|
NOREPINEPHR 8 MG/250-0.9% NACL 8 mg, 250 mL
|
Facility
|
IP
|
$176.00
|
|
|
Service Code
|
NDC 44567064110
|
| Hospital Charge Code |
4401564
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$96.80 |
| Max. Negotiated Rate |
$114.40 |
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Galaxy Health Commercial |
$114.40
|
| Rate for Payer: WellCare Medicare |
$96.80
|
|
|
NOREPINEPHRINE BITARTRATE 1MG/ML AMPS 10
|
Facility
|
IP
|
$27.04
|
|
|
Service Code
|
NDC 36000016210
|
| Hospital Charge Code |
4400433
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.87 |
| Max. Negotiated Rate |
$17.58 |
| Rate for Payer: Cash Price |
$20.28
|
| Rate for Payer: Galaxy Health Commercial |
$17.58
|
| Rate for Payer: WellCare Medicare |
$14.87
|
|
|
NOREPINEPHRINE BITARTRATE 1MG/ML AMPS 10
|
Facility
|
OP
|
$27.04
|
|
|
Service Code
|
NDC 36000016210
|
| Hospital Charge Code |
4400433
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.06 |
| Max. Negotiated Rate |
$21.63 |
| Rate for Payer: Aetna of NY Commercial |
$18.93
|
| Rate for Payer: Aetna of NY Medicare |
$12.44
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$10.82
|
| Rate for Payer: Cash Price |
$20.28
|
| Rate for Payer: CDPHP Medicare |
$10.00
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$21.63
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$21.63
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$21.63
|
| Rate for Payer: EmblemHealth Medicaid |
$21.63
|
| Rate for Payer: EmblemHealth Medicare |
$9.19
|
| Rate for Payer: EmblemHealth Select Care |
$19.47
|
| Rate for Payer: Fidelis Medicare |
$10.82
|
| Rate for Payer: Galaxy Health Commercial |
$17.58
|
| Rate for Payer: Hamaspik Choice Medicare |
$10.82
|
| Rate for Payer: Humana Medicare |
$10.82
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$18.93
|
| Rate for Payer: Local 1199SEIU Medicare |
$12.44
|
| Rate for Payer: MVP Health Care of NY Commercial |
$20.28
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$15.22
|
| Rate for Payer: MVP Health Care of NY Medicare |
$11.36
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$4.06
|
| Rate for Payer: United Healthcare Medicare |
$10.82
|
| Rate for Payer: WellCare Medicare |
$14.87
|
|
|
NORMAL SALINE FLUSH SYRINGE 10 mL, 10 mL
|
Facility
|
OP
|
$6.00
|
|
|
Service Code
|
NDC 8290306546
|
| Hospital Charge Code |
4401510
|
|
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
|
|
|
NORMAL SALINE FLUSH SYRINGE 10 mL, 10 mL
|
Facility
|
IP
|
$6.00
|
|
|
Service Code
|
NDC 8290306546
|
| Hospital Charge Code |
4401510
|
|
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
|
|
|
NORMAL SALINE INFUSION 1000 CC
|
Facility
|
IP
|
$19.57
|
|
|
Service Code
|
HCPCS J7030
|
| Hospital Charge Code |
4450022
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.19 |
| Max. Negotiated Rate |
$12.72 |
| Rate for Payer: Aetna of NY Commercial |
$10.76
|
| Rate for Payer: Cash Price |
$14.68
|
| Rate for Payer: Cash Price |
$14.68
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$2.19
|
| Rate for Payer: EmblemHealth Select Care |
$2.19
|
| Rate for Payer: Galaxy Health Commercial |
$12.72
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$10.76
|
| Rate for Payer: WellCare Medicare |
$10.76
|
|
|
NORMAL SALINE INFUSION 1000 CC
|
Facility
|
OP
|
$19.57
|
|
|
Service Code
|
HCPCS J7030
|
| Hospital Charge Code |
4450020
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.19 |
| Max. Negotiated Rate |
$15.66 |
| Rate for Payer: Aetna of NY Medicare |
$9.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$7.83
|
| Rate for Payer: Cash Price |
$14.68
|
| Rate for Payer: Cash Price |
$14.68
|
| Rate for Payer: CDPHP Medicare |
$7.24
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$2.19
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$15.66
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$15.66
|
| Rate for Payer: EmblemHealth Medicaid |
$15.66
|
| Rate for Payer: EmblemHealth Medicare |
$6.65
|
| Rate for Payer: EmblemHealth Select Care |
$2.19
|
| Rate for Payer: Fidelis Medicare |
$7.83
|
| Rate for Payer: Galaxy Health Commercial |
$12.72
|
| Rate for Payer: Hamaspik Choice Medicare |
$7.83
|
| Rate for Payer: Humana Medicare |
$7.83
|
| Rate for Payer: Local 1199SEIU Medicare |
$9.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$14.68
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$11.02
|
| Rate for Payer: MVP Health Care of NY Medicare |
$8.22
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$4.19
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$2.94
|
| Rate for Payer: United Healthcare Commercial |
$4.19
|
| Rate for Payer: United Healthcare Medicare |
$7.83
|
| Rate for Payer: WellCare Medicare |
$10.76
|
|
|
NORMAL SALINE INFUSION 1000 CC
|
Facility
|
OP
|
$19.57
|
|
|
Service Code
|
HCPCS J7030
|
| Hospital Charge Code |
4450021
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.19 |
| Max. Negotiated Rate |
$15.66 |
| Rate for Payer: Aetna of NY Medicare |
$9.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$7.83
|
| Rate for Payer: Cash Price |
$14.68
|
| Rate for Payer: Cash Price |
$14.68
|
| Rate for Payer: CDPHP Medicare |
$7.24
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$2.19
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$15.66
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$15.66
|
| Rate for Payer: EmblemHealth Medicaid |
$15.66
|
| Rate for Payer: EmblemHealth Medicare |
$6.65
|
| Rate for Payer: EmblemHealth Select Care |
$2.19
|
| Rate for Payer: Fidelis Medicare |
$7.83
|
| Rate for Payer: Galaxy Health Commercial |
$12.72
|
| Rate for Payer: Hamaspik Choice Medicare |
$7.83
|
| Rate for Payer: Humana Medicare |
$7.83
|
| Rate for Payer: Local 1199SEIU Medicare |
$9.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$14.68
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$11.02
|
| Rate for Payer: MVP Health Care of NY Medicare |
$8.22
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$4.19
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$2.94
|
| Rate for Payer: United Healthcare Commercial |
$4.19
|
| Rate for Payer: United Healthcare Medicare |
$7.83
|
| Rate for Payer: WellCare Medicare |
$10.76
|
|
|
NORMAL SALINE INFUSION 1000 CC
|
Facility
|
IP
|
$19.57
|
|
|
Service Code
|
HCPCS J7030
|
| Hospital Charge Code |
4450021
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.19 |
| Max. Negotiated Rate |
$12.72 |
| Rate for Payer: Aetna of NY Commercial |
$10.76
|
| Rate for Payer: Cash Price |
$14.68
|
| Rate for Payer: Cash Price |
$14.68
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$2.19
|
| Rate for Payer: EmblemHealth Select Care |
$2.19
|
| Rate for Payer: Galaxy Health Commercial |
$12.72
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$10.76
|
| Rate for Payer: WellCare Medicare |
$10.76
|
|
|
NORMAL SALINE INFUSION 1000 CC
|
Facility
|
IP
|
$19.57
|
|
|
Service Code
|
HCPCS J7030
|
| Hospital Charge Code |
4450020
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.19 |
| Max. Negotiated Rate |
$12.72 |
| Rate for Payer: Aetna of NY Commercial |
$10.76
|
| Rate for Payer: Cash Price |
$14.68
|
| Rate for Payer: Cash Price |
$14.68
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$2.19
|
| Rate for Payer: EmblemHealth Select Care |
$2.19
|
| Rate for Payer: Galaxy Health Commercial |
$12.72
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$10.76
|
| Rate for Payer: WellCare Medicare |
$10.76
|
|
|
NORMAL SALINE INFUSION 1000 CC
|
Facility
|
OP
|
$19.57
|
|
|
Service Code
|
HCPCS J7030
|
| Hospital Charge Code |
4450022
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.19 |
| Max. Negotiated Rate |
$15.66 |
| Rate for Payer: Aetna of NY Medicare |
$9.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$7.83
|
| Rate for Payer: Cash Price |
$14.68
|
| Rate for Payer: Cash Price |
$14.68
|
| Rate for Payer: CDPHP Medicare |
$7.24
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$2.19
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$15.66
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$15.66
|
| Rate for Payer: EmblemHealth Medicaid |
$15.66
|
| Rate for Payer: EmblemHealth Medicare |
$6.65
|
| Rate for Payer: EmblemHealth Select Care |
$2.19
|
| Rate for Payer: Fidelis Medicare |
$7.83
|
| Rate for Payer: Galaxy Health Commercial |
$12.72
|
| Rate for Payer: Hamaspik Choice Medicare |
$7.83
|
| Rate for Payer: Humana Medicare |
$7.83
|
| Rate for Payer: Local 1199SEIU Medicare |
$9.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$14.68
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$11.02
|
| Rate for Payer: MVP Health Care of NY Medicare |
$8.22
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$4.19
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$2.94
|
| Rate for Payer: United Healthcare Commercial |
$4.19
|
| Rate for Payer: United Healthcare Medicare |
$7.83
|
| Rate for Payer: WellCare Medicare |
$10.76
|
|
|
NORTRIPTYLINE 25 MG CAPSULE
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
NDC 93081101
|
| Hospital Charge Code |
4409090
|
|
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
|
|
|
NORTRIPTYLINE 25 MG CAPSULE
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 93081101
|
| Hospital Charge Code |
4409090
|
|
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
|
|
|
NORTRIPTYLINE HCL 10 MG CAP 10 mg, 100 eaches
|
Facility
|
IP
|
$6.00
|
|
|
Service Code
|
NDC 51672400101
|
| Hospital Charge Code |
4401513
|
|
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
|
|
|
NORTRIPTYLINE HCL 10 MG CAP 10 mg, 100 eaches
|
Facility
|
OP
|
$6.00
|
|
|
Service Code
|
NDC 51672400101
|
| Hospital Charge Code |
4401513
|
|
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
|
|
|
NovoLIN N 100 UNIT/ML FLEXPEN 3 mL, 3 mL
|
Facility
|
IP
|
$188.00
|
|
|
Service Code
|
NDC 169300415
|
| Hospital Charge Code |
4401537
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$103.40 |
| Max. Negotiated Rate |
$122.20 |
| Rate for Payer: Cash Price |
$141.00
|
| Rate for Payer: Galaxy Health Commercial |
$122.20
|
| Rate for Payer: WellCare Medicare |
$103.40
|
|
|
NovoLIN N 100 UNIT/ML FLEXPEN 3 mL, 3 mL
|
Facility
|
OP
|
$188.00
|
|
|
Service Code
|
NDC 169300415
|
| Hospital Charge Code |
4401537
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$28.20 |
| Max. Negotiated Rate |
$150.40 |
| Rate for Payer: Aetna of NY Commercial |
$131.60
|
| Rate for Payer: Aetna of NY Medicare |
$86.48
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$75.20
|
| Rate for Payer: Cash Price |
$141.00
|
| Rate for Payer: CDPHP Medicare |
$69.56
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$150.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$150.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$150.40
|
| Rate for Payer: EmblemHealth Medicaid |
$150.40
|
| Rate for Payer: EmblemHealth Medicare |
$63.92
|
| Rate for Payer: EmblemHealth Select Care |
$135.36
|
| Rate for Payer: Fidelis Medicare |
$75.20
|
| Rate for Payer: Galaxy Health Commercial |
$122.20
|
| Rate for Payer: Hamaspik Choice Medicare |
$75.20
|
| Rate for Payer: Humana Medicare |
$75.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$131.60
|
| Rate for Payer: Local 1199SEIU Medicare |
$86.48
|
| Rate for Payer: MVP Health Care of NY Commercial |
$141.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$105.84
|
| Rate for Payer: MVP Health Care of NY Medicare |
$78.96
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$28.20
|
| Rate for Payer: United Healthcare Medicare |
$75.20
|
| Rate for Payer: WellCare Medicare |
$103.40
|
|
|
NULOJIX 250 MG VIAL 1 mg, 1 each
|
Facility
|
IP
|
$14.00
|
|
|
Service Code
|
HCPCS J0485
|
| Hospital Charge Code |
4401410
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.89 |
| Max. Negotiated Rate |
$9.10 |
| Rate for Payer: Aetna of NY Commercial |
$7.70
|
| Rate for Payer: Cash Price |
$10.50
|
| Rate for Payer: Cash Price |
$10.50
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$3.89
|
| Rate for Payer: EmblemHealth Select Care |
$3.89
|
| Rate for Payer: Galaxy Health Commercial |
$9.10
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$7.70
|
| Rate for Payer: WellCare Medicare |
$7.70
|
|
|
NULOJIX 250 MG VIAL 1 mg, 1 each
|
Facility
|
OP
|
$14.00
|
|
|
Service Code
|
HCPCS J0485
|
| Hospital Charge Code |
4401410
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.10 |
| Max. Negotiated Rate |
$11.20 |
| Rate for Payer: Aetna of NY Medicare |
$6.44
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$5.60
|
| Rate for Payer: Cash Price |
$10.50
|
| Rate for Payer: Cash Price |
$10.50
|
| Rate for Payer: CDPHP Medicare |
$5.18
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$3.89
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$11.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$11.20
|
| Rate for Payer: EmblemHealth Medicaid |
$11.20
|
| Rate for Payer: EmblemHealth Medicare |
$4.76
|
| Rate for Payer: EmblemHealth Select Care |
$3.89
|
| Rate for Payer: Fidelis Medicare |
$5.60
|
| Rate for Payer: Galaxy Health Commercial |
$9.10
|
| Rate for Payer: Hamaspik Choice Medicare |
$5.60
|
| Rate for Payer: Humana Medicare |
$5.60
|
| Rate for Payer: Local 1199SEIU Medicare |
$6.44
|
| Rate for Payer: MVP Health Care of NY Commercial |
$10.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$7.88
|
| Rate for Payer: MVP Health Care of NY Medicare |
$5.88
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$6.24
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$2.10
|
| Rate for Payer: United Healthcare Commercial |
$6.24
|
| Rate for Payer: United Healthcare Medicare |
$5.60
|
| Rate for Payer: WellCare Medicare |
$7.70
|
|
|
NYAMYC 100,000 UNIT/GM POWDER 100000 g, 60 g
|
Facility
|
OP
|
$392.00
|
|
|
Service Code
|
NDC 832046560
|
| Hospital Charge Code |
4401562
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$58.80 |
| Max. Negotiated Rate |
$313.60 |
| Rate for Payer: Aetna of NY Commercial |
$274.40
|
| Rate for Payer: Aetna of NY Medicare |
$180.32
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$156.80
|
| Rate for Payer: Cash Price |
$294.00
|
| Rate for Payer: CDPHP Medicare |
$145.04
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$313.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$313.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$313.60
|
| Rate for Payer: EmblemHealth Medicaid |
$313.60
|
| Rate for Payer: EmblemHealth Medicare |
$133.28
|
| Rate for Payer: EmblemHealth Select Care |
$282.24
|
| Rate for Payer: Fidelis Medicare |
$156.80
|
| Rate for Payer: Galaxy Health Commercial |
$254.80
|
| Rate for Payer: Hamaspik Choice Medicare |
$156.80
|
| Rate for Payer: Humana Medicare |
$156.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$274.40
|
| Rate for Payer: Local 1199SEIU Medicare |
$180.32
|
| Rate for Payer: MVP Health Care of NY Commercial |
$294.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$220.70
|
| Rate for Payer: MVP Health Care of NY Medicare |
$164.64
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$58.80
|
| Rate for Payer: United Healthcare Medicare |
$156.80
|
| Rate for Payer: WellCare Medicare |
$215.60
|
|
|
NYAMYC 100,000 UNIT/GM POWDER 100000 g, 60 g
|
Facility
|
IP
|
$392.00
|
|
|
Service Code
|
NDC 832046560
|
| Hospital Charge Code |
4401562
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$215.60 |
| Max. Negotiated Rate |
$254.80 |
| Rate for Payer: Cash Price |
$294.00
|
| Rate for Payer: Galaxy Health Commercial |
$254.80
|
| Rate for Payer: WellCare Medicare |
$215.60
|
|
|
NYSATIN ORAL SUP 5ML
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
NDC 66689003701
|
| Hospital Charge Code |
4409176
|
|
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
|
|
|
NYSATIN ORAL SUP 5ML
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 66689003701
|
| Hospital Charge Code |
4409176
|
|
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
|
|
|
NYSTATIN 100MU/GM CRM 30 GM
|
Facility
|
IP
|
$81.11
|
|
|
Service Code
|
NDC 45802005911
|
| Hospital Charge Code |
4400580
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$44.61 |
| Max. Negotiated Rate |
$52.72 |
| Rate for Payer: Cash Price |
$60.83
|
| Rate for Payer: Galaxy Health Commercial |
$52.72
|
| Rate for Payer: WellCare Medicare |
$44.61
|
|
|
NYSTATIN 100MU/GM CRM 30 GM
|
Facility
|
OP
|
$81.11
|
|
|
Service Code
|
NDC 45802005911
|
| Hospital Charge Code |
4400580
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.17 |
| Max. Negotiated Rate |
$64.89 |
| Rate for Payer: Aetna of NY Commercial |
$56.78
|
| Rate for Payer: Aetna of NY Medicare |
$37.31
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$32.44
|
| Rate for Payer: Cash Price |
$60.83
|
| Rate for Payer: CDPHP Medicare |
$30.01
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$64.89
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$64.89
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$64.89
|
| Rate for Payer: EmblemHealth Medicaid |
$64.89
|
| Rate for Payer: EmblemHealth Medicare |
$27.58
|
| Rate for Payer: EmblemHealth Select Care |
$58.40
|
| Rate for Payer: Fidelis Medicare |
$32.44
|
| Rate for Payer: Galaxy Health Commercial |
$52.72
|
| Rate for Payer: Hamaspik Choice Medicare |
$32.44
|
| Rate for Payer: Humana Medicare |
$32.44
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$56.78
|
| Rate for Payer: Local 1199SEIU Medicare |
$37.31
|
| Rate for Payer: MVP Health Care of NY Commercial |
$60.83
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$45.66
|
| Rate for Payer: MVP Health Care of NY Medicare |
$34.07
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$12.17
|
| Rate for Payer: United Healthcare Medicare |
$32.44
|
| Rate for Payer: WellCare Medicare |
$44.61
|
|
