|
PERQ DRAINAGE PLEURA INSERT CATH W/IMAGING
|
Facility
|
IP
|
$457.00
|
|
|
Service Code
|
HCPCS 32557 26
|
| Hospital Charge Code |
5201081
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$297.05 |
| Max. Negotiated Rate |
$297.05 |
| Rate for Payer: Cash Price |
$342.75
|
| Rate for Payer: Galaxy Health Commercial |
$297.05
|
|
|
PERQ DRAINAGE PLEURA INSERT CATH W/IMAGING
|
Facility
|
IP
|
$4,825.00
|
|
|
Service Code
|
HCPCS 32557
|
| Hospital Charge Code |
4201081
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$3,136.25 |
| Max. Negotiated Rate |
$3,136.25 |
| Rate for Payer: Cash Price |
$3,618.75
|
| Rate for Payer: Galaxy Health Commercial |
$3,136.25
|
|
|
PERQ DRAINAGE PLEURA INSERT CATH W/IMAGING
|
Facility
|
OP
|
$457.00
|
|
|
Service Code
|
HCPCS 32557 26
|
| Hospital Charge Code |
5201081
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$68.55 |
| Max. Negotiated Rate |
$365.60 |
| Rate for Payer: Aetna of NY Commercial |
$319.90
|
| Rate for Payer: Aetna of NY Medicare |
$210.22
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$182.80
|
| Rate for Payer: Cash Price |
$342.75
|
| Rate for Payer: CDPHP Medicare |
$169.09
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$365.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$365.60
|
| Rate for Payer: EmblemHealth Medicaid |
$365.60
|
| Rate for Payer: EmblemHealth Medicare |
$155.38
|
| Rate for Payer: Fidelis Medicare |
$182.80
|
| Rate for Payer: Galaxy Health Commercial |
$297.05
|
| Rate for Payer: Hamaspik Choice Medicare |
$182.80
|
| Rate for Payer: Humana Medicare |
$182.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$319.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$210.22
|
| Rate for Payer: MVP Health Care of NY Commercial |
$342.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$257.29
|
| Rate for Payer: MVP Health Care of NY Medicare |
$191.94
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$68.55
|
| Rate for Payer: United Healthcare Medicare |
$182.80
|
| Rate for Payer: WellCare Medicare |
$251.35
|
|
|
PERSONAL THERAPY MANAGER
|
Facility
|
OP
|
$2,844.86
|
|
| Hospital Charge Code |
4471656
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$426.73 |
| Max. Negotiated Rate |
$2,275.89 |
| Rate for Payer: Aetna of NY Commercial |
$1,991.40
|
| Rate for Payer: Aetna of NY Medicare |
$1,308.64
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1,137.94
|
| Rate for Payer: Cash Price |
$2,133.64
|
| Rate for Payer: CDPHP Medicare |
$1,052.60
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,422.43
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2,275.89
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$2,275.89
|
| Rate for Payer: EmblemHealth Medicaid |
$2,275.89
|
| Rate for Payer: EmblemHealth Medicare |
$967.25
|
| Rate for Payer: EmblemHealth Select Care |
$1,422.43
|
| Rate for Payer: Fidelis Medicare |
$1,137.94
|
| Rate for Payer: Galaxy Health Commercial |
$1,849.16
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,137.94
|
| Rate for Payer: Humana Medicare |
$1,137.94
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,991.40
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,308.64
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,849.16
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1,849.16
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1,194.84
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$426.73
|
| Rate for Payer: United Healthcare Medicare |
$1,137.94
|
| Rate for Payer: WellCare Medicare |
$1,564.67
|
|
|
PERSONAL THERAPY MANAGER
|
Facility
|
IP
|
$2,844.86
|
|
| Hospital Charge Code |
4471656
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,280.19 |
| Max. Negotiated Rate |
$1,991.40 |
| Rate for Payer: Aetna of NY Commercial |
$1,991.40
|
| Rate for Payer: Cash Price |
$2,133.64
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,422.43
|
| Rate for Payer: EmblemHealth Select Care |
$1,422.43
|
| Rate for Payer: Galaxy Health Commercial |
$1,849.16
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,991.40
|
| Rate for Payer: Multiplan Commercial |
$1,280.19
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,849.16
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1,849.16
|
| Rate for Payer: WellCare Medicare |
$1,564.67
|
|
|
PFIZER COVID VACCINE 10 MCG/0.2 ML 5 Y - 11Y
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS 91319
|
| Hospital Charge Code |
4403002
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$94.80 |
| Rate for Payer: Aetna of NY Commercial |
$0.01
|
| Rate for Payer: Aetna of NY Medicare |
$0.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$0.00
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: CDPHP Medicare |
$0.00
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$94.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$0.01
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$0.01
|
| Rate for Payer: EmblemHealth Medicaid |
$0.01
|
| Rate for Payer: EmblemHealth Medicare |
$0.00
|
| Rate for Payer: EmblemHealth Select Care |
$94.80
|
| Rate for Payer: Fidelis Medicare |
$0.00
|
| Rate for Payer: Galaxy Health Commercial |
$0.01
|
| Rate for Payer: Hamaspik Choice Medicare |
$0.00
|
| Rate for Payer: Humana Medicare |
$0.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$0.01
|
| Rate for Payer: Local 1199SEIU Medicare |
$0.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.01
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$0.01
|
| Rate for Payer: MVP Health Care of NY Medicare |
$0.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$0.00
|
| Rate for Payer: United Healthcare Medicare |
$0.00
|
| Rate for Payer: WellCare Medicare |
$0.01
|
|
|
PFIZER COVID VACCINE 10 MCG/0.2 ML 5 Y - 11Y
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS 91319
|
| Hospital Charge Code |
4403002
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$94.80 |
| Rate for Payer: Aetna of NY Commercial |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$94.80
|
| Rate for Payer: EmblemHealth Select Care |
$94.80
|
| Rate for Payer: Galaxy Health Commercial |
$0.01
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$0.01
|
| Rate for Payer: WellCare Medicare |
$0.01
|
|
|
PFIZER COVID VACCINE 30 MCG/0.3 ML 12 Y OLDER
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS 91320
|
| Hospital Charge Code |
4403003
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$168.37 |
| Rate for Payer: Aetna of NY Commercial |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$168.37
|
| Rate for Payer: EmblemHealth Select Care |
$168.37
|
| Rate for Payer: Galaxy Health Commercial |
$0.01
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$0.01
|
| Rate for Payer: WellCare Medicare |
$0.01
|
|
|
PFIZER COVID VACCINE 30 MCG/0.3 ML 12 Y OLDER
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS 91320
|
| Hospital Charge Code |
4403003
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$168.37 |
| Rate for Payer: Aetna of NY Commercial |
$0.01
|
| Rate for Payer: Aetna of NY Medicare |
$0.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$0.00
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: CDPHP Medicare |
$0.00
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$168.37
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$0.01
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$0.01
|
| Rate for Payer: EmblemHealth Medicaid |
$0.01
|
| Rate for Payer: EmblemHealth Medicare |
$0.00
|
| Rate for Payer: EmblemHealth Select Care |
$168.37
|
| Rate for Payer: Fidelis Medicare |
$0.00
|
| Rate for Payer: Galaxy Health Commercial |
$0.01
|
| Rate for Payer: Hamaspik Choice Medicare |
$0.00
|
| Rate for Payer: Humana Medicare |
$0.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$0.01
|
| Rate for Payer: Local 1199SEIU Medicare |
$0.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.01
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$0.01
|
| Rate for Payer: MVP Health Care of NY Medicare |
$0.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$0.00
|
| Rate for Payer: United Healthcare Medicare |
$0.00
|
| Rate for Payer: WellCare Medicare |
$0.01
|
|
|
PFIZER COVID VACCINE 3MCG/0.2ML 6 MO - 4Y
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS 91318
|
| Hospital Charge Code |
4403001
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna of NY Commercial |
$0.01
|
| Rate for Payer: Aetna of NY Medicare |
$0.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$0.00
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: CDPHP Medicare |
$0.00
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.01
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$0.01
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$0.01
|
| Rate for Payer: EmblemHealth Medicaid |
$0.01
|
| Rate for Payer: EmblemHealth Medicare |
$0.00
|
| Rate for Payer: EmblemHealth Select Care |
$0.01
|
| Rate for Payer: Fidelis Medicare |
$0.00
|
| Rate for Payer: Galaxy Health Commercial |
$0.01
|
| Rate for Payer: Hamaspik Choice Medicare |
$0.00
|
| Rate for Payer: Humana Medicare |
$0.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$0.01
|
| Rate for Payer: Local 1199SEIU Medicare |
$0.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.01
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$0.01
|
| Rate for Payer: MVP Health Care of NY Medicare |
$0.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$0.00
|
| Rate for Payer: United Healthcare Medicare |
$0.00
|
| Rate for Payer: WellCare Medicare |
$0.01
|
|
|
PFIZER COVID VACCINE 3MCG/0.2ML 6 MO - 4Y
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS 91318
|
| Hospital Charge Code |
4403001
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna of NY Commercial |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Galaxy Health Commercial |
$0.01
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$0.01
|
| Rate for Payer: WellCare Medicare |
$0.01
|
|
|
PHARMACY GI COCKTAIL
|
Facility
|
OP
|
$35.02
|
|
| Hospital Charge Code |
4409070
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.25 |
| Max. Negotiated Rate |
$28.02 |
| Rate for Payer: Aetna of NY Commercial |
$24.51
|
| Rate for Payer: Aetna of NY Medicare |
$16.11
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$14.01
|
| Rate for Payer: Cash Price |
$26.26
|
| Rate for Payer: CDPHP Medicare |
$12.96
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$28.02
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$28.02
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$28.02
|
| Rate for Payer: EmblemHealth Medicaid |
$28.02
|
| Rate for Payer: EmblemHealth Medicare |
$11.91
|
| Rate for Payer: EmblemHealth Select Care |
$25.21
|
| Rate for Payer: Fidelis Medicare |
$14.01
|
| Rate for Payer: Galaxy Health Commercial |
$22.76
|
| Rate for Payer: Hamaspik Choice Medicare |
$14.01
|
| Rate for Payer: Humana Medicare |
$14.01
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$24.51
|
| Rate for Payer: Local 1199SEIU Medicare |
$16.11
|
| Rate for Payer: MVP Health Care of NY Commercial |
$26.27
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$19.72
|
| Rate for Payer: MVP Health Care of NY Medicare |
$14.71
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$5.25
|
| Rate for Payer: United Healthcare Medicare |
$14.01
|
| Rate for Payer: WellCare Medicare |
$19.26
|
|
|
PHARMACY GI COCKTAIL
|
Facility
|
IP
|
$35.02
|
|
| Hospital Charge Code |
4409070
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$19.26 |
| Max. Negotiated Rate |
$22.76 |
| Rate for Payer: Cash Price |
$26.26
|
| Rate for Payer: Galaxy Health Commercial |
$22.76
|
| Rate for Payer: WellCare Medicare |
$19.26
|
|
|
PHENAZOPYRIDINE HCL 100MG TABS 10X10EA
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
NDC 75826011410
|
| Hospital Charge Code |
4400617
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.40 |
| Max. Negotiated Rate |
$4.02 |
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: Galaxy Health Commercial |
$4.02
|
| Rate for Payer: WellCare Medicare |
$3.40
|
|
|
PHENAZOPYRIDINE HCL 100MG TABS 10X10EA
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 75826011410
|
| Hospital Charge Code |
4400617
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.93 |
| Max. Negotiated Rate |
$4.94 |
| Rate for Payer: Aetna of NY Commercial |
$4.33
|
| Rate for Payer: Aetna of NY Medicare |
$2.84
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2.47
|
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: CDPHP Medicare |
$2.29
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$4.94
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$4.94
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$4.94
|
| Rate for Payer: EmblemHealth Medicaid |
$4.94
|
| Rate for Payer: EmblemHealth Medicare |
$2.10
|
| Rate for Payer: EmblemHealth Select Care |
$4.45
|
| Rate for Payer: Fidelis Medicare |
$2.47
|
| Rate for Payer: Galaxy Health Commercial |
$4.02
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.47
|
| Rate for Payer: Humana Medicare |
$2.47
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$4.33
|
| Rate for Payer: Local 1199SEIU Medicare |
$2.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4.63
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3.48
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2.60
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$0.93
|
| Rate for Payer: United Healthcare Medicare |
$2.47
|
| Rate for Payer: WellCare Medicare |
$3.40
|
|
|
PHENobarbitaL 130 MG/ML VIAL 130 mg, 1 mL
|
Facility
|
OP
|
$183.00
|
|
|
Service Code
|
HCPCS J2560
|
| Hospital Charge Code |
4401570
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.65 |
| Max. Negotiated Rate |
$146.40 |
| Rate for Payer: Aetna of NY Medicare |
$84.18
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$73.20
|
| Rate for Payer: Cash Price |
$137.25
|
| Rate for Payer: Cash Price |
$137.25
|
| Rate for Payer: CDPHP Medicare |
$67.71
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$23.65
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$146.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$146.40
|
| Rate for Payer: EmblemHealth Medicaid |
$146.40
|
| Rate for Payer: EmblemHealth Medicare |
$62.22
|
| Rate for Payer: EmblemHealth Select Care |
$23.65
|
| Rate for Payer: Fidelis Medicare |
$73.20
|
| Rate for Payer: Galaxy Health Commercial |
$118.95
|
| Rate for Payer: Hamaspik Choice Medicare |
$73.20
|
| Rate for Payer: Humana Medicare |
$73.20
|
| Rate for Payer: Local 1199SEIU Medicare |
$84.18
|
| Rate for Payer: MVP Health Care of NY Commercial |
$137.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$103.03
|
| Rate for Payer: MVP Health Care of NY Medicare |
$76.86
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$64.98
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$27.45
|
| Rate for Payer: United Healthcare Commercial |
$64.98
|
| Rate for Payer: United Healthcare Medicare |
$73.20
|
| Rate for Payer: WellCare Medicare |
$100.65
|
|
|
PHENobarbitaL 130 MG/ML VIAL 130 mg, 1 mL
|
Facility
|
IP
|
$183.00
|
|
|
Service Code
|
HCPCS J2560
|
| Hospital Charge Code |
4401570
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.65 |
| Max. Negotiated Rate |
$118.95 |
| Rate for Payer: Aetna of NY Commercial |
$100.65
|
| Rate for Payer: Cash Price |
$137.25
|
| Rate for Payer: Cash Price |
$137.25
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$23.65
|
| Rate for Payer: EmblemHealth Select Care |
$23.65
|
| Rate for Payer: Galaxy Health Commercial |
$118.95
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$100.65
|
| Rate for Payer: WellCare Medicare |
$100.65
|
|
|
PHENOBARB SOLN 20 MG / 5 ML
|
Facility
|
IP
|
$6.18
|
|
| Hospital Charge Code |
4408953
|
|
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
|
|
|
PHENOBARB SOLN 20 MG / 5 ML
|
Facility
|
OP
|
$6.18
|
|
| Hospital Charge Code |
4408953
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.93 |
| Max. Negotiated Rate |
$4.94 |
| Rate for Payer: Aetna of NY Commercial |
$4.33
|
| Rate for Payer: Aetna of NY Medicare |
$2.84
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2.47
|
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: CDPHP Medicare |
$2.29
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$4.94
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$4.94
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$4.94
|
| Rate for Payer: EmblemHealth Medicaid |
$4.94
|
| Rate for Payer: EmblemHealth Medicare |
$2.10
|
| Rate for Payer: EmblemHealth Select Care |
$4.45
|
| Rate for Payer: Fidelis Medicare |
$2.47
|
| Rate for Payer: Galaxy Health Commercial |
$4.02
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.47
|
| Rate for Payer: Humana Medicare |
$2.47
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$4.33
|
| Rate for Payer: Local 1199SEIU Medicare |
$2.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4.63
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3.48
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2.60
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$0.93
|
| Rate for Payer: United Healthcare Medicare |
$2.47
|
| Rate for Payer: WellCare Medicare |
$3.40
|
|
|
PHENYLEPHRINE HCL 0.01 SPIN 15 ML
|
Facility
|
OP
|
$13.13
|
|
|
Service Code
|
NDC 69536010015
|
| Hospital Charge Code |
4400553
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.97 |
| Max. Negotiated Rate |
$10.50 |
| Rate for Payer: Aetna of NY Commercial |
$9.19
|
| Rate for Payer: Aetna of NY Medicare |
$6.04
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$5.25
|
| Rate for Payer: Cash Price |
$9.85
|
| Rate for Payer: CDPHP Medicare |
$4.86
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$10.50
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$10.50
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$10.50
|
| Rate for Payer: EmblemHealth Medicaid |
$10.50
|
| Rate for Payer: EmblemHealth Medicare |
$4.46
|
| Rate for Payer: EmblemHealth Select Care |
$9.45
|
| Rate for Payer: Fidelis Medicare |
$5.25
|
| Rate for Payer: Galaxy Health Commercial |
$8.53
|
| Rate for Payer: Hamaspik Choice Medicare |
$5.25
|
| Rate for Payer: Humana Medicare |
$5.25
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$9.19
|
| Rate for Payer: Local 1199SEIU Medicare |
$6.04
|
| Rate for Payer: MVP Health Care of NY Commercial |
$9.85
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$7.39
|
| Rate for Payer: MVP Health Care of NY Medicare |
$5.51
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1.97
|
| Rate for Payer: United Healthcare Medicare |
$5.25
|
| Rate for Payer: WellCare Medicare |
$7.22
|
|
|
PHENYLEPHRINE HCL 0.01 SPIN 15 ML
|
Facility
|
IP
|
$13.13
|
|
|
Service Code
|
NDC 69536010015
|
| Hospital Charge Code |
4400553
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.22 |
| Max. Negotiated Rate |
$8.53 |
| Rate for Payer: Cash Price |
$9.85
|
| Rate for Payer: Galaxy Health Commercial |
$8.53
|
| Rate for Payer: WellCare Medicare |
$7.22
|
|
|
PHENYLEPHRINE HCL 0.025 DROP 3 ML
|
Facility
|
OP
|
$72.10
|
|
|
Service Code
|
NDC 17478020102
|
| Hospital Charge Code |
4400618
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.81 |
| Max. Negotiated Rate |
$57.68 |
| Rate for Payer: Aetna of NY Commercial |
$50.47
|
| Rate for Payer: Aetna of NY Medicare |
$33.17
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$28.84
|
| Rate for Payer: Cash Price |
$54.08
|
| Rate for Payer: CDPHP Medicare |
$26.68
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$57.68
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$57.68
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$57.68
|
| Rate for Payer: EmblemHealth Medicaid |
$57.68
|
| Rate for Payer: EmblemHealth Medicare |
$24.51
|
| Rate for Payer: EmblemHealth Select Care |
$51.91
|
| Rate for Payer: Fidelis Medicare |
$28.84
|
| Rate for Payer: Galaxy Health Commercial |
$46.87
|
| Rate for Payer: Hamaspik Choice Medicare |
$28.84
|
| Rate for Payer: Humana Medicare |
$28.84
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$50.47
|
| Rate for Payer: Local 1199SEIU Medicare |
$33.17
|
| Rate for Payer: MVP Health Care of NY Commercial |
$54.08
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$40.59
|
| Rate for Payer: MVP Health Care of NY Medicare |
$30.28
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$10.81
|
| Rate for Payer: United Healthcare Medicare |
$28.84
|
| Rate for Payer: WellCare Medicare |
$39.66
|
|
|
PHENYLEPHRINE HCL 0.025 DROP 3 ML
|
Facility
|
IP
|
$72.10
|
|
|
Service Code
|
NDC 17478020102
|
| Hospital Charge Code |
4400618
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$39.66 |
| Max. Negotiated Rate |
$46.87 |
| Rate for Payer: Cash Price |
$54.08
|
| Rate for Payer: Galaxy Health Commercial |
$46.87
|
| Rate for Payer: WellCare Medicare |
$39.66
|
|
|
PHENYLEPHRINE HCL, UP TO 1 ML
|
Facility
|
IP
|
$44.55
|
|
|
Service Code
|
HCPCS J2370
|
| Hospital Charge Code |
4400619
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.50 |
| Max. Negotiated Rate |
$28.96 |
| Rate for Payer: Aetna of NY Commercial |
$24.50
|
| Rate for Payer: Cash Price |
$33.41
|
| Rate for Payer: Galaxy Health Commercial |
$28.96
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$24.50
|
| Rate for Payer: WellCare Medicare |
$24.50
|
|
|
PHENYLEPHRINE HCL, UP TO 1 ML
|
Facility
|
OP
|
$44.55
|
|
|
Service Code
|
HCPCS J2370
|
| Hospital Charge Code |
4400619
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.68 |
| Max. Negotiated Rate |
$35.64 |
| Rate for Payer: Aetna of NY Medicare |
$20.49
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$17.82
|
| Rate for Payer: Cash Price |
$33.41
|
| Rate for Payer: CDPHP Medicare |
$16.48
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$35.64
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$35.64
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$35.64
|
| Rate for Payer: EmblemHealth Medicaid |
$35.64
|
| Rate for Payer: EmblemHealth Medicare |
$15.15
|
| Rate for Payer: EmblemHealth Select Care |
$32.08
|
| Rate for Payer: Fidelis Medicare |
$17.82
|
| Rate for Payer: Galaxy Health Commercial |
$28.96
|
| Rate for Payer: Hamaspik Choice Medicare |
$17.82
|
| Rate for Payer: Humana Medicare |
$17.82
|
| Rate for Payer: Local 1199SEIU Medicare |
$20.49
|
| Rate for Payer: MVP Health Care of NY Commercial |
$33.41
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$25.08
|
| Rate for Payer: MVP Health Care of NY Medicare |
$18.71
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$6.68
|
| Rate for Payer: United Healthcare Medicare |
$17.82
|
| Rate for Payer: WellCare Medicare |
$24.50
|
|
