|
morphine SULFATE 4 MG/ML VIAL 4 mg, 1 mL
|
Facility
|
OP
|
$9.00
|
|
|
Service Code
|
HCPCS J2270
|
| Hospital Charge Code |
4401489
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.35 |
| Max. Negotiated Rate |
$7.59 |
| Rate for Payer: Aetna of NY Medicare |
$4.14
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$3.60
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: CDPHP Medicare |
$3.33
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$4.45
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$7.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$7.20
|
| Rate for Payer: EmblemHealth Medicaid |
$7.20
|
| Rate for Payer: EmblemHealth Medicare |
$3.06
|
| Rate for Payer: EmblemHealth Select Care |
$4.45
|
| Rate for Payer: Fidelis Medicare |
$3.60
|
| Rate for Payer: Galaxy Health Commercial |
$5.85
|
| Rate for Payer: Hamaspik Choice Medicare |
$3.60
|
| Rate for Payer: Humana Medicare |
$3.60
|
| Rate for Payer: Local 1199SEIU Medicare |
$4.14
|
| Rate for Payer: MVP Health Care of NY Commercial |
$6.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$5.07
|
| Rate for Payer: MVP Health Care of NY Medicare |
$3.78
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$7.59
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1.35
|
| Rate for Payer: United Healthcare Commercial |
$7.59
|
| Rate for Payer: United Healthcare Medicare |
$3.60
|
| Rate for Payer: WellCare Medicare |
$4.95
|
|
|
morphine SULFATE 4 MG/ML VIAL 4 mg, 1 mL
|
Facility
|
IP
|
$9.00
|
|
|
Service Code
|
HCPCS J2270
|
| Hospital Charge Code |
4401489
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.45 |
| Max. Negotiated Rate |
$5.85 |
| Rate for Payer: Aetna of NY Commercial |
$4.95
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$4.45
|
| Rate for Payer: EmblemHealth Select Care |
$4.45
|
| Rate for Payer: Galaxy Health Commercial |
$5.85
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$4.95
|
| Rate for Payer: WellCare Medicare |
$4.95
|
|
|
MORPHINE SULFATE INJ TO 10 MG
|
Facility
|
OP
|
$6.95
|
|
|
Service Code
|
HCPCS J2270
|
| Hospital Charge Code |
4400833
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.04 |
| Max. Negotiated Rate |
$7.59 |
| Rate for Payer: Aetna of NY Medicare |
$3.20
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2.78
|
| Rate for Payer: Cash Price |
$5.21
|
| Rate for Payer: Cash Price |
$5.21
|
| Rate for Payer: CDPHP Medicare |
$2.57
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$4.45
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$5.56
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$5.56
|
| Rate for Payer: EmblemHealth Medicaid |
$5.56
|
| Rate for Payer: EmblemHealth Medicare |
$2.36
|
| Rate for Payer: EmblemHealth Select Care |
$4.45
|
| Rate for Payer: Fidelis Medicare |
$2.78
|
| Rate for Payer: Galaxy Health Commercial |
$4.52
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.78
|
| Rate for Payer: Humana Medicare |
$2.78
|
| Rate for Payer: Local 1199SEIU Medicare |
$3.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$5.21
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3.91
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2.92
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$7.59
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1.04
|
| Rate for Payer: United Healthcare Commercial |
$7.59
|
| Rate for Payer: United Healthcare Medicare |
$2.78
|
| Rate for Payer: WellCare Medicare |
$3.82
|
|
|
MORPHINE SULFATE INJ TO 10 MG
|
Facility
|
IP
|
$6.95
|
|
|
Service Code
|
HCPCS J2270
|
| Hospital Charge Code |
4400833
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.82 |
| Max. Negotiated Rate |
$4.52 |
| Rate for Payer: Aetna of NY Commercial |
$3.82
|
| Rate for Payer: Cash Price |
$5.21
|
| Rate for Payer: Cash Price |
$5.21
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$4.45
|
| Rate for Payer: EmblemHealth Select Care |
$4.45
|
| Rate for Payer: Galaxy Health Commercial |
$4.52
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$3.82
|
| Rate for Payer: WellCare Medicare |
$3.82
|
|
|
MORPHINE SULFATE ORAL LIQUID SOLUTION CO
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
NDC 68094075458
|
| Hospital Charge Code |
4409164
|
|
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
|
|
|
MORPHINE SULFATE ORAL LIQUID SOLUTION CO
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 68094075458
|
| Hospital Charge Code |
4409164
|
|
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
|
|
|
MOTION FLUORO SWALLOW FCN
|
Facility
|
IP
|
$296.00
|
|
|
Service Code
|
HCPCS 92611 GN
|
| Hospital Charge Code |
4670085
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$192.40 |
| Max. Negotiated Rate |
$192.40 |
| Rate for Payer: Cash Price |
$222.00
|
| Rate for Payer: Galaxy Health Commercial |
$192.40
|
|
|
MOTION FLUORO SWALLOW FCN
|
Facility
|
OP
|
$296.00
|
|
|
Service Code
|
HCPCS 92611 GN
|
| Hospital Charge Code |
4670085
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$44.40 |
| Max. Negotiated Rate |
$236.80 |
| Rate for Payer: Aetna of NY Commercial |
$115.00
|
| Rate for Payer: Aetna of NY Medicare |
$136.16
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$118.40
|
| Rate for Payer: Cash Price |
$222.00
|
| Rate for Payer: Cash Price |
$222.00
|
| Rate for Payer: Cash Price |
$222.00
|
| Rate for Payer: CDPHP Medicare |
$109.52
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$236.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$236.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$236.80
|
| Rate for Payer: EmblemHealth Medicaid |
$236.80
|
| Rate for Payer: EmblemHealth Medicare |
$100.64
|
| Rate for Payer: EmblemHealth Select Care |
$213.12
|
| Rate for Payer: Fidelis Medicare |
$118.40
|
| Rate for Payer: Galaxy Health Commercial |
$192.40
|
| Rate for Payer: Hamaspik Choice Medicare |
$118.40
|
| Rate for Payer: Humana Medicare |
$118.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$136.16
|
| 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 |
$124.32
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$44.40
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$118.40
|
| Rate for Payer: WellCare Medicare |
$162.80
|
|
|
MOTION FLUORO SWALLOW FCN (MOD 59)
|
Facility
|
IP
|
$296.00
|
|
|
Service Code
|
HCPCS 92611 GN,59
|
| Hospital Charge Code |
4670293
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$192.40 |
| Max. Negotiated Rate |
$192.40 |
| Rate for Payer: Cash Price |
$222.00
|
| Rate for Payer: Galaxy Health Commercial |
$192.40
|
|
|
MOTION FLUORO SWALLOW FCN (MOD 59)
|
Facility
|
OP
|
$296.00
|
|
|
Service Code
|
HCPCS 92611 GN,59
|
| Hospital Charge Code |
4670293
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$44.40 |
| Max. Negotiated Rate |
$236.80 |
| Rate for Payer: Aetna of NY Commercial |
$115.00
|
| Rate for Payer: Aetna of NY Medicare |
$136.16
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$118.40
|
| Rate for Payer: Cash Price |
$222.00
|
| Rate for Payer: Cash Price |
$222.00
|
| Rate for Payer: Cash Price |
$222.00
|
| Rate for Payer: CDPHP Medicare |
$109.52
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$236.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$236.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$236.80
|
| Rate for Payer: EmblemHealth Medicaid |
$236.80
|
| Rate for Payer: EmblemHealth Medicare |
$100.64
|
| Rate for Payer: EmblemHealth Select Care |
$213.12
|
| Rate for Payer: Fidelis Medicare |
$118.40
|
| Rate for Payer: Galaxy Health Commercial |
$192.40
|
| Rate for Payer: Hamaspik Choice Medicare |
$118.40
|
| Rate for Payer: Humana Medicare |
$118.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$136.16
|
| 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 |
$124.32
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$44.40
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$118.40
|
| Rate for Payer: WellCare Medicare |
$162.80
|
|
|
MOTION FLUORO SWALLOW FCN (MOD 59 W KX)
|
Facility
|
IP
|
$296.00
|
|
|
Service Code
|
HCPCS 92611 GN,59,KX
|
| Hospital Charge Code |
4670309
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$192.40 |
| Max. Negotiated Rate |
$192.40 |
| Rate for Payer: Cash Price |
$222.00
|
| Rate for Payer: Galaxy Health Commercial |
$192.40
|
|
|
MOTION FLUORO SWALLOW FCN (MOD 59 W KX)
|
Facility
|
OP
|
$296.00
|
|
|
Service Code
|
HCPCS 92611 GN,59,KX
|
| Hospital Charge Code |
4670309
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$44.40 |
| Max. Negotiated Rate |
$236.80 |
| Rate for Payer: Aetna of NY Commercial |
$115.00
|
| Rate for Payer: Aetna of NY Medicare |
$136.16
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$118.40
|
| Rate for Payer: Cash Price |
$222.00
|
| Rate for Payer: Cash Price |
$222.00
|
| Rate for Payer: Cash Price |
$222.00
|
| Rate for Payer: CDPHP Medicare |
$109.52
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$236.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$236.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$236.80
|
| Rate for Payer: EmblemHealth Medicaid |
$236.80
|
| Rate for Payer: EmblemHealth Medicare |
$100.64
|
| Rate for Payer: EmblemHealth Select Care |
$213.12
|
| Rate for Payer: Fidelis Medicare |
$118.40
|
| Rate for Payer: Galaxy Health Commercial |
$192.40
|
| Rate for Payer: Hamaspik Choice Medicare |
$118.40
|
| Rate for Payer: Humana Medicare |
$118.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$136.16
|
| 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 |
$124.32
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$44.40
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$118.40
|
| Rate for Payer: WellCare Medicare |
$162.80
|
|
|
MOTION FLUORO SWALLOW FCN (W/ KX)
|
Facility
|
OP
|
$296.00
|
|
|
Service Code
|
HCPCS 92611 GN,KX
|
| Hospital Charge Code |
4670271
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$44.40 |
| Max. Negotiated Rate |
$236.80 |
| Rate for Payer: Aetna of NY Commercial |
$115.00
|
| Rate for Payer: Aetna of NY Medicare |
$136.16
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$118.40
|
| Rate for Payer: Cash Price |
$222.00
|
| Rate for Payer: Cash Price |
$222.00
|
| Rate for Payer: Cash Price |
$222.00
|
| Rate for Payer: CDPHP Medicare |
$109.52
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$236.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$236.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$236.80
|
| Rate for Payer: EmblemHealth Medicaid |
$236.80
|
| Rate for Payer: EmblemHealth Medicare |
$100.64
|
| Rate for Payer: EmblemHealth Select Care |
$213.12
|
| Rate for Payer: Fidelis Medicare |
$118.40
|
| Rate for Payer: Galaxy Health Commercial |
$192.40
|
| Rate for Payer: Hamaspik Choice Medicare |
$118.40
|
| Rate for Payer: Humana Medicare |
$118.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$136.16
|
| 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 |
$124.32
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$44.40
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$118.40
|
| Rate for Payer: WellCare Medicare |
$162.80
|
|
|
MOTION FLUORO SWALLOW FCN (W/ KX)
|
Facility
|
IP
|
$296.00
|
|
|
Service Code
|
HCPCS 92611 GN,KX
|
| Hospital Charge Code |
4670271
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$192.40 |
| Max. Negotiated Rate |
$192.40 |
| Rate for Payer: Cash Price |
$222.00
|
| Rate for Payer: Galaxy Health Commercial |
$192.40
|
|
|
MOXIFLOXACIN 0.5% EYE DROPS 1 ea, 3 mL
|
Facility
|
OP
|
$502.00
|
|
|
Service Code
|
NDC 60505058204
|
| Hospital Charge Code |
4401936
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$75.30 |
| Max. Negotiated Rate |
$401.60 |
| Rate for Payer: Aetna of NY Commercial |
$351.40
|
| Rate for Payer: Aetna of NY Medicare |
$230.92
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$200.80
|
| Rate for Payer: Cash Price |
$376.50
|
| Rate for Payer: CDPHP Medicare |
$185.74
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$401.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$401.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$401.60
|
| Rate for Payer: EmblemHealth Medicaid |
$401.60
|
| Rate for Payer: EmblemHealth Medicare |
$170.68
|
| Rate for Payer: EmblemHealth Select Care |
$361.44
|
| Rate for Payer: Fidelis Medicare |
$200.80
|
| Rate for Payer: Galaxy Health Commercial |
$326.30
|
| Rate for Payer: Hamaspik Choice Medicare |
$200.80
|
| Rate for Payer: Humana Medicare |
$200.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$351.40
|
| Rate for Payer: Local 1199SEIU Medicare |
$230.92
|
| Rate for Payer: MVP Health Care of NY Commercial |
$376.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$282.63
|
| Rate for Payer: MVP Health Care of NY Medicare |
$210.84
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$75.30
|
| Rate for Payer: United Healthcare Medicare |
$200.80
|
| Rate for Payer: WellCare Medicare |
$276.10
|
|
|
MOXIFLOXACIN 0.5% EYE DROPS 1 ea, 3 mL
|
Facility
|
IP
|
$502.00
|
|
|
Service Code
|
NDC 60505058204
|
| Hospital Charge Code |
4401936
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$276.10 |
| Max. Negotiated Rate |
$326.30 |
| Rate for Payer: Cash Price |
$376.50
|
| Rate for Payer: Galaxy Health Commercial |
$326.30
|
| Rate for Payer: WellCare Medicare |
$276.10
|
|
|
M/PHMTRC ALYS ISH QUANT/SEMIQ MNL EACH MULTIPRB
|
Facility
|
OP
|
$522.00
|
|
|
Service Code
|
HCPCS 88377 TC
|
| Hospital Charge Code |
4008377
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$78.30 |
| Max. Negotiated Rate |
$417.60 |
| Rate for Payer: Aetna of NY Commercial |
$339.30
|
| Rate for Payer: Aetna of NY Medicare |
$240.12
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$208.80
|
| Rate for Payer: Cash Price |
$391.50
|
| Rate for Payer: CDPHP Medicare |
$193.14
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$313.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$417.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$417.60
|
| Rate for Payer: EmblemHealth Medicaid |
$417.60
|
| Rate for Payer: EmblemHealth Medicare |
$177.48
|
| Rate for Payer: EmblemHealth Select Care |
$313.20
|
| Rate for Payer: Fidelis Medicare |
$208.80
|
| Rate for Payer: Galaxy Health Commercial |
$339.30
|
| Rate for Payer: Hamaspik Choice Medicare |
$208.80
|
| Rate for Payer: Humana Medicare |
$208.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$339.30
|
| Rate for Payer: Local 1199SEIU Medicare |
$240.12
|
| Rate for Payer: MVP Health Care of NY Commercial |
$391.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$293.89
|
| Rate for Payer: MVP Health Care of NY Medicare |
$219.24
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$391.50
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$78.30
|
| Rate for Payer: United Healthcare Commercial |
$391.50
|
| Rate for Payer: United Healthcare Medicare |
$208.80
|
| Rate for Payer: WellCare Medicare |
$287.10
|
|
|
M/PHMTRC ALYS ISH QUANT/SEMIQ MNL EACH MULTIPRB
|
Facility
|
IP
|
$522.00
|
|
|
Service Code
|
HCPCS 88377 TC
|
| Hospital Charge Code |
4008377
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$339.30 |
| Max. Negotiated Rate |
$339.30 |
| Rate for Payer: Cash Price |
$391.50
|
| Rate for Payer: Galaxy Health Commercial |
$339.30
|
|
|
M/PHMTRC ALYS TUMOR IMHCHEM EA ANTIBODY MANUAL
|
Facility
|
OP
|
$522.00
|
|
|
Service Code
|
HCPCS 88360 TC
|
| Hospital Charge Code |
4008360
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$78.30 |
| Max. Negotiated Rate |
$417.60 |
| Rate for Payer: Aetna of NY Commercial |
$339.30
|
| Rate for Payer: Aetna of NY Medicare |
$240.12
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$208.80
|
| Rate for Payer: Cash Price |
$391.50
|
| Rate for Payer: CDPHP Medicare |
$193.14
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$313.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$417.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$417.60
|
| Rate for Payer: EmblemHealth Medicaid |
$417.60
|
| Rate for Payer: EmblemHealth Medicare |
$177.48
|
| Rate for Payer: EmblemHealth Select Care |
$313.20
|
| Rate for Payer: Fidelis Medicare |
$208.80
|
| Rate for Payer: Galaxy Health Commercial |
$339.30
|
| Rate for Payer: Hamaspik Choice Medicare |
$208.80
|
| Rate for Payer: Humana Medicare |
$208.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$339.30
|
| Rate for Payer: Local 1199SEIU Medicare |
$240.12
|
| Rate for Payer: MVP Health Care of NY Commercial |
$391.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$293.89
|
| Rate for Payer: MVP Health Care of NY Medicare |
$219.24
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$391.50
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$78.30
|
| Rate for Payer: United Healthcare Commercial |
$391.50
|
| Rate for Payer: United Healthcare Medicare |
$208.80
|
| Rate for Payer: WellCare Medicare |
$287.10
|
|
|
M/PHMTRC ALYS TUMOR IMHCHEM EA ANTIBODY MANUAL
|
Facility
|
IP
|
$522.00
|
|
|
Service Code
|
HCPCS 88360 TC
|
| Hospital Charge Code |
4008360
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$339.30 |
| Max. Negotiated Rate |
$339.30 |
| Rate for Payer: Cash Price |
$391.50
|
| Rate for Payer: Galaxy Health Commercial |
$339.30
|
|
|
MRA ABDOMEN W/ W/O DYE
|
Facility
|
IP
|
$262.00
|
|
|
Service Code
|
HCPCS 74185 26
|
| Hospital Charge Code |
5230064
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$170.30 |
| Max. Negotiated Rate |
$170.30 |
| Rate for Payer: Cash Price |
$196.50
|
| Rate for Payer: Galaxy Health Commercial |
$170.30
|
|
|
MRA ABDOMEN W/ W/O DYE
|
Facility
|
IP
|
$262.00
|
|
|
Service Code
|
HCPCS 74185 26
|
| Hospital Charge Code |
5230063
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$170.30 |
| Max. Negotiated Rate |
$170.30 |
| Rate for Payer: Cash Price |
$196.50
|
| Rate for Payer: Galaxy Health Commercial |
$170.30
|
|
|
MRA ABDOMEN W/ W/O DYE
|
Facility
|
IP
|
$262.00
|
|
|
Service Code
|
HCPCS 74185 26
|
| Hospital Charge Code |
5230209
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$170.30 |
| Max. Negotiated Rate |
$170.30 |
| Rate for Payer: Cash Price |
$196.50
|
| Rate for Payer: Galaxy Health Commercial |
$170.30
|
|
|
MRA ABDOMEN W/ W/O DYE
|
Facility
|
IP
|
$262.00
|
|
|
Service Code
|
HCPCS 74185 26
|
| Hospital Charge Code |
5230049
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$170.30 |
| Max. Negotiated Rate |
$170.30 |
| Rate for Payer: Cash Price |
$196.50
|
| Rate for Payer: Galaxy Health Commercial |
$170.30
|
|
|
MRA ABDOMEN W/ W/O DYE
|
Facility
|
OP
|
$2,389.00
|
|
|
Service Code
|
HCPCS 74185
|
| Hospital Charge Code |
4230049
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$358.35 |
| Max. Negotiated Rate |
$2,328.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,750.00
|
| Rate for Payer: Aetna of NY Medicare |
$1,098.94
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$955.60
|
| Rate for Payer: Cash Price |
$1,791.75
|
| Rate for Payer: Cash Price |
$1,791.75
|
| Rate for Payer: Cash Price |
$1,791.75
|
| Rate for Payer: CDPHP Medicare |
$883.93
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,672.30
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,911.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,911.20
|
| Rate for Payer: EmblemHealth Medicaid |
$1,911.20
|
| Rate for Payer: EmblemHealth Medicare |
$812.26
|
| Rate for Payer: EmblemHealth Select Care |
$1,552.85
|
| Rate for Payer: Fidelis Medicare |
$955.60
|
| Rate for Payer: Galaxy Health Commercial |
$1,552.85
|
| Rate for Payer: Hamaspik Choice Medicare |
$955.60
|
| Rate for Payer: Humana Medicare |
$955.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,750.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,098.94
|
| 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 |
$1,003.38
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$2,328.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$358.35
|
| Rate for Payer: United Healthcare Commercial |
$2,328.00
|
| Rate for Payer: United Healthcare Medicare |
$955.60
|
| Rate for Payer: WellCare Medicare |
$1,313.95
|
|
