|
VALPOIC ACID SYP 250 MG / 5 ML
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 00121467505
|
| Hospital Charge Code |
4408974
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.10 |
| Max. Negotiated Rate |
$4.97 |
| Rate for Payer: Aetna of NY Commercial |
$4.33
|
| Rate for Payer: Aetna of NY Medicare |
$2.84
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$4.64
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$4.64
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2.29
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$3.09
|
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: CDPHP Commercial |
$4.97
|
| Rate for Payer: CDPHP Medicare |
$2.29
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$4.94
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$4.94
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$4.94
|
| Rate for Payer: EmblemHealth Medicaid |
$4.94
|
| Rate for Payer: EmblemHealth Medicare |
$2.10
|
| Rate for Payer: EmblemHealth Select Care |
$4.45
|
| Rate for Payer: Fidelis Medicare |
$2.36
|
| Rate for Payer: Galaxy Health Commercial |
$4.02
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.29
|
| Rate for Payer: Humana Medicare |
$2.29
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$4.33
|
| Rate for Payer: Local 1199SEIU Medicare |
$2.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4.64
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3.48
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2.40
|
| Rate for Payer: United Healthcare Medicare |
$2.29
|
| Rate for Payer: WellCare Medicare |
$3.40
|
|
|
VALPOIC ACID SYP 250 MG / 5 ML
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
NDC 00121467505
|
| Hospital Charge Code |
4408974
|
|
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
|
|
|
VALPROATE SODIUM INJECTABLE 100MG/ML SDV
|
Facility
|
IP
|
$13.39
|
|
|
Service Code
|
NDC 00143978510
|
| Hospital Charge Code |
4400786
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.36 |
| Max. Negotiated Rate |
$8.70 |
| Rate for Payer: Cash Price |
$10.04
|
| Rate for Payer: Galaxy Health Commercial |
$8.70
|
| Rate for Payer: WellCare Medicare |
$7.36
|
|
|
VALPROATE SODIUM INJECTABLE 100MG/ML SDV
|
Facility
|
OP
|
$13.39
|
|
|
Service Code
|
NDC 00143978510
|
| Hospital Charge Code |
4400786
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.55 |
| Max. Negotiated Rate |
$10.78 |
| Rate for Payer: Aetna of NY Commercial |
$9.37
|
| Rate for Payer: Aetna of NY Medicare |
$6.16
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$10.04
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$10.04
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$4.95
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$6.70
|
| Rate for Payer: Cash Price |
$10.04
|
| Rate for Payer: CDPHP Commercial |
$10.78
|
| Rate for Payer: CDPHP Medicare |
$4.95
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$10.71
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$10.71
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$10.71
|
| Rate for Payer: EmblemHealth Medicaid |
$10.71
|
| Rate for Payer: EmblemHealth Medicare |
$4.55
|
| Rate for Payer: EmblemHealth Select Care |
$9.64
|
| Rate for Payer: Fidelis Medicare |
$5.10
|
| Rate for Payer: Galaxy Health Commercial |
$8.70
|
| Rate for Payer: Hamaspik Choice Medicare |
$4.95
|
| Rate for Payer: Humana Medicare |
$4.95
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$9.37
|
| Rate for Payer: Local 1199SEIU Medicare |
$6.16
|
| Rate for Payer: MVP Health Care of NY Commercial |
$10.04
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$7.54
|
| Rate for Payer: MVP Health Care of NY Medicare |
$5.20
|
| Rate for Payer: United Healthcare Medicare |
$4.95
|
| Rate for Payer: WellCare Medicare |
$7.36
|
|
|
VALSARTAN 160MG TABS 100 EA
|
Facility
|
IP
|
$22.66
|
|
|
Service Code
|
NDC 00078035934
|
| Hospital Charge Code |
4400239
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.46 |
| Max. Negotiated Rate |
$14.73 |
| Rate for Payer: Cash Price |
$17.00
|
| Rate for Payer: Galaxy Health Commercial |
$14.73
|
| Rate for Payer: WellCare Medicare |
$12.46
|
|
|
VALSARTAN 160MG TABS 100 EA
|
Facility
|
OP
|
$22.66
|
|
|
Service Code
|
NDC 00078035934
|
| Hospital Charge Code |
4400239
|
|
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
|
|
|
VALVE F/SALEM SUMP ANTI-REFLU
|
Facility
|
IP
|
$23.00
|
|
| Hospital Charge Code |
4471341
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$14.95 |
| Max. Negotiated Rate |
$14.95 |
| Rate for Payer: Cash Price |
$17.25
|
| Rate for Payer: Galaxy Health Commercial |
$14.95
|
|
|
VALVE F/SALEM SUMP ANTI-REFLU
|
Facility
|
OP
|
$23.00
|
|
| Hospital Charge Code |
4471341
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.82 |
| Max. Negotiated Rate |
$18.52 |
| Rate for Payer: Aetna of NY Commercial |
$16.10
|
| Rate for Payer: Aetna of NY Medicare |
$10.58
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$17.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$17.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$8.51
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$11.50
|
| Rate for Payer: Cash Price |
$17.25
|
| Rate for Payer: CDPHP Commercial |
$18.52
|
| Rate for Payer: CDPHP Medicare |
$8.51
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$18.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$18.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$18.40
|
| Rate for Payer: EmblemHealth Medicaid |
$18.40
|
| Rate for Payer: EmblemHealth Medicare |
$7.82
|
| Rate for Payer: EmblemHealth Select Care |
$16.56
|
| Rate for Payer: Fidelis Medicare |
$8.77
|
| Rate for Payer: Galaxy Health Commercial |
$14.95
|
| Rate for Payer: Hamaspik Choice Medicare |
$8.51
|
| Rate for Payer: Humana Medicare |
$8.51
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$16.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$10.58
|
| Rate for Payer: MVP Health Care of NY Commercial |
$17.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$12.95
|
| Rate for Payer: MVP Health Care of NY Medicare |
$8.94
|
| Rate for Payer: United Healthcare Medicare |
$8.51
|
| Rate for Payer: WellCare Medicare |
$12.65
|
|
|
VANCOMUCIN PEAK
|
Facility
|
IP
|
$52.00
|
|
|
Service Code
|
HCPCS 80202
|
| Hospital Charge Code |
4300821
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$33.80 |
| Max. Negotiated Rate |
$33.80 |
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Galaxy Health Commercial |
$33.80
|
|
|
VANCOMUCIN PEAK
|
Facility
|
OP
|
$52.00
|
|
|
Service Code
|
HCPCS 80202
|
| Hospital Charge Code |
4300821
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.61 |
| Max. Negotiated Rate |
$41.86 |
| Rate for Payer: Aetna of NY Commercial |
$33.80
|
| Rate for Payer: Aetna of NY Medicare |
$23.92
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$39.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$39.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$19.24
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$26.00
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: CDPHP Commercial |
$41.86
|
| Rate for Payer: CDPHP Medicare |
$19.24
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$31.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$41.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$41.60
|
| Rate for Payer: EmblemHealth Medicaid |
$41.60
|
| Rate for Payer: EmblemHealth Medicare |
$17.68
|
| Rate for Payer: EmblemHealth Select Care |
$31.20
|
| Rate for Payer: Fidelis Medicare |
$19.82
|
| Rate for Payer: Galaxy Health Commercial |
$33.80
|
| Rate for Payer: Hamaspik Choice Medicare |
$19.24
|
| Rate for Payer: Humana Medicare |
$19.24
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$33.80
|
| Rate for Payer: Local 1199SEIU Medicare |
$23.92
|
| Rate for Payer: MVP Health Care of NY Commercial |
$39.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$29.28
|
| Rate for Payer: MVP Health Care of NY Medicare |
$20.20
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$39.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$10.61
|
| Rate for Payer: United Healthcare Commercial |
$39.00
|
| Rate for Payer: United Healthcare Medicare |
$19.24
|
| Rate for Payer: WellCare Medicare |
$28.60
|
|
|
VANCOMYCIN 125 MG CAPSULE
|
Facility
|
OP
|
$96.82
|
|
|
Service Code
|
NDC 68180016611
|
| Hospital Charge Code |
4409112
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$32.92 |
| Max. Negotiated Rate |
$77.94 |
| Rate for Payer: Aetna of NY Commercial |
$67.77
|
| Rate for Payer: Aetna of NY Medicare |
$44.54
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$72.62
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$72.62
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$35.82
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$48.41
|
| Rate for Payer: Cash Price |
$72.62
|
| Rate for Payer: CDPHP Commercial |
$77.94
|
| Rate for Payer: CDPHP Medicare |
$35.82
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$77.46
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$77.46
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$77.46
|
| Rate for Payer: EmblemHealth Medicaid |
$77.46
|
| Rate for Payer: EmblemHealth Medicare |
$32.92
|
| Rate for Payer: EmblemHealth Select Care |
$69.71
|
| Rate for Payer: Fidelis Medicare |
$36.90
|
| Rate for Payer: Galaxy Health Commercial |
$62.93
|
| Rate for Payer: Hamaspik Choice Medicare |
$35.82
|
| Rate for Payer: Humana Medicare |
$35.82
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$67.77
|
| Rate for Payer: Local 1199SEIU Medicare |
$44.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$72.62
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$54.51
|
| Rate for Payer: MVP Health Care of NY Medicare |
$37.61
|
| Rate for Payer: United Healthcare Medicare |
$35.82
|
| Rate for Payer: WellCare Medicare |
$53.25
|
|
|
VANCOMYCIN 125 MG CAPSULE
|
Facility
|
IP
|
$96.82
|
|
|
Service Code
|
NDC 68180016611
|
| Hospital Charge Code |
4409112
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$53.25 |
| Max. Negotiated Rate |
$62.93 |
| Rate for Payer: Cash Price |
$72.62
|
| Rate for Payer: Galaxy Health Commercial |
$62.93
|
| Rate for Payer: WellCare Medicare |
$53.25
|
|
|
VANCOMYCIN 1.5 GRAM/300 ML BAG 1.5 g, 300 mL
|
Facility
|
IP
|
$162.00
|
|
|
Service Code
|
NDC 70594004301
|
| Hospital Charge Code |
4401369
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$89.10 |
| Max. Negotiated Rate |
$105.30 |
| Rate for Payer: Cash Price |
$121.50
|
| Rate for Payer: Galaxy Health Commercial |
$105.30
|
| Rate for Payer: WellCare Medicare |
$89.10
|
|
|
VANCOMYCIN 1.5 GRAM/300 ML BAG 1.5 g, 300 mL
|
Facility
|
OP
|
$162.00
|
|
|
Service Code
|
NDC 70594004301
|
| Hospital Charge Code |
4401369
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$55.08 |
| Max. Negotiated Rate |
$130.41 |
| Rate for Payer: Aetna of NY Commercial |
$113.40
|
| Rate for Payer: Aetna of NY Medicare |
$74.52
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$121.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$121.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$59.94
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$81.00
|
| Rate for Payer: Cash Price |
$121.50
|
| Rate for Payer: CDPHP Commercial |
$130.41
|
| Rate for Payer: CDPHP Medicare |
$59.94
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$129.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$129.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$129.60
|
| Rate for Payer: EmblemHealth Medicaid |
$129.60
|
| Rate for Payer: EmblemHealth Medicare |
$55.08
|
| Rate for Payer: EmblemHealth Select Care |
$116.64
|
| Rate for Payer: Fidelis Medicare |
$61.74
|
| Rate for Payer: Galaxy Health Commercial |
$105.30
|
| Rate for Payer: Hamaspik Choice Medicare |
$59.94
|
| Rate for Payer: Humana Medicare |
$59.94
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$113.40
|
| Rate for Payer: Local 1199SEIU Medicare |
$74.52
|
| Rate for Payer: MVP Health Care of NY Commercial |
$121.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$91.21
|
| Rate for Payer: MVP Health Care of NY Medicare |
$62.94
|
| Rate for Payer: United Healthcare Medicare |
$59.94
|
| Rate for Payer: WellCare Medicare |
$89.10
|
|
|
VANCOMYCIN 1 GRAM/200 ML BAG 1 g, 200 mL
|
Facility
|
OP
|
$110.00
|
|
|
Service Code
|
NDC 70594004201
|
| Hospital Charge Code |
4401368
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$37.40 |
| Max. Negotiated Rate |
$88.55 |
| Rate for Payer: Aetna of NY Commercial |
$77.00
|
| Rate for Payer: Aetna of NY Medicare |
$50.60
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$82.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$82.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$40.70
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$55.00
|
| Rate for Payer: Cash Price |
$82.50
|
| Rate for Payer: CDPHP Commercial |
$88.55
|
| Rate for Payer: CDPHP Medicare |
$40.70
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$88.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$88.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$88.00
|
| Rate for Payer: EmblemHealth Medicaid |
$88.00
|
| Rate for Payer: EmblemHealth Medicare |
$37.40
|
| Rate for Payer: EmblemHealth Select Care |
$79.20
|
| Rate for Payer: Fidelis Medicare |
$41.92
|
| Rate for Payer: Galaxy Health Commercial |
$71.50
|
| Rate for Payer: Hamaspik Choice Medicare |
$40.70
|
| Rate for Payer: Humana Medicare |
$40.70
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$77.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$50.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$82.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$61.93
|
| Rate for Payer: MVP Health Care of NY Medicare |
$42.74
|
| Rate for Payer: United Healthcare Medicare |
$40.70
|
| Rate for Payer: WellCare Medicare |
$60.50
|
|
|
VANCOMYCIN 1 GRAM/200 ML BAG 1 g, 200 mL
|
Facility
|
IP
|
$110.00
|
|
|
Service Code
|
NDC 70594004201
|
| Hospital Charge Code |
4401368
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$60.50 |
| Max. Negotiated Rate |
$71.50 |
| Rate for Payer: Cash Price |
$82.50
|
| Rate for Payer: Galaxy Health Commercial |
$71.50
|
| Rate for Payer: WellCare Medicare |
$60.50
|
|
|
VANCOMYCIN 500 MG/100 ML BAG 500 mg, 100 mL
|
Facility
|
OP
|
$54.00
|
|
|
Service Code
|
HCPCS J3370
|
| Hospital Charge Code |
4401398
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.58 |
| Max. Negotiated Rate |
$43.47 |
| Rate for Payer: Aetna of NY Commercial |
$29.70
|
| Rate for Payer: Aetna of NY Medicare |
$24.84
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$2.58
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$2.58
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$19.98
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$27.00
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: CDPHP Commercial |
$43.47
|
| Rate for Payer: CDPHP Medicare |
$19.98
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$2.58
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$43.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$43.20
|
| Rate for Payer: EmblemHealth Medicaid |
$43.20
|
| Rate for Payer: EmblemHealth Medicare |
$18.36
|
| Rate for Payer: EmblemHealth Select Care |
$2.58
|
| Rate for Payer: Fidelis Medicare |
$20.58
|
| Rate for Payer: Galaxy Health Commercial |
$35.10
|
| Rate for Payer: Hamaspik Choice Medicare |
$19.98
|
| Rate for Payer: Humana Medicare |
$19.98
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$29.70
|
| Rate for Payer: Local 1199SEIU Medicare |
$24.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$40.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$30.40
|
| Rate for Payer: MVP Health Care of NY Medicare |
$20.98
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$3.98
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$2.58
|
| Rate for Payer: United Healthcare Commercial |
$3.98
|
| Rate for Payer: United Healthcare Medicare |
$19.98
|
| Rate for Payer: WellCare Medicare |
$29.70
|
|
|
VANCOMYCIN 500 MG/100 ML BAG 500 mg, 100 mL
|
Facility
|
IP
|
$54.00
|
|
|
Service Code
|
HCPCS J3370
|
| Hospital Charge Code |
4401398
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.58 |
| Max. Negotiated Rate |
$35.10 |
| Rate for Payer: Aetna of NY Commercial |
$29.70
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$2.58
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$2.58
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$2.58
|
| Rate for Payer: EmblemHealth Select Care |
$2.58
|
| Rate for Payer: Galaxy Health Commercial |
$35.10
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$29.70
|
| Rate for Payer: WellCare Medicare |
$29.70
|
|
|
VANCOMYCIN 750 MG/150 ML BAG 5 mg, 150 mL
|
Facility
|
OP
|
$45.00
|
|
|
Service Code
|
HCPCS J3370
|
| Hospital Charge Code |
4401498
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.58 |
| Max. Negotiated Rate |
$36.22 |
| Rate for Payer: Aetna of NY Commercial |
$24.75
|
| Rate for Payer: Aetna of NY Medicare |
$20.70
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$2.58
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$2.58
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$16.65
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$22.50
|
| Rate for Payer: Cash Price |
$33.75
|
| Rate for Payer: Cash Price |
$33.75
|
| Rate for Payer: CDPHP Commercial |
$36.22
|
| Rate for Payer: CDPHP Medicare |
$16.65
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$2.58
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$36.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$36.00
|
| Rate for Payer: EmblemHealth Medicaid |
$36.00
|
| Rate for Payer: EmblemHealth Medicare |
$15.30
|
| Rate for Payer: EmblemHealth Select Care |
$2.58
|
| Rate for Payer: Fidelis Medicare |
$17.15
|
| Rate for Payer: Galaxy Health Commercial |
$29.25
|
| Rate for Payer: Hamaspik Choice Medicare |
$16.65
|
| Rate for Payer: Humana Medicare |
$16.65
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$24.75
|
| Rate for Payer: Local 1199SEIU Medicare |
$20.70
|
| Rate for Payer: MVP Health Care of NY Commercial |
$33.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$25.34
|
| Rate for Payer: MVP Health Care of NY Medicare |
$17.48
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$3.98
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$2.58
|
| Rate for Payer: United Healthcare Commercial |
$3.98
|
| Rate for Payer: United Healthcare Medicare |
$16.65
|
| Rate for Payer: WellCare Medicare |
$24.75
|
|
|
VANCOMYCIN 750 MG/150 ML BAG 5 mg, 150 mL
|
Facility
|
IP
|
$45.00
|
|
|
Service Code
|
HCPCS J3370
|
| Hospital Charge Code |
4401498
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.58 |
| Max. Negotiated Rate |
$29.25 |
| Rate for Payer: Aetna of NY Commercial |
$24.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$2.58
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$2.58
|
| Rate for Payer: Cash Price |
$33.75
|
| Rate for Payer: Cash Price |
$33.75
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$2.58
|
| Rate for Payer: EmblemHealth Select Care |
$2.58
|
| Rate for Payer: Galaxy Health Commercial |
$29.25
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$24.75
|
| Rate for Payer: WellCare Medicare |
$24.75
|
|
|
VANCOMYCIN HCL 1.25 GRAM VIAL 1.25 g, 1 each
|
Facility
|
IP
|
$92.00
|
|
|
Service Code
|
NDC 67457082312
|
| Hospital Charge Code |
4401500
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$50.60 |
| Max. Negotiated Rate |
$59.80 |
| Rate for Payer: Cash Price |
$69.00
|
| Rate for Payer: Galaxy Health Commercial |
$59.80
|
| Rate for Payer: WellCare Medicare |
$50.60
|
|
|
VANCOMYCIN HCL 1.25 GRAM VIAL 1.25 g, 1 each
|
Facility
|
OP
|
$92.00
|
|
|
Service Code
|
NDC 67457082312
|
| Hospital Charge Code |
4401500
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$31.28 |
| Max. Negotiated Rate |
$74.06 |
| Rate for Payer: Aetna of NY Commercial |
$64.40
|
| Rate for Payer: Aetna of NY Medicare |
$42.32
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$69.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$69.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$34.04
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$46.00
|
| Rate for Payer: Cash Price |
$69.00
|
| Rate for Payer: CDPHP Commercial |
$74.06
|
| Rate for Payer: CDPHP Medicare |
$34.04
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$73.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$73.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$73.60
|
| Rate for Payer: EmblemHealth Medicaid |
$73.60
|
| Rate for Payer: EmblemHealth Medicare |
$31.28
|
| Rate for Payer: EmblemHealth Select Care |
$66.24
|
| Rate for Payer: Fidelis Medicare |
$35.06
|
| Rate for Payer: Galaxy Health Commercial |
$59.80
|
| Rate for Payer: Hamaspik Choice Medicare |
$34.04
|
| Rate for Payer: Humana Medicare |
$34.04
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$64.40
|
| Rate for Payer: Local 1199SEIU Medicare |
$42.32
|
| Rate for Payer: MVP Health Care of NY Commercial |
$69.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$51.80
|
| Rate for Payer: MVP Health Care of NY Medicare |
$35.74
|
| Rate for Payer: United Healthcare Medicare |
$34.04
|
| Rate for Payer: WellCare Medicare |
$50.60
|
|
|
VANCOMYCIN HCL 250MG CAPS 20 EA
|
Facility
|
OP
|
$178.45
|
|
|
Service Code
|
NDC 68180016713
|
| Hospital Charge Code |
4400788
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$60.67 |
| Max. Negotiated Rate |
$143.65 |
| Rate for Payer: Aetna of NY Commercial |
$124.92
|
| Rate for Payer: Aetna of NY Medicare |
$82.09
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$133.84
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$133.84
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$66.03
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$89.22
|
| Rate for Payer: Cash Price |
$133.84
|
| Rate for Payer: CDPHP Commercial |
$143.65
|
| Rate for Payer: CDPHP Medicare |
$66.03
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$142.76
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$142.76
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$142.76
|
| Rate for Payer: EmblemHealth Medicaid |
$142.76
|
| Rate for Payer: EmblemHealth Medicare |
$60.67
|
| Rate for Payer: EmblemHealth Select Care |
$128.48
|
| Rate for Payer: Fidelis Medicare |
$68.01
|
| Rate for Payer: Galaxy Health Commercial |
$115.99
|
| Rate for Payer: Hamaspik Choice Medicare |
$66.03
|
| Rate for Payer: Humana Medicare |
$66.03
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$124.92
|
| Rate for Payer: Local 1199SEIU Medicare |
$82.09
|
| Rate for Payer: MVP Health Care of NY Commercial |
$133.84
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$100.47
|
| Rate for Payer: MVP Health Care of NY Medicare |
$69.33
|
| Rate for Payer: United Healthcare Medicare |
$66.03
|
| Rate for Payer: WellCare Medicare |
$98.15
|
|
|
VANCOMYCIN HCL 250MG CAPS 20 EA
|
Facility
|
IP
|
$178.45
|
|
|
Service Code
|
NDC 68180016713
|
| Hospital Charge Code |
4400788
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$98.15 |
| Max. Negotiated Rate |
$115.99 |
| Rate for Payer: Cash Price |
$133.84
|
| Rate for Payer: Galaxy Health Commercial |
$115.99
|
| Rate for Payer: WellCare Medicare |
$98.15
|
|
|
VANCOMYCIN HCL 500 MG INJ
|
Facility
|
OP
|
$29.87
|
|
|
Service Code
|
HCPCS J3370
|
| Hospital Charge Code |
4400790
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.58 |
| Max. Negotiated Rate |
$24.05 |
| Rate for Payer: Aetna of NY Commercial |
$16.43
|
| Rate for Payer: Aetna of NY Medicare |
$13.74
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$2.58
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$2.58
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$11.05
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$14.94
|
| Rate for Payer: Cash Price |
$22.40
|
| Rate for Payer: Cash Price |
$22.40
|
| Rate for Payer: CDPHP Commercial |
$24.05
|
| Rate for Payer: CDPHP Medicare |
$11.05
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$2.58
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$23.90
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$23.90
|
| Rate for Payer: EmblemHealth Medicaid |
$23.90
|
| Rate for Payer: EmblemHealth Medicare |
$10.16
|
| Rate for Payer: EmblemHealth Select Care |
$2.58
|
| Rate for Payer: Fidelis Medicare |
$11.38
|
| Rate for Payer: Galaxy Health Commercial |
$19.42
|
| Rate for Payer: Hamaspik Choice Medicare |
$11.05
|
| Rate for Payer: Humana Medicare |
$11.05
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$16.43
|
| Rate for Payer: Local 1199SEIU Medicare |
$13.74
|
| Rate for Payer: MVP Health Care of NY Commercial |
$22.40
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$16.82
|
| Rate for Payer: MVP Health Care of NY Medicare |
$11.60
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$3.98
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$2.58
|
| Rate for Payer: United Healthcare Commercial |
$3.98
|
| Rate for Payer: United Healthcare Medicare |
$11.05
|
| Rate for Payer: WellCare Medicare |
$16.43
|
|
