|
MASSAGE 15 MINUTES THERAPEUTIC (W/ KX)
|
Facility
|
IP
|
$108.00
|
|
|
Service Code
|
HCPCS 97124 GP,KX
|
| Hospital Charge Code |
4650312
|
|
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 (W/ KX)
|
Facility
|
OP
|
$108.00
|
|
|
Service Code
|
HCPCS 97124 GP,KX
|
| Hospital Charge Code |
4650312
|
|
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
|
|
|
MEASLES (RUBEOLA SCREEN)
|
Facility
|
OP
|
$39.00
|
|
|
Service Code
|
HCPCS 86765
|
| Hospital Charge Code |
4300713
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.85 |
| Max. Negotiated Rate |
$31.20 |
| Rate for Payer: Aetna of NY Commercial |
$25.35
|
| Rate for Payer: Aetna of NY Medicare |
$17.94
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$15.60
|
| Rate for Payer: Cash Price |
$29.25
|
| Rate for Payer: CDPHP Medicare |
$14.43
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$23.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$31.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$31.20
|
| Rate for Payer: EmblemHealth Medicaid |
$31.20
|
| Rate for Payer: EmblemHealth Medicare |
$13.26
|
| Rate for Payer: EmblemHealth Select Care |
$23.40
|
| Rate for Payer: Fidelis Medicare |
$15.60
|
| Rate for Payer: Galaxy Health Commercial |
$25.35
|
| Rate for Payer: Hamaspik Choice Medicare |
$15.60
|
| Rate for Payer: Humana Medicare |
$15.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$25.35
|
| Rate for Payer: Local 1199SEIU Medicare |
$17.94
|
| Rate for Payer: MVP Health Care of NY Commercial |
$29.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$21.96
|
| Rate for Payer: MVP Health Care of NY Medicare |
$16.38
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$29.25
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$5.85
|
| Rate for Payer: United Healthcare Commercial |
$29.25
|
| Rate for Payer: United Healthcare Medicare |
$15.60
|
| Rate for Payer: WellCare Medicare |
$21.45
|
|
|
MEASLES (RUBEOLA SCREEN)
|
Facility
|
IP
|
$39.00
|
|
|
Service Code
|
HCPCS 86765
|
| Hospital Charge Code |
4300713
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$25.35 |
| Max. Negotiated Rate |
$25.35 |
| Rate for Payer: Cash Price |
$29.25
|
| Rate for Payer: Galaxy Health Commercial |
$25.35
|
|
|
MEAS POST-VOIDING RESIDUAL URINE&/BLADDER CAP
|
Facility
|
IP
|
$181.00
|
|
|
Service Code
|
HCPCS 51798
|
| Hospital Charge Code |
4609647
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$117.65 |
| Max. Negotiated Rate |
$117.65 |
| Rate for Payer: Cash Price |
$135.75
|
| Rate for Payer: Galaxy Health Commercial |
$117.65
|
|
|
MEAS POST-VOIDING RESIDUAL URINE&/BLADDER CAP
|
Facility
|
OP
|
$181.00
|
|
|
Service Code
|
HCPCS 51798
|
| Hospital Charge Code |
4609647
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$27.15 |
| Max. Negotiated Rate |
$1,234.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,000.00
|
| Rate for Payer: Aetna of NY Medicare |
$83.26
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$72.40
|
| Rate for Payer: Cash Price |
$135.75
|
| Rate for Payer: Cash Price |
$135.75
|
| Rate for Payer: Cash Price |
$135.75
|
| Rate for Payer: CDPHP Medicare |
$66.97
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,206.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$144.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$144.80
|
| Rate for Payer: EmblemHealth Medicaid |
$144.80
|
| Rate for Payer: EmblemHealth Medicare |
$61.54
|
| Rate for Payer: EmblemHealth Select Care |
$1,085.00
|
| Rate for Payer: Fidelis Medicare |
$72.40
|
| Rate for Payer: Galaxy Health Commercial |
$117.65
|
| Rate for Payer: Hamaspik Choice Medicare |
$72.40
|
| Rate for Payer: Humana Medicare |
$72.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,000.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$83.26
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,234.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$925.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$76.02
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,009.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$27.15
|
| Rate for Payer: United Healthcare Commercial |
$1,009.00
|
| Rate for Payer: United Healthcare Medicare |
$72.40
|
| Rate for Payer: WellCare Medicare |
$99.55
|
|
|
MEATOTOMY CUTTING MEATUS SPX EXCEPT INFANT
|
Facility
|
IP
|
$6,407.00
|
|
|
Service Code
|
HCPCS 53020
|
| Hospital Charge Code |
4002043
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$4,164.55 |
| Max. Negotiated Rate |
$4,164.55 |
| Rate for Payer: Cash Price |
$4,805.25
|
| Rate for Payer: Galaxy Health Commercial |
$4,164.55
|
|
|
MEATOTOMY CUTTING MEATUS SPX EXCEPT INFANT
|
Facility
|
OP
|
$6,407.00
|
|
|
Service Code
|
HCPCS 53020
|
| Hospital Charge Code |
4002043
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$961.05 |
| Max. Negotiated Rate |
$5,125.60 |
| Rate for Payer: Aetna of NY Commercial |
$1,900.00
|
| Rate for Payer: Aetna of NY Medicare |
$2,947.22
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2,562.80
|
| Rate for Payer: Cash Price |
$4,805.25
|
| Rate for Payer: Cash Price |
$4,805.25
|
| Rate for Payer: CDPHP Medicare |
$2,370.59
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$5,125.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$5,125.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$5,125.60
|
| Rate for Payer: EmblemHealth Medicaid |
$5,125.60
|
| Rate for Payer: EmblemHealth Medicare |
$2,178.38
|
| Rate for Payer: EmblemHealth Select Care |
$4,613.04
|
| Rate for Payer: Fidelis Medicare |
$2,562.80
|
| Rate for Payer: Galaxy Health Commercial |
$4,164.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$2,562.80
|
| Rate for Payer: Humana Medicare |
$2,562.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,900.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$2,947.22
|
| Rate for Payer: Multiplan Commercial |
$5,125.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4,805.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3,607.14
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2,690.94
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$2,097.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$961.05
|
| Rate for Payer: United Healthcare Commercial |
$2,097.00
|
| Rate for Payer: United Healthcare Medicare |
$2,562.80
|
| Rate for Payer: WellCare Medicare |
$3,523.85
|
|
|
MECHANICAL TRACTION THERAPY 1+ AREAS
|
Facility
|
OP
|
$51.00
|
|
|
Service Code
|
HCPCS 97012 GP
|
| Hospital Charge Code |
4650021
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$7.65 |
| Max. Negotiated Rate |
$187.00 |
| Rate for Payer: Aetna of NY Commercial |
$115.00
|
| Rate for Payer: Aetna of NY Medicare |
$23.46
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$20.40
|
| Rate for Payer: Cash Price |
$38.25
|
| Rate for Payer: Cash Price |
$38.25
|
| Rate for Payer: Cash Price |
$38.25
|
| Rate for Payer: CDPHP Medicare |
$18.87
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$40.80
|
| Rate for Payer: EmblemHealth Medicare |
$17.34
|
| Rate for Payer: EmblemHealth Select Care |
$36.72
|
| Rate for Payer: Fidelis Medicare |
$20.40
|
| Rate for Payer: Galaxy Health Commercial |
$33.15
|
| Rate for Payer: Hamaspik Choice Medicare |
$20.40
|
| Rate for Payer: Humana Medicare |
$20.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$23.46
|
| Rate for Payer: MVP Health Care of NY Commercial |
$187.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$141.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$21.42
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$7.65
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$20.40
|
| Rate for Payer: WellCare Medicare |
$28.05
|
|
|
MECHANICAL TRACTION THERAPY 1+ AREAS
|
Facility
|
IP
|
$51.00
|
|
|
Service Code
|
HCPCS 97012 GP
|
| Hospital Charge Code |
4650021
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$33.15 |
| Max. Negotiated Rate |
$33.15 |
| Rate for Payer: Cash Price |
$38.25
|
| Rate for Payer: Galaxy Health Commercial |
$33.15
|
|
|
MECHANICAL TRACTION THERAPY 1+ AREAS (MOD 59)
|
Facility
|
OP
|
$51.00
|
|
|
Service Code
|
HCPCS 97012 GP,59
|
| Hospital Charge Code |
4650368
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$7.65 |
| Max. Negotiated Rate |
$187.00 |
| Rate for Payer: Aetna of NY Commercial |
$115.00
|
| Rate for Payer: Aetna of NY Medicare |
$23.46
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$20.40
|
| Rate for Payer: Cash Price |
$38.25
|
| Rate for Payer: Cash Price |
$38.25
|
| Rate for Payer: Cash Price |
$38.25
|
| Rate for Payer: CDPHP Medicare |
$18.87
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$40.80
|
| Rate for Payer: EmblemHealth Medicare |
$17.34
|
| Rate for Payer: EmblemHealth Select Care |
$36.72
|
| Rate for Payer: Fidelis Medicare |
$20.40
|
| Rate for Payer: Galaxy Health Commercial |
$33.15
|
| Rate for Payer: Hamaspik Choice Medicare |
$20.40
|
| Rate for Payer: Humana Medicare |
$20.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$23.46
|
| Rate for Payer: MVP Health Care of NY Commercial |
$187.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$141.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$21.42
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$7.65
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$20.40
|
| Rate for Payer: WellCare Medicare |
$28.05
|
|
|
MECHANICAL TRACTION THERAPY 1+ AREAS (MOD 59)
|
Facility
|
IP
|
$51.00
|
|
|
Service Code
|
HCPCS 97012 GP,59
|
| Hospital Charge Code |
4650368
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$33.15 |
| Max. Negotiated Rate |
$33.15 |
| Rate for Payer: Cash Price |
$38.25
|
| Rate for Payer: Galaxy Health Commercial |
$33.15
|
|
|
MECHANICAL TRACTION THERAPY 1+ AREAS (MOD 59 W KX)
|
Facility
|
OP
|
$51.00
|
|
|
Service Code
|
HCPCS 97012 GP,59,KX
|
| Hospital Charge Code |
4650420
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$7.65 |
| Max. Negotiated Rate |
$187.00 |
| Rate for Payer: Aetna of NY Commercial |
$115.00
|
| Rate for Payer: Aetna of NY Medicare |
$23.46
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$20.40
|
| Rate for Payer: Cash Price |
$38.25
|
| Rate for Payer: Cash Price |
$38.25
|
| Rate for Payer: Cash Price |
$38.25
|
| Rate for Payer: CDPHP Medicare |
$18.87
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$40.80
|
| Rate for Payer: EmblemHealth Medicare |
$17.34
|
| Rate for Payer: EmblemHealth Select Care |
$36.72
|
| Rate for Payer: Fidelis Medicare |
$20.40
|
| Rate for Payer: Galaxy Health Commercial |
$33.15
|
| Rate for Payer: Hamaspik Choice Medicare |
$20.40
|
| Rate for Payer: Humana Medicare |
$20.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$23.46
|
| Rate for Payer: MVP Health Care of NY Commercial |
$187.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$141.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$21.42
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$7.65
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$20.40
|
| Rate for Payer: WellCare Medicare |
$28.05
|
|
|
MECHANICAL TRACTION THERAPY 1+ AREAS (MOD 59 W KX)
|
Facility
|
IP
|
$51.00
|
|
|
Service Code
|
HCPCS 97012 GP,59,KX
|
| Hospital Charge Code |
4650420
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$33.15 |
| Max. Negotiated Rate |
$33.15 |
| Rate for Payer: Cash Price |
$38.25
|
| Rate for Payer: Galaxy Health Commercial |
$33.15
|
|
|
MECHANICAL TRACTION THERAPY 1+ AREAS (W/ KX)
|
Facility
|
IP
|
$51.00
|
|
|
Service Code
|
HCPCS 97012 GP,KX
|
| Hospital Charge Code |
4650313
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$33.15 |
| Max. Negotiated Rate |
$33.15 |
| Rate for Payer: Cash Price |
$38.25
|
| Rate for Payer: Galaxy Health Commercial |
$33.15
|
|
|
MECHANICAL TRACTION THERAPY 1+ AREAS (W/ KX)
|
Facility
|
OP
|
$51.00
|
|
|
Service Code
|
HCPCS 97012 GP,KX
|
| Hospital Charge Code |
4650313
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$7.65 |
| Max. Negotiated Rate |
$187.00 |
| Rate for Payer: Aetna of NY Commercial |
$115.00
|
| Rate for Payer: Aetna of NY Medicare |
$23.46
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$20.40
|
| Rate for Payer: Cash Price |
$38.25
|
| Rate for Payer: Cash Price |
$38.25
|
| Rate for Payer: Cash Price |
$38.25
|
| Rate for Payer: CDPHP Medicare |
$18.87
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$40.80
|
| Rate for Payer: EmblemHealth Medicare |
$17.34
|
| Rate for Payer: EmblemHealth Select Care |
$36.72
|
| Rate for Payer: Fidelis Medicare |
$20.40
|
| Rate for Payer: Galaxy Health Commercial |
$33.15
|
| Rate for Payer: Hamaspik Choice Medicare |
$20.40
|
| Rate for Payer: Humana Medicare |
$20.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$23.46
|
| Rate for Payer: MVP Health Care of NY Commercial |
$187.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$141.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$21.42
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$7.65
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$20.40
|
| Rate for Payer: WellCare Medicare |
$28.05
|
|
|
MECKELS SCAN
|
Facility
|
IP
|
$1,225.00
|
|
|
Service Code
|
HCPCS 78290
|
| Hospital Charge Code |
4210021
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$796.25 |
| Max. Negotiated Rate |
$796.25 |
| Rate for Payer: Cash Price |
$918.75
|
| Rate for Payer: Galaxy Health Commercial |
$796.25
|
|
|
MECKELS SCAN
|
Facility
|
OP
|
$98.00
|
|
|
Service Code
|
HCPCS 78290 26
|
| Hospital Charge Code |
5210021
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$14.70 |
| Max. Negotiated Rate |
$78.40 |
| Rate for Payer: Aetna of NY Commercial |
$68.60
|
| Rate for Payer: Aetna of NY Medicare |
$45.08
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$39.20
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: CDPHP Medicare |
$36.26
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$78.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$78.40
|
| Rate for Payer: EmblemHealth Medicaid |
$78.40
|
| Rate for Payer: EmblemHealth Medicare |
$33.32
|
| Rate for Payer: Fidelis Medicare |
$39.20
|
| Rate for Payer: Galaxy Health Commercial |
$63.70
|
| Rate for Payer: Hamaspik Choice Medicare |
$39.20
|
| Rate for Payer: Humana Medicare |
$39.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$68.60
|
| Rate for Payer: Local 1199SEIU Medicare |
$45.08
|
| Rate for Payer: MVP Health Care of NY Commercial |
$73.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$55.17
|
| Rate for Payer: MVP Health Care of NY Medicare |
$41.16
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$14.70
|
| Rate for Payer: United Healthcare Medicare |
$39.20
|
| Rate for Payer: WellCare Medicare |
$53.90
|
|
|
MECKELS SCAN
|
Facility
|
OP
|
$1,225.00
|
|
|
Service Code
|
HCPCS 78290
|
| Hospital Charge Code |
4210021
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$183.75 |
| Max. Negotiated Rate |
$1,545.00 |
| Rate for Payer: Aetna of NY Commercial |
$857.50
|
| Rate for Payer: Aetna of NY Medicare |
$563.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$490.00
|
| Rate for Payer: Cash Price |
$918.75
|
| Rate for Payer: Cash Price |
$918.75
|
| Rate for Payer: CDPHP Medicare |
$453.25
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$857.50
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$980.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$980.00
|
| Rate for Payer: EmblemHealth Medicaid |
$980.00
|
| Rate for Payer: EmblemHealth Medicare |
$416.50
|
| Rate for Payer: EmblemHealth Select Care |
$796.25
|
| Rate for Payer: Fidelis Medicare |
$490.00
|
| Rate for Payer: Galaxy Health Commercial |
$796.25
|
| Rate for Payer: Hamaspik Choice Medicare |
$490.00
|
| Rate for Payer: Humana Medicare |
$490.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$857.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$563.50
|
| Rate for Payer: MVP Health Care of NY Commercial |
$918.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$689.67
|
| Rate for Payer: MVP Health Care of NY Medicare |
$514.50
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,545.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$183.75
|
| Rate for Payer: United Healthcare Commercial |
$1,545.00
|
| Rate for Payer: United Healthcare Medicare |
$490.00
|
| Rate for Payer: WellCare Medicare |
$673.75
|
|
|
MECKELS SCAN
|
Facility
|
IP
|
$98.00
|
|
|
Service Code
|
HCPCS 78290 26
|
| Hospital Charge Code |
5210021
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$63.70 |
| Max. Negotiated Rate |
$63.70 |
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Galaxy Health Commercial |
$63.70
|
|
|
MECLIZINE HCL 12.5MG TABS 100 EA
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 904651661
|
| Hospital Charge Code |
4400486
|
|
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
|
|
|
MECLIZINE HCL 12.5MG TABS 100 EA
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
NDC 904651661
|
| Hospital Charge Code |
4400486
|
|
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
|
|
|
MECLIZINE HCL 25MG TABS 100 EA
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
NDC 904651761
|
| Hospital Charge Code |
4400487
|
|
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
|
|
|
MECLIZINE HCL 25MG TABS 100 EA
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 904651761
|
| Hospital Charge Code |
4400487
|
|
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
|
|
|
MEDICAL NUTRITION THERAPY, GROUP (2 OR MORE), EA 30 MINS
|
Facility
|
OP
|
$55.00
|
|
|
Service Code
|
HCPCS 97804
|
| Hospital Charge Code |
4853015
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$8.25 |
| Max. Negotiated Rate |
$57.23 |
| Rate for Payer: Aetna of NY Commercial |
$38.50
|
| Rate for Payer: Aetna of NY Medicare |
$25.30
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$22.00
|
| Rate for Payer: Cash Price |
$41.25
|
| Rate for Payer: Cash Price |
$41.25
|
| Rate for Payer: CDPHP Medicare |
$20.35
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$44.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$31.94
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$26.62
|
| Rate for Payer: EmblemHealth Medicaid |
$26.62
|
| Rate for Payer: EmblemHealth Medicare |
$18.70
|
| Rate for Payer: EmblemHealth Select Care |
$39.60
|
| Rate for Payer: Fidelis Medicare |
$22.00
|
| Rate for Payer: Galaxy Health Commercial |
$35.75
|
| Rate for Payer: Galaxy Health Workers Comp |
$26.09
|
| Rate for Payer: Hamaspik Choice Medicaid |
$26.62
|
| Rate for Payer: Hamaspik Choice Medicare |
$22.00
|
| Rate for Payer: Humana Medicare |
$22.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$38.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$25.30
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$27.95
|
| Rate for Payer: MVP Health Care of NY Commercial |
$41.25
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$57.23
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$57.23
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$30.96
|
| Rate for Payer: MVP Health Care of NY Medicare |
$23.10
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$41.25
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$8.25
|
| Rate for Payer: United Healthcare Commercial |
$41.25
|
| Rate for Payer: United Healthcare Medicare |
$22.00
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$27.95
|
| Rate for Payer: WellCare Medicare |
$30.25
|
|
