United Healthcare Medicare |
$5.20
|
| Rate for Payer: WellCare Medicare |
$7.15
|
|
|
MACROSCOPIC EXAM PARASITE
|
Facility
|
IP
|
$13.00
|
|
|
Service Code
|
HCPCS 87169
|
| Hospital Charge Code |
4301253
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.45 |
| Max. Negotiated Rate |
$8.45 |
| Rate for Payer: Cash Price |
$9.75
|
| Rate for Payer: Galaxy Health Commercial |
$8.45
|
|
|
MAG AL PLUS XS 30 ML UNIT DOSE CONTAIN
|
Facility
|
IP
|
$6.70
|
|
|
Service Code
|
NDC 121176230
|
| Hospital Charge Code |
4409175
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.69 |
| 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 |
$3.69
|
|
|
MAG AL PLUS XS 30 ML UNIT DOSE CONTAIN
|
Facility
|
OP
|
$6.70
|
|
|
Service Code
|
NDC 121176230
|
| Hospital Charge Code |
4409175
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$5.36 |
| 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) Medicare |
$2.68
|
| Rate for Payer: Cash Price |
$5.03
|
| 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 |
$2.68
|
| Rate for Payer: Galaxy Health Commercial |
$4.36
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.68
|
| Rate for Payer: Humana Medicare |
$2.68
|
| 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 |
$5.03
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3.77
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2.81
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1.00
|
| Rate for Payer: United Healthcare Medicare |
$2.68
|
| Rate for Payer: WellCare Medicare |
$3.69
|
|
|
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 |
$5.70 |
| Max. Negotiated Rate |
$30.40 |
| 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) Medicare |
$15.20
|
| Rate for Payer: Cash Price |
$28.50
|
| 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 |
$15.20
|
| Rate for Payer: Galaxy Health Commercial |
$24.70
|
| Rate for Payer: Hamaspik Choice Medicare |
$15.20
|
| Rate for Payer: Humana Medicare |
$15.20
|
| 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 |
$15.96
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$28.50
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$5.70
|
| Rate for Payer: United Healthcare Commercial |
$28.50
|
| Rate for Payer: United Healthcare Medicare |
$15.20
|
| Rate for Payer: WellCare Medicare |
$20.90
|
|
|
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
|
|
