|
cefaDROXiL 500 MG CAPSULE 500 mg, 50 eaches
|
Facility
OP
|
$6.00
|
|
| Hospital Charge Code |
4401515
|
|
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
|
|
|
CEFAZOLIN SODIUM INJECTION 500 MG
|
Facility
OP
|
$6.76
|
|
| Hospital Charge Code |
4409236
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.30 |
| Max. Negotiated Rate |
$5.44 |
| Rate for Payer: Aetna of NY Commercial |
$4.73
|
| Rate for Payer: Aetna of NY Medicare |
$3.11
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$5.07
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$5.07
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2.50
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$3.38
|
| Rate for Payer: Cash Price |
$5.07
|
| Rate for Payer: CDPHP Commercial |
$5.44
|
| Rate for Payer: CDPHP Medicare |
$2.50
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$5.41
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$5.41
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$5.41
|
| Rate for Payer: EmblemHealth Medicaid |
$5.41
|
| Rate for Payer: EmblemHealth Medicare |
$2.30
|
| Rate for Payer: EmblemHealth Select Care |
$4.87
|
| Rate for Payer: Fidelis Medicare |
$2.58
|
| Rate for Payer: Galaxy Health Commercial |
$4.39
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.50
|
| Rate for Payer: Humana Medicare |
$2.50
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$4.73
|
| Rate for Payer: Local 1199SEIU Medicare |
$3.11
|
| Rate for Payer: MVP Health Care of NY Commercial |
$5.07
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3.81
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2.63
|
| Rate for Payer: United Healthcare Medicare |
$2.50
|
| Rate for Payer: WellCare Medicare |
$3.72
|
|
|
CEFAZOLIN SODIUM INJECTION 500 MG
|
Facility
OP
|
$8.00
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
4401249
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.82 |
| Max. Negotiated Rate |
$6.44 |
| Rate for Payer: Aetna of NY Commercial |
$4.40
|
| Rate for Payer: Aetna of NY Medicare |
$3.68
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$0.82
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$0.82
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2.96
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$4.00
|
| Rate for Payer: Cash Price |
$6.00
|
| Rate for Payer: Cash Price |
$6.00
|
| Rate for Payer: CDPHP Commercial |
$6.44
|
| Rate for Payer: CDPHP Medicare |
$2.96
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.82
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$6.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$6.40
|
| Rate for Payer: EmblemHealth Medicaid |
$6.40
|
| Rate for Payer: EmblemHealth Medicare |
$2.72
|
| Rate for Payer: EmblemHealth Select Care |
$0.82
|
| Rate for Payer: Fidelis Medicare |
$3.05
|
| Rate for Payer: Galaxy Health Commercial |
$5.20
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.96
|
| Rate for Payer: Humana Medicare |
$2.96
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$4.40
|
| Rate for Payer: Local 1199SEIU Medicare |
$3.68
|
| Rate for Payer: MVP Health Care of NY Commercial |
$6.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$4.50
|
| Rate for Payer: MVP Health Care of NY Medicare |
$3.11
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1.44
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$0.82
|
| Rate for Payer: United Healthcare Commercial |
$1.44
|
| Rate for Payer: United Healthcare Medicare |
$2.96
|
| Rate for Payer: WellCare Medicare |
$4.40
|
|
|
CEFAZOLIN SODIUM INJECTION 500 MG
|
Facility
OP
|
$3.09
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
4400140
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.82 |
| Max. Negotiated Rate |
$2.49 |
| Rate for Payer: Aetna of NY Commercial |
$1.70
|
| Rate for Payer: Aetna of NY Medicare |
$1.42
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$0.82
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$0.82
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1.14
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$1.54
|
| Rate for Payer: Cash Price |
$2.32
|
| Rate for Payer: Cash Price |
$2.32
|
| Rate for Payer: CDPHP Commercial |
$2.49
|
| Rate for Payer: CDPHP Medicare |
$1.14
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.82
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2.47
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$2.47
|
| Rate for Payer: EmblemHealth Medicaid |
$2.47
|
| Rate for Payer: EmblemHealth Medicare |
$1.05
|
| Rate for Payer: EmblemHealth Select Care |
$0.82
|
| Rate for Payer: Fidelis Medicare |
$1.18
|
| Rate for Payer: Galaxy Health Commercial |
$2.01
|
| Rate for Payer: Hamaspik Choice Medicare |
$1.14
|
| Rate for Payer: Humana Medicare |
$1.14
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1.70
|
| Rate for Payer: Local 1199SEIU Medicare |
$1.42
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2.32
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1.74
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1.20
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1.44
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$0.82
|
| Rate for Payer: United Healthcare Commercial |
$1.44
|
| Rate for Payer: United Healthcare Medicare |
$1.14
|
| Rate for Payer: WellCare Medicare |
$1.70
|
|
|
CEFDINIR 125 MG/5 ML SUSP 125 mg, 60 mL
|
Facility
OP
|
$153.00
|
|
| Hospital Charge Code |
4401559
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$52.02 |
| Max. Negotiated Rate |
$123.16 |
| Rate for Payer: Aetna of NY Commercial |
$107.10
|
| Rate for Payer: Aetna of NY Medicare |
$70.38
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$114.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$114.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$56.61
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$76.50
|
| Rate for Payer: Cash Price |
$114.75
|
| Rate for Payer: CDPHP Commercial |
$123.16
|
| Rate for Payer: CDPHP Medicare |
$56.61
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$122.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$122.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$122.40
|
| Rate for Payer: EmblemHealth Medicaid |
$122.40
|
| Rate for Payer: EmblemHealth Medicare |
$52.02
|
| Rate for Payer: EmblemHealth Select Care |
$110.16
|
| Rate for Payer: Fidelis Medicare |
$58.31
|
| Rate for Payer: Galaxy Health Commercial |
$99.45
|
| Rate for Payer: Hamaspik Choice Medicare |
$56.61
|
| Rate for Payer: Humana Medicare |
$56.61
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$107.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$70.38
|
| Rate for Payer: MVP Health Care of NY Commercial |
$114.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$86.14
|
| Rate for Payer: MVP Health Care of NY Medicare |
$59.44
|
| Rate for Payer: United Healthcare Medicare |
$56.61
|
| Rate for Payer: WellCare Medicare |
$84.15
|
|
|
CEFDINIR 250 MG/5 ML SUSP 250 mg, 60 mL
|
Facility
OP
|
$298.00
|
|
| Hospital Charge Code |
4401560
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$101.32 |
| Max. Negotiated Rate |
$239.89 |
| Rate for Payer: Aetna of NY Commercial |
$208.60
|
| Rate for Payer: Aetna of NY Medicare |
$137.08
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$223.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$223.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$110.26
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$149.00
|
| Rate for Payer: Cash Price |
$223.50
|
| Rate for Payer: CDPHP Commercial |
$239.89
|
| Rate for Payer: CDPHP Medicare |
$110.26
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$238.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$238.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$238.40
|
| Rate for Payer: EmblemHealth Medicaid |
$238.40
|
| Rate for Payer: EmblemHealth Medicare |
$101.32
|
| Rate for Payer: EmblemHealth Select Care |
$214.56
|
| Rate for Payer: Fidelis Medicare |
$113.57
|
| Rate for Payer: Galaxy Health Commercial |
$193.70
|
| Rate for Payer: Hamaspik Choice Medicare |
$110.26
|
| Rate for Payer: Humana Medicare |
$110.26
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$208.60
|
| Rate for Payer: Local 1199SEIU Medicare |
$137.08
|
| Rate for Payer: MVP Health Care of NY Commercial |
$223.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$167.77
|
| Rate for Payer: MVP Health Care of NY Medicare |
$115.77
|
| Rate for Payer: United Healthcare Medicare |
$110.26
|
| Rate for Payer: WellCare Medicare |
$163.90
|
|
|
CEFDINIR 300MG CAPSULE
|
Facility
OP
|
$2.40
|
|
| Hospital Charge Code |
4400845
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.82 |
| Max. Negotiated Rate |
$1.93 |
| Rate for Payer: Aetna of NY Commercial |
$1.68
|
| Rate for Payer: Aetna of NY Medicare |
$1.10
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1.80
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1.80
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$0.89
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$1.20
|
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: CDPHP Commercial |
$1.93
|
| Rate for Payer: CDPHP Medicare |
$0.89
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1.92
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1.92
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1.92
|
| Rate for Payer: EmblemHealth Medicaid |
$1.92
|
| Rate for Payer: EmblemHealth Medicare |
$0.82
|
| Rate for Payer: EmblemHealth Select Care |
$1.73
|
| Rate for Payer: Fidelis Medicare |
$0.91
|
| Rate for Payer: Galaxy Health Commercial |
$1.56
|
| Rate for Payer: Hamaspik Choice Medicare |
$0.89
|
| Rate for Payer: Humana Medicare |
$0.89
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1.68
|
| Rate for Payer: Local 1199SEIU Medicare |
$1.10
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1.80
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1.35
|
| Rate for Payer: MVP Health Care of NY Medicare |
$0.93
|
| Rate for Payer: United Healthcare Medicare |
$0.89
|
| Rate for Payer: WellCare Medicare |
$1.32
|
|
|
CEFEPIME HCL INJ 500 MG
|
Facility
OP
|
$22.15
|
|
|
Service Code
|
HCPCS J0692
|
| Hospital Charge Code |
4400141
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.34 |
| 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 |
$1.34
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1.34
|
| 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 |
$1.34
|
| 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 |
$1.34
|
| 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 |
$2.03
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1.34
|
| Rate for Payer: United Healthcare Commercial |
$2.03
|
| Rate for Payer: United Healthcare Medicare |
$8.20
|
| Rate for Payer: WellCare Medicare |
$12.18
|
|
|
CEFEPIME HCL INJ 500 MG
|
Facility
OP
|
$36.31
|
|
|
Service Code
|
HCPCS J0692
|
| Hospital Charge Code |
4409210
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.34 |
| Max. Negotiated Rate |
$29.23 |
| Rate for Payer: Aetna of NY Commercial |
$19.97
|
| Rate for Payer: Aetna of NY Medicare |
$16.70
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1.34
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1.34
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$13.43
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$18.16
|
| Rate for Payer: Cash Price |
$27.23
|
| Rate for Payer: Cash Price |
$27.23
|
| Rate for Payer: CDPHP Commercial |
$29.23
|
| Rate for Payer: CDPHP Medicare |
$13.43
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1.34
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$29.05
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$29.05
|
| Rate for Payer: EmblemHealth Medicaid |
$29.05
|
| Rate for Payer: EmblemHealth Medicare |
$12.35
|
| Rate for Payer: EmblemHealth Select Care |
$1.34
|
| Rate for Payer: Fidelis Medicare |
$13.84
|
| Rate for Payer: Galaxy Health Commercial |
$23.60
|
| Rate for Payer: Hamaspik Choice Medicare |
$13.43
|
| Rate for Payer: Humana Medicare |
$13.43
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$19.97
|
| Rate for Payer: Local 1199SEIU Medicare |
$16.70
|
| Rate for Payer: MVP Health Care of NY Commercial |
$27.23
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$20.44
|
| Rate for Payer: MVP Health Care of NY Medicare |
$14.11
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$2.03
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1.34
|
| Rate for Payer: United Healthcare Commercial |
$2.03
|
| Rate for Payer: United Healthcare Medicare |
$13.43
|
| Rate for Payer: WellCare Medicare |
$19.97
|
|
|
cefOXitin 1 GM PIGGYBACK BAG 1 g, 1 each
|
Facility
OP
|
$75.50
|
|
|
Service Code
|
HCPCS J0694
|
| Hospital Charge Code |
4401508
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.90 |
| Max. Negotiated Rate |
$60.78 |
| Rate for Payer: Aetna of NY Commercial |
$41.52
|
| Rate for Payer: Aetna of NY Medicare |
$34.73
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$4.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$4.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$27.94
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$37.75
|
| Rate for Payer: Cash Price |
$56.62
|
| Rate for Payer: Cash Price |
$56.62
|
| Rate for Payer: CDPHP Commercial |
$60.78
|
| Rate for Payer: CDPHP Medicare |
$27.94
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$4.90
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$60.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$60.40
|
| Rate for Payer: EmblemHealth Medicaid |
$60.40
|
| Rate for Payer: EmblemHealth Medicare |
$25.67
|
| Rate for Payer: EmblemHealth Select Care |
$4.90
|
| Rate for Payer: Fidelis Medicare |
$28.77
|
| Rate for Payer: Galaxy Health Commercial |
$49.08
|
| Rate for Payer: Hamaspik Choice Medicare |
$27.94
|
| Rate for Payer: Humana Medicare |
$27.94
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$41.52
|
| Rate for Payer: Local 1199SEIU Medicare |
$34.73
|
| Rate for Payer: MVP Health Care of NY Commercial |
$56.62
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$42.51
|
| Rate for Payer: MVP Health Care of NY Medicare |
$29.33
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$8.25
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$4.90
|
| Rate for Payer: United Healthcare Commercial |
$8.25
|
| Rate for Payer: United Healthcare Medicare |
$27.94
|
| Rate for Payer: WellCare Medicare |
$41.52
|
|
|
cefOXitin 2 GM PIGGYBACK BAG 2 g, 1 each
|
Facility
OP
|
$135.15
|
|
|
Service Code
|
HCPCS J0694
|
| Hospital Charge Code |
4401509
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.90 |
| Max. Negotiated Rate |
$108.80 |
| Rate for Payer: Aetna of NY Commercial |
$74.33
|
| Rate for Payer: Aetna of NY Medicare |
$62.17
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$4.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$4.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$50.01
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$67.58
|
| Rate for Payer: Cash Price |
$101.36
|
| Rate for Payer: Cash Price |
$101.36
|
| Rate for Payer: CDPHP Commercial |
$108.80
|
| Rate for Payer: CDPHP Medicare |
$50.01
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$4.90
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$108.12
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$108.12
|
| Rate for Payer: EmblemHealth Medicaid |
$108.12
|
| Rate for Payer: EmblemHealth Medicare |
$45.95
|
| Rate for Payer: EmblemHealth Select Care |
$4.90
|
| Rate for Payer: Fidelis Medicare |
$51.51
|
| Rate for Payer: Galaxy Health Commercial |
$87.85
|
| Rate for Payer: Hamaspik Choice Medicare |
$50.01
|
| Rate for Payer: Humana Medicare |
$50.01
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$74.33
|
| Rate for Payer: Local 1199SEIU Medicare |
$62.17
|
| Rate for Payer: MVP Health Care of NY Commercial |
$101.36
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$76.09
|
| Rate for Payer: MVP Health Care of NY Medicare |
$52.51
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$8.25
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$4.90
|
| Rate for Payer: United Healthcare Commercial |
$8.25
|
| Rate for Payer: United Healthcare Medicare |
$50.01
|
| Rate for Payer: WellCare Medicare |
$74.33
|
|
|
CEFOXITIN SODIUM INJECTION 1 GM
|
Facility
OP
|
$22.15
|
|
|
Service Code
|
HCPCS J0694
|
| Hospital Charge Code |
4400143
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.90 |
| 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 |
$4.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$4.90
|
| 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 |
$4.90
|
| 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 |
$4.90
|
| 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 |
$8.25
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$4.90
|
| Rate for Payer: United Healthcare Commercial |
$8.25
|
| Rate for Payer: United Healthcare Medicare |
$8.20
|
| Rate for Payer: WellCare Medicare |
$12.18
|
|
|
cefPODOXime 200 MG TABLET 200 mg, 20 eaches
|
Facility
OP
|
$38.00
|
|
| Hospital Charge Code |
4401521
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.92 |
| Max. Negotiated Rate |
$30.59 |
| Rate for Payer: Aetna of NY Commercial |
$26.60
|
| Rate for Payer: Aetna of NY Medicare |
$17.48
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$28.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$28.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$14.06
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$19.00
|
| Rate for Payer: Cash Price |
$28.50
|
| Rate for Payer: CDPHP Commercial |
$30.59
|
| Rate for Payer: CDPHP Medicare |
$14.06
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$30.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$30.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$30.40
|
| Rate for Payer: EmblemHealth Medicaid |
$30.40
|
| Rate for Payer: EmblemHealth Medicare |
$12.92
|
| Rate for Payer: EmblemHealth Select Care |
$27.36
|
| Rate for Payer: Fidelis Medicare |
$14.48
|
| Rate for Payer: Galaxy Health Commercial |
$24.70
|
| Rate for Payer: Hamaspik Choice Medicare |
$14.06
|
| Rate for Payer: Humana Medicare |
$14.06
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$26.60
|
| Rate for Payer: Local 1199SEIU Medicare |
$17.48
|
| Rate for Payer: MVP Health Care of NY Commercial |
$28.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$21.39
|
| Rate for Payer: MVP Health Care of NY Medicare |
$14.76
|
| Rate for Payer: United Healthcare Medicare |
$14.06
|
| Rate for Payer: WellCare Medicare |
$20.90
|
|
|
CEFTAROLINE FOSAMIL INJ 10 MG
|
Facility
OP
|
$11.00
|
|
|
Service Code
|
HCPCS J0712
|
| Hospital Charge Code |
4409105
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.74 |
| Max. Negotiated Rate |
$8.86 |
| Rate for Payer: Aetna of NY Commercial |
$6.05
|
| Rate for Payer: Aetna of NY Medicare |
$5.06
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$3.86
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$3.86
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$4.07
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$5.50
|
| Rate for Payer: Cash Price |
$8.25
|
| Rate for Payer: Cash Price |
$8.25
|
| Rate for Payer: CDPHP Commercial |
$8.86
|
| Rate for Payer: CDPHP Medicare |
$4.07
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$3.86
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$8.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$8.80
|
| Rate for Payer: EmblemHealth Medicaid |
$8.80
|
| Rate for Payer: EmblemHealth Medicare |
$3.74
|
| Rate for Payer: EmblemHealth Select Care |
$3.86
|
| Rate for Payer: Fidelis Medicare |
$4.19
|
| Rate for Payer: Galaxy Health Commercial |
$7.15
|
| Rate for Payer: Hamaspik Choice Medicare |
$4.07
|
| Rate for Payer: Humana Medicare |
$4.07
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$6.05
|
| Rate for Payer: Local 1199SEIU Medicare |
$5.06
|
| Rate for Payer: MVP Health Care of NY Commercial |
$8.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$6.19
|
| Rate for Payer: MVP Health Care of NY Medicare |
$4.27
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$6.42
|
| Rate for Payer: United Healthcare Commercial |
$6.42
|
| Rate for Payer: United Healthcare Medicare |
$4.07
|
| Rate for Payer: WellCare Medicare |
$6.05
|
|
|
cefTAZidime 2 GM VIAL 2 g, 1 each
|
Facility
OP
|
$10.00
|
|
|
Service Code
|
HCPCS J0713
|
| Hospital Charge Code |
4401401
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.66 |
| Max. Negotiated Rate |
$8.05 |
| Rate for Payer: Aetna of NY Commercial |
$5.50
|
| Rate for Payer: Aetna of NY Medicare |
$4.60
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1.66
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1.66
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$3.70
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$5.00
|
| Rate for Payer: Cash Price |
$7.50
|
| Rate for Payer: Cash Price |
$7.50
|
| Rate for Payer: CDPHP Commercial |
$8.05
|
| Rate for Payer: CDPHP Medicare |
$3.70
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1.66
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$8.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$8.00
|
| Rate for Payer: EmblemHealth Medicaid |
$8.00
|
| Rate for Payer: EmblemHealth Medicare |
$3.40
|
| Rate for Payer: EmblemHealth Select Care |
$1.66
|
| Rate for Payer: Fidelis Medicare |
$3.81
|
| Rate for Payer: Galaxy Health Commercial |
$6.50
|
| Rate for Payer: Hamaspik Choice Medicare |
$3.70
|
| Rate for Payer: Humana Medicare |
$3.70
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$5.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$4.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$7.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$5.63
|
| Rate for Payer: MVP Health Care of NY Medicare |
$3.88
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$3.04
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1.66
|
| Rate for Payer: United Healthcare Commercial |
$3.04
|
| Rate for Payer: United Healthcare Medicare |
$3.70
|
| Rate for Payer: WellCare Medicare |
$5.50
|
|
|
cefTRIAXone 2 GM-D5W BAG, 1 each
|
Facility
OP
|
$7.50
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
4401305
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$6.04 |
| Rate for Payer: Aetna of NY Commercial |
$4.12
|
| Rate for Payer: Aetna of NY Medicare |
$3.45
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$0.45
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$0.45
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2.78
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$3.75
|
| Rate for Payer: Cash Price |
$5.62
|
| Rate for Payer: Cash Price |
$5.62
|
| Rate for Payer: CDPHP Commercial |
$6.04
|
| Rate for Payer: CDPHP Medicare |
$2.78
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.45
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$6.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$6.00
|
| Rate for Payer: EmblemHealth Medicaid |
$6.00
|
| Rate for Payer: EmblemHealth Medicare |
$2.55
|
| Rate for Payer: EmblemHealth Select Care |
$0.45
|
| Rate for Payer: Fidelis Medicare |
$2.86
|
| Rate for Payer: Galaxy Health Commercial |
$4.88
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.78
|
| Rate for Payer: Humana Medicare |
$2.78
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$4.12
|
| Rate for Payer: Local 1199SEIU Medicare |
$3.45
|
| Rate for Payer: MVP Health Care of NY Commercial |
$5.62
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$4.22
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2.91
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$0.94
|
| Rate for Payer: United Healthcare Commercial |
$0.94
|
| Rate for Payer: United Healthcare Medicare |
$2.78
|
| Rate for Payer: WellCare Medicare |
$4.12
|
|
|
CEFTRIAXONE SODIUM
|
Facility
OP
|
$3.00
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
4400147
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$2.42 |
| Rate for Payer: Aetna of NY Commercial |
$1.65
|
| Rate for Payer: Aetna of NY Medicare |
$1.38
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$0.45
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$0.45
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1.11
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$1.50
|
| Rate for Payer: Cash Price |
$2.25
|
| Rate for Payer: Cash Price |
$2.25
|
| Rate for Payer: CDPHP Commercial |
$2.42
|
| Rate for Payer: CDPHP Medicare |
$1.11
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.45
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$2.40
|
| Rate for Payer: EmblemHealth Medicaid |
$2.40
|
| Rate for Payer: EmblemHealth Medicare |
$1.02
|
| Rate for Payer: EmblemHealth Select Care |
$0.45
|
| Rate for Payer: Fidelis Medicare |
$1.14
|
| Rate for Payer: Galaxy Health Commercial |
$1.95
|
| Rate for Payer: Hamaspik Choice Medicare |
$1.11
|
| Rate for Payer: Humana Medicare |
$1.11
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1.65
|
| Rate for Payer: Local 1199SEIU Medicare |
$1.38
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1.69
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1.17
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$0.94
|
| Rate for Payer: United Healthcare Commercial |
$0.94
|
| Rate for Payer: United Healthcare Medicare |
$1.11
|
| Rate for Payer: WellCare Medicare |
$1.65
|
|
|
CEFTRIAXONE SODIUM, PER 250 MG
|
Facility
OP
|
$3.09
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
4408961
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$2.49 |
| Rate for Payer: Aetna of NY Commercial |
$1.70
|
| Rate for Payer: Aetna of NY Medicare |
$1.42
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$0.45
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$0.45
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1.14
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$1.54
|
| Rate for Payer: Cash Price |
$2.32
|
| Rate for Payer: Cash Price |
$2.32
|
| Rate for Payer: CDPHP Commercial |
$2.49
|
| Rate for Payer: CDPHP Medicare |
$1.14
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.45
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2.47
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$2.47
|
| Rate for Payer: EmblemHealth Medicaid |
$2.47
|
| Rate for Payer: EmblemHealth Medicare |
$1.05
|
| Rate for Payer: EmblemHealth Select Care |
$0.45
|
| Rate for Payer: Fidelis Medicare |
$1.18
|
| Rate for Payer: Galaxy Health Commercial |
$2.01
|
| Rate for Payer: Hamaspik Choice Medicare |
$1.14
|
| Rate for Payer: Humana Medicare |
$1.14
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1.70
|
| Rate for Payer: Local 1199SEIU Medicare |
$1.42
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2.32
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1.74
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1.20
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$0.94
|
| Rate for Payer: United Healthcare Commercial |
$0.94
|
| Rate for Payer: United Healthcare Medicare |
$1.14
|
| Rate for Payer: WellCare Medicare |
$1.70
|
|
|
CEFTRIAXONE SODIUM, PER 250 MG
|
Facility
OP
|
$3.49
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
4400146
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$2.81 |
| Rate for Payer: Aetna of NY Commercial |
$1.92
|
| Rate for Payer: Aetna of NY Medicare |
$1.61
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$0.45
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$0.45
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1.29
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$1.74
|
| Rate for Payer: Cash Price |
$2.62
|
| Rate for Payer: Cash Price |
$2.62
|
| Rate for Payer: CDPHP Commercial |
$2.81
|
| Rate for Payer: CDPHP Medicare |
$1.29
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.45
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2.79
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$2.79
|
| Rate for Payer: EmblemHealth Medicaid |
$2.79
|
| Rate for Payer: EmblemHealth Medicare |
$1.19
|
| Rate for Payer: EmblemHealth Select Care |
$0.45
|
| Rate for Payer: Fidelis Medicare |
$1.33
|
| Rate for Payer: Galaxy Health Commercial |
$2.27
|
| Rate for Payer: Hamaspik Choice Medicare |
$1.29
|
| Rate for Payer: Humana Medicare |
$1.29
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1.92
|
| Rate for Payer: Local 1199SEIU Medicare |
$1.61
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2.62
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1.96
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1.36
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$0.94
|
| Rate for Payer: United Healthcare Commercial |
$0.94
|
| Rate for Payer: United Healthcare Medicare |
$1.29
|
| Rate for Payer: WellCare Medicare |
$1.92
|
|
|
CEFTRIAXONE SODIUM, Per 50 ml
|
Facility
OP
|
$10.75
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
4401248
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$8.65 |
| Rate for Payer: Aetna of NY Commercial |
$5.91
|
| Rate for Payer: Aetna of NY Medicare |
$4.94
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$0.45
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$0.45
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$3.98
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$5.38
|
| Rate for Payer: Cash Price |
$8.06
|
| Rate for Payer: Cash Price |
$8.06
|
| Rate for Payer: CDPHP Commercial |
$8.65
|
| Rate for Payer: CDPHP Medicare |
$3.98
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.45
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$8.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$8.60
|
| Rate for Payer: EmblemHealth Medicaid |
$8.60
|
| Rate for Payer: EmblemHealth Medicare |
$3.66
|
| Rate for Payer: EmblemHealth Select Care |
$0.45
|
| Rate for Payer: Fidelis Medicare |
$4.10
|
| Rate for Payer: Galaxy Health Commercial |
$6.99
|
| Rate for Payer: Hamaspik Choice Medicare |
$3.98
|
| Rate for Payer: Humana Medicare |
$3.98
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$5.91
|
| Rate for Payer: Local 1199SEIU Medicare |
$4.94
|
| Rate for Payer: MVP Health Care of NY Commercial |
$8.06
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$6.05
|
| Rate for Payer: MVP Health Care of NY Medicare |
$4.18
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$0.94
|
| Rate for Payer: United Healthcare Commercial |
$0.94
|
| Rate for Payer: United Healthcare Medicare |
$3.98
|
| Rate for Payer: WellCare Medicare |
$5.91
|
|
|
CEFUROXIME 250 MG TABLET
|
Facility
OP
|
$12.50
|
|
| Hospital Charge Code |
4401292
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.25 |
| Max. Negotiated Rate |
$10.06 |
| Rate for Payer: Aetna of NY Commercial |
$8.75
|
| Rate for Payer: Aetna of NY Medicare |
$5.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$9.38
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$9.38
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$4.62
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$6.25
|
| Rate for Payer: Cash Price |
$9.38
|
| Rate for Payer: CDPHP Commercial |
$10.06
|
| Rate for Payer: CDPHP Medicare |
$4.62
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$10.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$10.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$10.00
|
| Rate for Payer: EmblemHealth Medicaid |
$10.00
|
| Rate for Payer: EmblemHealth Medicare |
$4.25
|
| Rate for Payer: EmblemHealth Select Care |
$9.00
|
| Rate for Payer: Fidelis Medicare |
$4.76
|
| Rate for Payer: Galaxy Health Commercial |
$8.12
|
| Rate for Payer: Hamaspik Choice Medicare |
$4.62
|
| Rate for Payer: Humana Medicare |
$4.62
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$8.75
|
| Rate for Payer: Local 1199SEIU Medicare |
$5.75
|
| Rate for Payer: MVP Health Care of NY Commercial |
$9.38
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$7.04
|
| Rate for Payer: MVP Health Care of NY Medicare |
$4.86
|
| Rate for Payer: United Healthcare Medicare |
$4.62
|
| Rate for Payer: WellCare Medicare |
$6.88
|
|
|
CEFUROXIME AXETIL 500MG TABS 60 EA
|
Facility
OP
|
$24.72
|
|
| Hospital Charge Code |
4400148
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.40 |
| Max. Negotiated Rate |
$19.90 |
| Rate for Payer: Aetna of NY Commercial |
$17.30
|
| Rate for Payer: Aetna of NY Medicare |
$11.37
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$18.54
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$18.54
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$9.15
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$12.36
|
| Rate for Payer: Cash Price |
$18.54
|
| Rate for Payer: CDPHP Commercial |
$19.90
|
| Rate for Payer: CDPHP Medicare |
$9.15
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$19.78
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$19.78
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$19.78
|
| Rate for Payer: EmblemHealth Medicaid |
$19.78
|
| Rate for Payer: EmblemHealth Medicare |
$8.40
|
| Rate for Payer: EmblemHealth Select Care |
$17.80
|
| Rate for Payer: Fidelis Medicare |
$9.42
|
| Rate for Payer: Galaxy Health Commercial |
$16.07
|
| Rate for Payer: Hamaspik Choice Medicare |
$9.15
|
| Rate for Payer: Humana Medicare |
$9.15
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$17.30
|
| Rate for Payer: Local 1199SEIU Medicare |
$11.37
|
| Rate for Payer: MVP Health Care of NY Commercial |
$18.54
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$13.92
|
| Rate for Payer: MVP Health Care of NY Medicare |
$9.60
|
| Rate for Payer: United Healthcare Medicare |
$9.15
|
| Rate for Payer: WellCare Medicare |
$13.60
|
|
|
CELECOXIB 100MG CAPS 100 EA
|
Facility
OP
|
$22.66
|
|
| Hospital Charge Code |
4400150
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.70 |
| Max. Negotiated Rate |
$18.24 |
| Rate for Payer: Aetna of NY Commercial |
$15.86
|
| Rate for Payer: Aetna of NY Medicare |
$10.42
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$17.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$17.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$8.38
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$11.33
|
| Rate for Payer: Cash Price |
$17.00
|
| Rate for Payer: CDPHP Commercial |
$18.24
|
| Rate for Payer: CDPHP Medicare |
$8.38
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$18.13
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$18.13
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$18.13
|
| Rate for Payer: EmblemHealth Medicaid |
$18.13
|
| Rate for Payer: EmblemHealth Medicare |
$7.70
|
| Rate for Payer: EmblemHealth Select Care |
$16.32
|
| Rate for Payer: Fidelis Medicare |
$8.64
|
| Rate for Payer: Galaxy Health Commercial |
$14.73
|
| Rate for Payer: Hamaspik Choice Medicare |
$8.38
|
| Rate for Payer: Humana Medicare |
$8.38
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$15.86
|
| Rate for Payer: Local 1199SEIU Medicare |
$10.42
|
| Rate for Payer: MVP Health Care of NY Commercial |
$17.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$12.76
|
| Rate for Payer: MVP Health Care of NY Medicare |
$8.80
|
| Rate for Payer: United Healthcare Medicare |
$8.38
|
| Rate for Payer: WellCare Medicare |
$12.46
|
|
|
CELERO HANDPIECES / CELERO-12
|
Facility
OP
|
$449.00
|
|
| Hospital Charge Code |
4473013
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$152.66 |
| Max. Negotiated Rate |
$361.44 |
| Rate for Payer: Aetna of NY Commercial |
$314.30
|
| Rate for Payer: Aetna of NY Medicare |
$206.54
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$336.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$336.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$166.13
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$224.50
|
| Rate for Payer: Cash Price |
$336.75
|
| Rate for Payer: CDPHP Commercial |
$361.44
|
| Rate for Payer: CDPHP Medicare |
$166.13
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$359.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$359.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$359.20
|
| Rate for Payer: EmblemHealth Medicaid |
$359.20
|
| Rate for Payer: EmblemHealth Medicare |
$152.66
|
| Rate for Payer: EmblemHealth Select Care |
$323.28
|
| Rate for Payer: Fidelis Medicare |
$171.11
|
| Rate for Payer: Galaxy Health Commercial |
$291.85
|
| Rate for Payer: Hamaspik Choice Medicare |
$166.13
|
| Rate for Payer: Humana Medicare |
$166.13
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$314.30
|
| Rate for Payer: Local 1199SEIU Medicare |
$206.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$336.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$252.79
|
| Rate for Payer: MVP Health Care of NY Medicare |
$174.44
|
| Rate for Payer: United Healthcare Medicare |
$166.13
|
| Rate for Payer: WellCare Medicare |
$246.95
|
|
|
CELERO INTRO-12 / INTRODUCER
|
Facility
OP
|
$42.00
|
|
| Hospital Charge Code |
4473014
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.28 |
| Max. Negotiated Rate |
$33.81 |
| Rate for Payer: Aetna of NY Commercial |
$29.40
|
| Rate for Payer: Aetna of NY Medicare |
$19.32
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$31.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$31.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$15.54
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$21.00
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: CDPHP Commercial |
$33.81
|
| Rate for Payer: CDPHP Medicare |
$15.54
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$33.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$33.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$33.60
|
| Rate for Payer: EmblemHealth Medicaid |
$33.60
|
| Rate for Payer: EmblemHealth Medicare |
$14.28
|
| Rate for Payer: EmblemHealth Select Care |
$30.24
|
| Rate for Payer: Fidelis Medicare |
$16.01
|
| Rate for Payer: Galaxy Health Commercial |
$27.30
|
| Rate for Payer: Hamaspik Choice Medicare |
$15.54
|
| Rate for Payer: Humana Medicare |
$15.54
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$29.40
|
| Rate for Payer: Local 1199SEIU Medicare |
$19.32
|
| Rate for Payer: MVP Health Care of NY Commercial |
$31.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$23.65
|
| Rate for Payer: MVP Health Care of NY Medicare |
$16.32
|
| Rate for Payer: United Healthcare Medicare |
$15.54
|
| Rate for Payer: WellCare Medicare |
$23.10
|
|
