|
PROGRAMER KIT SC5500-04 BOS SCIENTIFIC
|
Facility
|
OP
|
$5,028.00
|
|
| Hospital Charge Code |
4479092
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,709.52 |
| Max. Negotiated Rate |
$4,047.54 |
| Rate for Payer: Aetna of NY Commercial |
$3,519.60
|
| Rate for Payer: Aetna of NY Medicare |
$2,312.88
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$2,262.60
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$2,262.60
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1,860.36
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$2,514.00
|
| Rate for Payer: Cash Price |
$3,771.00
|
| Rate for Payer: CDPHP Commercial |
$4,047.54
|
| Rate for Payer: CDPHP Medicare |
$1,860.36
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$2,514.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$4,022.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$4,022.40
|
| Rate for Payer: EmblemHealth Medicaid |
$4,022.40
|
| Rate for Payer: EmblemHealth Medicare |
$1,709.52
|
| Rate for Payer: EmblemHealth Select Care |
$2,514.00
|
| Rate for Payer: Fidelis Medicare |
$1,916.17
|
| Rate for Payer: Galaxy Health Commercial |
$3,268.20
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,860.36
|
| Rate for Payer: Humana Medicare |
$1,860.36
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$3,519.60
|
| Rate for Payer: Local 1199SEIU Medicare |
$2,312.88
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,268.20
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3,268.20
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1,953.38
|
| Rate for Payer: United Healthcare Medicare |
$1,860.36
|
| Rate for Payer: WellCare Medicare |
$2,765.40
|
|
|
PROLACTIN
|
Facility
|
OP
|
$134.00
|
|
|
Service Code
|
HCPCS 84146
|
| Hospital Charge Code |
4300654
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.38 |
| Max. Negotiated Rate |
$107.87 |
| Rate for Payer: Aetna of NY Commercial |
$87.10
|
| Rate for Payer: Aetna of NY Medicare |
$61.64
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$100.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$100.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$49.58
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$67.00
|
| Rate for Payer: Cash Price |
$100.50
|
| Rate for Payer: Cash Price |
$100.50
|
| Rate for Payer: CDPHP Commercial |
$107.87
|
| Rate for Payer: CDPHP Medicare |
$49.58
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$80.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$107.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$107.20
|
| Rate for Payer: EmblemHealth Medicaid |
$107.20
|
| Rate for Payer: EmblemHealth Medicare |
$45.56
|
| Rate for Payer: EmblemHealth Select Care |
$80.40
|
| Rate for Payer: Fidelis Medicare |
$51.07
|
| Rate for Payer: Galaxy Health Commercial |
$87.10
|
| Rate for Payer: Hamaspik Choice Medicare |
$49.58
|
| Rate for Payer: Humana Medicare |
$49.58
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$87.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$61.64
|
| Rate for Payer: MVP Health Care of NY Commercial |
$100.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$75.44
|
| Rate for Payer: MVP Health Care of NY Medicare |
$52.06
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$100.50
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$19.38
|
| Rate for Payer: United Healthcare Commercial |
$100.50
|
| Rate for Payer: United Healthcare Medicare |
$49.58
|
| Rate for Payer: WellCare Medicare |
$73.70
|
|
|
PROLACTIN
|
Facility
|
IP
|
$134.00
|
|
|
Service Code
|
HCPCS 84146
|
| Hospital Charge Code |
4300654
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$87.10 |
| Max. Negotiated Rate |
$87.10 |
| Rate for Payer: Cash Price |
$100.50
|
| Rate for Payer: Galaxy Health Commercial |
$87.10
|
|
|
PROLIA 60 MG/ML SYRINGE 60 mcg, 1 mL
|
Facility
|
IP
|
$89.00
|
|
|
Service Code
|
HCPCS J0897
|
| Hospital Charge Code |
4401927
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$25.19 |
| Max. Negotiated Rate |
$57.85 |
| Rate for Payer: Aetna of NY Commercial |
$48.95
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$25.19
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$25.19
|
| Rate for Payer: Cash Price |
$66.75
|
| Rate for Payer: Cash Price |
$66.75
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$25.19
|
| Rate for Payer: EmblemHealth Select Care |
$25.19
|
| Rate for Payer: Galaxy Health Commercial |
$57.85
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$48.95
|
| Rate for Payer: WellCare Medicare |
$48.95
|
|
|
PROLIA 60 MG/ML SYRINGE 60 mcg, 1 mL
|
Facility
|
OP
|
$89.00
|
|
|
Service Code
|
HCPCS J0897
|
| Hospital Charge Code |
4401927
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$25.19 |
| Max. Negotiated Rate |
$71.64 |
| Rate for Payer: Aetna of NY Commercial |
$48.95
|
| Rate for Payer: Aetna of NY Medicare |
$40.94
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$25.19
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$25.19
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$32.93
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$44.50
|
| Rate for Payer: Cash Price |
$66.75
|
| Rate for Payer: Cash Price |
$66.75
|
| Rate for Payer: CDPHP Commercial |
$71.64
|
| Rate for Payer: CDPHP Medicare |
$32.93
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$25.19
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$71.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$71.20
|
| Rate for Payer: EmblemHealth Medicaid |
$71.20
|
| Rate for Payer: EmblemHealth Medicare |
$30.26
|
| Rate for Payer: EmblemHealth Select Care |
$25.19
|
| Rate for Payer: Fidelis Medicare |
$33.92
|
| Rate for Payer: Galaxy Health Commercial |
$57.85
|
| Rate for Payer: Hamaspik Choice Medicare |
$32.93
|
| Rate for Payer: Humana Medicare |
$32.93
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$48.95
|
| Rate for Payer: Local 1199SEIU Medicare |
$40.94
|
| Rate for Payer: MVP Health Care of NY Commercial |
$66.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$50.11
|
| Rate for Payer: MVP Health Care of NY Medicare |
$34.58
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$39.91
|
| Rate for Payer: United Healthcare Commercial |
$39.91
|
| Rate for Payer: United Healthcare Medicare |
$32.93
|
| Rate for Payer: WellCare Medicare |
$48.95
|
|
|
PROMETHAZINE HCL 25MG TABS 10X10EA
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
NDC 00904646161
|
| Hospital Charge Code |
4400657
|
|
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
|
|
|
PROMETHAZINE HCL 25MG TABS 10X10EA
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 00904646161
|
| Hospital Charge Code |
4400657
|
|
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
|
|
|
PROMETHAZINE HCL, UP TO 50 MG
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
HCPCS J2550
|
| Hospital Charge Code |
4400656
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.10 |
| Max. Negotiated Rate |
$5.20 |
| 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 |
$3.10
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$3.10
|
| 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 |
$3.10
|
| 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 |
$3.10
|
| 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 |
$5.20
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$3.10
|
| Rate for Payer: United Healthcare Commercial |
$5.20
|
| Rate for Payer: United Healthcare Medicare |
$2.29
|
| Rate for Payer: WellCare Medicare |
$3.40
|
|
|
PROMETHAZINE HCL, UP TO 50 MG
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
HCPCS J2550
|
| Hospital Charge Code |
4400656
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.10 |
| 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 |
$3.10
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$3.10
|
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$3.10
|
| Rate for Payer: EmblemHealth Select Care |
$3.10
|
| 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
|
|
|
PROPOFOL INJ, 10 MG
|
Facility
|
OP
|
$22.15
|
|
|
Service Code
|
HCPCS J2704
|
| Hospital Charge Code |
4400660
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$17.83 |
| Rate for Payer: Aetna of NY Commercial |
$12.18
|
| Rate for Payer: Aetna of NY Medicare |
$10.19
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$0.12
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$0.12
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$8.20
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$11.08
|
| Rate for Payer: Cash Price |
$16.61
|
| Rate for Payer: Cash Price |
$16.61
|
| Rate for Payer: CDPHP Commercial |
$17.83
|
| Rate for Payer: CDPHP Medicare |
$8.20
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.12
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$17.72
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$17.72
|
| Rate for Payer: EmblemHealth Medicaid |
$17.72
|
| Rate for Payer: EmblemHealth Medicare |
$7.53
|
| Rate for Payer: EmblemHealth Select Care |
$0.12
|
| Rate for Payer: Fidelis Medicare |
$8.44
|
| Rate for Payer: Galaxy Health Commercial |
$14.40
|
| Rate for Payer: Hamaspik Choice Medicare |
$8.20
|
| Rate for Payer: Humana Medicare |
$8.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$12.18
|
| Rate for Payer: Local 1199SEIU Medicare |
$10.19
|
| Rate for Payer: MVP Health Care of NY Commercial |
$16.61
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$12.47
|
| Rate for Payer: MVP Health Care of NY Medicare |
$8.61
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$0.17
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$0.12
|
| Rate for Payer: United Healthcare Commercial |
$0.17
|
| Rate for Payer: United Healthcare Medicare |
$8.20
|
| Rate for Payer: WellCare Medicare |
$12.18
|
|
|
PROPOFOL INJ, 10 MG
|
Facility
|
IP
|
$22.15
|
|
|
Service Code
|
HCPCS J2704
|
| Hospital Charge Code |
4400660
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$14.40 |
| Rate for Payer: Aetna of NY Commercial |
$12.18
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$0.12
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$0.12
|
| Rate for Payer: Cash Price |
$16.61
|
| Rate for Payer: Cash Price |
$16.61
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.12
|
| Rate for Payer: EmblemHealth Select Care |
$0.12
|
| Rate for Payer: Galaxy Health Commercial |
$14.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$12.18
|
| Rate for Payer: WellCare Medicare |
$12.18
|
|
|
PROPOFOL INJ, 10 MG
|
Facility
|
IP
|
$115.88
|
|
|
Service Code
|
HCPCS J2704
|
| Hospital Charge Code |
4400661
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$75.32 |
| Rate for Payer: Aetna of NY Commercial |
$63.73
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$0.12
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$0.12
|
| Rate for Payer: Cash Price |
$86.91
|
| Rate for Payer: Cash Price |
$86.91
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.12
|
| Rate for Payer: EmblemHealth Select Care |
$0.12
|
| Rate for Payer: Galaxy Health Commercial |
$75.32
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$63.73
|
| Rate for Payer: WellCare Medicare |
$63.73
|
|
|
PROPOFOL INJ, 10 MG
|
Facility
|
OP
|
$115.88
|
|
|
Service Code
|
HCPCS J2704
|
| Hospital Charge Code |
4400661
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$93.28 |
| Rate for Payer: Aetna of NY Commercial |
$63.73
|
| Rate for Payer: Aetna of NY Medicare |
$53.30
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$0.12
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$0.12
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$42.88
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$57.94
|
| Rate for Payer: Cash Price |
$86.91
|
| Rate for Payer: Cash Price |
$86.91
|
| Rate for Payer: CDPHP Commercial |
$93.28
|
| Rate for Payer: CDPHP Medicare |
$42.88
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.12
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$92.70
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$92.70
|
| Rate for Payer: EmblemHealth Medicaid |
$92.70
|
| Rate for Payer: EmblemHealth Medicare |
$39.40
|
| Rate for Payer: EmblemHealth Select Care |
$0.12
|
| Rate for Payer: Fidelis Medicare |
$44.16
|
| Rate for Payer: Galaxy Health Commercial |
$75.32
|
| Rate for Payer: Hamaspik Choice Medicare |
$42.88
|
| Rate for Payer: Humana Medicare |
$42.88
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$63.73
|
| Rate for Payer: Local 1199SEIU Medicare |
$53.30
|
| Rate for Payer: MVP Health Care of NY Commercial |
$86.91
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$65.24
|
| Rate for Payer: MVP Health Care of NY Medicare |
$45.02
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$0.17
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$0.12
|
| Rate for Payer: United Healthcare Commercial |
$0.17
|
| Rate for Payer: United Healthcare Medicare |
$42.88
|
| Rate for Payer: WellCare Medicare |
$63.73
|
|
|
PROPRANOLOL 80 MG TABLET 80 mg, 100 eaches
|
Facility
|
IP
|
$6.00
|
|
|
Service Code
|
NDC 69292053801
|
| Hospital Charge Code |
4401478
|
|
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
|
|
|
PROPRANOLOL 80 MG TABLET 80 mg, 100 eaches
|
Facility
|
OP
|
$6.00
|
|
|
Service Code
|
NDC 69292053801
|
| Hospital Charge Code |
4401478
|
|
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
|
|
|
PROPRANOLOL ER 160 MG CAPSULE 160 mg, 100 eaches
|
Facility
|
IP
|
$6.00
|
|
|
Service Code
|
NDC 51991082001
|
| Hospital Charge Code |
4401477
|
|
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
|
|
|
PROPRANOLOL ER 160 MG CAPSULE 160 mg, 100 eaches
|
Facility
|
OP
|
$6.00
|
|
|
Service Code
|
NDC 51991082001
|
| Hospital Charge Code |
4401477
|
|
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
|
|
|
PROPRANOLOL ER 60 MG
|
Facility
|
OP
|
$6.70
|
|
|
Service Code
|
NDC 68084050301
|
| Hospital Charge Code |
4409030
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.28 |
| Max. Negotiated Rate |
$5.39 |
| Rate for Payer: Aetna of NY Commercial |
$4.69
|
| Rate for Payer: Aetna of NY Medicare |
$3.08
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$5.02
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$5.02
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2.48
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$3.35
|
| Rate for Payer: Cash Price |
$5.03
|
| Rate for Payer: CDPHP Commercial |
$5.39
|
| Rate for Payer: CDPHP Medicare |
$2.48
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$5.36
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$5.36
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$5.36
|
| Rate for Payer: EmblemHealth Medicaid |
$5.36
|
| Rate for Payer: EmblemHealth Medicare |
$2.28
|
| Rate for Payer: EmblemHealth Select Care |
$4.82
|
| Rate for Payer: Fidelis Medicare |
$2.55
|
| Rate for Payer: Galaxy Health Commercial |
$4.36
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.48
|
| Rate for Payer: Humana Medicare |
$2.48
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$4.69
|
| Rate for Payer: Local 1199SEIU Medicare |
$3.08
|
| Rate for Payer: MVP Health Care of NY Commercial |
$5.02
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3.77
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2.60
|
| Rate for Payer: United Healthcare Medicare |
$2.48
|
| Rate for Payer: WellCare Medicare |
$3.68
|
|
|
PROPRANOLOL ER 60 MG
|
Facility
|
IP
|
$6.70
|
|
|
Service Code
|
NDC 68084050301
|
| Hospital Charge Code |
4409030
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.68 |
| Max. Negotiated Rate |
$4.36 |
| Rate for Payer: Cash Price |
$5.03
|
| Rate for Payer: Galaxy Health Commercial |
$4.36
|
| Rate for Payer: WellCare Medicare |
$3.68
|
|
|
propranoloL ER 80 MG CAPSULE 80 mcg, 100 eaches
|
Facility
|
OP
|
$7.00
|
|
|
Service Code
|
NDC 00527411737
|
| Hospital Charge Code |
4401522
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.38 |
| Max. Negotiated Rate |
$5.64 |
| Rate for Payer: Aetna of NY Commercial |
$4.90
|
| Rate for Payer: Aetna of NY Medicare |
$3.22
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$5.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$5.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2.59
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$3.50
|
| Rate for Payer: Cash Price |
$5.25
|
| Rate for Payer: CDPHP Commercial |
$5.64
|
| Rate for Payer: CDPHP Medicare |
$2.59
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$5.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$5.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$5.60
|
| Rate for Payer: EmblemHealth Medicaid |
$5.60
|
| Rate for Payer: EmblemHealth Medicare |
$2.38
|
| Rate for Payer: EmblemHealth Select Care |
$5.04
|
| Rate for Payer: Fidelis Medicare |
$2.67
|
| Rate for Payer: Galaxy Health Commercial |
$4.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.59
|
| Rate for Payer: Humana Medicare |
$2.59
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$4.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$3.22
|
| Rate for Payer: MVP Health Care of NY Commercial |
$5.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3.94
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2.72
|
| Rate for Payer: United Healthcare Medicare |
$2.59
|
| Rate for Payer: WellCare Medicare |
$3.85
|
|
|
propranoloL ER 80 MG CAPSULE 80 mcg, 100 eaches
|
Facility
|
IP
|
$7.00
|
|
|
Service Code
|
NDC 00527411737
|
| Hospital Charge Code |
4401522
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.85 |
| Max. Negotiated Rate |
$4.55 |
| Rate for Payer: Cash Price |
$5.25
|
| Rate for Payer: Galaxy Health Commercial |
$4.55
|
| Rate for Payer: WellCare Medicare |
$3.85
|
|
|
PROPRANOLOL HCL 10MG TABS 100 EA
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
NDC 00904655061
|
| Hospital Charge Code |
4400662
|
|
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
|
|
|
PROPRANOLOL HCL 10MG TABS 100 EA
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 00904655061
|
| Hospital Charge Code |
4400662
|
|
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
|
|
|
PROPRANOLOL HCL INJ TO 1 MG
|
Facility
|
OP
|
$30.90
|
|
|
Service Code
|
HCPCS J1800
|
| Hospital Charge Code |
4400663
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.68 |
| Max. Negotiated Rate |
$24.87 |
| Rate for Payer: Aetna of NY Commercial |
$17.00
|
| Rate for Payer: Aetna of NY Medicare |
$14.21
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$13.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$13.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$11.43
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$15.45
|
| Rate for Payer: Cash Price |
$23.18
|
| Rate for Payer: Cash Price |
$23.18
|
| Rate for Payer: CDPHP Commercial |
$24.87
|
| Rate for Payer: CDPHP Medicare |
$11.43
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$24.72
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$24.72
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$24.72
|
| Rate for Payer: EmblemHealth Medicaid |
$24.72
|
| Rate for Payer: EmblemHealth Medicare |
$10.51
|
| Rate for Payer: EmblemHealth Select Care |
$22.25
|
| Rate for Payer: Fidelis Medicare |
$11.78
|
| Rate for Payer: Galaxy Health Commercial |
$20.08
|
| Rate for Payer: Hamaspik Choice Medicare |
$11.43
|
| Rate for Payer: Humana Medicare |
$11.43
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$17.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$14.21
|
| Rate for Payer: MVP Health Care of NY Commercial |
$23.18
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$17.40
|
| Rate for Payer: MVP Health Care of NY Medicare |
$12.00
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$15.97
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$9.68
|
| Rate for Payer: United Healthcare Commercial |
$15.97
|
| Rate for Payer: United Healthcare Medicare |
$11.43
|
| Rate for Payer: WellCare Medicare |
$17.00
|
|
|
PROPRANOLOL HCL INJ TO 1 MG
|
Facility
|
IP
|
$30.90
|
|
|
Service Code
|
HCPCS J1800
|
| Hospital Charge Code |
4400663
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.90 |
| Max. Negotiated Rate |
$20.08 |
| Rate for Payer: Aetna of NY Commercial |
$17.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$13.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$13.90
|
| Rate for Payer: Cash Price |
$23.18
|
| Rate for Payer: Galaxy Health Commercial |
$20.08
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$17.00
|
| Rate for Payer: WellCare Medicare |
$17.00
|
|
