|
MAGNESIUM CITRATE SOLN 10 OZ
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 37205036238
|
| Hospital Charge Code |
4400168
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.93 |
| Max. Negotiated Rate |
$4.94 |
| 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) Medicare |
$2.47
|
| Rate for Payer: Cash Price |
$4.64
|
| 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 |
$2.47
|
| Rate for Payer: Galaxy Health Commercial |
$4.02
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.47
|
| Rate for Payer: Humana Medicare |
$2.47
|
| 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 |
$4.63
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3.48
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2.60
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$0.93
|
| Rate for Payer: United Healthcare Medicare |
$2.47
|
| Rate for Payer: WellCare Medicare |
$3.40
|
|
|
MAGNESIUM HYDROX/AL HYDROX/SIM SUSP 360
|
Facility
|
IP
|
$17.51
|
|
| Hospital Charge Code |
4400478
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.63 |
| Max. Negotiated Rate |
$11.38 |
| Rate for Payer: Cash Price |
$13.13
|
| Rate for Payer: Galaxy Health Commercial |
$11.38
|
| Rate for Payer: WellCare Medicare |
$9.63
|
|
|
MAGNESIUM HYDROX/AL HYDROX/SIM SUSP 360
|
Facility
|
OP
|
$17.51
|
|
| Hospital Charge Code |
4400478
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.63 |
| Max. Negotiated Rate |
$14.01 |
| Rate for Payer: Aetna of NY Commercial |
$12.26
|
| Rate for Payer: Aetna of NY Medicare |
$8.05
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$7.00
|
| Rate for Payer: Cash Price |
$13.13
|
| Rate for Payer: CDPHP Medicare |
$6.48
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$14.01
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$14.01
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$14.01
|
| Rate for Payer: EmblemHealth Medicaid |
$14.01
|
| Rate for Payer: EmblemHealth Medicare |
$5.95
|
| Rate for Payer: EmblemHealth Select Care |
$12.61
|
| Rate for Payer: Fidelis Medicare |
$7.00
|
| Rate for Payer: Galaxy Health Commercial |
$11.38
|
| Rate for Payer: Hamaspik Choice Medicare |
$7.00
|
| Rate for Payer: Humana Medicare |
$7.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$12.26
|
| Rate for Payer: Local 1199SEIU Medicare |
$8.05
|
| Rate for Payer: MVP Health Care of NY Commercial |
$13.13
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$9.86
|
| Rate for Payer: MVP Health Care of NY Medicare |
$7.35
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$2.63
|
| Rate for Payer: United Healthcare Medicare |
$7.00
|
| Rate for Payer: WellCare Medicare |
$9.63
|
|
|
MAGNESIUM HYDROXIDE 400MG/5ML SUSP 100X3
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 121043130
|
| Hospital Charge Code |
4400519
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.93 |
| Max. Negotiated Rate |
$4.94 |
| 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) Medicare |
$2.47
|
| Rate for Payer: Cash Price |
$4.64
|
| 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 |
$2.47
|
| Rate for Payer: Galaxy Health Commercial |
$4.02
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.47
|
| Rate for Payer: Humana Medicare |
$2.47
|
| 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 |
$4.63
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3.48
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2.60
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$0.93
|
| Rate for Payer: United Healthcare Medicare |
$2.47
|
| Rate for Payer: WellCare Medicare |
$3.40
|
|
|
MAGNESIUM HYDROXIDE 400MG/5ML SUSP 100X3
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
NDC 121043130
|
| 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
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 63739035401
|
| Hospital Charge Code |
4400479
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.93 |
| Max. Negotiated Rate |
$4.94 |
| 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) Medicare |
$2.47
|
| Rate for Payer: Cash Price |
$4.64
|
| 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 |
$2.47
|
| Rate for Payer: Galaxy Health Commercial |
$4.02
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.47
|
| Rate for Payer: Humana Medicare |
$2.47
|
| 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 |
$4.63
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3.48
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2.60
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$0.93
|
| Rate for Payer: United Healthcare Medicare |
$2.47
|
| 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 SULFATE 4MEQ/ML SDV 25X2ML
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
HCPCS J3475
|
| Hospital Charge Code |
4400482
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.43 |
| Max. Negotiated Rate |
$4.94 |
| Rate for Payer: Aetna of NY Medicare |
$2.84
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2.47
|
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: CDPHP Medicare |
$2.29
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.43
|
| 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 |
$0.43
|
| Rate for Payer: Fidelis Medicare |
$2.47
|
| Rate for Payer: Galaxy Health Commercial |
$4.02
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.47
|
| Rate for Payer: Humana Medicare |
$2.47
|
| Rate for Payer: Local 1199SEIU Medicare |
$2.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4.63
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3.48
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2.60
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1.53
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$0.93
|
| Rate for Payer: United Healthcare Commercial |
$1.53
|
| Rate for Payer: United Healthcare Medicare |
$2.47
|
| 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 |
$0.43 |
| Max. Negotiated Rate |
$4.02 |
| Rate for Payer: Aetna of NY Commercial |
$3.40
|
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.43
|
| Rate for Payer: EmblemHealth Select Care |
$0.43
|
| 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
|
IP
|
$6.18
|
|
|
Service Code
|
HCPCS J3475
|
| Hospital Charge Code |
4400481
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.43 |
| Max. Negotiated Rate |
$4.02 |
| Rate for Payer: Aetna of NY Commercial |
$3.40
|
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.43
|
| Rate for Payer: EmblemHealth Select Care |
$0.43
|
| 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 |
$0.43 |
| Max. Negotiated Rate |
$4.94 |
| Rate for Payer: Aetna of NY Medicare |
$2.84
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2.47
|
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: CDPHP Medicare |
$2.29
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.43
|
| 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 |
$0.43
|
| Rate for Payer: Fidelis Medicare |
$2.47
|
| Rate for Payer: Galaxy Health Commercial |
$4.02
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.47
|
| Rate for Payer: Humana Medicare |
$2.47
|
| Rate for Payer: Local 1199SEIU Medicare |
$2.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4.63
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3.48
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2.60
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1.53
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$0.93
|
| Rate for Payer: United Healthcare Commercial |
$1.53
|
| Rate for Payer: United Healthcare Medicare |
$2.47
|
| 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 |
$358.95 |
| Max. Negotiated Rate |
$2,328.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,750.00
|
| Rate for Payer: Aetna of NY Medicare |
$1,100.78
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$957.20
|
| 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 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 |
$957.20
|
| Rate for Payer: Galaxy Health Commercial |
$1,555.45
|
| Rate for Payer: Hamaspik Choice Medicare |
$957.20
|
| Rate for Payer: Humana Medicare |
$957.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,750.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,100.78
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,334.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$964.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1,005.06
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$2,328.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$358.95
|
| Rate for Payer: United Healthcare Commercial |
$2,328.00
|
| Rate for Payer: United Healthcare Medicare |
$957.20
|
| 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
|
IP
|
$883.74
|
|
| Hospital Charge Code |
4470950
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$574.43 |
| Max. Negotiated Rate |
$574.43 |
| Rate for Payer: Cash Price |
$662.80
|
| Rate for Payer: Galaxy Health Commercial |
$574.43
|
|
|
MAMMOTOME - 13G PROBE
|
Facility
|
OP
|
$883.74
|
|
| Hospital Charge Code |
4470950
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$132.56 |
| Max. Negotiated Rate |
$706.99 |
| Rate for Payer: Aetna of NY Commercial |
$618.62
|
| Rate for Payer: Aetna of NY Medicare |
$406.52
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$353.50
|
| Rate for Payer: Cash Price |
$662.80
|
| Rate for Payer: CDPHP Medicare |
$326.98
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$706.99
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$706.99
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$706.99
|
| Rate for Payer: EmblemHealth Medicaid |
$706.99
|
| Rate for Payer: EmblemHealth Medicare |
$300.47
|
| Rate for Payer: EmblemHealth Select Care |
$636.29
|
| Rate for Payer: Fidelis Medicare |
$353.50
|
| Rate for Payer: Galaxy Health Commercial |
$574.43
|
| Rate for Payer: Hamaspik Choice Medicare |
$353.50
|
| Rate for Payer: Humana Medicare |
$353.50
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$618.62
|
| Rate for Payer: Local 1199SEIU Medicare |
$406.52
|
| Rate for Payer: MVP Health Care of NY Commercial |
$662.80
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$497.55
|
| Rate for Payer: MVP Health Care of NY Medicare |
$371.17
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$132.56
|
| Rate for Payer: United Healthcare Medicare |
$353.50
|
| Rate for Payer: WellCare Medicare |
$486.06
|
|
|
MANNITOL INJ 25% IN 50 ML
|
Facility
|
OP
|
$6.70
|
|
|
Service Code
|
HCPCS J2150
|
| Hospital Charge Code |
4408988
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$8.13 |
| 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: 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 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: Oxford Health Plans Freedom/Liberty/Metro |
$8.13
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1.00
|
| Rate for Payer: United Healthcare Commercial |
$8.13
|
| Rate for Payer: United Healthcare Medicare |
$2.68
|
| Rate for Payer: WellCare Medicare |
$3.69
|
|
|
MANNITOL INJ 25% IN 50 ML
|
Facility
|
IP
|
$6.70
|
|
|
Service Code
|
HCPCS J2150
|
| Hospital Charge Code |
4408988
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.69 |
| Max. Negotiated Rate |
$4.36 |
| Rate for Payer: Aetna of NY Commercial |
$3.69
|
| Rate for Payer: Cash Price |
$5.03
|
| Rate for Payer: Galaxy Health Commercial |
$4.36
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$3.69
|
| Rate for Payer: WellCare Medicare |
$3.69
|
|
|
MARINOL CAPSULES 2.5 MG
|
Facility
|
OP
|
$27.00
|
|
|
Service Code
|
NDC 904674561
|
| Hospital Charge Code |
4409098
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.05 |
| Max. Negotiated Rate |
$21.60 |
| Rate for Payer: Aetna of NY Commercial |
$18.90
|
| Rate for Payer: Aetna of NY Medicare |
$12.42
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$10.80
|
| Rate for Payer: Cash Price |
$20.25
|
| Rate for Payer: CDPHP Medicare |
$9.99
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$21.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$21.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$21.60
|
| Rate for Payer: EmblemHealth Medicaid |
$21.60
|
| Rate for Payer: EmblemHealth Medicare |
$9.18
|
| Rate for Payer: EmblemHealth Select Care |
$19.44
|
| Rate for Payer: Fidelis Medicare |
$10.80
|
| Rate for Payer: Galaxy Health Commercial |
$17.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$10.80
|
| Rate for Payer: Humana Medicare |
$10.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$18.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$12.42
|
| Rate for Payer: MVP Health Care of NY Commercial |
$20.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$15.20
|
| Rate for Payer: MVP Health Care of NY Medicare |
$11.34
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$4.05
|
| Rate for Payer: United Healthcare Medicare |
$10.80
|
| Rate for Payer: WellCare Medicare |
$14.85
|
|
|
MARINOL CAPSULES 2.5 MG
|
Facility
|
IP
|
$27.00
|
|
|
Service Code
|
NDC 904674561
|
| Hospital Charge Code |
4409098
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.85 |
| Max. Negotiated Rate |
$17.55 |
| Rate for Payer: Cash Price |
$20.25
|
| Rate for Payer: Galaxy Health Commercial |
$17.55
|
| Rate for Payer: WellCare Medicare |
$14.85
|
|
|
MASSAGE 15 MINUTES THERAPEUTIC
|
Facility
|
IP
|
$108.00
|
|
|
Service Code
|
HCPCS 97124 GP
|
| Hospital Charge Code |
4650019
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$70.20 |
| Max. Negotiated Rate |
$70.20 |
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Galaxy Health Commercial |
$70.20
|
|
|
MASSAGE 15 MINUTES THERAPEUTIC
|
Facility
|
OP
|
$108.00
|
|
|
Service Code
|
HCPCS 97124 GP
|
| Hospital Charge Code |
4650019
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$16.20 |
| Max. Negotiated Rate |
$187.00 |
| Rate for Payer: Aetna of NY Commercial |
$115.00
|
| Rate for Payer: Aetna of NY Medicare |
$49.68
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$43.20
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: CDPHP Medicare |
$39.96
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$86.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$44.39
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$36.99
|
| Rate for Payer: EmblemHealth Medicaid |
$36.99
|
| Rate for Payer: EmblemHealth Medicare |
$36.72
|
| Rate for Payer: EmblemHealth Select Care |
$77.76
|
| Rate for Payer: Fidelis Medicare |
$43.20
|
| Rate for Payer: Galaxy Health Commercial |
$70.20
|
| Rate for Payer: Galaxy Health Workers Comp |
$36.25
|
| Rate for Payer: Hamaspik Choice Medicaid |
$36.99
|
| Rate for Payer: Hamaspik Choice Medicare |
$43.20
|
| Rate for Payer: Humana Medicare |
$43.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$49.68
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$38.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$187.00
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$79.53
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$79.53
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$141.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$45.36
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$16.20
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$43.20
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$38.84
|
| Rate for Payer: WellCare Medicare |
$59.40
|
|
|
MASSAGE 15 MINUTES THERAPEUTIC (MOD 59)
|
Facility
|
OP
|
$108.00
|
|
|
Service Code
|
HCPCS 97124 GP,59
|
| Hospital Charge Code |
4650367
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$16.20 |
| Max. Negotiated Rate |
$187.00 |
| Rate for Payer: Aetna of NY Commercial |
$115.00
|
| Rate for Payer: Aetna of NY Medicare |
$49.68
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$43.20
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: CDPHP Medicare |
$39.96
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$86.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$44.39
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$36.99
|
| Rate for Payer: EmblemHealth Medicaid |
$36.99
|
| Rate for Payer: EmblemHealth Medicare |
$36.72
|
| Rate for Payer: EmblemHealth Select Care |
$77.76
|
| Rate for Payer: Fidelis Medicare |
$43.20
|
| Rate for Payer: Galaxy Health Commercial |
$70.20
|
| Rate for Payer: Galaxy Health Workers Comp |
$36.25
|
| Rate for Payer: Hamaspik Choice Medicaid |
$36.99
|
| Rate for Payer: Hamaspik Choice Medicare |
$43.20
|
| Rate for Payer: Humana Medicare |
$43.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$49.68
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$38.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$187.00
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$79.53
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$79.53
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$141.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$45.36
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$16.20
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$43.20
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$38.84
|
| Rate for Payer: WellCare Medicare |
$59.40
|
|
|
MASSAGE 15 MINUTES THERAPEUTIC (MOD 59)
|
Facility
|
IP
|
$108.00
|
|
|
Service Code
|
HCPCS 97124 GP,59
|
| Hospital Charge Code |
4650367
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$70.20 |
| Max. Negotiated Rate |
$70.20 |
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Galaxy Health Commercial |
$70.20
|
|
|
MASSAGE 15 MINUTES THERAPEUTIC (MOD 59 W KX)
|
Facility
|
IP
|
$108.00
|
|
|
Service Code
|
HCPCS 97124 GP,59,KX
|
| Hospital Charge Code |
4650419
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$70.20 |
| Max. Negotiated Rate |
$70.20 |
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Galaxy Health Commercial |
$70.20
|
|
|
MASSAGE 15 MINUTES THERAPEUTIC (MOD 59 W KX)
|
Facility
|
OP
|
$108.00
|
|
|
Service Code
|
HCPCS 97124 GP,59,KX
|
| Hospital Charge Code |
4650419
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$16.20 |
| Max. Negotiated Rate |
$187.00 |
| Rate for Payer: Aetna of NY Commercial |
$115.00
|
| Rate for Payer: Aetna of NY Medicare |
$49.68
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$43.20
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: CDPHP Medicare |
$39.96
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$86.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$44.39
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$36.99
|
| Rate for Payer: EmblemHealth Medicaid |
$36.99
|
| Rate for Payer: EmblemHealth Medicare |
$36.72
|
| Rate for Payer: EmblemHealth Select Care |
$77.76
|
| Rate for Payer: Fidelis Medicare |
$43.20
|
| Rate for Payer: Galaxy Health Commercial |
$70.20
|
| Rate for Payer: Galaxy Health Workers Comp |
$36.25
|
| Rate for Payer: Hamaspik Choice Medicaid |
$36.99
|
| Rate for Payer: Hamaspik Choice Medicare |
$43.20
|
| Rate for Payer: Humana Medicare |
$43.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$49.68
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$38.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$187.00
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$79.53
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$79.53
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$141.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$45.36
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$16.20
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$43.20
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$38.84
|
| Rate for Payer: WellCare Medicare |
$59.40
|
|
