|
MUGA SGL W RV EF BY 1ST PASS
|
Facility
|
IP
|
$379.00
|
|
|
Service Code
|
HCPCS 78496
|
| Hospital Charge Code |
4210082
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$246.35 |
| Max. Negotiated Rate |
$246.35 |
| Rate for Payer: Cash Price |
$284.25
|
| Rate for Payer: Galaxy Health Commercial |
$246.35
|
|
|
MUGA SGL W RV EF BY 1ST PASS
|
Facility
|
OP
|
$379.00
|
|
|
Service Code
|
HCPCS 78496
|
| Hospital Charge Code |
4210082
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$56.85 |
| Max. Negotiated Rate |
$1,545.00 |
| Rate for Payer: Aetna of NY Commercial |
$265.30
|
| Rate for Payer: Aetna of NY Medicare |
$174.34
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$151.60
|
| Rate for Payer: Cash Price |
$284.25
|
| Rate for Payer: Cash Price |
$284.25
|
| Rate for Payer: CDPHP Medicare |
$140.23
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$265.30
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$303.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$303.20
|
| Rate for Payer: EmblemHealth Medicaid |
$303.20
|
| Rate for Payer: EmblemHealth Medicare |
$128.86
|
| Rate for Payer: EmblemHealth Select Care |
$246.35
|
| Rate for Payer: Fidelis Medicare |
$151.60
|
| Rate for Payer: Galaxy Health Commercial |
$246.35
|
| Rate for Payer: Hamaspik Choice Medicare |
$151.60
|
| Rate for Payer: Humana Medicare |
$151.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$265.30
|
| Rate for Payer: Local 1199SEIU Medicare |
$174.34
|
| Rate for Payer: MVP Health Care of NY Commercial |
$284.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$213.38
|
| Rate for Payer: MVP Health Care of NY Medicare |
$159.18
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,545.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$56.85
|
| Rate for Payer: United Healthcare Commercial |
$1,545.00
|
| Rate for Payer: United Healthcare Medicare |
$151.60
|
| Rate for Payer: WellCare Medicare |
$208.45
|
|
|
MUGA, SGL W WM & EF
|
Facility
|
IP
|
$140.00
|
|
|
Service Code
|
HCPCS 78472 26
|
| Hospital Charge Code |
5211249
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$91.00 |
| Max. Negotiated Rate |
$91.00 |
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Galaxy Health Commercial |
$91.00
|
|
|
MUGA, SGL W WM & EF
|
Facility
|
OP
|
$140.00
|
|
|
Service Code
|
HCPCS 78472 26
|
| Hospital Charge Code |
5211249
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$21.00 |
| Max. Negotiated Rate |
$112.00 |
| Rate for Payer: Aetna of NY Commercial |
$98.00
|
| Rate for Payer: Aetna of NY Medicare |
$64.40
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$56.00
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: CDPHP Medicare |
$51.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$112.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$112.00
|
| Rate for Payer: EmblemHealth Medicaid |
$112.00
|
| Rate for Payer: EmblemHealth Medicare |
$47.60
|
| Rate for Payer: Fidelis Medicare |
$56.00
|
| Rate for Payer: Galaxy Health Commercial |
$91.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$56.00
|
| Rate for Payer: Humana Medicare |
$56.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$98.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$64.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$105.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$78.82
|
| Rate for Payer: MVP Health Care of NY Medicare |
$58.80
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$21.00
|
| Rate for Payer: United Healthcare Medicare |
$56.00
|
| Rate for Payer: WellCare Medicare |
$77.00
|
|
|
MUGA; SGL W WM & EF
|
Facility
|
OP
|
$1,225.00
|
|
|
Service Code
|
HCPCS 78472
|
| Hospital Charge Code |
4211249
|
|
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
|
|
|
MUGA; SGL W WM & EF
|
Facility
|
IP
|
$1,225.00
|
|
|
Service Code
|
HCPCS 78472
|
| Hospital Charge Code |
4211249
|
|
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
|
|
|
MUGA SPECT W WM & EF
|
Facility
|
IP
|
$1,225.00
|
|
|
Service Code
|
HCPCS 78494
|
| Hospital Charge Code |
4210083
|
|
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
|
|
|
MUGA SPECT W WM & EF
|
Facility
|
OP
|
$1,225.00
|
|
|
Service Code
|
HCPCS 78494
|
| Hospital Charge Code |
4210083
|
|
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
|
|
|
MUGA SPECT W WM & EF
|
Facility
|
IP
|
$170.00
|
|
|
Service Code
|
HCPCS 78494 26
|
| Hospital Charge Code |
5210083
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$110.50 |
| Max. Negotiated Rate |
$110.50 |
| Rate for Payer: Cash Price |
$127.50
|
| Rate for Payer: Galaxy Health Commercial |
$110.50
|
|
|
MUGA SPECT W WM & EF
|
Facility
|
OP
|
$170.00
|
|
|
Service Code
|
HCPCS 78494 26
|
| Hospital Charge Code |
5210083
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$25.50 |
| Max. Negotiated Rate |
$136.00 |
| Rate for Payer: Aetna of NY Commercial |
$119.00
|
| Rate for Payer: Aetna of NY Medicare |
$78.20
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$68.00
|
| Rate for Payer: Cash Price |
$127.50
|
| Rate for Payer: CDPHP Medicare |
$62.90
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$136.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$136.00
|
| Rate for Payer: EmblemHealth Medicaid |
$136.00
|
| Rate for Payer: EmblemHealth Medicare |
$57.80
|
| Rate for Payer: Fidelis Medicare |
$68.00
|
| Rate for Payer: Galaxy Health Commercial |
$110.50
|
| Rate for Payer: Hamaspik Choice Medicare |
$68.00
|
| Rate for Payer: Humana Medicare |
$68.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$119.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$78.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$127.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$95.71
|
| Rate for Payer: MVP Health Care of NY Medicare |
$71.40
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$25.50
|
| Rate for Payer: United Healthcare Medicare |
$68.00
|
| Rate for Payer: WellCare Medicare |
$93.50
|
|
|
MULTIPLE AREA STATIC BONE
|
Facility
|
OP
|
$1,225.00
|
|
|
Service Code
|
HCPCS 78305
|
| Hospital Charge Code |
4210003
|
|
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
|
|
|
MULTIPLE AREA STATIC BONE
|
Facility
|
IP
|
$121.00
|
|
|
Service Code
|
HCPCS 78305 26
|
| Hospital Charge Code |
5210003
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$78.65 |
| Max. Negotiated Rate |
$78.65 |
| Rate for Payer: Cash Price |
$90.75
|
| Rate for Payer: Galaxy Health Commercial |
$78.65
|
|
|
MULTIPLE AREA STATIC BONE
|
Facility
|
IP
|
$1,225.00
|
|
|
Service Code
|
HCPCS 78305
|
| Hospital Charge Code |
4210003
|
|
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
|
|
|
MULTIPLE AREA STATIC BONE
|
Facility
|
OP
|
$121.00
|
|
|
Service Code
|
HCPCS 78305 26
|
| Hospital Charge Code |
5210003
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$18.15 |
| Max. Negotiated Rate |
$96.80 |
| Rate for Payer: Aetna of NY Commercial |
$84.70
|
| Rate for Payer: Aetna of NY Medicare |
$55.66
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$48.40
|
| Rate for Payer: Cash Price |
$90.75
|
| Rate for Payer: CDPHP Medicare |
$44.77
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$96.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$96.80
|
| Rate for Payer: EmblemHealth Medicaid |
$96.80
|
| Rate for Payer: EmblemHealth Medicare |
$41.14
|
| Rate for Payer: Fidelis Medicare |
$48.40
|
| Rate for Payer: Galaxy Health Commercial |
$78.65
|
| Rate for Payer: Hamaspik Choice Medicare |
$48.40
|
| Rate for Payer: Humana Medicare |
$48.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$84.70
|
| Rate for Payer: Local 1199SEIU Medicare |
$55.66
|
| Rate for Payer: MVP Health Care of NY Commercial |
$90.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$68.12
|
| Rate for Payer: MVP Health Care of NY Medicare |
$50.82
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$18.15
|
| Rate for Payer: United Healthcare Medicare |
$48.40
|
| Rate for Payer: WellCare Medicare |
$66.55
|
|
|
MULTIVITAMIN SDV 5X10ML
|
Facility
|
IP
|
$32.70
|
|
|
Service Code
|
NDC 54643564901
|
| Hospital Charge Code |
4400388
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.98 |
| Max. Negotiated Rate |
$21.25 |
| Rate for Payer: Cash Price |
$24.52
|
| Rate for Payer: Galaxy Health Commercial |
$21.25
|
| Rate for Payer: WellCare Medicare |
$17.98
|
|
|
MULTIVITAMIN SDV 5X10ML
|
Facility
|
OP
|
$32.70
|
|
|
Service Code
|
NDC 54643564901
|
| Hospital Charge Code |
4400388
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.91 |
| Max. Negotiated Rate |
$26.16 |
| Rate for Payer: Aetna of NY Commercial |
$22.89
|
| Rate for Payer: Aetna of NY Medicare |
$15.04
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$13.08
|
| Rate for Payer: Cash Price |
$24.52
|
| Rate for Payer: CDPHP Medicare |
$12.10
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$26.16
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$26.16
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$26.16
|
| Rate for Payer: EmblemHealth Medicaid |
$26.16
|
| Rate for Payer: EmblemHealth Medicare |
$11.12
|
| Rate for Payer: EmblemHealth Select Care |
$23.54
|
| Rate for Payer: Fidelis Medicare |
$13.08
|
| Rate for Payer: Galaxy Health Commercial |
$21.25
|
| Rate for Payer: Hamaspik Choice Medicare |
$13.08
|
| Rate for Payer: Humana Medicare |
$13.08
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$22.89
|
| Rate for Payer: Local 1199SEIU Medicare |
$15.04
|
| Rate for Payer: MVP Health Care of NY Commercial |
$24.52
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$18.41
|
| Rate for Payer: MVP Health Care of NY Medicare |
$13.73
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$4.91
|
| Rate for Payer: United Healthcare Medicare |
$13.08
|
| Rate for Payer: WellCare Medicare |
$17.98
|
|
|
MULTIVIT/MINERALS TABS 10X10EA
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
NDC 904549261
|
| Hospital Charge Code |
4400754
|
|
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
|
|
|
MULTIVIT/MINERALS TABS 10X10EA
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 904549261
|
| Hospital Charge Code |
4400754
|
|
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
|
|
|
MUMPS SCREEN IGG
|
Facility
|
OP
|
$39.00
|
|
|
Service Code
|
HCPCS 86735
|
| Hospital Charge Code |
4300570
|
|
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
|
|
|
MUMPS SCREEN IGG
|
Facility
|
IP
|
$39.00
|
|
|
Service Code
|
HCPCS 86735
|
| Hospital Charge Code |
4300570
|
|
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
|
|
|
MUPIROCIN 0.02 OINT 22 GM
|
Facility
|
OP
|
$75.00
|
|
|
Service Code
|
NDC 45802011222
|
| Hospital Charge Code |
4400531
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.25 |
| Max. Negotiated Rate |
$60.00 |
| Rate for Payer: Aetna of NY Commercial |
$52.50
|
| Rate for Payer: Aetna of NY Medicare |
$34.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$30.00
|
| Rate for Payer: Cash Price |
$56.25
|
| Rate for Payer: CDPHP Medicare |
$27.75
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$60.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$60.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$60.00
|
| Rate for Payer: EmblemHealth Medicaid |
$60.00
|
| Rate for Payer: EmblemHealth Medicare |
$25.50
|
| Rate for Payer: EmblemHealth Select Care |
$54.00
|
| Rate for Payer: Fidelis Medicare |
$30.00
|
| Rate for Payer: Galaxy Health Commercial |
$48.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$30.00
|
| Rate for Payer: Humana Medicare |
$30.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$52.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$34.50
|
| Rate for Payer: MVP Health Care of NY Commercial |
$56.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$42.23
|
| Rate for Payer: MVP Health Care of NY Medicare |
$31.50
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$11.25
|
| Rate for Payer: United Healthcare Medicare |
$30.00
|
| Rate for Payer: WellCare Medicare |
$41.25
|
|
|
MUPIROCIN 0.02 OINT 22 GM
|
Facility
|
IP
|
$75.00
|
|
|
Service Code
|
NDC 45802011222
|
| Hospital Charge Code |
4400531
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$41.25 |
| Max. Negotiated Rate |
$48.75 |
| Rate for Payer: Cash Price |
$56.25
|
| Rate for Payer: Galaxy Health Commercial |
$48.75
|
| Rate for Payer: WellCare Medicare |
$41.25
|
|
|
mycophenolate 250 MG CAPSULE 250 mg, 100 eaches
|
Facility
|
OP
|
$6.00
|
|
|
Service Code
|
NDC 904707461
|
| Hospital Charge Code |
4401523
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$4.80 |
| Rate for Payer: Aetna of NY Commercial |
$4.20
|
| Rate for Payer: Aetna of NY Medicare |
$2.76
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2.40
|
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: CDPHP Medicare |
$2.22
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$4.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$4.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$4.80
|
| Rate for Payer: EmblemHealth Medicaid |
$4.80
|
| Rate for Payer: EmblemHealth Medicare |
$2.04
|
| Rate for Payer: EmblemHealth Select Care |
$4.32
|
| Rate for Payer: Fidelis Medicare |
$2.40
|
| Rate for Payer: Galaxy Health Commercial |
$3.90
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.40
|
| Rate for Payer: Humana Medicare |
$2.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$4.20
|
| Rate for Payer: Local 1199SEIU Medicare |
$2.76
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3.38
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2.52
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$0.90
|
| Rate for Payer: United Healthcare Medicare |
$2.40
|
| Rate for Payer: WellCare Medicare |
$3.30
|
|
|
mycophenolate 250 MG CAPSULE 250 mg, 100 eaches
|
Facility
|
IP
|
$6.00
|
|
|
Service Code
|
NDC 904707461
|
| Hospital Charge Code |
4401523
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.30 |
| Max. Negotiated Rate |
$3.90 |
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: Galaxy Health Commercial |
$3.90
|
| Rate for Payer: WellCare Medicare |
$3.30
|
|
|
MYCOPLASMA PNEUMONIA AB
|
Facility
|
OP
|
$40.00
|
|
|
Service Code
|
HCPCS 86738
|
| Hospital Charge Code |
4300573
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$32.00 |
| Rate for Payer: Aetna of NY Commercial |
$26.00
|
| Rate for Payer: Aetna of NY Medicare |
$18.40
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$16.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: CDPHP Medicare |
$14.80
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$24.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$32.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$32.00
|
| Rate for Payer: EmblemHealth Medicaid |
$32.00
|
| Rate for Payer: EmblemHealth Medicare |
$13.60
|
| Rate for Payer: EmblemHealth Select Care |
$24.00
|
| Rate for Payer: Fidelis Medicare |
$16.00
|
| Rate for Payer: Galaxy Health Commercial |
$26.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$16.00
|
| Rate for Payer: Humana Medicare |
$16.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$26.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$18.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$30.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$22.52
|
| Rate for Payer: MVP Health Care of NY Medicare |
$16.80
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$30.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$6.00
|
| Rate for Payer: United Healthcare Commercial |
$30.00
|
| Rate for Payer: United Healthcare Medicare |
$16.00
|
| Rate for Payer: WellCare Medicare |
$22.00
|
|
