|
PFIZER COVID VACCINE 30 MCG/0.3 ML 12 Y OLDER
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS 91320
|
| Hospital Charge Code |
4403003
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$131.10 |
| Rate for Payer: Aetna of NY Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$131.10
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$131.10
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$131.10
|
| Rate for Payer: EmblemHealth Select Care |
$131.10
|
| Rate for Payer: Galaxy Health Commercial |
$0.01
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$0.01
|
| Rate for Payer: WellCare Medicare |
$0.01
|
|
|
PFIZER COVID VACCINE 30 MCG/0.3 ML 12 Y OLDER
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS 91320
|
| Hospital Charge Code |
4403003
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$131.10 |
| Rate for Payer: Aetna of NY Commercial |
$0.01
|
| Rate for Payer: Aetna of NY Medicare |
$0.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$131.10
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$131.10
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$0.00
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: CDPHP Commercial |
$0.01
|
| Rate for Payer: CDPHP Medicare |
$0.00
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$131.10
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$0.01
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$0.01
|
| Rate for Payer: EmblemHealth Medicaid |
$0.01
|
| Rate for Payer: EmblemHealth Medicare |
$0.00
|
| Rate for Payer: EmblemHealth Select Care |
$131.10
|
| Rate for Payer: Fidelis Medicare |
$0.00
|
| Rate for Payer: Galaxy Health Commercial |
$0.01
|
| Rate for Payer: Hamaspik Choice Medicare |
$0.00
|
| Rate for Payer: Humana Medicare |
$0.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$0.01
|
| Rate for Payer: Local 1199SEIU Medicare |
$0.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.01
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$0.01
|
| Rate for Payer: MVP Health Care of NY Medicare |
$0.00
|
| Rate for Payer: United Healthcare Medicare |
$0.00
|
| Rate for Payer: WellCare Medicare |
$0.01
|
|
|
PFIZER COVID VACCINE 3MCG/0.2ML 6 MO - 4Y
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS 91318
|
| Hospital Charge Code |
4403001
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$65.55 |
| Rate for Payer: Aetna of NY Commercial |
$0.01
|
| Rate for Payer: Aetna of NY Medicare |
$0.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$65.55
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$65.55
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$0.00
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: CDPHP Commercial |
$0.01
|
| Rate for Payer: CDPHP Medicare |
$0.00
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$65.55
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$0.01
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$0.01
|
| Rate for Payer: EmblemHealth Medicaid |
$0.01
|
| Rate for Payer: EmblemHealth Medicare |
$0.00
|
| Rate for Payer: EmblemHealth Select Care |
$65.55
|
| Rate for Payer: Fidelis Medicare |
$0.00
|
| Rate for Payer: Galaxy Health Commercial |
$0.01
|
| Rate for Payer: Hamaspik Choice Medicare |
$0.00
|
| Rate for Payer: Humana Medicare |
$0.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$0.01
|
| Rate for Payer: Local 1199SEIU Medicare |
$0.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.01
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$0.01
|
| Rate for Payer: MVP Health Care of NY Medicare |
$0.00
|
| Rate for Payer: United Healthcare Medicare |
$0.00
|
| Rate for Payer: WellCare Medicare |
$0.01
|
|
|
PFIZER COVID VACCINE 3MCG/0.2ML 6 MO - 4Y
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS 91318
|
| Hospital Charge Code |
4403001
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$65.55 |
| Rate for Payer: Aetna of NY Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$65.55
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$65.55
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$65.55
|
| Rate for Payer: EmblemHealth Select Care |
$65.55
|
| Rate for Payer: Galaxy Health Commercial |
$0.01
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$0.01
|
| Rate for Payer: WellCare Medicare |
$0.01
|
|
|
PHARMACY GI COCKTAIL
|
Facility
|
OP
|
$34.00
|
|
| Hospital Charge Code |
4409070
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.56 |
| Max. Negotiated Rate |
$27.37 |
| Rate for Payer: Aetna of NY Commercial |
$23.80
|
| Rate for Payer: Aetna of NY Medicare |
$15.64
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$25.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$25.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$12.58
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$17.00
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: CDPHP Commercial |
$27.37
|
| Rate for Payer: CDPHP Medicare |
$12.58
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$27.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$27.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$27.20
|
| Rate for Payer: EmblemHealth Medicaid |
$27.20
|
| Rate for Payer: EmblemHealth Medicare |
$11.56
|
| Rate for Payer: EmblemHealth Select Care |
$24.48
|
| Rate for Payer: Fidelis Medicare |
$12.96
|
| Rate for Payer: Galaxy Health Commercial |
$22.10
|
| Rate for Payer: Hamaspik Choice Medicare |
$12.58
|
| Rate for Payer: Humana Medicare |
$12.58
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$23.80
|
| Rate for Payer: Local 1199SEIU Medicare |
$15.64
|
| Rate for Payer: MVP Health Care of NY Commercial |
$25.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$19.14
|
| Rate for Payer: MVP Health Care of NY Medicare |
$13.21
|
| Rate for Payer: United Healthcare Medicare |
$12.58
|
| Rate for Payer: WellCare Medicare |
$18.70
|
|
|
PHARMACY GI COCKTAIL
|
Facility
|
IP
|
$34.00
|
|
| Hospital Charge Code |
4409070
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$18.70 |
| Max. Negotiated Rate |
$22.10 |
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Galaxy Health Commercial |
$22.10
|
| Rate for Payer: WellCare Medicare |
$18.70
|
|
|
PHENAZOPYRIDINE HCL 100MG TABS 10X10EA
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 75826011410
|
| Hospital Charge Code |
4400617
|
|
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
|
|
|
PHENAZOPYRIDINE HCL 100MG TABS 10X10EA
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
NDC 75826011410
|
| Hospital Charge Code |
4400617
|
|
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
|
|
|
PHENobarbitaL 130 MG/ML VIAL 130 mg, 1 mL
|
Facility
|
OP
|
$183.00
|
|
|
Service Code
|
HCPCS J2560
|
| Hospital Charge Code |
4401570
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$32.80 |
| Max. Negotiated Rate |
$147.32 |
| Rate for Payer: Aetna of NY Commercial |
$100.65
|
| Rate for Payer: Aetna of NY Medicare |
$84.18
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$32.80
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$32.80
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$67.71
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$91.50
|
| Rate for Payer: Cash Price |
$137.25
|
| Rate for Payer: Cash Price |
$137.25
|
| Rate for Payer: CDPHP Commercial |
$147.32
|
| Rate for Payer: CDPHP Medicare |
$67.71
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$32.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$146.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$146.40
|
| Rate for Payer: EmblemHealth Medicaid |
$146.40
|
| Rate for Payer: EmblemHealth Medicare |
$62.22
|
| Rate for Payer: EmblemHealth Select Care |
$32.80
|
| Rate for Payer: Fidelis Medicare |
$69.74
|
| Rate for Payer: Galaxy Health Commercial |
$118.95
|
| Rate for Payer: Hamaspik Choice Medicare |
$67.71
|
| Rate for Payer: Humana Medicare |
$67.71
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$100.65
|
| Rate for Payer: Local 1199SEIU Medicare |
$84.18
|
| Rate for Payer: MVP Health Care of NY Commercial |
$137.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$103.03
|
| Rate for Payer: MVP Health Care of NY Medicare |
$71.10
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$64.98
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$32.80
|
| Rate for Payer: United Healthcare Commercial |
$64.98
|
| Rate for Payer: United Healthcare Medicare |
$67.71
|
| Rate for Payer: WellCare Medicare |
$100.65
|
|
|
PHENobarbitaL 130 MG/ML VIAL 130 mg, 1 mL
|
Facility
|
IP
|
$183.00
|
|
|
Service Code
|
HCPCS J2560
|
| Hospital Charge Code |
4401570
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$32.80 |
| Max. Negotiated Rate |
$118.95 |
| Rate for Payer: Aetna of NY Commercial |
$100.65
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$32.80
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$32.80
|
| Rate for Payer: Cash Price |
$137.25
|
| Rate for Payer: Cash Price |
$137.25
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$32.80
|
| Rate for Payer: EmblemHealth Select Care |
$32.80
|
| Rate for Payer: Galaxy Health Commercial |
$118.95
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$100.65
|
| Rate for Payer: WellCare Medicare |
$100.65
|
|
|
PHENOBARB SOLN 20 MG / 5 ML
|
Facility
|
IP
|
$6.00
|
|
| Hospital Charge Code |
4408953
|
|
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
|
|
|
PHENOBARB SOLN 20 MG / 5 ML
|
Facility
|
OP
|
$6.00
|
|
| Hospital Charge Code |
4408953
|
|
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
|
|
|
PHENYLEPHRINE HCL 0.01 SPIN 15 ML
|
Facility
|
OP
|
$13.13
|
|
|
Service Code
|
NDC 69536010015
|
| Hospital Charge Code |
4400553
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.46 |
| Max. Negotiated Rate |
$10.57 |
| Rate for Payer: Aetna of NY Commercial |
$9.19
|
| Rate for Payer: Aetna of NY Medicare |
$6.04
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$9.85
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$9.85
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$4.86
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$6.56
|
| Rate for Payer: Cash Price |
$9.85
|
| Rate for Payer: CDPHP Commercial |
$10.57
|
| Rate for Payer: CDPHP Medicare |
$4.86
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$10.50
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$10.50
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$10.50
|
| Rate for Payer: EmblemHealth Medicaid |
$10.50
|
| Rate for Payer: EmblemHealth Medicare |
$4.46
|
| Rate for Payer: EmblemHealth Select Care |
$9.45
|
| Rate for Payer: Fidelis Medicare |
$5.00
|
| Rate for Payer: Galaxy Health Commercial |
$8.53
|
| Rate for Payer: Hamaspik Choice Medicare |
$4.86
|
| Rate for Payer: Humana Medicare |
$4.86
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$9.19
|
| Rate for Payer: Local 1199SEIU Medicare |
$6.04
|
| Rate for Payer: MVP Health Care of NY Commercial |
$9.85
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$7.39
|
| Rate for Payer: MVP Health Care of NY Medicare |
$5.10
|
| Rate for Payer: United Healthcare Medicare |
$4.86
|
| Rate for Payer: WellCare Medicare |
$7.22
|
|
|
PHENYLEPHRINE HCL 0.01 SPIN 15 ML
|
Facility
|
IP
|
$13.13
|
|
|
Service Code
|
NDC 69536010015
|
| Hospital Charge Code |
4400553
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.22 |
| Max. Negotiated Rate |
$8.53 |
| Rate for Payer: Cash Price |
$9.85
|
| Rate for Payer: Galaxy Health Commercial |
$8.53
|
| Rate for Payer: WellCare Medicare |
$7.22
|
|
|
PHENYLEPHRINE HCL 0.025 DROP 3 ML
|
Facility
|
OP
|
$72.10
|
|
|
Service Code
|
NDC 17478020102
|
| Hospital Charge Code |
4400618
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$24.51 |
| Max. Negotiated Rate |
$58.04 |
| Rate for Payer: Aetna of NY Commercial |
$50.47
|
| Rate for Payer: Aetna of NY Medicare |
$33.17
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$54.08
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$54.08
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$26.68
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$36.05
|
| Rate for Payer: Cash Price |
$54.08
|
| Rate for Payer: CDPHP Commercial |
$58.04
|
| Rate for Payer: CDPHP Medicare |
$26.68
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$57.68
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$57.68
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$57.68
|
| Rate for Payer: EmblemHealth Medicaid |
$57.68
|
| Rate for Payer: EmblemHealth Medicare |
$24.51
|
| Rate for Payer: EmblemHealth Select Care |
$51.91
|
| Rate for Payer: Fidelis Medicare |
$27.48
|
| Rate for Payer: Galaxy Health Commercial |
$46.86
|
| Rate for Payer: Hamaspik Choice Medicare |
$26.68
|
| Rate for Payer: Humana Medicare |
$26.68
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$50.47
|
| Rate for Payer: Local 1199SEIU Medicare |
$33.17
|
| Rate for Payer: MVP Health Care of NY Commercial |
$54.08
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$40.59
|
| Rate for Payer: MVP Health Care of NY Medicare |
$28.01
|
| Rate for Payer: United Healthcare Medicare |
$26.68
|
| Rate for Payer: WellCare Medicare |
$39.66
|
|
|
PHENYLEPHRINE HCL 0.025 DROP 3 ML
|
Facility
|
IP
|
$72.10
|
|
|
Service Code
|
NDC 17478020102
|
| Hospital Charge Code |
4400618
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$39.66 |
| Max. Negotiated Rate |
$46.86 |
| Rate for Payer: Cash Price |
$54.08
|
| Rate for Payer: Galaxy Health Commercial |
$46.86
|
| Rate for Payer: WellCare Medicare |
$39.66
|
|
|
PHENYLEPHRINE HCL, UP TO 1 ML
|
Facility
|
IP
|
$44.55
|
|
|
Service Code
|
HCPCS J2370
|
| Hospital Charge Code |
4400619
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.05 |
| Max. Negotiated Rate |
$28.96 |
| Rate for Payer: Aetna of NY Commercial |
$24.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$20.05
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$20.05
|
| Rate for Payer: Cash Price |
$33.41
|
| Rate for Payer: Galaxy Health Commercial |
$28.96
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$24.50
|
| Rate for Payer: WellCare Medicare |
$24.50
|
|
|
PHENYLEPHRINE HCL, UP TO 1 ML
|
Facility
|
OP
|
$44.55
|
|
|
Service Code
|
HCPCS J2370
|
| Hospital Charge Code |
4400619
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.15 |
| Max. Negotiated Rate |
$35.86 |
| Rate for Payer: Aetna of NY Commercial |
$24.50
|
| Rate for Payer: Aetna of NY Medicare |
$20.49
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$20.05
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$20.05
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$16.48
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$22.28
|
| Rate for Payer: Cash Price |
$33.41
|
| Rate for Payer: CDPHP Commercial |
$35.86
|
| Rate for Payer: CDPHP Medicare |
$16.48
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$35.64
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$35.64
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$35.64
|
| Rate for Payer: EmblemHealth Medicaid |
$35.64
|
| Rate for Payer: EmblemHealth Medicare |
$15.15
|
| Rate for Payer: EmblemHealth Select Care |
$32.08
|
| Rate for Payer: Fidelis Medicare |
$16.98
|
| Rate for Payer: Galaxy Health Commercial |
$28.96
|
| Rate for Payer: Hamaspik Choice Medicare |
$16.48
|
| Rate for Payer: Humana Medicare |
$16.48
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$24.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$20.49
|
| Rate for Payer: MVP Health Care of NY Commercial |
$33.41
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$25.08
|
| Rate for Payer: MVP Health Care of NY Medicare |
$17.31
|
| Rate for Payer: United Healthcare Medicare |
$16.48
|
| Rate for Payer: WellCare Medicare |
$24.50
|
|
|
PHENYTOIN SOD EXTENDED 100MG CAPS 10X10E
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
NDC 00071036940
|
| Hospital Charge Code |
4400230
|
|
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
|
|
|
PHENYTOIN SOD EXTENDED 100MG CAPS 10X10E
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 00071036940
|
| Hospital Charge Code |
4400230
|
|
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
|
|
|
PHENYTOIN SODIUM, PER 50 MG
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
HCPCS J1165
|
| Hospital Charge Code |
4400620
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.64 |
| Max. Negotiated Rate |
$4.02 |
| Rate for Payer: Aetna of NY Commercial |
$3.40
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$0.64
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$0.64
|
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.64
|
| Rate for Payer: EmblemHealth Select Care |
$0.64
|
| Rate for Payer: Galaxy Health Commercial |
$4.02
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$3.40
|
| Rate for Payer: WellCare Medicare |
$3.40
|
|
|
PHENYTOIN SODIUM, PER 50 MG
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
HCPCS J1165
|
| Hospital Charge Code |
4400620
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.64 |
| Max. Negotiated Rate |
$4.97 |
| 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 |
$0.64
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$0.64
|
| 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: 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 |
$0.64
|
| 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 |
$0.64
|
| 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 |
$1.04
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$0.64
|
| Rate for Payer: United Healthcare Commercial |
$1.04
|
| Rate for Payer: United Healthcare Medicare |
$2.29
|
| Rate for Payer: WellCare Medicare |
$3.40
|
|
|
PHILLIPS MASK AF531
|
Facility
|
IP
|
$157.00
|
|
| Hospital Charge Code |
4473005
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$102.05 |
| Max. Negotiated Rate |
$102.05 |
| Rate for Payer: Cash Price |
$117.75
|
| Rate for Payer: Galaxy Health Commercial |
$102.05
|
|
|
PHILLIPS MASK AF531
|
Facility
|
OP
|
$157.00
|
|
| Hospital Charge Code |
4473005
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$53.38 |
| Max. Negotiated Rate |
$126.38 |
| Rate for Payer: Aetna of NY Commercial |
$109.90
|
| Rate for Payer: Aetna of NY Medicare |
$72.22
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$117.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$117.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$58.09
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$78.50
|
| Rate for Payer: Cash Price |
$117.75
|
| Rate for Payer: CDPHP Commercial |
$126.38
|
| Rate for Payer: CDPHP Medicare |
$58.09
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$125.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$125.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$125.60
|
| Rate for Payer: EmblemHealth Medicaid |
$125.60
|
| Rate for Payer: EmblemHealth Medicare |
$53.38
|
| Rate for Payer: EmblemHealth Select Care |
$113.04
|
| Rate for Payer: Fidelis Medicare |
$59.83
|
| Rate for Payer: Galaxy Health Commercial |
$102.05
|
| Rate for Payer: Hamaspik Choice Medicare |
$58.09
|
| Rate for Payer: Humana Medicare |
$58.09
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$109.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$72.22
|
| Rate for Payer: MVP Health Care of NY Commercial |
$117.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$88.39
|
| Rate for Payer: MVP Health Care of NY Medicare |
$60.99
|
| Rate for Payer: United Healthcare Medicare |
$58.09
|
| Rate for Payer: WellCare Medicare |
$86.35
|
|
|
PHOSPHOLIPID NEUTRALIZATION PLATELET
|
Facility
|
OP
|
$63.00
|
|
|
Service Code
|
HCPCS 85597
|
| Hospital Charge Code |
4302012
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.98 |
| Max. Negotiated Rate |
$50.72 |
| Rate for Payer: Aetna of NY Commercial |
$40.95
|
| Rate for Payer: Aetna of NY Medicare |
$28.98
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$47.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$47.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$23.31
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$31.50
|
| Rate for Payer: Cash Price |
$47.25
|
| Rate for Payer: Cash Price |
$47.25
|
| Rate for Payer: CDPHP Commercial |
$50.72
|
| Rate for Payer: CDPHP Medicare |
$23.31
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$37.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$50.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$50.40
|
| Rate for Payer: EmblemHealth Medicaid |
$50.40
|
| Rate for Payer: EmblemHealth Medicare |
$21.42
|
| Rate for Payer: EmblemHealth Select Care |
$37.80
|
| Rate for Payer: Fidelis Medicare |
$24.01
|
| Rate for Payer: Galaxy Health Commercial |
$40.95
|
| Rate for Payer: Hamaspik Choice Medicare |
$23.31
|
| Rate for Payer: Humana Medicare |
$23.31
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$40.95
|
| Rate for Payer: Local 1199SEIU Medicare |
$28.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$47.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$35.47
|
| Rate for Payer: MVP Health Care of NY Medicare |
$24.48
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$47.25
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$17.98
|
| Rate for Payer: United Healthcare Commercial |
$47.25
|
| Rate for Payer: United Healthcare Medicare |
$23.31
|
| Rate for Payer: WellCare Medicare |
$34.65
|
|
