|
FAMOTIDINE 10MG/ML SDPF 25X2ML
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
4400284
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.10 |
| Max. Negotiated Rate |
$4.97 |
| Rate for Payer: Aetna of NY Commercial |
$3.40
|
| Rate for Payer: Aetna of NY Medicare |
$2.84
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$2.78
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$2.78
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2.29
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$3.09
|
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: CDPHP Commercial |
$4.97
|
| 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 |
$2.36
|
| Rate for Payer: Galaxy Health Commercial |
$4.02
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.29
|
| Rate for Payer: Humana Medicare |
$2.29
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$3.40
|
| Rate for Payer: Local 1199SEIU Medicare |
$2.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4.64
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3.48
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2.40
|
| Rate for Payer: United Healthcare Medicare |
$2.29
|
| Rate for Payer: WellCare Medicare |
$3.40
|
|
|
FAMOTIDINE 20MG TABS 100 EA
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 00172572860
|
| Hospital Charge Code |
4400285
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.10 |
| Max. Negotiated Rate |
$4.97 |
| 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) Blue Access/Small Group |
$4.64
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$4.64
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2.29
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$3.09
|
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: CDPHP Commercial |
$4.97
|
| 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 |
$2.36
|
| Rate for Payer: Galaxy Health Commercial |
$4.02
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.29
|
| Rate for Payer: Humana Medicare |
$2.29
|
| 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 |
$4.64
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3.48
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2.40
|
| Rate for Payer: United Healthcare Medicare |
$2.29
|
| Rate for Payer: WellCare Medicare |
$3.40
|
|
|
FAMOTIDINE 20MG TABS 100 EA
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
NDC 00172572860
|
| Hospital Charge Code |
4400285
|
|
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
|
|
|
FASCIECTOMY, PLANTAR FASCIA; PARTIAL (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$3,084.03
|
|
|
Service Code
|
CPT 28060
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$1,266.00 |
| Max. Negotiated Rate |
$3,084.03 |
| Rate for Payer: Aetna of NY Commercial |
$1,857.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$2,017.33
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$2,521.93
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$1,266.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,857.00
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,775.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$3,084.03
|
| Rate for Payer: United Healthcare Commercial |
$2,036.00
|
|
|
FEMORAL VENA CAVA FILTER
|
Facility
|
OP
|
$5,540.00
|
|
| Hospital Charge Code |
4471879
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,883.60 |
| Max. Negotiated Rate |
$4,459.70 |
| Rate for Payer: Aetna of NY Commercial |
$3,878.00
|
| Rate for Payer: Aetna of NY Medicare |
$2,548.40
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$4,155.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$4,155.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2,049.80
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$2,770.00
|
| Rate for Payer: Cash Price |
$4,155.00
|
| Rate for Payer: CDPHP Commercial |
$4,459.70
|
| Rate for Payer: CDPHP Medicare |
$2,049.80
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$4,432.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$4,432.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$4,432.00
|
| Rate for Payer: EmblemHealth Medicaid |
$4,432.00
|
| Rate for Payer: EmblemHealth Medicare |
$1,883.60
|
| Rate for Payer: EmblemHealth Select Care |
$3,988.80
|
| Rate for Payer: Fidelis Medicare |
$2,111.29
|
| Rate for Payer: Galaxy Health Commercial |
$3,601.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$2,049.80
|
| Rate for Payer: Humana Medicare |
$2,049.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$3,878.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$2,548.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4,155.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3,119.02
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2,152.29
|
| Rate for Payer: United Healthcare Medicare |
$2,049.80
|
| Rate for Payer: WellCare Medicare |
$3,047.00
|
|
|
FEMORAL VENA CAVA FILTER
|
Facility
|
IP
|
$5,540.00
|
|
| Hospital Charge Code |
4471879
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3,601.00 |
| Max. Negotiated Rate |
$3,601.00 |
| Rate for Payer: Cash Price |
$4,155.00
|
| Rate for Payer: Galaxy Health Commercial |
$3,601.00
|
|
|
FENOFIBRATE 48 MG TABLET 1 ea, 1 each
|
Facility
|
IP
|
$6.00
|
|
|
Service Code
|
NDC 68084063511
|
| Hospital Charge Code |
4401457
|
|
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
|
|
|
FENOFIBRATE 48 MG TABLET 1 ea, 1 each
|
Facility
|
OP
|
$6.00
|
|
|
Service Code
|
NDC 68084063511
|
| Hospital Charge Code |
4401457
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.04 |
| Max. Negotiated Rate |
$4.83 |
| 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) Blue Access/Small Group |
$4.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$4.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2.22
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$3.00
|
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: CDPHP Commercial |
$4.83
|
| 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 |
$2.29
|
| Rate for Payer: Galaxy Health Commercial |
$3.90
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.22
|
| Rate for Payer: Humana Medicare |
$2.22
|
| 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 |
$2.33
|
| Rate for Payer: United Healthcare Medicare |
$2.22
|
| Rate for Payer: WellCare Medicare |
$3.30
|
|
|
FENTANYL 100MCG/HR PTCH 5 EA
|
Facility
|
OP
|
$190.55
|
|
|
Service Code
|
NDC 60505700902
|
| Hospital Charge Code |
4400286
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$64.79 |
| Max. Negotiated Rate |
$153.39 |
| Rate for Payer: Aetna of NY Commercial |
$133.38
|
| Rate for Payer: Aetna of NY Medicare |
$87.65
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$142.91
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$142.91
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$70.50
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$95.28
|
| Rate for Payer: Cash Price |
$142.91
|
| Rate for Payer: CDPHP Commercial |
$153.39
|
| Rate for Payer: CDPHP Medicare |
$70.50
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$152.44
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$152.44
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$152.44
|
| Rate for Payer: EmblemHealth Medicaid |
$152.44
|
| Rate for Payer: EmblemHealth Medicare |
$64.79
|
| Rate for Payer: EmblemHealth Select Care |
$137.20
|
| Rate for Payer: Fidelis Medicare |
$72.62
|
| Rate for Payer: Galaxy Health Commercial |
$123.86
|
| Rate for Payer: Hamaspik Choice Medicare |
$70.50
|
| Rate for Payer: Humana Medicare |
$70.50
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$133.38
|
| Rate for Payer: Local 1199SEIU Medicare |
$87.65
|
| Rate for Payer: MVP Health Care of NY Commercial |
$142.91
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$107.28
|
| Rate for Payer: MVP Health Care of NY Medicare |
$74.03
|
| Rate for Payer: United Healthcare Medicare |
$70.50
|
| Rate for Payer: WellCare Medicare |
$104.80
|
|
|
FENTANYL 100MCG/HR PTCH 5 EA
|
Facility
|
IP
|
$190.55
|
|
|
Service Code
|
NDC 60505700902
|
| Hospital Charge Code |
4400286
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$104.80 |
| Max. Negotiated Rate |
$123.86 |
| Rate for Payer: Cash Price |
$142.91
|
| Rate for Payer: Galaxy Health Commercial |
$123.86
|
| Rate for Payer: WellCare Medicare |
$104.80
|
|
|
FENTANYL 25MCG/HR PTCH 5 EA
|
Facility
|
IP
|
$51.50
|
|
|
Service Code
|
NDC 60505700602
|
| Hospital Charge Code |
4400287
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$28.32 |
| Max. Negotiated Rate |
$33.48 |
| Rate for Payer: Cash Price |
$38.63
|
| Rate for Payer: Galaxy Health Commercial |
$33.48
|
| Rate for Payer: WellCare Medicare |
$28.32
|
|
|
FENTANYL 25MCG/HR PTCH 5 EA
|
Facility
|
OP
|
$51.50
|
|
|
Service Code
|
NDC 60505700602
|
| Hospital Charge Code |
4400287
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.51 |
| Max. Negotiated Rate |
$41.46 |
| Rate for Payer: Aetna of NY Commercial |
$36.05
|
| Rate for Payer: Aetna of NY Medicare |
$23.69
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$38.62
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$38.62
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$19.06
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$25.75
|
| Rate for Payer: Cash Price |
$38.63
|
| Rate for Payer: CDPHP Commercial |
$41.46
|
| Rate for Payer: CDPHP Medicare |
$19.06
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$41.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$41.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$41.20
|
| Rate for Payer: EmblemHealth Medicaid |
$41.20
|
| Rate for Payer: EmblemHealth Medicare |
$17.51
|
| Rate for Payer: EmblemHealth Select Care |
$37.08
|
| Rate for Payer: Fidelis Medicare |
$19.63
|
| Rate for Payer: Galaxy Health Commercial |
$33.48
|
| Rate for Payer: Hamaspik Choice Medicare |
$19.06
|
| Rate for Payer: Humana Medicare |
$19.06
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$36.05
|
| Rate for Payer: Local 1199SEIU Medicare |
$23.69
|
| Rate for Payer: MVP Health Care of NY Commercial |
$38.62
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$28.99
|
| Rate for Payer: MVP Health Care of NY Medicare |
$20.01
|
| Rate for Payer: United Healthcare Medicare |
$19.06
|
| Rate for Payer: WellCare Medicare |
$28.32
|
|
|
FENTANYL 50MCG/HR PTCH 5 EA
|
Facility
|
OP
|
$81.37
|
|
|
Service Code
|
NDC 00378912298
|
| Hospital Charge Code |
4400288
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$27.67 |
| Max. Negotiated Rate |
$65.50 |
| Rate for Payer: Aetna of NY Commercial |
$56.96
|
| Rate for Payer: Aetna of NY Medicare |
$37.43
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$61.03
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$61.03
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$30.11
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$40.68
|
| Rate for Payer: Cash Price |
$61.03
|
| Rate for Payer: CDPHP Commercial |
$65.50
|
| Rate for Payer: CDPHP Medicare |
$30.11
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$65.10
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$65.10
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$65.10
|
| Rate for Payer: EmblemHealth Medicaid |
$65.10
|
| Rate for Payer: EmblemHealth Medicare |
$27.67
|
| Rate for Payer: EmblemHealth Select Care |
$58.59
|
| Rate for Payer: Fidelis Medicare |
$31.01
|
| Rate for Payer: Galaxy Health Commercial |
$52.89
|
| Rate for Payer: Hamaspik Choice Medicare |
$30.11
|
| Rate for Payer: Humana Medicare |
$30.11
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$56.96
|
| Rate for Payer: Local 1199SEIU Medicare |
$37.43
|
| Rate for Payer: MVP Health Care of NY Commercial |
$61.03
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$45.81
|
| Rate for Payer: MVP Health Care of NY Medicare |
$31.61
|
| Rate for Payer: United Healthcare Medicare |
$30.11
|
| Rate for Payer: WellCare Medicare |
$44.75
|
|
|
FENTANYL 50MCG/HR PTCH 5 EA
|
Facility
|
IP
|
$81.37
|
|
|
Service Code
|
NDC 00378912298
|
| Hospital Charge Code |
4400288
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$44.75 |
| Max. Negotiated Rate |
$52.89 |
| Rate for Payer: Cash Price |
$61.03
|
| Rate for Payer: Galaxy Health Commercial |
$52.89
|
| Rate for Payer: WellCare Medicare |
$44.75
|
|
|
FENTANYL CITRATE INJ 0.05 MG
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
HCPCS J3010
|
| Hospital Charge Code |
4400289
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.99 |
| Max. Negotiated Rate |
$4.02 |
| Rate for Payer: Aetna of NY Commercial |
$3.40
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$0.99
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$0.99
|
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.99
|
| Rate for Payer: EmblemHealth Select Care |
$0.99
|
| 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
|
|
|
FENTANYL CITRATE INJ 0.05 MG
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
HCPCS J3010
|
| Hospital Charge Code |
4400289
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.99 |
| Max. Negotiated Rate |
$4.97 |
| Rate for Payer: Aetna of NY Commercial |
$3.40
|
| Rate for Payer: Aetna of NY Medicare |
$2.84
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$0.99
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$0.99
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2.29
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$3.09
|
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: CDPHP Commercial |
$4.97
|
| Rate for Payer: CDPHP Medicare |
$2.29
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.99
|
| 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 |
$0.99
|
| Rate for Payer: Fidelis Medicare |
$2.36
|
| Rate for Payer: Galaxy Health Commercial |
$4.02
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.29
|
| Rate for Payer: Humana Medicare |
$2.29
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$3.40
|
| Rate for Payer: Local 1199SEIU Medicare |
$2.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4.64
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3.48
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2.40
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1.39
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$0.99
|
| Rate for Payer: United Healthcare Commercial |
$1.39
|
| Rate for Payer: United Healthcare Medicare |
$2.29
|
| Rate for Payer: WellCare Medicare |
$3.40
|
|
|
FENTANYL PATCH
|
Facility
|
OP
|
$60.91
|
|
|
Service Code
|
NDC 00378911998
|
| Hospital Charge Code |
4401625
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$20.71 |
| Max. Negotiated Rate |
$49.03 |
| Rate for Payer: Aetna of NY Commercial |
$42.64
|
| Rate for Payer: Aetna of NY Medicare |
$28.02
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$45.68
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$45.68
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$22.54
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$30.46
|
| Rate for Payer: Cash Price |
$45.68
|
| Rate for Payer: CDPHP Commercial |
$49.03
|
| Rate for Payer: CDPHP Medicare |
$22.54
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$48.73
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$48.73
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$48.73
|
| Rate for Payer: EmblemHealth Medicaid |
$48.73
|
| Rate for Payer: EmblemHealth Medicare |
$20.71
|
| Rate for Payer: EmblemHealth Select Care |
$43.86
|
| Rate for Payer: Fidelis Medicare |
$23.21
|
| Rate for Payer: Galaxy Health Commercial |
$39.59
|
| Rate for Payer: Hamaspik Choice Medicare |
$22.54
|
| Rate for Payer: Humana Medicare |
$22.54
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$42.64
|
| Rate for Payer: Local 1199SEIU Medicare |
$28.02
|
| Rate for Payer: MVP Health Care of NY Commercial |
$45.68
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$34.29
|
| Rate for Payer: MVP Health Care of NY Medicare |
$23.66
|
| Rate for Payer: United Healthcare Medicare |
$22.54
|
| Rate for Payer: WellCare Medicare |
$33.50
|
|
|
FENTANYL PATCH
|
Facility
|
IP
|
$60.91
|
|
|
Service Code
|
NDC 00378911998
|
| Hospital Charge Code |
4401625
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$33.50 |
| Max. Negotiated Rate |
$39.59 |
| Rate for Payer: Cash Price |
$45.68
|
| Rate for Payer: Galaxy Health Commercial |
$39.59
|
| Rate for Payer: WellCare Medicare |
$33.50
|
|
|
FENTANYL PATCH 75 MCG/HR
|
Facility
|
IP
|
$143.69
|
|
|
Service Code
|
NDC 60505700802
|
| Hospital Charge Code |
4408955
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$79.03 |
| Max. Negotiated Rate |
$93.40 |
| Rate for Payer: Cash Price |
$107.77
|
| Rate for Payer: Galaxy Health Commercial |
$93.40
|
| Rate for Payer: WellCare Medicare |
$79.03
|
|
|
FENTANYL PATCH 75 MCG/HR
|
Facility
|
OP
|
$143.69
|
|
|
Service Code
|
NDC 60505700802
|
| Hospital Charge Code |
4408955
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$48.85 |
| Max. Negotiated Rate |
$115.67 |
| Rate for Payer: Aetna of NY Commercial |
$100.58
|
| Rate for Payer: Aetna of NY Medicare |
$66.10
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$107.77
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$107.77
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$53.17
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$71.84
|
| Rate for Payer: Cash Price |
$107.77
|
| Rate for Payer: CDPHP Commercial |
$115.67
|
| Rate for Payer: CDPHP Medicare |
$53.17
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$114.95
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$114.95
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$114.95
|
| Rate for Payer: EmblemHealth Medicaid |
$114.95
|
| Rate for Payer: EmblemHealth Medicare |
$48.85
|
| Rate for Payer: EmblemHealth Select Care |
$103.46
|
| Rate for Payer: Fidelis Medicare |
$54.76
|
| Rate for Payer: Galaxy Health Commercial |
$93.40
|
| Rate for Payer: Hamaspik Choice Medicare |
$53.17
|
| Rate for Payer: Humana Medicare |
$53.17
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$100.58
|
| Rate for Payer: Local 1199SEIU Medicare |
$66.10
|
| Rate for Payer: MVP Health Care of NY Commercial |
$107.77
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$80.90
|
| Rate for Payer: MVP Health Care of NY Medicare |
$55.82
|
| Rate for Payer: United Healthcare Medicare |
$53.17
|
| Rate for Payer: WellCare Medicare |
$79.03
|
|
|
FERAHEME 510 MG/17 ML VIAL 510 mg, 17 mL
|
Facility
|
OP
|
$7.50
|
|
|
Service Code
|
HCPCS Q0138
|
| Hospital Charge Code |
4401919
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.39 |
| Max. Negotiated Rate |
$90.00 |
| Rate for Payer: Aetna of NY Commercial |
$4.12
|
| Rate for Payer: Aetna of NY Medicare |
$3.45
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$0.39
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$0.39
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$2.02
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$0.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2.78
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$3.75
|
| Rate for Payer: Cash Price |
$5.63
|
| Rate for Payer: Cash Price |
$5.63
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$0.90
|
| Rate for Payer: CDPHP Commercial |
$6.04
|
| Rate for Payer: CDPHP Essential Plan |
$2.02
|
| Rate for Payer: CDPHP Medicare |
$2.78
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.39
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1.08
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$0.90
|
| Rate for Payer: EmblemHealth Medicaid |
$0.90
|
| Rate for Payer: EmblemHealth Medicare |
$2.55
|
| Rate for Payer: EmblemHealth Select Care |
$0.39
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$2.02
|
| Rate for Payer: Fidelis Medicare |
$2.86
|
| Rate for Payer: Galaxy Health Commercial |
$4.88
|
| Rate for Payer: Galaxy Health Workers Comp |
$1.32
|
| Rate for Payer: Hamaspik Choice Medicaid |
$90.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.78
|
| Rate for Payer: Humana Medicare |
$2.78
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$4.12
|
| Rate for Payer: Local 1199SEIU Medicare |
$3.45
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$90.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$5.62
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$1.94
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$1.94
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$4.22
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2.91
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$0.83
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$0.90
|
| Rate for Payer: United Healthcare Commercial |
$0.83
|
| Rate for Payer: United Healthcare Medicare |
$2.78
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$0.95
|
| Rate for Payer: WellCare Medicare |
$4.12
|
|
|
FERAHEME 510 MG/17 ML VIAL 510 mg, 17 mL
|
Facility
|
IP
|
$7.50
|
|
|
Service Code
|
HCPCS Q0138
|
| Hospital Charge Code |
4401919
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.39 |
| Max. Negotiated Rate |
$4.88 |
| Rate for Payer: Aetna of NY Commercial |
$4.12
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$0.39
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$0.39
|
| Rate for Payer: Cash Price |
$5.63
|
| Rate for Payer: Cash Price |
$5.63
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.39
|
| Rate for Payer: EmblemHealth Select Care |
$0.39
|
| Rate for Payer: Galaxy Health Commercial |
$4.88
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$4.12
|
| Rate for Payer: WellCare Medicare |
$4.12
|
|
|
FERRITIN
|
Facility
|
IP
|
$52.00
|
|
|
Service Code
|
HCPCS 82728
|
| Hospital Charge Code |
4300349
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$33.80 |
| Max. Negotiated Rate |
$33.80 |
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Galaxy Health Commercial |
$33.80
|
|
|
FERRITIN
|
Facility
|
OP
|
$52.00
|
|
|
Service Code
|
HCPCS 82728
|
| Hospital Charge Code |
4300349
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.63 |
| Max. Negotiated Rate |
$41.86 |
| Rate for Payer: Aetna of NY Commercial |
$33.80
|
| Rate for Payer: Aetna of NY Medicare |
$23.92
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$39.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$39.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$19.24
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$26.00
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: CDPHP Commercial |
$41.86
|
| Rate for Payer: CDPHP Medicare |
$19.24
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$31.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$41.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$41.60
|
| Rate for Payer: EmblemHealth Medicaid |
$41.60
|
| Rate for Payer: EmblemHealth Medicare |
$17.68
|
| Rate for Payer: EmblemHealth Select Care |
$31.20
|
| Rate for Payer: Fidelis Medicare |
$19.82
|
| Rate for Payer: Galaxy Health Commercial |
$33.80
|
| Rate for Payer: Hamaspik Choice Medicare |
$19.24
|
| Rate for Payer: Humana Medicare |
$19.24
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$33.80
|
| Rate for Payer: Local 1199SEIU Medicare |
$23.92
|
| Rate for Payer: MVP Health Care of NY Commercial |
$39.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$29.28
|
| Rate for Payer: MVP Health Care of NY Medicare |
$20.20
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$39.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$13.63
|
| Rate for Payer: United Healthcare Commercial |
$39.00
|
| Rate for Payer: United Healthcare Medicare |
$19.24
|
| Rate for Payer: WellCare Medicare |
$28.60
|
|
|
FERRLECIT INJ 12.5 MG
|
Facility
|
IP
|
$23.59
|
|
|
Service Code
|
HCPCS J2916
|
| Hospital Charge Code |
4409235
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.18 |
| Max. Negotiated Rate |
$15.33 |
| Rate for Payer: Aetna of NY Commercial |
$12.97
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$2.18
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$2.18
|
| Rate for Payer: Cash Price |
$17.69
|
| Rate for Payer: Cash Price |
$17.69
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$2.18
|
| Rate for Payer: EmblemHealth Select Care |
$2.18
|
| Rate for Payer: Galaxy Health Commercial |
$15.33
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$12.97
|
| Rate for Payer: WellCare Medicare |
$12.97
|
|
