|
MULTIVIT/MINERALS TABS 10X10EA
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 00904549261
|
| Hospital Charge Code |
4400754
|
|
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
|
|
|
MULTIVIT/MINERALS TABS 10X10EA
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
NDC 00904549261
|
| Hospital Charge Code |
4400754
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.40 |
| Max. Negotiated Rate |
$4.02 |
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: Galaxy Health Commercial |
$4.02
|
| Rate for Payer: WellCare Medicare |
$3.40
|
|
|
MUMPS SCREEN IGG
|
Facility
|
IP
|
$56.00
|
|
|
Service Code
|
HCPCS 86735
|
| Hospital Charge Code |
4300570
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$36.40 |
| Max. Negotiated Rate |
$36.40 |
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Galaxy Health Commercial |
$36.40
|
|
|
MUMPS SCREEN IGG
|
Facility
|
OP
|
$56.00
|
|
|
Service Code
|
HCPCS 86735
|
| Hospital Charge Code |
4300570
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.11 |
| Max. Negotiated Rate |
$45.08 |
| Rate for Payer: Aetna of NY Commercial |
$36.40
|
| Rate for Payer: Aetna of NY Medicare |
$25.76
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$42.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$42.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$20.72
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$28.00
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: CDPHP Commercial |
$45.08
|
| Rate for Payer: CDPHP Medicare |
$20.72
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$33.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$44.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$44.80
|
| Rate for Payer: EmblemHealth Medicaid |
$44.80
|
| Rate for Payer: EmblemHealth Medicare |
$19.04
|
| Rate for Payer: EmblemHealth Select Care |
$33.60
|
| Rate for Payer: Fidelis Medicare |
$21.34
|
| Rate for Payer: Galaxy Health Commercial |
$36.40
|
| Rate for Payer: Hamaspik Choice Medicare |
$20.72
|
| Rate for Payer: Humana Medicare |
$20.72
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$36.40
|
| Rate for Payer: Local 1199SEIU Medicare |
$25.76
|
| Rate for Payer: MVP Health Care of NY Commercial |
$42.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$31.53
|
| Rate for Payer: MVP Health Care of NY Medicare |
$21.76
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$42.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$8.11
|
| Rate for Payer: United Healthcare Commercial |
$42.00
|
| Rate for Payer: United Healthcare Medicare |
$20.72
|
| Rate for Payer: WellCare Medicare |
$30.80
|
|
|
MUPIROCIN 0.02 OINT 22 GM
|
Facility
|
OP
|
$75.00
|
|
|
Service Code
|
NDC 45802011222
|
| Hospital Charge Code |
4400531
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$25.50 |
| Max. Negotiated Rate |
$60.38 |
| Rate for Payer: Aetna of NY Commercial |
$52.50
|
| Rate for Payer: Aetna of NY Medicare |
$34.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$56.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$56.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$27.75
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$37.50
|
| Rate for Payer: Cash Price |
$56.25
|
| Rate for Payer: CDPHP Commercial |
$60.38
|
| Rate for Payer: CDPHP Medicare |
$27.75
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$60.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$60.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$60.00
|
| Rate for Payer: EmblemHealth Medicaid |
$60.00
|
| Rate for Payer: EmblemHealth Medicare |
$25.50
|
| Rate for Payer: EmblemHealth Select Care |
$54.00
|
| Rate for Payer: Fidelis Medicare |
$28.58
|
| Rate for Payer: Galaxy Health Commercial |
$48.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$27.75
|
| Rate for Payer: Humana Medicare |
$27.75
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$52.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$34.50
|
| Rate for Payer: MVP Health Care of NY Commercial |
$56.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$42.22
|
| Rate for Payer: MVP Health Care of NY Medicare |
$29.14
|
| Rate for Payer: United Healthcare Medicare |
$27.75
|
| Rate for Payer: WellCare Medicare |
$41.25
|
|
|
MUPIROCIN 0.02 OINT 22 GM
|
Facility
|
IP
|
$75.00
|
|
|
Service Code
|
NDC 45802011222
|
| Hospital Charge Code |
4400531
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$41.25 |
| Max. Negotiated Rate |
$48.75 |
| Rate for Payer: Cash Price |
$56.25
|
| Rate for Payer: Galaxy Health Commercial |
$48.75
|
| Rate for Payer: WellCare Medicare |
$41.25
|
|
|
mycophenolate 250 MG CAPSULE 250 mg, 100 eaches
|
Facility
|
OP
|
$6.00
|
|
|
Service Code
|
NDC 00904707461
|
| Hospital Charge Code |
4401523
|
|
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
|
|
|
mycophenolate 250 MG CAPSULE 250 mg, 100 eaches
|
Facility
|
IP
|
$6.00
|
|
|
Service Code
|
NDC 00904707461
|
| Hospital Charge Code |
4401523
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.30 |
| Max. Negotiated Rate |
$3.90 |
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: Galaxy Health Commercial |
$3.90
|
| Rate for Payer: WellCare Medicare |
$3.30
|
|
|
MYCOPLASMA PNEUMONIA AB
|
Facility
|
OP
|
$87.00
|
|
|
Service Code
|
HCPCS 86738
|
| Hospital Charge Code |
4300573
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.24 |
| Max. Negotiated Rate |
$70.04 |
| Rate for Payer: Aetna of NY Commercial |
$56.55
|
| Rate for Payer: Aetna of NY Medicare |
$40.02
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$65.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$65.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$32.19
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$43.50
|
| Rate for Payer: Cash Price |
$65.25
|
| Rate for Payer: Cash Price |
$65.25
|
| Rate for Payer: CDPHP Commercial |
$70.04
|
| Rate for Payer: CDPHP Medicare |
$32.19
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$52.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$69.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$69.60
|
| Rate for Payer: EmblemHealth Medicaid |
$69.60
|
| Rate for Payer: EmblemHealth Medicare |
$29.58
|
| Rate for Payer: EmblemHealth Select Care |
$52.20
|
| Rate for Payer: Fidelis Medicare |
$33.16
|
| Rate for Payer: Galaxy Health Commercial |
$56.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$32.19
|
| Rate for Payer: Humana Medicare |
$32.19
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$56.55
|
| Rate for Payer: Local 1199SEIU Medicare |
$40.02
|
| Rate for Payer: MVP Health Care of NY Commercial |
$65.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$48.98
|
| Rate for Payer: MVP Health Care of NY Medicare |
$33.80
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$65.25
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$13.24
|
| Rate for Payer: United Healthcare Commercial |
$65.25
|
| Rate for Payer: United Healthcare Medicare |
$32.19
|
| Rate for Payer: WellCare Medicare |
$47.85
|
|
|
MYCOPLASMA PNEUMONIA AB
|
Facility
|
IP
|
$87.00
|
|
|
Service Code
|
HCPCS 86738
|
| Hospital Charge Code |
4300573
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$56.55 |
| Max. Negotiated Rate |
$56.55 |
| Rate for Payer: Cash Price |
$65.25
|
| Rate for Payer: Galaxy Health Commercial |
$56.55
|
|
|
MYELIN BASIC PROTEIN CSF
|
Facility
|
OP
|
$146.00
|
|
|
Service Code
|
HCPCS 83873
|
| Hospital Charge Code |
4300574
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.20 |
| Max. Negotiated Rate |
$117.53 |
| Rate for Payer: Aetna of NY Commercial |
$94.90
|
| Rate for Payer: Aetna of NY Medicare |
$67.16
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$109.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$109.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$54.02
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$73.00
|
| Rate for Payer: Cash Price |
$109.50
|
| Rate for Payer: Cash Price |
$109.50
|
| Rate for Payer: CDPHP Commercial |
$117.53
|
| Rate for Payer: CDPHP Medicare |
$54.02
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$87.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$116.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$116.80
|
| Rate for Payer: EmblemHealth Medicaid |
$116.80
|
| Rate for Payer: EmblemHealth Medicare |
$49.64
|
| Rate for Payer: EmblemHealth Select Care |
$87.60
|
| Rate for Payer: Fidelis Medicare |
$55.64
|
| Rate for Payer: Galaxy Health Commercial |
$94.90
|
| Rate for Payer: Hamaspik Choice Medicare |
$54.02
|
| Rate for Payer: Humana Medicare |
$54.02
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$94.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$67.16
|
| Rate for Payer: MVP Health Care of NY Commercial |
$109.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$82.20
|
| Rate for Payer: MVP Health Care of NY Medicare |
$56.72
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$109.50
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$17.20
|
| Rate for Payer: United Healthcare Commercial |
$109.50
|
| Rate for Payer: United Healthcare Medicare |
$54.02
|
| Rate for Payer: WellCare Medicare |
$80.30
|
|
|
MYELIN BASIC PROTEIN CSF
|
Facility
|
IP
|
$146.00
|
|
|
Service Code
|
HCPCS 83873
|
| Hospital Charge Code |
4300574
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$94.90 |
| Max. Negotiated Rate |
$94.90 |
| Rate for Payer: Cash Price |
$109.50
|
| Rate for Payer: Galaxy Health Commercial |
$94.90
|
|
|
MYOGLOBIN-URINE QUALITA
|
Facility
|
OP
|
$98.00
|
|
|
Service Code
|
HCPCS 83874
|
| Hospital Charge Code |
4300576
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.92 |
| Max. Negotiated Rate |
$78.89 |
| Rate for Payer: Aetna of NY Commercial |
$63.70
|
| Rate for Payer: Aetna of NY Medicare |
$45.08
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$73.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$73.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$36.26
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$49.00
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: CDPHP Commercial |
$78.89
|
| Rate for Payer: CDPHP Medicare |
$36.26
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$58.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$78.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$78.40
|
| Rate for Payer: EmblemHealth Medicaid |
$78.40
|
| Rate for Payer: EmblemHealth Medicare |
$33.32
|
| Rate for Payer: EmblemHealth Select Care |
$58.80
|
| Rate for Payer: Fidelis Medicare |
$37.35
|
| Rate for Payer: Galaxy Health Commercial |
$63.70
|
| Rate for Payer: Hamaspik Choice Medicare |
$36.26
|
| Rate for Payer: Humana Medicare |
$36.26
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$63.70
|
| Rate for Payer: Local 1199SEIU Medicare |
$45.08
|
| Rate for Payer: MVP Health Care of NY Commercial |
$73.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$55.17
|
| Rate for Payer: MVP Health Care of NY Medicare |
$38.07
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$73.50
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$12.92
|
| Rate for Payer: United Healthcare Commercial |
$73.50
|
| Rate for Payer: United Healthcare Medicare |
$36.26
|
| Rate for Payer: WellCare Medicare |
$53.90
|
|
|
MYOGLOBIN-URINE QUALITA
|
Facility
|
IP
|
$98.00
|
|
|
Service Code
|
HCPCS 83874
|
| Hospital Charge Code |
4300576
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$63.70 |
| Max. Negotiated Rate |
$63.70 |
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Galaxy Health Commercial |
$63.70
|
|
|
MYRBETRIQ ER 25 MG TABLET 25 mg, 30 eaches
|
Facility
|
OP
|
$54.00
|
|
|
Service Code
|
NDC 00469260130
|
| Hospital Charge Code |
4401549
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$18.36 |
| Max. Negotiated Rate |
$43.47 |
| Rate for Payer: Aetna of NY Commercial |
$37.80
|
| Rate for Payer: Aetna of NY Medicare |
$24.84
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$40.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$40.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$19.98
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$27.00
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: CDPHP Commercial |
$43.47
|
| Rate for Payer: CDPHP Medicare |
$19.98
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$43.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$43.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$43.20
|
| Rate for Payer: EmblemHealth Medicaid |
$43.20
|
| Rate for Payer: EmblemHealth Medicare |
$18.36
|
| Rate for Payer: EmblemHealth Select Care |
$38.88
|
| Rate for Payer: Fidelis Medicare |
$20.58
|
| Rate for Payer: Galaxy Health Commercial |
$35.10
|
| Rate for Payer: Hamaspik Choice Medicare |
$19.98
|
| Rate for Payer: Humana Medicare |
$19.98
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$37.80
|
| Rate for Payer: Local 1199SEIU Medicare |
$24.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$40.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$30.40
|
| Rate for Payer: MVP Health Care of NY Medicare |
$20.98
|
| Rate for Payer: United Healthcare Medicare |
$19.98
|
| Rate for Payer: WellCare Medicare |
$29.70
|
|
|
MYRBETRIQ ER 25 MG TABLET 25 mg, 30 eaches
|
Facility
|
IP
|
$54.00
|
|
|
Service Code
|
NDC 00469260130
|
| Hospital Charge Code |
4401549
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$29.70 |
| Max. Negotiated Rate |
$35.10 |
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Galaxy Health Commercial |
$35.10
|
| Rate for Payer: WellCare Medicare |
$29.70
|
|
|
MYRBETRIQ ER 50 MG TABLET 50 mg, 30 eaches
|
Facility
|
IP
|
$61.00
|
|
|
Service Code
|
NDC 00469260230
|
| Hospital Charge Code |
4401464
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$33.55 |
| Max. Negotiated Rate |
$39.65 |
| Rate for Payer: Cash Price |
$45.75
|
| Rate for Payer: Galaxy Health Commercial |
$39.65
|
| Rate for Payer: WellCare Medicare |
$33.55
|
|
|
MYRBETRIQ ER 50 MG TABLET 50 mg, 30 eaches
|
Facility
|
OP
|
$61.00
|
|
|
Service Code
|
NDC 00469260230
|
| Hospital Charge Code |
4401464
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$20.74 |
| Max. Negotiated Rate |
$49.10 |
| Rate for Payer: Aetna of NY Commercial |
$42.70
|
| Rate for Payer: Aetna of NY Medicare |
$28.06
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$45.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$45.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$22.57
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$30.50
|
| Rate for Payer: Cash Price |
$45.75
|
| Rate for Payer: CDPHP Commercial |
$49.10
|
| Rate for Payer: CDPHP Medicare |
$22.57
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$48.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$48.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$48.80
|
| Rate for Payer: EmblemHealth Medicaid |
$48.80
|
| Rate for Payer: EmblemHealth Medicare |
$20.74
|
| Rate for Payer: EmblemHealth Select Care |
$43.92
|
| Rate for Payer: Fidelis Medicare |
$23.25
|
| Rate for Payer: Galaxy Health Commercial |
$39.65
|
| Rate for Payer: Hamaspik Choice Medicare |
$22.57
|
| Rate for Payer: Humana Medicare |
$22.57
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$42.70
|
| Rate for Payer: Local 1199SEIU Medicare |
$28.06
|
| Rate for Payer: MVP Health Care of NY Commercial |
$45.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$34.34
|
| Rate for Payer: MVP Health Care of NY Medicare |
$23.70
|
| Rate for Payer: United Healthcare Medicare |
$22.57
|
| Rate for Payer: WellCare Medicare |
$33.55
|
|
|
MYXREDLIN 100 UNIT/100 ML BAG 100 unit, 100 mL
|
Facility
|
IP
|
$157.50
|
|
|
Service Code
|
HCPCS J3590
|
| Hospital Charge Code |
4401917
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$70.88 |
| Max. Negotiated Rate |
$102.38 |
| Rate for Payer: Aetna of NY Commercial |
$86.62
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$70.88
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$70.88
|
| Rate for Payer: Cash Price |
$118.13
|
| Rate for Payer: Galaxy Health Commercial |
$102.38
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$86.62
|
| Rate for Payer: WellCare Medicare |
$86.62
|
|
|
MYXREDLIN 100 UNIT/100 ML BAG 100 unit, 100 mL
|
Facility
|
OP
|
$157.50
|
|
|
Service Code
|
HCPCS J3590
|
| Hospital Charge Code |
4401917
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$53.55 |
| Max. Negotiated Rate |
$126.79 |
| Rate for Payer: Aetna of NY Commercial |
$86.62
|
| Rate for Payer: Aetna of NY Medicare |
$72.45
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$70.88
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$70.88
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$58.28
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$78.75
|
| Rate for Payer: Cash Price |
$118.13
|
| Rate for Payer: CDPHP Commercial |
$126.79
|
| Rate for Payer: CDPHP Medicare |
$58.28
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$126.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$126.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$126.00
|
| Rate for Payer: EmblemHealth Medicaid |
$126.00
|
| Rate for Payer: EmblemHealth Medicare |
$53.55
|
| Rate for Payer: EmblemHealth Select Care |
$113.40
|
| Rate for Payer: Fidelis Medicare |
$60.02
|
| Rate for Payer: Galaxy Health Commercial |
$102.38
|
| Rate for Payer: Hamaspik Choice Medicare |
$58.28
|
| Rate for Payer: Humana Medicare |
$58.28
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$86.62
|
| Rate for Payer: Local 1199SEIU Medicare |
$72.45
|
| Rate for Payer: MVP Health Care of NY Commercial |
$118.12
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$88.67
|
| Rate for Payer: MVP Health Care of NY Medicare |
$61.19
|
| Rate for Payer: United Healthcare Medicare |
$58.28
|
| Rate for Payer: WellCare Medicare |
$86.62
|
|
|
NAFCILLIN SODIUM 1GM PWVL 10X1EA
|
Facility
|
IP
|
$40.69
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
4400534
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.31 |
| Max. Negotiated Rate |
$26.45 |
| Rate for Payer: Aetna of NY Commercial |
$22.38
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$18.31
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$18.31
|
| Rate for Payer: Cash Price |
$30.52
|
| Rate for Payer: Galaxy Health Commercial |
$26.45
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$22.38
|
| Rate for Payer: WellCare Medicare |
$22.38
|
|
|
NAFCILLIN SODIUM 1GM PWVL 10X1EA
|
Facility
|
OP
|
$40.69
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
4400534
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.83 |
| Max. Negotiated Rate |
$32.76 |
| Rate for Payer: Aetna of NY Commercial |
$22.38
|
| Rate for Payer: Aetna of NY Medicare |
$18.72
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$18.31
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$18.31
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$15.06
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$20.34
|
| Rate for Payer: Cash Price |
$30.52
|
| Rate for Payer: CDPHP Commercial |
$32.76
|
| Rate for Payer: CDPHP Medicare |
$15.06
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$32.55
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$32.55
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$32.55
|
| Rate for Payer: EmblemHealth Medicaid |
$32.55
|
| Rate for Payer: EmblemHealth Medicare |
$13.83
|
| Rate for Payer: EmblemHealth Select Care |
$29.30
|
| Rate for Payer: Fidelis Medicare |
$15.51
|
| Rate for Payer: Galaxy Health Commercial |
$26.45
|
| Rate for Payer: Hamaspik Choice Medicare |
$15.06
|
| Rate for Payer: Humana Medicare |
$15.06
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$22.38
|
| Rate for Payer: Local 1199SEIU Medicare |
$18.72
|
| Rate for Payer: MVP Health Care of NY Commercial |
$30.52
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$22.91
|
| Rate for Payer: MVP Health Care of NY Medicare |
$15.81
|
| Rate for Payer: United Healthcare Medicare |
$15.06
|
| Rate for Payer: WellCare Medicare |
$22.38
|
|
|
NAFCILLIN SODIUM 2GM PWVL 10X1EA
|
Facility
|
IP
|
$107.12
|
|
|
Service Code
|
NDC 63323032820
|
| Hospital Charge Code |
4400535
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$58.92 |
| Max. Negotiated Rate |
$69.63 |
| Rate for Payer: Cash Price |
$80.34
|
| Rate for Payer: Galaxy Health Commercial |
$69.63
|
| Rate for Payer: WellCare Medicare |
$58.92
|
|
|
NAFCILLIN SODIUM 2GM PWVL 10X1EA
|
Facility
|
OP
|
$107.12
|
|
|
Service Code
|
NDC 63323032820
|
| Hospital Charge Code |
4400535
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$36.42 |
| Max. Negotiated Rate |
$86.23 |
| Rate for Payer: Aetna of NY Commercial |
$74.98
|
| Rate for Payer: Aetna of NY Medicare |
$49.28
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$80.34
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$80.34
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$39.63
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$53.56
|
| Rate for Payer: Cash Price |
$80.34
|
| Rate for Payer: CDPHP Commercial |
$86.23
|
| Rate for Payer: CDPHP Medicare |
$39.63
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$85.70
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$85.70
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$85.70
|
| Rate for Payer: EmblemHealth Medicaid |
$85.70
|
| Rate for Payer: EmblemHealth Medicare |
$36.42
|
| Rate for Payer: EmblemHealth Select Care |
$77.13
|
| Rate for Payer: Fidelis Medicare |
$40.82
|
| Rate for Payer: Galaxy Health Commercial |
$69.63
|
| Rate for Payer: Hamaspik Choice Medicare |
$39.63
|
| Rate for Payer: Humana Medicare |
$39.63
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$74.98
|
| Rate for Payer: Local 1199SEIU Medicare |
$49.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$80.34
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$60.31
|
| Rate for Payer: MVP Health Care of NY Medicare |
$41.62
|
| Rate for Payer: United Healthcare Medicare |
$39.63
|
| Rate for Payer: WellCare Medicare |
$58.92
|
|
|
NALBUPHINE HYDROCHLORIDE INJ, PER 10 MG
|
Facility
|
IP
|
$10.82
|
|
|
Service Code
|
HCPCS J2300
|
| Hospital Charge Code |
4400536
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.82 |
| Max. Negotiated Rate |
$7.03 |
| Rate for Payer: Aetna of NY Commercial |
$5.95
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$2.82
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$2.82
|
| Rate for Payer: Cash Price |
$8.12
|
| Rate for Payer: Cash Price |
$8.12
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$2.82
|
| Rate for Payer: EmblemHealth Select Care |
$2.82
|
| Rate for Payer: Galaxy Health Commercial |
$7.03
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$5.95
|
| Rate for Payer: WellCare Medicare |
$5.95
|
|
