|
ALLIANCE_ II INFLATION SYSTEM
|
Facility
|
OP
|
$1,631.00
|
|
| Hospital Charge Code |
4471399
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$554.54 |
| Max. Negotiated Rate |
$1,312.96 |
| Rate for Payer: Aetna of NY Commercial |
$1,141.70
|
| Rate for Payer: Aetna of NY Medicare |
$750.26
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1,223.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,223.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$603.47
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$815.50
|
| Rate for Payer: Cash Price |
$1,223.25
|
| Rate for Payer: CDPHP Commercial |
$1,312.96
|
| Rate for Payer: CDPHP Medicare |
$603.47
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,304.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,304.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,304.80
|
| Rate for Payer: EmblemHealth Medicaid |
$1,304.80
|
| Rate for Payer: EmblemHealth Medicare |
$554.54
|
| Rate for Payer: EmblemHealth Select Care |
$1,174.32
|
| Rate for Payer: Fidelis Medicare |
$621.57
|
| Rate for Payer: Galaxy Health Commercial |
$1,060.15
|
| Rate for Payer: Hamaspik Choice Medicare |
$603.47
|
| Rate for Payer: Humana Medicare |
$603.47
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,141.70
|
| Rate for Payer: Local 1199SEIU Medicare |
$750.26
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,223.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$918.25
|
| Rate for Payer: MVP Health Care of NY Medicare |
$633.64
|
| Rate for Payer: United Healthcare Medicare |
$603.47
|
| Rate for Payer: WellCare Medicare |
$897.05
|
|
|
ALLOPURINOL 100MG TABS 100 EA
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
NDC 00904657161
|
| Hospital Charge Code |
4400031
|
|
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
|
|
|
ALLOPURINOL 100MG TABS 100 EA
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 00904657161
|
| Hospital Charge Code |
4400031
|
|
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
|
|
|
ALLOPURINOL 300 MG
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 51079020601
|
| Hospital Charge Code |
4409075
|
|
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
|
|
|
ALLOPURINOL 300 MG
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
NDC 51079020601
|
| Hospital Charge Code |
4409075
|
|
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
|
|
|
ALPHA FETO PROTEIN
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
HCPCS 82105
|
| Hospital Charge Code |
4301030
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.57 |
| Max. Negotiated Rate |
$52.32 |
| Rate for Payer: Aetna of NY Commercial |
$42.25
|
| Rate for Payer: Aetna of NY Medicare |
$29.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$48.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$48.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$24.05
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$32.50
|
| Rate for Payer: Cash Price |
$48.75
|
| Rate for Payer: Cash Price |
$48.75
|
| Rate for Payer: CDPHP Commercial |
$52.32
|
| Rate for Payer: CDPHP Medicare |
$24.05
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$39.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$52.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$52.00
|
| Rate for Payer: EmblemHealth Medicaid |
$52.00
|
| Rate for Payer: EmblemHealth Medicare |
$22.10
|
| Rate for Payer: EmblemHealth Select Care |
$39.00
|
| Rate for Payer: Fidelis Medicare |
$24.77
|
| Rate for Payer: Galaxy Health Commercial |
$42.25
|
| Rate for Payer: Hamaspik Choice Medicare |
$24.05
|
| Rate for Payer: Humana Medicare |
$24.05
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$42.25
|
| Rate for Payer: Local 1199SEIU Medicare |
$29.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$48.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$36.60
|
| Rate for Payer: MVP Health Care of NY Medicare |
$25.25
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$48.75
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$6.57
|
| Rate for Payer: United Healthcare Commercial |
$48.75
|
| Rate for Payer: United Healthcare Medicare |
$24.05
|
| Rate for Payer: WellCare Medicare |
$35.75
|
|
|
ALPHA FETO PROTEIN
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
HCPCS 82105
|
| Hospital Charge Code |
4301030
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$42.25 |
| Max. Negotiated Rate |
$42.25 |
| Rate for Payer: Cash Price |
$48.75
|
| Rate for Payer: Galaxy Health Commercial |
$42.25
|
|
|
ALPHAGANP 0.15 OS
|
Facility
|
OP
|
$402.73
|
|
|
Service Code
|
NDC 61314014405
|
| Hospital Charge Code |
4409004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$136.93 |
| Max. Negotiated Rate |
$324.20 |
| Rate for Payer: Aetna of NY Commercial |
$281.91
|
| Rate for Payer: Aetna of NY Medicare |
$185.26
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$302.05
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$302.05
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$149.01
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$201.36
|
| Rate for Payer: Cash Price |
$302.05
|
| Rate for Payer: CDPHP Commercial |
$324.20
|
| Rate for Payer: CDPHP Medicare |
$149.01
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$322.18
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$322.18
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$322.18
|
| Rate for Payer: EmblemHealth Medicaid |
$322.18
|
| Rate for Payer: EmblemHealth Medicare |
$136.93
|
| Rate for Payer: EmblemHealth Select Care |
$289.97
|
| Rate for Payer: Fidelis Medicare |
$153.48
|
| Rate for Payer: Galaxy Health Commercial |
$261.77
|
| Rate for Payer: Hamaspik Choice Medicare |
$149.01
|
| Rate for Payer: Humana Medicare |
$149.01
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$281.91
|
| Rate for Payer: Local 1199SEIU Medicare |
$185.26
|
| Rate for Payer: MVP Health Care of NY Commercial |
$302.05
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$226.74
|
| Rate for Payer: MVP Health Care of NY Medicare |
$156.46
|
| Rate for Payer: United Healthcare Medicare |
$149.01
|
| Rate for Payer: WellCare Medicare |
$221.50
|
|
|
ALPHAGANP 0.15 OS
|
Facility
|
IP
|
$402.73
|
|
|
Service Code
|
NDC 61314014405
|
| Hospital Charge Code |
4409004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$221.50 |
| Max. Negotiated Rate |
$261.77 |
| Rate for Payer: Cash Price |
$302.05
|
| Rate for Payer: Galaxy Health Commercial |
$261.77
|
| Rate for Payer: WellCare Medicare |
$221.50
|
|
|
ALPHAGAN P 0.1% DROPS 1 ea, 5 mL
|
Facility
|
OP
|
$580.00
|
|
|
Service Code
|
NDC 00023932105
|
| Hospital Charge Code |
4401366
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$197.20 |
| Max. Negotiated Rate |
$466.90 |
| Rate for Payer: Aetna of NY Commercial |
$406.00
|
| Rate for Payer: Aetna of NY Medicare |
$266.80
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$435.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$435.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$214.60
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$290.00
|
| Rate for Payer: Cash Price |
$435.00
|
| Rate for Payer: CDPHP Commercial |
$466.90
|
| Rate for Payer: CDPHP Medicare |
$214.60
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$464.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$464.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$464.00
|
| Rate for Payer: EmblemHealth Medicaid |
$464.00
|
| Rate for Payer: EmblemHealth Medicare |
$197.20
|
| Rate for Payer: EmblemHealth Select Care |
$417.60
|
| Rate for Payer: Fidelis Medicare |
$221.04
|
| Rate for Payer: Galaxy Health Commercial |
$377.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$214.60
|
| Rate for Payer: Humana Medicare |
$214.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$406.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$266.80
|
| Rate for Payer: MVP Health Care of NY Commercial |
$435.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$326.54
|
| Rate for Payer: MVP Health Care of NY Medicare |
$225.33
|
| Rate for Payer: United Healthcare Medicare |
$214.60
|
| Rate for Payer: WellCare Medicare |
$319.00
|
|
|
ALPHAGAN P 0.1% DROPS 1 ea, 5 mL
|
Facility
|
IP
|
$580.00
|
|
|
Service Code
|
NDC 00023932105
|
| Hospital Charge Code |
4401366
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$319.00 |
| Max. Negotiated Rate |
$377.00 |
| Rate for Payer: Cash Price |
$435.00
|
| Rate for Payer: Galaxy Health Commercial |
$377.00
|
| Rate for Payer: WellCare Medicare |
$319.00
|
|
|
ALPRAZOLAM 0.25MG TABS 10X10EA
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
NDC 00228202710
|
| Hospital Charge Code |
4400032
|
|
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
|
|
|
ALPRAZOLAM 0.25MG TABS 10X10EA
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 00228202710
|
| Hospital Charge Code |
4400032
|
|
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
|
|
|
ALPRAZolam 0.5 MG TABLET 0.5 mg, 100 eaches
|
Facility
|
IP
|
$6.00
|
|
|
Service Code
|
NDC 00904585961
|
| Hospital Charge Code |
4401361
|
|
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
|
|
|
ALPRAZolam 0.5 MG TABLET 0.5 mg, 100 eaches
|
Facility
|
OP
|
$6.00
|
|
|
Service Code
|
NDC 00904585961
|
| Hospital Charge Code |
4401361
|
|
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
|
|
|
ALPRAZOLAM 0.5MG TABS 100 EA
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
NDC 51079078920
|
| Hospital Charge Code |
4400033
|
|
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
|
|
|
ALPRAZOLAM 0.5MG TABS 100 EA
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 51079078920
|
| Hospital Charge Code |
4400033
|
|
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
|
|
|
ALTEPLASE RECOMBINANT, 1 MG
|
Facility
|
IP
|
$235.50
|
|
|
Service Code
|
HCPCS J2997
|
| Hospital Charge Code |
4400835
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$88.82 |
| Max. Negotiated Rate |
$153.08 |
| Rate for Payer: Aetna of NY Commercial |
$129.52
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$88.82
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$88.82
|
| Rate for Payer: Cash Price |
$176.63
|
| Rate for Payer: Cash Price |
$176.63
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$88.82
|
| Rate for Payer: EmblemHealth Select Care |
$88.82
|
| Rate for Payer: Galaxy Health Commercial |
$153.08
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$129.52
|
| Rate for Payer: WellCare Medicare |
$129.52
|
|
|
ALTEPLASE RECOMBINANT, 1 MG
|
Facility
|
OP
|
$235.50
|
|
|
Service Code
|
HCPCS J2997
|
| Hospital Charge Code |
4400835
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$73.78 |
| Max. Negotiated Rate |
$7,378.00 |
| Rate for Payer: Aetna of NY Commercial |
$129.52
|
| Rate for Payer: Aetna of NY Medicare |
$108.33
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$88.82
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$88.82
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$166.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$73.78
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$87.14
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$117.75
|
| Rate for Payer: Cash Price |
$176.63
|
| Rate for Payer: Cash Price |
$176.63
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$73.78
|
| Rate for Payer: CDPHP Commercial |
$189.58
|
| Rate for Payer: CDPHP Essential Plan |
$166.00
|
| Rate for Payer: CDPHP Medicare |
$87.14
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$88.82
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$88.54
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$73.78
|
| Rate for Payer: EmblemHealth Medicaid |
$73.78
|
| Rate for Payer: EmblemHealth Medicare |
$80.07
|
| Rate for Payer: EmblemHealth Select Care |
$88.82
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$166.00
|
| Rate for Payer: Fidelis Medicare |
$89.75
|
| Rate for Payer: Galaxy Health Commercial |
$153.08
|
| Rate for Payer: Galaxy Health Workers Comp |
$108.46
|
| Rate for Payer: Hamaspik Choice Medicaid |
$7,378.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$87.14
|
| Rate for Payer: Humana Medicare |
$87.14
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$129.52
|
| Rate for Payer: Local 1199SEIU Medicare |
$108.33
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$7,378.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$176.62
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$158.63
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$158.63
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$132.59
|
| Rate for Payer: MVP Health Care of NY Medicare |
$91.49
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$147.10
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$73.78
|
| Rate for Payer: United Healthcare Commercial |
$147.10
|
| Rate for Payer: United Healthcare Medicare |
$87.14
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$77.47
|
| Rate for Payer: WellCare Medicare |
$129.52
|
|
|
ALT (SGPT)
|
Facility
|
OP
|
$29.00
|
|
|
Service Code
|
HCPCS 84460
|
| Hospital Charge Code |
4300038
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.08 |
| Max. Negotiated Rate |
$23.34 |
| Rate for Payer: Aetna of NY Commercial |
$18.85
|
| Rate for Payer: Aetna of NY Medicare |
$13.34
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$21.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$21.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$10.73
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$14.50
|
| Rate for Payer: Cash Price |
$21.75
|
| Rate for Payer: Cash Price |
$21.75
|
| Rate for Payer: CDPHP Commercial |
$23.34
|
| Rate for Payer: CDPHP Medicare |
$10.73
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$17.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$23.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$23.20
|
| Rate for Payer: EmblemHealth Medicaid |
$23.20
|
| Rate for Payer: EmblemHealth Medicare |
$9.86
|
| Rate for Payer: EmblemHealth Select Care |
$17.40
|
| Rate for Payer: Fidelis Medicare |
$11.05
|
| Rate for Payer: Galaxy Health Commercial |
$18.85
|
| Rate for Payer: Hamaspik Choice Medicare |
$10.73
|
| Rate for Payer: Humana Medicare |
$10.73
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$18.85
|
| Rate for Payer: Local 1199SEIU Medicare |
$13.34
|
| Rate for Payer: MVP Health Care of NY Commercial |
$21.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$16.33
|
| Rate for Payer: MVP Health Care of NY Medicare |
$11.27
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$21.75
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$5.08
|
| Rate for Payer: United Healthcare Commercial |
$21.75
|
| Rate for Payer: United Healthcare Medicare |
$10.73
|
| Rate for Payer: WellCare Medicare |
$15.95
|
|
|
ALT (SGPT)
|
Facility
|
IP
|
$29.00
|
|
|
Service Code
|
HCPCS 84460
|
| Hospital Charge Code |
4300038
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.85 |
| Max. Negotiated Rate |
$18.85 |
| Rate for Payer: Cash Price |
$21.75
|
| Rate for Payer: Galaxy Health Commercial |
$18.85
|
|
|
AMANTADINE (GENERIC SYMMETREL) 100 MG CAPSULE
|
Facility
|
OP
|
$6.00
|
|
|
Service Code
|
NDC 00904663061
|
| Hospital Charge Code |
4400846
|
|
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
|
|
|
AMANTADINE (GENERIC SYMMETREL) 100 MG CAPSULE
|
Facility
|
IP
|
$6.00
|
|
|
Service Code
|
NDC 00904663061
|
| Hospital Charge Code |
4400846
|
|
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
|
|
|
AMBU SPUR II ADULT, CLOSED R
|
Facility
|
IP
|
$35.00
|
|
| Hospital Charge Code |
4471267
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$22.75 |
| Max. Negotiated Rate |
$22.75 |
| Rate for Payer: Cash Price |
$26.25
|
| Rate for Payer: Galaxy Health Commercial |
$22.75
|
|
|
AMBU SPUR II ADULT, CLOSED R
|
Facility
|
OP
|
$35.00
|
|
| Hospital Charge Code |
4471267
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$11.90 |
| Max. Negotiated Rate |
$28.18 |
| Rate for Payer: Aetna of NY Commercial |
$24.50
|
| Rate for Payer: Aetna of NY Medicare |
$16.10
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$26.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$26.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$12.95
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$17.50
|
| Rate for Payer: Cash Price |
$26.25
|
| Rate for Payer: CDPHP Commercial |
$28.18
|
| Rate for Payer: CDPHP Medicare |
$12.95
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$28.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$28.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$28.00
|
| Rate for Payer: EmblemHealth Medicaid |
$28.00
|
| Rate for Payer: EmblemHealth Medicare |
$11.90
|
| Rate for Payer: EmblemHealth Select Care |
$25.20
|
| Rate for Payer: Fidelis Medicare |
$13.34
|
| Rate for Payer: Galaxy Health Commercial |
$22.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$12.95
|
| Rate for Payer: Humana Medicare |
$12.95
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$24.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$16.10
|
| Rate for Payer: MVP Health Care of NY Commercial |
$26.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$19.70
|
| Rate for Payer: MVP Health Care of NY Medicare |
$13.60
|
| Rate for Payer: United Healthcare Medicare |
$12.95
|
| Rate for Payer: WellCare Medicare |
$19.25
|
|
