|
AMINOPHYLLINE 250MG INJ
|
Facility
|
IP
|
$38.63
|
|
|
Service Code
|
HCPCS J0280
|
| Hospital Charge Code |
4401277
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.84 |
| Max. Negotiated Rate |
$25.11 |
| Rate for Payer: Aetna of NY Commercial |
$21.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$8.84
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$8.84
|
| Rate for Payer: Cash Price |
$28.97
|
| Rate for Payer: Cash Price |
$28.97
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$8.84
|
| Rate for Payer: EmblemHealth Select Care |
$8.84
|
| Rate for Payer: Galaxy Health Commercial |
$25.11
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$21.25
|
| Rate for Payer: WellCare Medicare |
$21.25
|
|
|
AMINOPHYLLINE 250MG INJ
|
Facility
|
OP
|
$38.63
|
|
|
Service Code
|
HCPCS J0280
|
| Hospital Charge Code |
4401277
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.44 |
| Max. Negotiated Rate |
$31.10 |
| Rate for Payer: Aetna of NY Commercial |
$21.25
|
| Rate for Payer: Aetna of NY Medicare |
$17.77
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$8.84
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$8.84
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$14.29
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$19.32
|
| Rate for Payer: Cash Price |
$28.97
|
| Rate for Payer: Cash Price |
$28.97
|
| Rate for Payer: CDPHP Commercial |
$31.10
|
| Rate for Payer: CDPHP Medicare |
$14.29
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$8.84
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$30.90
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$30.90
|
| Rate for Payer: EmblemHealth Medicaid |
$30.90
|
| Rate for Payer: EmblemHealth Medicare |
$13.13
|
| Rate for Payer: EmblemHealth Select Care |
$8.84
|
| Rate for Payer: Fidelis Medicare |
$14.72
|
| Rate for Payer: Galaxy Health Commercial |
$25.11
|
| Rate for Payer: Hamaspik Choice Medicare |
$14.29
|
| Rate for Payer: Humana Medicare |
$14.29
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$21.25
|
| Rate for Payer: Local 1199SEIU Medicare |
$17.77
|
| Rate for Payer: MVP Health Care of NY Commercial |
$28.97
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$21.75
|
| Rate for Payer: MVP Health Care of NY Medicare |
$15.01
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$7.44
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$8.84
|
| Rate for Payer: United Healthcare Commercial |
$7.44
|
| Rate for Payer: United Healthcare Medicare |
$14.29
|
| Rate for Payer: WellCare Medicare |
$21.25
|
|
|
AMINOSYN 3.5%
|
Facility
|
OP
|
$187.00
|
|
| Hospital Charge Code |
4471542
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$63.58 |
| Max. Negotiated Rate |
$150.54 |
| Rate for Payer: Aetna of NY Commercial |
$130.90
|
| Rate for Payer: Aetna of NY Medicare |
$86.02
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$140.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$140.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$69.19
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$93.50
|
| Rate for Payer: Cash Price |
$140.25
|
| Rate for Payer: CDPHP Commercial |
$150.54
|
| Rate for Payer: CDPHP Medicare |
$69.19
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$149.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$149.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$149.60
|
| Rate for Payer: EmblemHealth Medicaid |
$149.60
|
| Rate for Payer: EmblemHealth Medicare |
$63.58
|
| Rate for Payer: EmblemHealth Select Care |
$134.64
|
| Rate for Payer: Fidelis Medicare |
$71.27
|
| Rate for Payer: Galaxy Health Commercial |
$121.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$69.19
|
| Rate for Payer: Humana Medicare |
$69.19
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$130.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$86.02
|
| Rate for Payer: MVP Health Care of NY Commercial |
$140.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$105.28
|
| Rate for Payer: MVP Health Care of NY Medicare |
$72.65
|
| Rate for Payer: United Healthcare Medicare |
$69.19
|
| Rate for Payer: WellCare Medicare |
$102.85
|
|
|
AMINOSYN 3.5%
|
Facility
|
IP
|
$187.00
|
|
| Hospital Charge Code |
4471542
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$121.55 |
| Max. Negotiated Rate |
$121.55 |
| Rate for Payer: Cash Price |
$140.25
|
| Rate for Payer: Galaxy Health Commercial |
$121.55
|
|
|
AMIODARONE 450MG INJ 9ML
|
Facility
|
IP
|
$27.30
|
|
|
Service Code
|
HCPCS J0282
|
| Hospital Charge Code |
4409187
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.28 |
| Max. Negotiated Rate |
$17.74 |
| Rate for Payer: Aetna of NY Commercial |
$15.02
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$12.28
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$12.28
|
| Rate for Payer: Cash Price |
$20.48
|
| Rate for Payer: Galaxy Health Commercial |
$17.74
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$15.02
|
| Rate for Payer: WellCare Medicare |
$15.02
|
|
|
AMIODARONE 450MG INJ 9ML
|
Facility
|
OP
|
$27.30
|
|
|
Service Code
|
HCPCS J0282
|
| Hospital Charge Code |
4409187
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.82 |
| Max. Negotiated Rate |
$21.98 |
| Rate for Payer: Aetna of NY Commercial |
$15.02
|
| Rate for Payer: Aetna of NY Medicare |
$12.56
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$12.28
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$12.28
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$10.10
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$13.65
|
| Rate for Payer: Cash Price |
$20.48
|
| Rate for Payer: Cash Price |
$20.48
|
| Rate for Payer: CDPHP Commercial |
$21.98
|
| Rate for Payer: CDPHP Medicare |
$10.10
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$21.84
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$21.84
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$21.84
|
| Rate for Payer: EmblemHealth Medicaid |
$21.84
|
| Rate for Payer: EmblemHealth Medicare |
$9.28
|
| Rate for Payer: EmblemHealth Select Care |
$19.66
|
| Rate for Payer: Fidelis Medicare |
$10.40
|
| Rate for Payer: Galaxy Health Commercial |
$17.74
|
| Rate for Payer: Hamaspik Choice Medicare |
$10.10
|
| Rate for Payer: Humana Medicare |
$10.10
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$15.02
|
| Rate for Payer: Local 1199SEIU Medicare |
$12.56
|
| Rate for Payer: MVP Health Care of NY Commercial |
$20.48
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$15.37
|
| Rate for Payer: MVP Health Care of NY Medicare |
$10.61
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1.35
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$0.82
|
| Rate for Payer: United Healthcare Commercial |
$1.35
|
| Rate for Payer: United Healthcare Medicare |
$10.10
|
| Rate for Payer: WellCare Medicare |
$15.02
|
|
|
AMIODARONE HCL 200MG TABS 100 EA
|
Facility
|
IP
|
$9.00
|
|
|
Service Code
|
NDC 00245014789
|
| Hospital Charge Code |
4400036
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.95 |
| Max. Negotiated Rate |
$5.85 |
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Galaxy Health Commercial |
$5.85
|
| Rate for Payer: WellCare Medicare |
$4.95
|
|
|
AMIODARONE HCL 200MG TABS 100 EA
|
Facility
|
OP
|
$9.00
|
|
|
Service Code
|
NDC 00245014789
|
| Hospital Charge Code |
4400036
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.06 |
| Max. Negotiated Rate |
$7.24 |
| Rate for Payer: Aetna of NY Commercial |
$6.30
|
| Rate for Payer: Aetna of NY Medicare |
$4.14
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$6.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$6.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$3.33
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$4.50
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: CDPHP Commercial |
$7.24
|
| Rate for Payer: CDPHP Medicare |
$3.33
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$7.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$7.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$7.20
|
| Rate for Payer: EmblemHealth Medicaid |
$7.20
|
| Rate for Payer: EmblemHealth Medicare |
$3.06
|
| Rate for Payer: EmblemHealth Select Care |
$6.48
|
| Rate for Payer: Fidelis Medicare |
$3.43
|
| Rate for Payer: Galaxy Health Commercial |
$5.85
|
| Rate for Payer: Hamaspik Choice Medicare |
$3.33
|
| Rate for Payer: Humana Medicare |
$3.33
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$6.30
|
| Rate for Payer: Local 1199SEIU Medicare |
$4.14
|
| Rate for Payer: MVP Health Care of NY Commercial |
$6.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$5.07
|
| Rate for Payer: MVP Health Care of NY Medicare |
$3.50
|
| Rate for Payer: United Healthcare Medicare |
$3.33
|
| Rate for Payer: WellCare Medicare |
$4.95
|
|
|
AMIODARON HCL INJ 30 MG
|
Facility
|
IP
|
$7.73
|
|
|
Service Code
|
HCPCS J0282
|
| Hospital Charge Code |
4400037
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.48 |
| Max. Negotiated Rate |
$5.02 |
| Rate for Payer: Aetna of NY Commercial |
$4.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$3.48
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$3.48
|
| Rate for Payer: Cash Price |
$5.80
|
| Rate for Payer: Galaxy Health Commercial |
$5.02
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$4.25
|
| Rate for Payer: WellCare Medicare |
$4.25
|
|
|
AMIODARON HCL INJ 30 MG
|
Facility
|
OP
|
$7.73
|
|
|
Service Code
|
HCPCS J0282
|
| Hospital Charge Code |
4400037
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.82 |
| Max. Negotiated Rate |
$6.22 |
| Rate for Payer: Aetna of NY Commercial |
$4.25
|
| Rate for Payer: Aetna of NY Medicare |
$3.56
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$3.48
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$3.48
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2.86
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$3.86
|
| Rate for Payer: Cash Price |
$5.80
|
| Rate for Payer: Cash Price |
$5.80
|
| Rate for Payer: CDPHP Commercial |
$6.22
|
| Rate for Payer: CDPHP Medicare |
$2.86
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$6.18
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$6.18
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$6.18
|
| Rate for Payer: EmblemHealth Medicaid |
$6.18
|
| Rate for Payer: EmblemHealth Medicare |
$2.63
|
| Rate for Payer: EmblemHealth Select Care |
$5.57
|
| Rate for Payer: Fidelis Medicare |
$2.95
|
| Rate for Payer: Galaxy Health Commercial |
$5.02
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.86
|
| Rate for Payer: Humana Medicare |
$2.86
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$4.25
|
| Rate for Payer: Local 1199SEIU Medicare |
$3.56
|
| Rate for Payer: MVP Health Care of NY Commercial |
$5.80
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$4.35
|
| Rate for Payer: MVP Health Care of NY Medicare |
$3.00
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1.35
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$0.82
|
| Rate for Payer: United Healthcare Commercial |
$1.35
|
| Rate for Payer: United Healthcare Medicare |
$2.86
|
| Rate for Payer: WellCare Medicare |
$4.25
|
|
|
AMITRIPTYLINE HCL 10MG TABS 100 EA
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 51079013120
|
| Hospital Charge Code |
4400038
|
|
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
|
|
|
AMITRIPTYLINE HCL 10MG TABS 100 EA
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
NDC 51079013120
|
| Hospital Charge Code |
4400038
|
|
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
|
|
|
AMITRIPTYLINE HCL 25MG TABS 100 EA
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
NDC 51079010720
|
| Hospital Charge Code |
4400039
|
|
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
|
|
|
AMITRIPTYLINE HCL 25MG TABS 100 EA
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 51079010720
|
| Hospital Charge Code |
4400039
|
|
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
|
|
|
AMLODIPINE BESYLATE 10MG TABS 10X10EA
|
Facility
|
OP
|
$7.21
|
|
|
Service Code
|
NDC 51079045201
|
| Hospital Charge Code |
4400040
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.45 |
| Max. Negotiated Rate |
$5.80 |
| Rate for Payer: Aetna of NY Commercial |
$5.05
|
| Rate for Payer: Aetna of NY Medicare |
$3.32
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$5.41
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$5.41
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2.67
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$3.60
|
| Rate for Payer: Cash Price |
$5.41
|
| Rate for Payer: CDPHP Commercial |
$5.80
|
| Rate for Payer: CDPHP Medicare |
$2.67
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$5.77
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$5.77
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$5.77
|
| Rate for Payer: EmblemHealth Medicaid |
$5.77
|
| Rate for Payer: EmblemHealth Medicare |
$2.45
|
| Rate for Payer: EmblemHealth Select Care |
$5.19
|
| Rate for Payer: Fidelis Medicare |
$2.75
|
| Rate for Payer: Galaxy Health Commercial |
$4.69
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.67
|
| Rate for Payer: Humana Medicare |
$2.67
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$5.05
|
| Rate for Payer: Local 1199SEIU Medicare |
$3.32
|
| Rate for Payer: MVP Health Care of NY Commercial |
$5.41
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$4.06
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2.80
|
| Rate for Payer: United Healthcare Medicare |
$2.67
|
| Rate for Payer: WellCare Medicare |
$3.97
|
|
|
AMLODIPINE BESYLATE 10MG TABS 10X10EA
|
Facility
|
IP
|
$7.21
|
|
|
Service Code
|
NDC 51079045201
|
| Hospital Charge Code |
4400040
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.97 |
| Max. Negotiated Rate |
$4.69 |
| Rate for Payer: Cash Price |
$5.41
|
| Rate for Payer: Galaxy Health Commercial |
$4.69
|
| Rate for Payer: WellCare Medicare |
$3.97
|
|
|
AMLODIPINE BESYLATE 2.5MG TABS 10X10EA
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 00904636961
|
| Hospital Charge Code |
4400041
|
|
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
|
|
|
AMLODIPINE BESYLATE 2.5MG TABS 10X10EA
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
NDC 00904636961
|
| Hospital Charge Code |
4400041
|
|
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
|
|
|
AMLODIPINE BESYLATE 5MG TABS 10X10EA
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
NDC 00904637061
|
| Hospital Charge Code |
4400042
|
|
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
|
|
|
AMLODIPINE BESYLATE 5MG TABS 10X10EA
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 00904637061
|
| Hospital Charge Code |
4400042
|
|
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
|
|
|
AMMONIA PLASMA
|
Facility
|
OP
|
$99.00
|
|
|
Service Code
|
HCPCS 82140
|
| Hospital Charge Code |
4300046
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.57 |
| Max. Negotiated Rate |
$79.70 |
| Rate for Payer: Aetna of NY Commercial |
$64.35
|
| Rate for Payer: Aetna of NY Medicare |
$45.54
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$74.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$74.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$36.63
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$49.50
|
| Rate for Payer: Cash Price |
$74.25
|
| Rate for Payer: Cash Price |
$74.25
|
| Rate for Payer: CDPHP Commercial |
$79.70
|
| Rate for Payer: CDPHP Medicare |
$36.63
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$59.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$79.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$79.20
|
| Rate for Payer: EmblemHealth Medicaid |
$79.20
|
| Rate for Payer: EmblemHealth Medicare |
$33.66
|
| Rate for Payer: EmblemHealth Select Care |
$59.40
|
| Rate for Payer: Fidelis Medicare |
$37.73
|
| Rate for Payer: Galaxy Health Commercial |
$64.35
|
| Rate for Payer: Hamaspik Choice Medicare |
$36.63
|
| Rate for Payer: Humana Medicare |
$36.63
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$64.35
|
| Rate for Payer: Local 1199SEIU Medicare |
$45.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$74.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$55.74
|
| Rate for Payer: MVP Health Care of NY Medicare |
$38.46
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$74.25
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$14.57
|
| Rate for Payer: United Healthcare Commercial |
$74.25
|
| Rate for Payer: United Healthcare Medicare |
$36.63
|
| Rate for Payer: WellCare Medicare |
$54.45
|
|
|
AMMONIA PLASMA
|
Facility
|
IP
|
$99.00
|
|
|
Service Code
|
HCPCS 82140
|
| Hospital Charge Code |
4300046
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$64.35 |
| Max. Negotiated Rate |
$64.35 |
| Rate for Payer: Cash Price |
$74.25
|
| Rate for Payer: Galaxy Health Commercial |
$64.35
|
|
|
AMMONIUM LACTATE 0.12 CRM 140 GM
|
Facility
|
IP
|
$43.00
|
|
|
Service Code
|
NDC 45802051377
|
| Hospital Charge Code |
4400043
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$23.65 |
| Max. Negotiated Rate |
$27.95 |
| Rate for Payer: Cash Price |
$32.25
|
| Rate for Payer: Galaxy Health Commercial |
$27.95
|
| Rate for Payer: WellCare Medicare |
$23.65
|
|
|
AMMONIUM LACTATE 0.12 CRM 140 GM
|
Facility
|
OP
|
$43.00
|
|
|
Service Code
|
NDC 45802051377
|
| Hospital Charge Code |
4400043
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.62 |
| Max. Negotiated Rate |
$34.62 |
| Rate for Payer: Aetna of NY Commercial |
$30.10
|
| Rate for Payer: Aetna of NY Medicare |
$19.78
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$32.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$32.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$15.91
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$21.50
|
| Rate for Payer: Cash Price |
$32.25
|
| Rate for Payer: CDPHP Commercial |
$34.62
|
| Rate for Payer: CDPHP Medicare |
$15.91
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$34.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$34.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$34.40
|
| Rate for Payer: EmblemHealth Medicaid |
$34.40
|
| Rate for Payer: EmblemHealth Medicare |
$14.62
|
| Rate for Payer: EmblemHealth Select Care |
$30.96
|
| Rate for Payer: Fidelis Medicare |
$16.39
|
| Rate for Payer: Galaxy Health Commercial |
$27.95
|
| Rate for Payer: Hamaspik Choice Medicare |
$15.91
|
| Rate for Payer: Humana Medicare |
$15.91
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$30.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$19.78
|
| Rate for Payer: MVP Health Care of NY Commercial |
$32.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$24.21
|
| Rate for Payer: MVP Health Care of NY Medicare |
$16.71
|
| Rate for Payer: United Healthcare Medicare |
$15.91
|
| Rate for Payer: WellCare Medicare |
$23.65
|
|
|
AMMONIUM LACTATE 0.12 LOTN 225 GM
|
Facility
|
OP
|
$56.39
|
|
|
Service Code
|
NDC 45802041954
|
| Hospital Charge Code |
4400044
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$19.17 |
| Max. Negotiated Rate |
$45.39 |
| Rate for Payer: Aetna of NY Commercial |
$39.47
|
| Rate for Payer: Aetna of NY Medicare |
$25.94
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$42.29
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$42.29
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$20.86
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$28.20
|
| Rate for Payer: Cash Price |
$42.29
|
| Rate for Payer: CDPHP Commercial |
$45.39
|
| Rate for Payer: CDPHP Medicare |
$20.86
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$45.11
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$45.11
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$45.11
|
| Rate for Payer: EmblemHealth Medicaid |
$45.11
|
| Rate for Payer: EmblemHealth Medicare |
$19.17
|
| Rate for Payer: EmblemHealth Select Care |
$40.60
|
| Rate for Payer: Fidelis Medicare |
$21.49
|
| Rate for Payer: Galaxy Health Commercial |
$36.65
|
| Rate for Payer: Hamaspik Choice Medicare |
$20.86
|
| Rate for Payer: Humana Medicare |
$20.86
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$39.47
|
| Rate for Payer: Local 1199SEIU Medicare |
$25.94
|
| Rate for Payer: MVP Health Care of NY Commercial |
$42.29
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$31.75
|
| Rate for Payer: MVP Health Care of NY Medicare |
$21.91
|
| Rate for Payer: United Healthcare Medicare |
$20.86
|
| Rate for Payer: WellCare Medicare |
$31.01
|
|
