|
METOLAZONE 2.5MG TABS 10X10EA
|
Facility
|
OP
|
$10.04
|
|
|
Service Code
|
NDC 51079002320
|
| Hospital Charge Code |
4400504
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.41 |
| Max. Negotiated Rate |
$8.08 |
| Rate for Payer: Aetna of NY Commercial |
$7.03
|
| Rate for Payer: Aetna of NY Medicare |
$4.62
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$7.53
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$7.53
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$3.71
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$5.02
|
| Rate for Payer: Cash Price |
$7.53
|
| Rate for Payer: CDPHP Commercial |
$8.08
|
| Rate for Payer: CDPHP Medicare |
$3.71
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$8.03
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$8.03
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$8.03
|
| Rate for Payer: EmblemHealth Medicaid |
$8.03
|
| Rate for Payer: EmblemHealth Medicare |
$3.41
|
| Rate for Payer: EmblemHealth Select Care |
$7.23
|
| Rate for Payer: Fidelis Medicare |
$3.83
|
| Rate for Payer: Galaxy Health Commercial |
$6.53
|
| Rate for Payer: Hamaspik Choice Medicare |
$3.71
|
| Rate for Payer: Humana Medicare |
$3.71
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$7.03
|
| Rate for Payer: Local 1199SEIU Medicare |
$4.62
|
| Rate for Payer: MVP Health Care of NY Commercial |
$7.53
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$5.65
|
| Rate for Payer: MVP Health Care of NY Medicare |
$3.90
|
| Rate for Payer: United Healthcare Medicare |
$3.71
|
| Rate for Payer: WellCare Medicare |
$5.52
|
|
|
METOLAZONE 2.5MG TABS 10X10EA
|
Facility
|
IP
|
$10.04
|
|
|
Service Code
|
NDC 51079002320
|
| Hospital Charge Code |
4400504
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.52 |
| Max. Negotiated Rate |
$6.53 |
| Rate for Payer: Cash Price |
$7.53
|
| Rate for Payer: Galaxy Health Commercial |
$6.53
|
| Rate for Payer: WellCare Medicare |
$5.52
|
|
|
METOLAZONE 5MG TABS 10X10EA
|
Facility
|
OP
|
$11.59
|
|
|
Service Code
|
NDC 51079002420
|
| Hospital Charge Code |
4400505
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.94 |
| Max. Negotiated Rate |
$9.33 |
| Rate for Payer: Aetna of NY Commercial |
$8.11
|
| Rate for Payer: Aetna of NY Medicare |
$5.33
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$8.69
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$8.69
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$4.29
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$5.80
|
| Rate for Payer: Cash Price |
$8.69
|
| Rate for Payer: CDPHP Commercial |
$9.33
|
| Rate for Payer: CDPHP Medicare |
$4.29
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$9.27
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$9.27
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$9.27
|
| Rate for Payer: EmblemHealth Medicaid |
$9.27
|
| Rate for Payer: EmblemHealth Medicare |
$3.94
|
| Rate for Payer: EmblemHealth Select Care |
$8.34
|
| Rate for Payer: Fidelis Medicare |
$4.42
|
| Rate for Payer: Galaxy Health Commercial |
$7.53
|
| Rate for Payer: Hamaspik Choice Medicare |
$4.29
|
| Rate for Payer: Humana Medicare |
$4.29
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$8.11
|
| Rate for Payer: Local 1199SEIU Medicare |
$5.33
|
| Rate for Payer: MVP Health Care of NY Commercial |
$8.69
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$6.53
|
| Rate for Payer: MVP Health Care of NY Medicare |
$4.50
|
| Rate for Payer: United Healthcare Medicare |
$4.29
|
| Rate for Payer: WellCare Medicare |
$6.37
|
|
|
METOLAZONE 5MG TABS 10X10EA
|
Facility
|
IP
|
$11.59
|
|
|
Service Code
|
NDC 51079002420
|
| Hospital Charge Code |
4400505
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.37 |
| Max. Negotiated Rate |
$7.53 |
| Rate for Payer: Cash Price |
$8.69
|
| Rate for Payer: Galaxy Health Commercial |
$7.53
|
| Rate for Payer: WellCare Medicare |
$6.37
|
|
|
METOPROLOL SUCCINATE 25MG TABS 10X10EA
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
NDC 68084065911
|
| Hospital Charge Code |
4400766
|
|
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
|
|
|
METOPROLOL SUCCINATE 25MG TABS 10X10EA
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 68084065911
|
| Hospital Charge Code |
4400766
|
|
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
|
|
|
METOPROLOL SUCCINATE 50MG TABS 10X10EA
|
Facility
|
OP
|
$6.35
|
|
|
Service Code
|
NDC 00904632361
|
| Hospital Charge Code |
4400767
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.16 |
| Max. Negotiated Rate |
$5.11 |
| Rate for Payer: Aetna of NY Commercial |
$4.44
|
| Rate for Payer: Aetna of NY Medicare |
$2.92
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$4.76
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$4.76
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2.35
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$3.18
|
| Rate for Payer: Cash Price |
$4.76
|
| Rate for Payer: CDPHP Commercial |
$5.11
|
| Rate for Payer: CDPHP Medicare |
$2.35
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$5.08
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$5.08
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$5.08
|
| Rate for Payer: EmblemHealth Medicaid |
$5.08
|
| Rate for Payer: EmblemHealth Medicare |
$2.16
|
| Rate for Payer: EmblemHealth Select Care |
$4.57
|
| Rate for Payer: Fidelis Medicare |
$2.42
|
| Rate for Payer: Galaxy Health Commercial |
$4.13
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.35
|
| Rate for Payer: Humana Medicare |
$2.35
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$4.44
|
| Rate for Payer: Local 1199SEIU Medicare |
$2.92
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4.76
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3.58
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2.47
|
| Rate for Payer: United Healthcare Medicare |
$2.35
|
| Rate for Payer: WellCare Medicare |
$3.49
|
|
|
METOPROLOL SUCCINATE 50MG TABS 10X10EA
|
Facility
|
IP
|
$6.35
|
|
|
Service Code
|
NDC 00904632361
|
| Hospital Charge Code |
4400767
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.49 |
| Max. Negotiated Rate |
$4.13 |
| Rate for Payer: Cash Price |
$4.76
|
| Rate for Payer: Galaxy Health Commercial |
$4.13
|
| Rate for Payer: WellCare Medicare |
$3.49
|
|
|
METOPROLOL TARTRATE 100MG TABS 100 EA
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 51079080220
|
| Hospital Charge Code |
4400507
|
|
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
|
|
|
METOPROLOL TARTRATE 100MG TABS 100 EA
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
NDC 51079080220
|
| Hospital Charge Code |
4400507
|
|
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
|
|
|
METOPROLOL TARTRATE 1MG/ML AMPS 12X5ML
|
Facility
|
OP
|
$9.50
|
|
|
Service Code
|
NDC 63323066005
|
| Hospital Charge Code |
4400508
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.23 |
| Max. Negotiated Rate |
$7.65 |
| Rate for Payer: Aetna of NY Commercial |
$6.65
|
| Rate for Payer: Aetna of NY Medicare |
$4.37
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$7.12
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$7.12
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$3.52
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$4.75
|
| Rate for Payer: Cash Price |
$7.13
|
| Rate for Payer: CDPHP Commercial |
$7.65
|
| Rate for Payer: CDPHP Medicare |
$3.52
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$7.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$7.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$7.60
|
| Rate for Payer: EmblemHealth Medicaid |
$7.60
|
| Rate for Payer: EmblemHealth Medicare |
$3.23
|
| Rate for Payer: EmblemHealth Select Care |
$6.84
|
| Rate for Payer: Fidelis Medicare |
$3.62
|
| Rate for Payer: Galaxy Health Commercial |
$6.18
|
| Rate for Payer: Hamaspik Choice Medicare |
$3.52
|
| Rate for Payer: Humana Medicare |
$3.52
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$6.65
|
| Rate for Payer: Local 1199SEIU Medicare |
$4.37
|
| Rate for Payer: MVP Health Care of NY Commercial |
$7.12
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$5.35
|
| Rate for Payer: MVP Health Care of NY Medicare |
$3.69
|
| Rate for Payer: United Healthcare Medicare |
$3.52
|
| Rate for Payer: WellCare Medicare |
$5.22
|
|
|
METOPROLOL TARTRATE 1MG/ML AMPS 12X5ML
|
Facility
|
IP
|
$9.50
|
|
|
Service Code
|
NDC 63323066005
|
| Hospital Charge Code |
4400508
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$6.18 |
| Rate for Payer: Cash Price |
$7.13
|
| Rate for Payer: Galaxy Health Commercial |
$6.18
|
| Rate for Payer: WellCare Medicare |
$5.22
|
|
|
METOPROLOL TARTRATE 25MG TABS 10X10EA
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 62584026501
|
| Hospital Charge Code |
4400510
|
|
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
|
|
|
METOPROLOL TARTRATE 25MG TABS 10X10EA
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
NDC 62584026501
|
| Hospital Charge Code |
4400510
|
|
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
|
|
|
METOPROLOL TARTRATE 50MG TABS 100 EA
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 51079080120
|
| Hospital Charge Code |
4400511
|
|
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
|
|
|
METOPROLOL TARTRATE 50MG TABS 100 EA
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
NDC 51079080120
|
| Hospital Charge Code |
4400511
|
|
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
|
|
|
METRONIDAZOLE 10 MG INJ
|
Facility
|
IP
|
$0.12
|
|
|
Service Code
|
HCPCS J1836
|
| Hospital Charge Code |
4408963
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.08 |
| Rate for Payer: Aetna of NY Commercial |
$0.07
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$0.03
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$0.03
|
| Rate for Payer: Cash Price |
$0.09
|
| Rate for Payer: Cash Price |
$0.09
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.03
|
| Rate for Payer: EmblemHealth Select Care |
$0.03
|
| Rate for Payer: Galaxy Health Commercial |
$0.08
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$0.07
|
| Rate for Payer: WellCare Medicare |
$0.07
|
|
|
METRONIDAZOLE 10 MG INJ
|
Facility
|
OP
|
$0.12
|
|
|
Service Code
|
HCPCS J1836
|
| Hospital Charge Code |
4408963
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.10 |
| Rate for Payer: Aetna of NY Commercial |
$0.07
|
| Rate for Payer: Aetna of NY Medicare |
$0.06
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$0.03
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$0.03
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$0.04
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$0.06
|
| Rate for Payer: Cash Price |
$0.09
|
| Rate for Payer: Cash Price |
$0.09
|
| Rate for Payer: CDPHP Commercial |
$0.10
|
| Rate for Payer: CDPHP Medicare |
$0.04
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.03
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$0.10
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$0.10
|
| Rate for Payer: EmblemHealth Medicaid |
$0.10
|
| Rate for Payer: EmblemHealth Medicare |
$0.04
|
| Rate for Payer: EmblemHealth Select Care |
$0.03
|
| Rate for Payer: Fidelis Medicare |
$0.05
|
| Rate for Payer: Galaxy Health Commercial |
$0.08
|
| Rate for Payer: Hamaspik Choice Medicare |
$0.04
|
| Rate for Payer: Humana Medicare |
$0.04
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$0.07
|
| Rate for Payer: Local 1199SEIU Medicare |
$0.06
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.09
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$0.07
|
| Rate for Payer: MVP Health Care of NY Medicare |
$0.05
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$0.03
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$0.03
|
| Rate for Payer: United Healthcare Commercial |
$0.03
|
| Rate for Payer: United Healthcare Medicare |
$0.04
|
| Rate for Payer: WellCare Medicare |
$0.07
|
|
|
METRONIDAZOLE 250MG TABS 100 EA
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 00904145361
|
| Hospital Charge Code |
4400512
|
|
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
|
|
|
METRONIDAZOLE 250MG TABS 100 EA
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
NDC 00904145361
|
| Hospital Charge Code |
4400512
|
|
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
|
|
|
METRONIDAZOLE 500MG TABS 100 EA
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
NDC 42292000101
|
| Hospital Charge Code |
4400513
|
|
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
|
|
|
METRONIDAZOLE 500MG TABS 100 EA
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 42292000101
|
| Hospital Charge Code |
4400513
|
|
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
|
|
|
MEXILETINE 150 MG CAPSULE
|
Facility
|
IP
|
$7.73
|
|
|
Service Code
|
NDC 00093873901
|
| Hospital Charge Code |
4400838
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.25 |
| Max. Negotiated Rate |
$5.02 |
| Rate for Payer: Cash Price |
$5.80
|
| Rate for Payer: Galaxy Health Commercial |
$5.02
|
| Rate for Payer: WellCare Medicare |
$4.25
|
|
|
MEXILETINE 150 MG CAPSULE
|
Facility
|
OP
|
$7.73
|
|
|
Service Code
|
NDC 00093873901
|
| Hospital Charge Code |
4400838
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.63 |
| Max. Negotiated Rate |
$6.22 |
| Rate for Payer: Aetna of NY Commercial |
$5.41
|
| Rate for Payer: Aetna of NY Medicare |
$3.56
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$5.80
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$5.80
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2.86
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$3.86
|
| Rate for Payer: Cash Price |
$5.80
|
| Rate for Payer: CDPHP Commercial |
$6.22
|
| Rate for Payer: CDPHP Medicare |
$2.86
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$6.18
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$6.18
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$6.18
|
| Rate for Payer: EmblemHealth Medicaid |
$6.18
|
| Rate for Payer: EmblemHealth Medicare |
$2.63
|
| Rate for Payer: EmblemHealth Select Care |
$5.57
|
| Rate for Payer: Fidelis Medicare |
$2.95
|
| Rate for Payer: Galaxy Health Commercial |
$5.02
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.86
|
| Rate for Payer: Humana Medicare |
$2.86
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$5.41
|
| Rate for Payer: Local 1199SEIU Medicare |
$3.56
|
| Rate for Payer: MVP Health Care of NY Commercial |
$5.80
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$4.35
|
| Rate for Payer: MVP Health Care of NY Medicare |
$3.00
|
| Rate for Payer: United Healthcare Medicare |
$2.86
|
| Rate for Payer: WellCare Medicare |
$4.25
|
|
|
MICROALBUMIN URINE
|
Facility
|
OP
|
$22.00
|
|
|
Service Code
|
HCPCS 82043
|
| Hospital Charge Code |
4300563
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.08 |
| Max. Negotiated Rate |
$17.71 |
| 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) Blue Access/Small Group |
$16.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$16.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$8.14
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$11.00
|
| Rate for Payer: Cash Price |
$16.50
|
| Rate for Payer: Cash Price |
$16.50
|
| Rate for Payer: CDPHP Commercial |
$17.71
|
| 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 |
$8.38
|
| Rate for Payer: Galaxy Health Commercial |
$14.30
|
| Rate for Payer: Hamaspik Choice Medicare |
$8.14
|
| Rate for Payer: Humana Medicare |
$8.14
|
| 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 |
$8.55
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$16.50
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$5.08
|
| Rate for Payer: United Healthcare Commercial |
$16.50
|
| Rate for Payer: United Healthcare Medicare |
$8.14
|
| Rate for Payer: WellCare Medicare |
$12.10
|
|
