|
MEMANTINE HCL 5MG TABS 10X10EA
|
Facility
|
IP
|
$22.92
|
|
|
Service Code
|
NDC 00591387045
|
| Hospital Charge Code |
4400540
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.61 |
| Max. Negotiated Rate |
$14.90 |
| Rate for Payer: Cash Price |
$17.19
|
| Rate for Payer: Galaxy Health Commercial |
$14.90
|
| Rate for Payer: WellCare Medicare |
$12.61
|
|
|
MEMANTINE HCL 5MG TABS 10X10EA
|
Facility
|
OP
|
$22.92
|
|
|
Service Code
|
NDC 00591387045
|
| Hospital Charge Code |
4400540
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.79 |
| Max. Negotiated Rate |
$18.45 |
| Rate for Payer: Aetna of NY Commercial |
$16.04
|
| Rate for Payer: Aetna of NY Medicare |
$10.54
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$17.19
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$17.19
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$8.48
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$11.46
|
| Rate for Payer: Cash Price |
$17.19
|
| Rate for Payer: CDPHP Commercial |
$18.45
|
| Rate for Payer: CDPHP Medicare |
$8.48
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$18.34
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$18.34
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$18.34
|
| Rate for Payer: EmblemHealth Medicaid |
$18.34
|
| Rate for Payer: EmblemHealth Medicare |
$7.79
|
| Rate for Payer: EmblemHealth Select Care |
$16.50
|
| Rate for Payer: Fidelis Medicare |
$8.73
|
| Rate for Payer: Galaxy Health Commercial |
$14.90
|
| Rate for Payer: Hamaspik Choice Medicare |
$8.48
|
| Rate for Payer: Humana Medicare |
$8.48
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$16.04
|
| Rate for Payer: Local 1199SEIU Medicare |
$10.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$17.19
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$12.90
|
| Rate for Payer: MVP Health Care of NY Medicare |
$8.90
|
| Rate for Payer: United Healthcare Medicare |
$8.48
|
| Rate for Payer: WellCare Medicare |
$12.61
|
|
|
MEMANTINE HCL ER 14 MG CAPSULE 14 mg, 30 eaches
|
Facility
|
IP
|
$46.00
|
|
|
Service Code
|
NDC 60505620903
|
| Hospital Charge Code |
4401404
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$25.30 |
| Max. Negotiated Rate |
$29.90 |
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Galaxy Health Commercial |
$29.90
|
| Rate for Payer: WellCare Medicare |
$25.30
|
|
|
MEMANTINE HCL ER 14 MG CAPSULE 14 mg, 30 eaches
|
Facility
|
OP
|
$46.00
|
|
|
Service Code
|
NDC 60505620903
|
| Hospital Charge Code |
4401404
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.64 |
| Max. Negotiated Rate |
$37.03 |
| Rate for Payer: Aetna of NY Commercial |
$32.20
|
| Rate for Payer: Aetna of NY Medicare |
$21.16
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$34.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$34.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$17.02
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$23.00
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: CDPHP Commercial |
$37.03
|
| Rate for Payer: CDPHP Medicare |
$17.02
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$36.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$36.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$36.80
|
| Rate for Payer: EmblemHealth Medicaid |
$36.80
|
| Rate for Payer: EmblemHealth Medicare |
$15.64
|
| Rate for Payer: EmblemHealth Select Care |
$33.12
|
| Rate for Payer: Fidelis Medicare |
$17.53
|
| Rate for Payer: Galaxy Health Commercial |
$29.90
|
| Rate for Payer: Hamaspik Choice Medicare |
$17.02
|
| Rate for Payer: Humana Medicare |
$17.02
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$32.20
|
| Rate for Payer: Local 1199SEIU Medicare |
$21.16
|
| Rate for Payer: MVP Health Care of NY Commercial |
$34.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$25.90
|
| Rate for Payer: MVP Health Care of NY Medicare |
$17.87
|
| Rate for Payer: United Healthcare Medicare |
$17.02
|
| Rate for Payer: WellCare Medicare |
$25.30
|
|
|
MEPERIDINE HYDROCHLORIDE INJ, PER 100 MG
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
HCPCS J2175
|
| Hospital Charge Code |
4409064
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.40 |
| Max. Negotiated Rate |
$6.90 |
| Rate for Payer: Aetna of NY Commercial |
$3.40
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$6.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$6.90
|
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$6.90
|
| Rate for Payer: EmblemHealth Select Care |
$6.90
|
| 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
|
|
|
MEPERIDINE HYDROCHLORIDE INJ, PER 100 MG
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
HCPCS J2175
|
| Hospital Charge Code |
4409064
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.10 |
| Max. Negotiated Rate |
$12.06 |
| 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 |
$6.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$6.90
|
| 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 |
$6.90
|
| 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 |
$6.90
|
| 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 |
$12.06
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$6.90
|
| Rate for Payer: United Healthcare Commercial |
$12.06
|
| Rate for Payer: United Healthcare Medicare |
$2.29
|
| Rate for Payer: WellCare Medicare |
$3.40
|
|
|
MEROCEL NASAL PACKING 4.5CM
|
Facility
|
OP
|
$137.00
|
|
| Hospital Charge Code |
4472003
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$46.58 |
| Max. Negotiated Rate |
$110.28 |
| Rate for Payer: Aetna of NY Commercial |
$95.90
|
| Rate for Payer: Aetna of NY Medicare |
$63.02
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$102.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$102.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$50.69
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$68.50
|
| Rate for Payer: Cash Price |
$102.75
|
| Rate for Payer: CDPHP Commercial |
$110.28
|
| Rate for Payer: CDPHP Medicare |
$50.69
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$109.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$109.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$109.60
|
| Rate for Payer: EmblemHealth Medicaid |
$109.60
|
| Rate for Payer: EmblemHealth Medicare |
$46.58
|
| Rate for Payer: EmblemHealth Select Care |
$98.64
|
| Rate for Payer: Fidelis Medicare |
$52.21
|
| Rate for Payer: Galaxy Health Commercial |
$89.05
|
| Rate for Payer: Hamaspik Choice Medicare |
$50.69
|
| Rate for Payer: Humana Medicare |
$50.69
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$95.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$63.02
|
| Rate for Payer: MVP Health Care of NY Commercial |
$102.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$77.13
|
| Rate for Payer: MVP Health Care of NY Medicare |
$53.22
|
| Rate for Payer: United Healthcare Medicare |
$50.69
|
| Rate for Payer: WellCare Medicare |
$75.35
|
|
|
MEROCEL NASAL PACKING 4.5CM
|
Facility
|
IP
|
$137.00
|
|
| Hospital Charge Code |
4472003
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$89.05 |
| Max. Negotiated Rate |
$89.05 |
| Rate for Payer: Cash Price |
$102.75
|
| Rate for Payer: Galaxy Health Commercial |
$89.05
|
|
|
MEROCEL NASAL PACKING 8.0CM
|
Facility
|
IP
|
$137.00
|
|
| Hospital Charge Code |
4472006
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$89.05 |
| Max. Negotiated Rate |
$89.05 |
| Rate for Payer: Cash Price |
$102.75
|
| Rate for Payer: Galaxy Health Commercial |
$89.05
|
|
|
MEROCEL NASAL PACKING 8.0CM
|
Facility
|
OP
|
$137.00
|
|
| Hospital Charge Code |
4472006
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$46.58 |
| Max. Negotiated Rate |
$110.28 |
| Rate for Payer: Aetna of NY Commercial |
$95.90
|
| Rate for Payer: Aetna of NY Medicare |
$63.02
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$102.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$102.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$50.69
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$68.50
|
| Rate for Payer: Cash Price |
$102.75
|
| Rate for Payer: CDPHP Commercial |
$110.28
|
| Rate for Payer: CDPHP Medicare |
$50.69
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$109.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$109.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$109.60
|
| Rate for Payer: EmblemHealth Medicaid |
$109.60
|
| Rate for Payer: EmblemHealth Medicare |
$46.58
|
| Rate for Payer: EmblemHealth Select Care |
$98.64
|
| Rate for Payer: Fidelis Medicare |
$52.21
|
| Rate for Payer: Galaxy Health Commercial |
$89.05
|
| Rate for Payer: Hamaspik Choice Medicare |
$50.69
|
| Rate for Payer: Humana Medicare |
$50.69
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$95.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$63.02
|
| Rate for Payer: MVP Health Care of NY Commercial |
$102.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$77.13
|
| Rate for Payer: MVP Health Care of NY Medicare |
$53.22
|
| Rate for Payer: United Healthcare Medicare |
$50.69
|
| Rate for Payer: WellCare Medicare |
$75.35
|
|
|
MEROPENEM-0.9% NACL 1 GRAM/50 100 mg, 1 each
|
Facility
|
IP
|
$8.00
|
|
|
Service Code
|
HCPCS J2185
|
| Hospital Charge Code |
4401352
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.39 |
| Max. Negotiated Rate |
$5.20 |
| Rate for Payer: Aetna of NY Commercial |
$4.40
|
| 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 |
$6.00
|
| Rate for Payer: Cash Price |
$6.00
|
| 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 |
$5.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$4.40
|
| Rate for Payer: WellCare Medicare |
$4.40
|
|
|
MEROPENEM-0.9% NACL 1 GRAM/50 100 mg, 1 each
|
Facility
|
OP
|
$8.00
|
|
|
Service Code
|
HCPCS J2185
|
| Hospital Charge Code |
4401352
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.39 |
| Max. Negotiated Rate |
$6.44 |
| Rate for Payer: Aetna of NY Commercial |
$4.40
|
| Rate for Payer: Aetna of NY Medicare |
$3.68
|
| 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) Medicare |
$2.96
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$4.00
|
| Rate for Payer: Cash Price |
$6.00
|
| Rate for Payer: Cash Price |
$6.00
|
| Rate for Payer: CDPHP Commercial |
$6.44
|
| Rate for Payer: CDPHP Medicare |
$2.96
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.39
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$6.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$6.40
|
| Rate for Payer: EmblemHealth Medicaid |
$6.40
|
| Rate for Payer: EmblemHealth Medicare |
$2.72
|
| Rate for Payer: EmblemHealth Select Care |
$0.39
|
| Rate for Payer: Fidelis Medicare |
$3.05
|
| Rate for Payer: Galaxy Health Commercial |
$5.20
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.96
|
| Rate for Payer: Humana Medicare |
$2.96
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$4.40
|
| Rate for Payer: Local 1199SEIU Medicare |
$3.68
|
| Rate for Payer: MVP Health Care of NY Commercial |
$6.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$4.50
|
| Rate for Payer: MVP Health Care of NY Medicare |
$3.11
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$0.86
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$0.39
|
| Rate for Payer: United Healthcare Commercial |
$0.86
|
| Rate for Payer: United Healthcare Medicare |
$2.96
|
| Rate for Payer: WellCare Medicare |
$4.40
|
|
|
MEROPENEM 100 MG INJ
|
Facility
|
IP
|
$10.50
|
|
|
Service Code
|
HCPCS J2185
|
| Hospital Charge Code |
4409188
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.39 |
| Max. Negotiated Rate |
$6.82 |
| Rate for Payer: Aetna of NY Commercial |
$5.78
|
| 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 |
$7.88
|
| Rate for Payer: Cash Price |
$7.88
|
| 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 |
$6.82
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$5.78
|
| Rate for Payer: WellCare Medicare |
$5.78
|
|
|
MEROPENEM 100 MG INJ
|
Facility
|
OP
|
$10.50
|
|
|
Service Code
|
HCPCS J2185
|
| Hospital Charge Code |
4409188
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.39 |
| Max. Negotiated Rate |
$8.45 |
| Rate for Payer: Aetna of NY Commercial |
$5.78
|
| Rate for Payer: Aetna of NY Medicare |
$4.83
|
| 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) Medicare |
$3.88
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$5.25
|
| Rate for Payer: Cash Price |
$7.88
|
| Rate for Payer: Cash Price |
$7.88
|
| Rate for Payer: CDPHP Commercial |
$8.45
|
| Rate for Payer: CDPHP Medicare |
$3.88
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.39
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$8.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$8.40
|
| Rate for Payer: EmblemHealth Medicaid |
$8.40
|
| Rate for Payer: EmblemHealth Medicare |
$3.57
|
| Rate for Payer: EmblemHealth Select Care |
$0.39
|
| Rate for Payer: Fidelis Medicare |
$4.00
|
| Rate for Payer: Galaxy Health Commercial |
$6.82
|
| Rate for Payer: Hamaspik Choice Medicare |
$3.88
|
| Rate for Payer: Humana Medicare |
$3.88
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$5.78
|
| Rate for Payer: Local 1199SEIU Medicare |
$4.83
|
| Rate for Payer: MVP Health Care of NY Commercial |
$7.88
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$5.91
|
| Rate for Payer: MVP Health Care of NY Medicare |
$4.08
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$0.86
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$0.39
|
| Rate for Payer: United Healthcare Commercial |
$0.86
|
| Rate for Payer: United Healthcare Medicare |
$3.88
|
| Rate for Payer: WellCare Medicare |
$5.78
|
|
|
METAMUCIL FIBER SINGLES PACKET 1 ea, 44 eaches
|
Facility
|
IP
|
$6.00
|
|
|
Service Code
|
NDC 37000025445
|
| Hospital Charge Code |
4401419
|
|
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
|
|
|
METAMUCIL FIBER SINGLES PACKET 1 ea, 44 eaches
|
Facility
|
OP
|
$6.00
|
|
|
Service Code
|
NDC 37000025445
|
| Hospital Charge Code |
4401419
|
|
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
|
|
|
METANEPHRINES 24 HR URIN
|
Facility
|
OP
|
$66.00
|
|
|
Service Code
|
HCPCS 83835
|
| Hospital Charge Code |
4300556
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.94 |
| Max. Negotiated Rate |
$53.13 |
| Rate for Payer: Aetna of NY Commercial |
$42.90
|
| Rate for Payer: Aetna of NY Medicare |
$30.36
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$49.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$49.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$24.42
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$33.00
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: CDPHP Commercial |
$53.13
|
| Rate for Payer: CDPHP Medicare |
$24.42
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$39.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$52.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$52.80
|
| Rate for Payer: EmblemHealth Medicaid |
$52.80
|
| Rate for Payer: EmblemHealth Medicare |
$22.44
|
| Rate for Payer: EmblemHealth Select Care |
$39.60
|
| Rate for Payer: Fidelis Medicare |
$25.15
|
| Rate for Payer: Galaxy Health Commercial |
$42.90
|
| Rate for Payer: Hamaspik Choice Medicare |
$24.42
|
| Rate for Payer: Humana Medicare |
$24.42
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$42.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$30.36
|
| Rate for Payer: MVP Health Care of NY Commercial |
$49.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$37.16
|
| Rate for Payer: MVP Health Care of NY Medicare |
$25.64
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$49.50
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$16.94
|
| Rate for Payer: United Healthcare Commercial |
$49.50
|
| Rate for Payer: United Healthcare Medicare |
$24.42
|
| Rate for Payer: WellCare Medicare |
$36.30
|
|
|
METANEPHRINES 24 HR URIN
|
Facility
|
IP
|
$66.00
|
|
|
Service Code
|
HCPCS 83835
|
| Hospital Charge Code |
4300556
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$42.90 |
| Max. Negotiated Rate |
$42.90 |
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Galaxy Health Commercial |
$42.90
|
|
|
METATARSAL DECOMPRESSION IMPLANT (MDI)
|
Facility
|
IP
|
$16,738.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
4471665
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,532.10 |
| Max. Negotiated Rate |
$11,716.60 |
| Rate for Payer: Aetna of NY Commercial |
$11,716.60
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$7,532.10
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$7,532.10
|
| Rate for Payer: Cash Price |
$12,553.50
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$8,369.00
|
| Rate for Payer: EmblemHealth Select Care |
$8,369.00
|
| Rate for Payer: Galaxy Health Commercial |
$10,879.70
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$11,716.60
|
| Rate for Payer: Multiplan Commercial |
$7,532.10
|
| Rate for Payer: MVP Health Care of NY Commercial |
$10,879.70
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$10,879.70
|
| Rate for Payer: WellCare Medicare |
$9,205.90
|
|
|
METATARSAL DECOMPRESSION IMPLANT (MDI)
|
Facility
|
OP
|
$16,738.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
4471665
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,690.92 |
| Max. Negotiated Rate |
$13,474.09 |
| Rate for Payer: Aetna of NY Commercial |
$11,716.60
|
| Rate for Payer: Aetna of NY Medicare |
$7,699.48
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$7,532.10
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$7,532.10
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$6,193.06
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$8,369.00
|
| Rate for Payer: Cash Price |
$12,553.50
|
| Rate for Payer: CDPHP Commercial |
$13,474.09
|
| Rate for Payer: CDPHP Medicare |
$6,193.06
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$8,369.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$13,390.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$13,390.40
|
| Rate for Payer: EmblemHealth Medicaid |
$13,390.40
|
| Rate for Payer: EmblemHealth Medicare |
$5,690.92
|
| Rate for Payer: EmblemHealth Select Care |
$8,369.00
|
| Rate for Payer: Fidelis Medicare |
$6,378.85
|
| Rate for Payer: Galaxy Health Commercial |
$10,879.70
|
| Rate for Payer: Hamaspik Choice Medicare |
$6,193.06
|
| Rate for Payer: Humana Medicare |
$6,193.06
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$11,716.60
|
| Rate for Payer: Local 1199SEIU Medicare |
$7,699.48
|
| Rate for Payer: MVP Health Care of NY Commercial |
$10,879.70
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$10,879.70
|
| Rate for Payer: MVP Health Care of NY Medicare |
$6,502.71
|
| Rate for Payer: United Healthcare Medicare |
$6,193.06
|
| Rate for Payer: WellCare Medicare |
$9,205.90
|
|
|
METAXALONE 800 MG
|
Facility
|
IP
|
$18.54
|
|
|
Service Code
|
NDC 50268053011
|
| Hospital Charge Code |
4409020
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.20 |
| Max. Negotiated Rate |
$12.05 |
| Rate for Payer: Cash Price |
$13.91
|
| Rate for Payer: Galaxy Health Commercial |
$12.05
|
| Rate for Payer: WellCare Medicare |
$10.20
|
|
|
METAXALONE 800 MG
|
Facility
|
OP
|
$18.54
|
|
|
Service Code
|
NDC 50268053011
|
| Hospital Charge Code |
4409020
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.30 |
| Max. Negotiated Rate |
$14.92 |
| Rate for Payer: Aetna of NY Commercial |
$12.98
|
| Rate for Payer: Aetna of NY Medicare |
$8.53
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$13.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$13.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$6.86
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$9.27
|
| Rate for Payer: Cash Price |
$13.91
|
| Rate for Payer: CDPHP Commercial |
$14.92
|
| Rate for Payer: CDPHP Medicare |
$6.86
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$14.83
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$14.83
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$14.83
|
| Rate for Payer: EmblemHealth Medicaid |
$14.83
|
| Rate for Payer: EmblemHealth Medicare |
$6.30
|
| Rate for Payer: EmblemHealth Select Care |
$13.35
|
| Rate for Payer: Fidelis Medicare |
$7.07
|
| Rate for Payer: Galaxy Health Commercial |
$12.05
|
| Rate for Payer: Hamaspik Choice Medicare |
$6.86
|
| Rate for Payer: Humana Medicare |
$6.86
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$12.98
|
| Rate for Payer: Local 1199SEIU Medicare |
$8.53
|
| Rate for Payer: MVP Health Care of NY Commercial |
$13.90
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$10.44
|
| Rate for Payer: MVP Health Care of NY Medicare |
$7.20
|
| Rate for Payer: United Healthcare Medicare |
$6.86
|
| Rate for Payer: WellCare Medicare |
$10.20
|
|
|
METER PEAK FLOW
|
Facility
|
OP
|
$72.00
|
|
| Hospital Charge Code |
4471034
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$24.48 |
| Max. Negotiated Rate |
$57.96 |
| Rate for Payer: Aetna of NY Commercial |
$50.40
|
| Rate for Payer: Aetna of NY Medicare |
$33.12
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$54.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$54.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$26.64
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$36.00
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: CDPHP Commercial |
$57.96
|
| Rate for Payer: CDPHP Medicare |
$26.64
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$57.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$57.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$57.60
|
| Rate for Payer: EmblemHealth Medicaid |
$57.60
|
| Rate for Payer: EmblemHealth Medicare |
$24.48
|
| Rate for Payer: EmblemHealth Select Care |
$51.84
|
| Rate for Payer: Fidelis Medicare |
$27.44
|
| Rate for Payer: Galaxy Health Commercial |
$46.80
|
| Rate for Payer: Hamaspik Choice Medicare |
$26.64
|
| Rate for Payer: Humana Medicare |
$26.64
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$50.40
|
| Rate for Payer: Local 1199SEIU Medicare |
$33.12
|
| Rate for Payer: MVP Health Care of NY Commercial |
$54.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$40.54
|
| Rate for Payer: MVP Health Care of NY Medicare |
$27.97
|
| Rate for Payer: United Healthcare Medicare |
$26.64
|
| Rate for Payer: WellCare Medicare |
$39.60
|
|
|
METER PEAK FLOW
|
Facility
|
IP
|
$72.00
|
|
| Hospital Charge Code |
4471034
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$46.80 |
| Max. Negotiated Rate |
$46.80 |
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Galaxy Health Commercial |
$46.80
|
|
|
METFORMIN 500 MG TAB
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 60687015511
|
| Hospital Charge Code |
4409019
|
|
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
|
|
