|
PROCHLORPERAZINE 5 MG TABLET
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
NDC 51079054120
|
| Hospital Charge Code |
4409097
|
|
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
|
|
|
PROCHLORPERAZINE 5 MG TABLET
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 51079054120
|
| Hospital Charge Code |
4409097
|
|
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
|
|
|
PROCHLORPERAZINE INJ, UP TO 10 MG
|
Facility
|
OP
|
$68.50
|
|
|
Service Code
|
HCPCS J0780
|
| Hospital Charge Code |
4400653
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.33 |
| Max. Negotiated Rate |
$54.80 |
| Rate for Payer: Aetna of NY Medicare |
$31.51
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$27.40
|
| Rate for Payer: Cash Price |
$51.38
|
| Rate for Payer: Cash Price |
$51.38
|
| Rate for Payer: CDPHP Medicare |
$25.34
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$3.33
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$54.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$54.80
|
| Rate for Payer: EmblemHealth Medicaid |
$54.80
|
| Rate for Payer: EmblemHealth Medicare |
$23.29
|
| Rate for Payer: EmblemHealth Select Care |
$3.33
|
| Rate for Payer: Fidelis Medicare |
$27.40
|
| Rate for Payer: Galaxy Health Commercial |
$44.52
|
| Rate for Payer: Hamaspik Choice Medicare |
$27.40
|
| Rate for Payer: Humana Medicare |
$27.40
|
| Rate for Payer: Local 1199SEIU Medicare |
$31.51
|
| Rate for Payer: MVP Health Care of NY Commercial |
$51.38
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$38.57
|
| Rate for Payer: MVP Health Care of NY Medicare |
$28.77
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$4.97
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$10.28
|
| Rate for Payer: United Healthcare Commercial |
$4.97
|
| Rate for Payer: United Healthcare Medicare |
$27.40
|
| Rate for Payer: WellCare Medicare |
$37.67
|
|
|
PROCHLORPERAZINE INJ, UP TO 10 MG
|
Facility
|
IP
|
$68.50
|
|
|
Service Code
|
HCPCS J0780
|
| Hospital Charge Code |
4400653
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.33 |
| Max. Negotiated Rate |
$44.52 |
| Rate for Payer: Aetna of NY Commercial |
$37.67
|
| Rate for Payer: Cash Price |
$51.38
|
| Rate for Payer: Cash Price |
$51.38
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$3.33
|
| Rate for Payer: EmblemHealth Select Care |
$3.33
|
| Rate for Payer: Galaxy Health Commercial |
$44.52
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$37.67
|
| Rate for Payer: WellCare Medicare |
$37.67
|
|
|
PROCRIT 10,000 UNITS/ML VIAL 1000 unit, 1 mL
|
Facility
|
OP
|
$96.75
|
|
|
Service Code
|
HCPCS J0885
|
| Hospital Charge Code |
4401310
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.30 |
| Max. Negotiated Rate |
$72.56 |
| Rate for Payer: Aetna of NY Medicare |
$44.51
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$38.70
|
| Rate for Payer: Cash Price |
$72.56
|
| Rate for Payer: Cash Price |
$72.56
|
| Rate for Payer: CDPHP Medicare |
$35.80
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$7.30
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$14.71
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$12.26
|
| Rate for Payer: EmblemHealth Medicaid |
$12.26
|
| Rate for Payer: EmblemHealth Medicare |
$32.90
|
| Rate for Payer: EmblemHealth Select Care |
$7.30
|
| Rate for Payer: Fidelis Medicare |
$38.70
|
| Rate for Payer: Galaxy Health Commercial |
$62.89
|
| Rate for Payer: Galaxy Health Workers Comp |
$12.01
|
| Rate for Payer: Hamaspik Choice Medicaid |
$12.26
|
| Rate for Payer: Hamaspik Choice Medicare |
$38.70
|
| Rate for Payer: Humana Medicare |
$38.70
|
| Rate for Payer: Local 1199SEIU Medicare |
$44.51
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$12.87
|
| Rate for Payer: MVP Health Care of NY Commercial |
$72.56
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$26.36
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$26.36
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$54.47
|
| Rate for Payer: MVP Health Care of NY Medicare |
$40.63
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$11.35
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$14.51
|
| Rate for Payer: United Healthcare Commercial |
$11.35
|
| Rate for Payer: United Healthcare Medicare |
$38.70
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$12.87
|
| Rate for Payer: WellCare Medicare |
$53.21
|
|
|
PROCRIT 10,000 UNITS/ML VIAL 1000 unit, 1 mL
|
Facility
|
IP
|
$96.75
|
|
|
Service Code
|
HCPCS J0885
|
| Hospital Charge Code |
4401310
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.30 |
| Max. Negotiated Rate |
$62.89 |
| Rate for Payer: Aetna of NY Commercial |
$53.21
|
| Rate for Payer: Cash Price |
$72.56
|
| Rate for Payer: Cash Price |
$72.56
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$7.30
|
| Rate for Payer: EmblemHealth Select Care |
$7.30
|
| Rate for Payer: Galaxy Health Commercial |
$62.89
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$53.21
|
| Rate for Payer: WellCare Medicare |
$53.21
|
|
|
PROCRIT 40,000 UNITS/ML VIAL 40000 UNIT, 1 ML
|
Facility
|
IP
|
$97.00
|
|
|
Service Code
|
HCPCS J0885
|
| Hospital Charge Code |
4401301
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.30 |
| Max. Negotiated Rate |
$63.05 |
| Rate for Payer: Aetna of NY Commercial |
$53.35
|
| Rate for Payer: Cash Price |
$72.75
|
| Rate for Payer: Cash Price |
$72.75
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$7.30
|
| Rate for Payer: EmblemHealth Select Care |
$7.30
|
| Rate for Payer: Galaxy Health Commercial |
$63.05
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$53.35
|
| Rate for Payer: WellCare Medicare |
$53.35
|
|
|
PROCRIT 40,000 UNITS/ML VIAL 40000 UNIT, 1 ML
|
Facility
|
OP
|
$97.00
|
|
|
Service Code
|
HCPCS J0885
|
| Hospital Charge Code |
4401301
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.30 |
| Max. Negotiated Rate |
$72.75 |
| Rate for Payer: Aetna of NY Medicare |
$44.62
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$38.80
|
| Rate for Payer: Cash Price |
$72.75
|
| Rate for Payer: Cash Price |
$72.75
|
| Rate for Payer: CDPHP Medicare |
$35.89
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$7.30
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$14.71
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$12.26
|
| Rate for Payer: EmblemHealth Medicaid |
$12.26
|
| Rate for Payer: EmblemHealth Medicare |
$32.98
|
| Rate for Payer: EmblemHealth Select Care |
$7.30
|
| Rate for Payer: Fidelis Medicare |
$38.80
|
| Rate for Payer: Galaxy Health Commercial |
$63.05
|
| Rate for Payer: Galaxy Health Workers Comp |
$12.01
|
| Rate for Payer: Hamaspik Choice Medicaid |
$12.26
|
| Rate for Payer: Hamaspik Choice Medicare |
$38.80
|
| Rate for Payer: Humana Medicare |
$38.80
|
| Rate for Payer: Local 1199SEIU Medicare |
$44.62
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$12.87
|
| Rate for Payer: MVP Health Care of NY Commercial |
$72.75
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$26.36
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$26.36
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$54.61
|
| Rate for Payer: MVP Health Care of NY Medicare |
$40.74
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$11.35
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$14.55
|
| Rate for Payer: United Healthcare Commercial |
$11.35
|
| Rate for Payer: United Healthcare Medicare |
$38.80
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$12.87
|
| Rate for Payer: WellCare Medicare |
$53.35
|
|
|
PROGRAMER KIT SC5500-04 BOS SCIENTIFIC
|
Facility
|
OP
|
$5,178.84
|
|
| Hospital Charge Code |
4479092
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$776.83 |
| Max. Negotiated Rate |
$4,143.07 |
| Rate for Payer: Aetna of NY Commercial |
$3,625.19
|
| Rate for Payer: Aetna of NY Medicare |
$2,382.27
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2,071.54
|
| Rate for Payer: Cash Price |
$3,884.13
|
| Rate for Payer: CDPHP Medicare |
$1,916.17
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$2,589.42
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$4,143.07
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$4,143.07
|
| Rate for Payer: EmblemHealth Medicaid |
$4,143.07
|
| Rate for Payer: EmblemHealth Medicare |
$1,760.81
|
| Rate for Payer: EmblemHealth Select Care |
$2,589.42
|
| Rate for Payer: Fidelis Medicare |
$2,071.54
|
| Rate for Payer: Galaxy Health Commercial |
$3,366.25
|
| Rate for Payer: Hamaspik Choice Medicare |
$2,071.54
|
| Rate for Payer: Humana Medicare |
$2,071.54
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$3,625.19
|
| Rate for Payer: Local 1199SEIU Medicare |
$2,382.27
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,366.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3,366.25
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2,175.11
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$776.83
|
| Rate for Payer: United Healthcare Medicare |
$2,071.54
|
| Rate for Payer: WellCare Medicare |
$2,848.36
|
|
|
PROGRAMER KIT SC5500-04 BOS SCIENTIFIC
|
Facility
|
IP
|
$5,178.84
|
|
| Hospital Charge Code |
4479092
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,330.48 |
| Max. Negotiated Rate |
$3,625.19 |
| Rate for Payer: Aetna of NY Commercial |
$3,625.19
|
| Rate for Payer: Cash Price |
$3,884.13
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$2,589.42
|
| Rate for Payer: EmblemHealth Select Care |
$2,589.42
|
| Rate for Payer: Galaxy Health Commercial |
$3,366.25
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$3,625.19
|
| Rate for Payer: Multiplan Commercial |
$2,330.48
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,366.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3,366.25
|
| Rate for Payer: WellCare Medicare |
$2,848.36
|
|
|
PROLACTIN
|
Facility
|
IP
|
$58.00
|
|
|
Service Code
|
HCPCS 84146
|
| Hospital Charge Code |
4300654
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$37.70 |
| Max. Negotiated Rate |
$37.70 |
| Rate for Payer: Cash Price |
$43.50
|
| Rate for Payer: Galaxy Health Commercial |
$37.70
|
|
|
PROLACTIN
|
Facility
|
OP
|
$58.00
|
|
|
Service Code
|
HCPCS 84146
|
| Hospital Charge Code |
4300654
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.70 |
| Max. Negotiated Rate |
$46.40 |
| Rate for Payer: Aetna of NY Commercial |
$37.70
|
| Rate for Payer: Aetna of NY Medicare |
$26.68
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$23.20
|
| Rate for Payer: Cash Price |
$43.50
|
| Rate for Payer: CDPHP Medicare |
$21.46
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$34.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$46.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$46.40
|
| Rate for Payer: EmblemHealth Medicaid |
$46.40
|
| Rate for Payer: EmblemHealth Medicare |
$19.72
|
| Rate for Payer: EmblemHealth Select Care |
$34.80
|
| Rate for Payer: Fidelis Medicare |
$23.20
|
| Rate for Payer: Galaxy Health Commercial |
$37.70
|
| Rate for Payer: Hamaspik Choice Medicare |
$23.20
|
| Rate for Payer: Humana Medicare |
$23.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$37.70
|
| Rate for Payer: Local 1199SEIU Medicare |
$26.68
|
| Rate for Payer: MVP Health Care of NY Commercial |
$43.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$32.65
|
| Rate for Payer: MVP Health Care of NY Medicare |
$24.36
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$43.50
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$8.70
|
| Rate for Payer: United Healthcare Commercial |
$43.50
|
| Rate for Payer: United Healthcare Medicare |
$23.20
|
| Rate for Payer: WellCare Medicare |
$31.90
|
|
|
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 |
$29.51 |
| Max. Negotiated Rate |
$57.85 |
| Rate for Payer: Aetna of NY Commercial |
$48.95
|
| Rate for Payer: Cash Price |
$66.75
|
| Rate for Payer: Cash Price |
$66.75
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$29.51
|
| Rate for Payer: EmblemHealth Select Care |
$29.51
|
| 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 |
$13.35 |
| Max. Negotiated Rate |
$71.20 |
| Rate for Payer: Aetna of NY Medicare |
$40.94
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$35.60
|
| Rate for Payer: Cash Price |
$66.75
|
| Rate for Payer: Cash Price |
$66.75
|
| Rate for Payer: CDPHP Medicare |
$32.93
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$29.51
|
| 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 |
$29.51
|
| Rate for Payer: Fidelis Medicare |
$35.60
|
| Rate for Payer: Galaxy Health Commercial |
$57.85
|
| Rate for Payer: Hamaspik Choice Medicare |
$35.60
|
| Rate for Payer: Humana Medicare |
$35.60
|
| 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 |
$37.38
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$39.91
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$13.35
|
| Rate for Payer: United Healthcare Commercial |
$39.91
|
| Rate for Payer: United Healthcare Medicare |
$35.60
|
| Rate for Payer: WellCare Medicare |
$48.95
|
|
|
PROMETHAZINE HCL 25MG TABS 10X10EA
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
NDC 904646161
|
| 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 904646161
|
| Hospital Charge Code |
4400657
|
|
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
|
|
|
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 |
$3.34 |
| Max. Negotiated Rate |
$4.02 |
| Rate for Payer: Aetna of NY Commercial |
$3.40
|
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$3.34
|
| Rate for Payer: EmblemHealth Select Care |
$3.34
|
| 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
|
|
|
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 |
$0.93 |
| Max. Negotiated Rate |
$5.20 |
| 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: Cash Price |
$4.64
|
| Rate for Payer: CDPHP Medicare |
$2.29
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$3.34
|
| 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 |
$3.34
|
| 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 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: Oxford Health Plans Freedom/Liberty/Metro |
$5.20
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$0.93
|
| Rate for Payer: United Healthcare Commercial |
$5.20
|
| Rate for Payer: United Healthcare Medicare |
$2.47
|
| Rate for Payer: WellCare Medicare |
$3.40
|
|
|
PROPOFOL INJ, 10 MG
|
Facility
|
IP
|
$115.88
|
|
|
Service Code
|
HCPCS J2704
|
| Hospital Charge Code |
4400661
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$75.32 |
| Rate for Payer: Aetna of NY Commercial |
$63.73
|
| Rate for Payer: Cash Price |
$86.91
|
| Rate for Payer: Cash Price |
$86.91
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.09
|
| Rate for Payer: EmblemHealth Select Care |
$0.09
|
| 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
|
$22.15
|
|
|
Service Code
|
HCPCS J2704
|
| Hospital Charge Code |
4400660
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$17.72 |
| Rate for Payer: Aetna of NY Medicare |
$10.19
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$8.86
|
| Rate for Payer: Cash Price |
$16.61
|
| Rate for Payer: Cash Price |
$16.61
|
| Rate for Payer: CDPHP Medicare |
$8.20
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.09
|
| 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 |
$0.09
|
| Rate for Payer: Fidelis Medicare |
$8.86
|
| Rate for Payer: Galaxy Health Commercial |
$14.40
|
| Rate for Payer: Hamaspik Choice Medicare |
$8.86
|
| Rate for Payer: Humana Medicare |
$8.86
|
| 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 |
$9.30
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$0.17
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$3.32
|
| Rate for Payer: United Healthcare Commercial |
$0.17
|
| Rate for Payer: United Healthcare Medicare |
$8.86
|
| 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 |
$0.09 |
| Max. Negotiated Rate |
$14.40 |
| Rate for Payer: Aetna of NY Commercial |
$12.18
|
| Rate for Payer: Cash Price |
$16.61
|
| Rate for Payer: Cash Price |
$16.61
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.09
|
| Rate for Payer: EmblemHealth Select Care |
$0.09
|
| 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
|
OP
|
$115.88
|
|
|
Service Code
|
HCPCS J2704
|
| Hospital Charge Code |
4400661
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$92.70 |
| Rate for Payer: Aetna of NY Medicare |
$53.30
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$46.35
|
| Rate for Payer: Cash Price |
$86.91
|
| Rate for Payer: Cash Price |
$86.91
|
| Rate for Payer: CDPHP Medicare |
$42.88
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.09
|
| 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 |
$0.09
|
| Rate for Payer: Fidelis Medicare |
$46.35
|
| Rate for Payer: Galaxy Health Commercial |
$75.32
|
| Rate for Payer: Hamaspik Choice Medicare |
$46.35
|
| Rate for Payer: Humana Medicare |
$46.35
|
| 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 |
$48.67
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$0.17
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$17.38
|
| Rate for Payer: United Healthcare Commercial |
$0.17
|
| Rate for Payer: United Healthcare Medicare |
$46.35
|
| 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 |
$0.90 |
| Max. Negotiated Rate |
$4.80 |
| 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) Medicare |
$2.40
|
| Rate for Payer: Cash Price |
$4.50
|
| 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 |
$2.40
|
| Rate for Payer: Galaxy Health Commercial |
$3.90
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.40
|
| Rate for Payer: Humana Medicare |
$2.40
|
| 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 |
$2.52
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$0.90
|
| Rate for Payer: United Healthcare Medicare |
$2.40
|
| 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
|
|
