|
FLEET PEDIA-LAX SUPPOSITORIES 1 ea, 4 mL
|
Facility
|
IP
|
$6.00
|
|
|
Service Code
|
NDC 132019012
|
| Hospital Charge Code |
4401400
|
|
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
|
|
|
FLEET PEDIA-LAX SUPPOSITORIES 1 ea, 4 mL
|
Facility
|
OP
|
$6.00
|
|
|
Service Code
|
NDC 132019012
|
| Hospital Charge Code |
4401400
|
|
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
|
|
|
FLEXBUMIN 25% IV SOLUTION 100 mL, 100 mL
|
Facility
|
OP
|
$210.00
|
|
|
Service Code
|
HCPCS P9047
|
| Hospital Charge Code |
4401395
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$31.50 |
| Max. Negotiated Rate |
$168.00 |
| Rate for Payer: Aetna of NY Medicare |
$96.60
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$84.00
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: CDPHP Medicare |
$77.70
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$53.08
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$168.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$168.00
|
| Rate for Payer: EmblemHealth Medicaid |
$168.00
|
| Rate for Payer: EmblemHealth Medicare |
$71.40
|
| Rate for Payer: EmblemHealth Select Care |
$53.08
|
| Rate for Payer: Fidelis Medicare |
$84.00
|
| Rate for Payer: Galaxy Health Commercial |
$136.50
|
| Rate for Payer: Hamaspik Choice Medicare |
$84.00
|
| Rate for Payer: Humana Medicare |
$84.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$96.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$157.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$118.23
|
| Rate for Payer: MVP Health Care of NY Medicare |
$88.20
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$87.58
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$31.50
|
| Rate for Payer: United Healthcare Commercial |
$87.58
|
| Rate for Payer: United Healthcare Medicare |
$84.00
|
| Rate for Payer: WellCare Medicare |
$115.50
|
|
|
FLEXBUMIN 25% IV SOLUTION 100 mL, 100 mL
|
Facility
|
IP
|
$210.00
|
|
|
Service Code
|
HCPCS P9047
|
| Hospital Charge Code |
4401395
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$53.08 |
| Max. Negotiated Rate |
$136.50 |
| Rate for Payer: Aetna of NY Commercial |
$115.50
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$53.08
|
| Rate for Payer: EmblemHealth Select Care |
$53.08
|
| Rate for Payer: Galaxy Health Commercial |
$136.50
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.50
|
| Rate for Payer: WellCare Medicare |
$115.50
|
|
|
FLOWMTR PEAK ASTHMA
|
Facility
|
OP
|
$42.23
|
|
| Hospital Charge Code |
4471018
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$6.33 |
| Max. Negotiated Rate |
$33.78 |
| Rate for Payer: Aetna of NY Commercial |
$29.56
|
| Rate for Payer: Aetna of NY Medicare |
$19.43
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$16.89
|
| Rate for Payer: Cash Price |
$31.67
|
| Rate for Payer: CDPHP Medicare |
$15.63
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$33.78
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$33.78
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$33.78
|
| Rate for Payer: EmblemHealth Medicaid |
$33.78
|
| Rate for Payer: EmblemHealth Medicare |
$14.36
|
| Rate for Payer: EmblemHealth Select Care |
$30.41
|
| Rate for Payer: Fidelis Medicare |
$16.89
|
| Rate for Payer: Galaxy Health Commercial |
$27.45
|
| Rate for Payer: Hamaspik Choice Medicare |
$16.89
|
| Rate for Payer: Humana Medicare |
$16.89
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$29.56
|
| Rate for Payer: Local 1199SEIU Medicare |
$19.43
|
| Rate for Payer: MVP Health Care of NY Commercial |
$31.67
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$23.78
|
| Rate for Payer: MVP Health Care of NY Medicare |
$17.74
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$6.33
|
| Rate for Payer: United Healthcare Medicare |
$16.89
|
| Rate for Payer: WellCare Medicare |
$23.23
|
|
|
FLOWMTR PEAK ASTHMA
|
Facility
|
IP
|
$42.23
|
|
| Hospital Charge Code |
4471018
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$27.45 |
| Max. Negotiated Rate |
$27.45 |
| Rate for Payer: Cash Price |
$31.67
|
| Rate for Payer: Galaxy Health Commercial |
$27.45
|
|
|
FLUARIX QUAD 2022-2023 SYRINGE 1 ea, 0.5 mL
|
Facility
|
IP
|
$62.00
|
|
|
Service Code
|
HCPCS 90686
|
| Hospital Charge Code |
4401453
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$34.10 |
| Max. Negotiated Rate |
$40.30 |
| Rate for Payer: Aetna of NY Commercial |
$34.10
|
| Rate for Payer: Cash Price |
$46.50
|
| Rate for Payer: Galaxy Health Commercial |
$40.30
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$34.10
|
| Rate for Payer: WellCare Medicare |
$34.10
|
|
|
FLUARIX QUAD 2022-2023 SYRINGE 1 ea, 0.5 mL
|
Facility
|
OP
|
$62.00
|
|
|
Service Code
|
HCPCS 90686
|
| Hospital Charge Code |
4401453
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.30 |
| Max. Negotiated Rate |
$49.60 |
| Rate for Payer: Aetna of NY Commercial |
$34.10
|
| Rate for Payer: Aetna of NY Medicare |
$28.52
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$24.80
|
| Rate for Payer: Cash Price |
$46.50
|
| Rate for Payer: Cash Price |
$46.50
|
| Rate for Payer: CDPHP Medicare |
$22.94
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$49.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$49.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$49.60
|
| Rate for Payer: EmblemHealth Medicaid |
$49.60
|
| Rate for Payer: EmblemHealth Medicare |
$21.08
|
| Rate for Payer: EmblemHealth Select Care |
$44.64
|
| Rate for Payer: Fidelis Medicare |
$24.80
|
| Rate for Payer: Galaxy Health Commercial |
$40.30
|
| Rate for Payer: Hamaspik Choice Medicare |
$24.80
|
| Rate for Payer: Humana Medicare |
$24.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$34.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$28.52
|
| Rate for Payer: MVP Health Care of NY Commercial |
$46.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$34.91
|
| Rate for Payer: MVP Health Care of NY Medicare |
$26.04
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$35.51
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$9.30
|
| Rate for Payer: United Healthcare Commercial |
$35.51
|
| Rate for Payer: United Healthcare Medicare |
$24.80
|
| Rate for Payer: WellCare Medicare |
$34.10
|
|
|
FLUARIX QUADRIVALENT FLU VACCINE 17-18
|
Facility
|
OP
|
$51.50
|
|
|
Service Code
|
HCPCS 90686
|
| Hospital Charge Code |
4400847
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.72 |
| Max. Negotiated Rate |
$41.20 |
| Rate for Payer: Aetna of NY Commercial |
$28.32
|
| Rate for Payer: Aetna of NY Medicare |
$23.69
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$20.60
|
| Rate for Payer: Cash Price |
$38.62
|
| Rate for Payer: Cash Price |
$38.62
|
| Rate for Payer: CDPHP Medicare |
$19.05
|
| 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 |
$20.60
|
| Rate for Payer: Galaxy Health Commercial |
$33.48
|
| Rate for Payer: Hamaspik Choice Medicare |
$20.60
|
| Rate for Payer: Humana Medicare |
$20.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$28.32
|
| 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 |
$21.63
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$35.51
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$7.72
|
| Rate for Payer: United Healthcare Commercial |
$35.51
|
| Rate for Payer: United Healthcare Medicare |
$20.60
|
| Rate for Payer: WellCare Medicare |
$28.32
|
|
|
FLUARIX QUADRIVALENT FLU VACCINE 17-18
|
Facility
|
IP
|
$51.50
|
|
|
Service Code
|
HCPCS 90686
|
| Hospital Charge Code |
4400847
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$28.32 |
| Max. Negotiated Rate |
$33.48 |
| Rate for Payer: Aetna of NY Commercial |
$28.32
|
| Rate for Payer: Cash Price |
$38.62
|
| Rate for Payer: Galaxy Health Commercial |
$33.48
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$28.32
|
| Rate for Payer: WellCare Medicare |
$28.32
|
|
|
FLUCONAZOLE 100 MG TABLET 100 mg, 100 eaches
|
Facility
|
OP
|
$29.00
|
|
|
Service Code
|
NDC 904650061
|
| Hospital Charge Code |
4401431
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.35 |
| Max. Negotiated Rate |
$23.20 |
| Rate for Payer: Aetna of NY Commercial |
$20.30
|
| Rate for Payer: Aetna of NY Medicare |
$13.34
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$11.60
|
| Rate for Payer: Cash Price |
$21.75
|
| Rate for Payer: CDPHP Medicare |
$10.73
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$23.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$23.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$23.20
|
| Rate for Payer: EmblemHealth Medicaid |
$23.20
|
| Rate for Payer: EmblemHealth Medicare |
$9.86
|
| Rate for Payer: EmblemHealth Select Care |
$20.88
|
| Rate for Payer: Fidelis Medicare |
$11.60
|
| Rate for Payer: Galaxy Health Commercial |
$18.85
|
| Rate for Payer: Hamaspik Choice Medicare |
$11.60
|
| Rate for Payer: Humana Medicare |
$11.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$20.30
|
| Rate for Payer: Local 1199SEIU Medicare |
$13.34
|
| Rate for Payer: MVP Health Care of NY Commercial |
$21.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$16.33
|
| Rate for Payer: MVP Health Care of NY Medicare |
$12.18
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$4.35
|
| Rate for Payer: United Healthcare Medicare |
$11.60
|
| Rate for Payer: WellCare Medicare |
$15.95
|
|
|
FLUCONAZOLE 100 MG TABLET 100 mg, 100 eaches
|
Facility
|
IP
|
$29.00
|
|
|
Service Code
|
NDC 904650061
|
| Hospital Charge Code |
4401431
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.95 |
| Max. Negotiated Rate |
$18.85 |
| Rate for Payer: Cash Price |
$21.75
|
| Rate for Payer: Galaxy Health Commercial |
$18.85
|
| Rate for Payer: WellCare Medicare |
$15.95
|
|
|
FLUCONAZOLE 150MG TABS 12X1EA
|
Facility
|
IP
|
$43.26
|
|
|
Service Code
|
NDC 172541279
|
| Hospital Charge Code |
4400301
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$23.79 |
| Max. Negotiated Rate |
$28.12 |
| Rate for Payer: Cash Price |
$32.44
|
| Rate for Payer: Galaxy Health Commercial |
$28.12
|
| Rate for Payer: WellCare Medicare |
$23.79
|
|
|
FLUCONAZOLE 150MG TABS 12X1EA
|
Facility
|
OP
|
$43.26
|
|
|
Service Code
|
NDC 172541279
|
| Hospital Charge Code |
4400301
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.49 |
| Max. Negotiated Rate |
$34.61 |
| Rate for Payer: Aetna of NY Commercial |
$30.28
|
| Rate for Payer: Aetna of NY Medicare |
$19.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$17.30
|
| Rate for Payer: Cash Price |
$32.44
|
| Rate for Payer: CDPHP Medicare |
$16.01
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$34.61
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$34.61
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$34.61
|
| Rate for Payer: EmblemHealth Medicaid |
$34.61
|
| Rate for Payer: EmblemHealth Medicare |
$14.71
|
| Rate for Payer: EmblemHealth Select Care |
$31.15
|
| Rate for Payer: Fidelis Medicare |
$17.30
|
| Rate for Payer: Galaxy Health Commercial |
$28.12
|
| Rate for Payer: Hamaspik Choice Medicare |
$17.30
|
| Rate for Payer: Humana Medicare |
$17.30
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$30.28
|
| Rate for Payer: Local 1199SEIU Medicare |
$19.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$32.45
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$24.36
|
| Rate for Payer: MVP Health Care of NY Medicare |
$18.17
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$6.49
|
| Rate for Payer: United Healthcare Medicare |
$17.30
|
| Rate for Payer: WellCare Medicare |
$23.79
|
|
|
FLUCONAZOLE, 200 MG
|
Facility
|
IP
|
$1.80
|
|
|
Service Code
|
HCPCS J1450
|
| Hospital Charge Code |
4450006
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.99 |
| Max. Negotiated Rate |
$3.87 |
| Rate for Payer: Aetna of NY Commercial |
$0.99
|
| Rate for Payer: Cash Price |
$1.35
|
| Rate for Payer: Cash Price |
$1.35
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$3.87
|
| Rate for Payer: EmblemHealth Select Care |
$3.87
|
| Rate for Payer: Galaxy Health Commercial |
$1.17
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$0.99
|
| Rate for Payer: WellCare Medicare |
$0.99
|
|
|
FLUCONAZOLE, 200 MG
|
Facility
|
OP
|
$1.80
|
|
|
Service Code
|
HCPCS J1450
|
| Hospital Charge Code |
4450006
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.27 |
| Max. Negotiated Rate |
$4.42 |
| Rate for Payer: Aetna of NY Medicare |
$0.83
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$0.72
|
| Rate for Payer: Cash Price |
$1.35
|
| Rate for Payer: Cash Price |
$1.35
|
| Rate for Payer: CDPHP Medicare |
$0.67
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$3.87
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1.44
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1.44
|
| Rate for Payer: EmblemHealth Medicaid |
$1.44
|
| Rate for Payer: EmblemHealth Medicare |
$0.61
|
| Rate for Payer: EmblemHealth Select Care |
$3.87
|
| Rate for Payer: Fidelis Medicare |
$0.72
|
| Rate for Payer: Galaxy Health Commercial |
$1.17
|
| Rate for Payer: Hamaspik Choice Medicare |
$0.72
|
| Rate for Payer: Humana Medicare |
$0.72
|
| Rate for Payer: Local 1199SEIU Medicare |
$0.83
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1.35
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1.01
|
| Rate for Payer: MVP Health Care of NY Medicare |
$0.76
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$4.42
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$0.27
|
| Rate for Payer: United Healthcare Commercial |
$4.42
|
| Rate for Payer: United Healthcare Medicare |
$0.72
|
| Rate for Payer: WellCare Medicare |
$0.99
|
|
|
FLUCONAZOLE INJ, 200 MG
|
Facility
|
OP
|
$3.71
|
|
|
Service Code
|
HCPCS J1450
|
| Hospital Charge Code |
4450005
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.56 |
| Max. Negotiated Rate |
$4.42 |
| Rate for Payer: Aetna of NY Medicare |
$1.71
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1.48
|
| Rate for Payer: Cash Price |
$2.78
|
| Rate for Payer: Cash Price |
$2.78
|
| Rate for Payer: CDPHP Medicare |
$1.37
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$3.87
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2.97
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$2.97
|
| Rate for Payer: EmblemHealth Medicaid |
$2.97
|
| Rate for Payer: EmblemHealth Medicare |
$1.26
|
| Rate for Payer: EmblemHealth Select Care |
$3.87
|
| Rate for Payer: Fidelis Medicare |
$1.48
|
| Rate for Payer: Galaxy Health Commercial |
$2.41
|
| Rate for Payer: Hamaspik Choice Medicare |
$1.48
|
| Rate for Payer: Humana Medicare |
$1.48
|
| Rate for Payer: Local 1199SEIU Medicare |
$1.71
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2.78
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$2.09
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1.56
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$4.42
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$0.56
|
| Rate for Payer: United Healthcare Commercial |
$4.42
|
| Rate for Payer: United Healthcare Medicare |
$1.48
|
| Rate for Payer: WellCare Medicare |
$2.04
|
|
|
FLUCONAZOLE INJ, 200 MG
|
Facility
|
IP
|
$3.71
|
|
|
Service Code
|
HCPCS J1450
|
| Hospital Charge Code |
4450005
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.04 |
| Max. Negotiated Rate |
$3.87 |
| Rate for Payer: Aetna of NY Commercial |
$2.04
|
| Rate for Payer: Cash Price |
$2.78
|
| Rate for Payer: Cash Price |
$2.78
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$3.87
|
| Rate for Payer: EmblemHealth Select Care |
$3.87
|
| Rate for Payer: Galaxy Health Commercial |
$2.41
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$2.04
|
| Rate for Payer: WellCare Medicare |
$2.04
|
|
|
FLUCONAZPLE ORAL SUSP
|
Facility
|
OP
|
$15.19
|
|
|
Service Code
|
NDC 59762502901
|
| Hospital Charge Code |
4408981
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.28 |
| Max. Negotiated Rate |
$12.15 |
| Rate for Payer: Aetna of NY Commercial |
$10.63
|
| Rate for Payer: Aetna of NY Medicare |
$6.99
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$6.08
|
| Rate for Payer: Cash Price |
$11.39
|
| Rate for Payer: CDPHP Medicare |
$5.62
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$12.15
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$12.15
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$12.15
|
| Rate for Payer: EmblemHealth Medicaid |
$12.15
|
| Rate for Payer: EmblemHealth Medicare |
$5.16
|
| Rate for Payer: EmblemHealth Select Care |
$10.94
|
| Rate for Payer: Fidelis Medicare |
$6.08
|
| Rate for Payer: Galaxy Health Commercial |
$9.87
|
| Rate for Payer: Hamaspik Choice Medicare |
$6.08
|
| Rate for Payer: Humana Medicare |
$6.08
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$10.63
|
| Rate for Payer: Local 1199SEIU Medicare |
$6.99
|
| Rate for Payer: MVP Health Care of NY Commercial |
$11.39
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$8.55
|
| Rate for Payer: MVP Health Care of NY Medicare |
$6.38
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$2.28
|
| Rate for Payer: United Healthcare Medicare |
$6.08
|
| Rate for Payer: WellCare Medicare |
$8.35
|
|
|
FLUCONAZPLE ORAL SUSP
|
Facility
|
IP
|
$15.19
|
|
|
Service Code
|
NDC 59762502901
|
| Hospital Charge Code |
4408981
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.35 |
| Max. Negotiated Rate |
$9.87 |
| Rate for Payer: Cash Price |
$11.39
|
| Rate for Payer: Galaxy Health Commercial |
$9.87
|
| Rate for Payer: WellCare Medicare |
$8.35
|
|
|
FLUDROCORTISONE ACETATE 0.1MG TABS 100 E
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
NDC 50268033011
|
| Hospital Charge Code |
4400302
|
|
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
|
|
|
FLUDROCORTISONE ACETATE 0.1MG TABS 100 E
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 50268033011
|
| Hospital Charge Code |
4400302
|
|
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
|
|
|
FLUID CRYSTAL EXAM (SYNOVIAL)
|
Facility
|
OP
|
$22.00
|
|
|
Service Code
|
HCPCS 89060
|
| Hospital Charge Code |
4301119
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.30 |
| Max. Negotiated Rate |
$17.60 |
| Rate for Payer: Aetna of NY Commercial |
$14.30
|
| Rate for Payer: Aetna of NY Medicare |
$10.12
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$8.80
|
| Rate for Payer: Cash Price |
$16.50
|
| Rate for Payer: CDPHP Medicare |
$8.14
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$13.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$17.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$17.60
|
| Rate for Payer: EmblemHealth Medicaid |
$17.60
|
| Rate for Payer: EmblemHealth Medicare |
$7.48
|
| Rate for Payer: EmblemHealth Select Care |
$13.20
|
| Rate for Payer: Fidelis Medicare |
$8.80
|
| Rate for Payer: Galaxy Health Commercial |
$14.30
|
| Rate for Payer: Hamaspik Choice Medicare |
$8.80
|
| Rate for Payer: Humana Medicare |
$8.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$14.30
|
| Rate for Payer: Local 1199SEIU Medicare |
$10.12
|
| Rate for Payer: MVP Health Care of NY Commercial |
$16.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$12.39
|
| Rate for Payer: MVP Health Care of NY Medicare |
$9.24
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$16.50
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$3.30
|
| Rate for Payer: United Healthcare Commercial |
$16.50
|
| Rate for Payer: United Healthcare Medicare |
$8.80
|
| Rate for Payer: WellCare Medicare |
$12.10
|
|
|
FLUID CRYSTAL EXAM (SYNOVIAL)
|
Facility
|
IP
|
$22.00
|
|
|
Service Code
|
HCPCS 89060
|
| Hospital Charge Code |
4301119
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.30 |
| Max. Negotiated Rate |
$14.30 |
| Rate for Payer: Cash Price |
$16.50
|
| Rate for Payer: Galaxy Health Commercial |
$14.30
|
|
|
FLUMAZENIL 0.1MG/ML MDV 10X10ML
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
4400303
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.40 |
| Max. Negotiated Rate |
$4.02 |
| Rate for Payer: Aetna of NY Commercial |
$3.40
|
| Rate for Payer: Cash Price |
$4.64
|
| 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
|
|
