|
VIREAD 300 MG TABLET
|
Facility
|
OP
|
$105.00
|
|
|
Service Code
|
NDC 61958040101
|
| Hospital Charge Code |
4401289
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$35.70 |
| Max. Negotiated Rate |
$84.52 |
| Rate for Payer: Aetna of NY Commercial |
$73.50
|
| Rate for Payer: Aetna of NY Medicare |
$48.30
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$78.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$78.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$38.85
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$52.50
|
| Rate for Payer: Cash Price |
$78.75
|
| Rate for Payer: CDPHP Commercial |
$84.52
|
| Rate for Payer: CDPHP Medicare |
$38.85
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$84.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$84.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$84.00
|
| Rate for Payer: EmblemHealth Medicaid |
$84.00
|
| Rate for Payer: EmblemHealth Medicare |
$35.70
|
| Rate for Payer: EmblemHealth Select Care |
$75.60
|
| Rate for Payer: Fidelis Medicare |
$40.02
|
| Rate for Payer: Galaxy Health Commercial |
$68.25
|
| Rate for Payer: Hamaspik Choice Medicare |
$38.85
|
| Rate for Payer: Humana Medicare |
$38.85
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$73.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$48.30
|
| Rate for Payer: MVP Health Care of NY Commercial |
$78.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$59.12
|
| Rate for Payer: MVP Health Care of NY Medicare |
$40.79
|
| Rate for Payer: United Healthcare Medicare |
$38.85
|
| Rate for Payer: WellCare Medicare |
$57.75
|
|
|
VIREAD 300 MG TABLET
|
Facility
|
IP
|
$105.00
|
|
|
Service Code
|
NDC 61958040101
|
| Hospital Charge Code |
4401289
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$57.75 |
| Max. Negotiated Rate |
$68.25 |
| Rate for Payer: Cash Price |
$78.75
|
| Rate for Payer: Galaxy Health Commercial |
$68.25
|
| Rate for Payer: WellCare Medicare |
$57.75
|
|
|
VIRUS ISOL SHELL VIAL TECHN
|
Facility
|
OP
|
$278.00
|
|
|
Service Code
|
HCPCS 87254
|
| Hospital Charge Code |
4304877
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$6.83 |
| Max. Negotiated Rate |
$223.79 |
| Rate for Payer: Aetna of NY Commercial |
$180.70
|
| Rate for Payer: Aetna of NY Medicare |
$127.88
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$208.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$208.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$102.86
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$139.00
|
| Rate for Payer: Cash Price |
$208.50
|
| Rate for Payer: Cash Price |
$208.50
|
| Rate for Payer: CDPHP Commercial |
$223.79
|
| Rate for Payer: CDPHP Medicare |
$102.86
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$166.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$222.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$222.40
|
| Rate for Payer: EmblemHealth Medicaid |
$222.40
|
| Rate for Payer: EmblemHealth Medicare |
$94.52
|
| Rate for Payer: EmblemHealth Select Care |
$166.80
|
| Rate for Payer: Fidelis Medicare |
$105.95
|
| Rate for Payer: Galaxy Health Commercial |
$180.70
|
| Rate for Payer: Hamaspik Choice Medicare |
$102.86
|
| Rate for Payer: Humana Medicare |
$102.86
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$180.70
|
| Rate for Payer: Local 1199SEIU Medicare |
$127.88
|
| Rate for Payer: MVP Health Care of NY Commercial |
$208.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$156.51
|
| Rate for Payer: MVP Health Care of NY Medicare |
$108.00
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$208.50
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$6.83
|
| Rate for Payer: United Healthcare Commercial |
$208.50
|
| Rate for Payer: United Healthcare Medicare |
$102.86
|
| Rate for Payer: WellCare Medicare |
$152.90
|
|
|
VIRUS ISOL SHELL VIAL TECHN
|
Facility
|
IP
|
$278.00
|
|
|
Service Code
|
HCPCS 87254
|
| Hospital Charge Code |
4304877
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$180.70 |
| Max. Negotiated Rate |
$180.70 |
| Rate for Payer: Cash Price |
$208.50
|
| Rate for Payer: Galaxy Health Commercial |
$180.70
|
|
|
VITA B COMPLEX CAPS 100 EA
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 00536478701
|
| Hospital Charge Code |
4400802
|
|
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
|
|
|
VITA B COMPLEX CAPS 100 EA
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
NDC 00536478701
|
| Hospital Charge Code |
4400802
|
|
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
|
|
|
VITAMIN B1
|
Facility
|
IP
|
$109.00
|
|
|
Service Code
|
HCPCS 84425
|
| Hospital Charge Code |
4300832
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$70.85 |
| Max. Negotiated Rate |
$70.85 |
| Rate for Payer: Cash Price |
$81.75
|
| Rate for Payer: Galaxy Health Commercial |
$70.85
|
|
|
VITAMIN B1
|
Facility
|
OP
|
$109.00
|
|
|
Service Code
|
HCPCS 84425
|
| Hospital Charge Code |
4300832
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.15 |
| Max. Negotiated Rate |
$87.74 |
| Rate for Payer: Aetna of NY Commercial |
$70.85
|
| Rate for Payer: Aetna of NY Medicare |
$50.14
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$81.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$81.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$40.33
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$54.50
|
| Rate for Payer: Cash Price |
$81.75
|
| Rate for Payer: Cash Price |
$81.75
|
| Rate for Payer: CDPHP Commercial |
$87.74
|
| Rate for Payer: CDPHP Medicare |
$40.33
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$65.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$87.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$87.20
|
| Rate for Payer: EmblemHealth Medicaid |
$87.20
|
| Rate for Payer: EmblemHealth Medicare |
$37.06
|
| Rate for Payer: EmblemHealth Select Care |
$65.40
|
| Rate for Payer: Fidelis Medicare |
$41.54
|
| Rate for Payer: Galaxy Health Commercial |
$70.85
|
| Rate for Payer: Hamaspik Choice Medicare |
$40.33
|
| Rate for Payer: Humana Medicare |
$40.33
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$70.85
|
| Rate for Payer: Local 1199SEIU Medicare |
$50.14
|
| Rate for Payer: MVP Health Care of NY Commercial |
$81.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$61.37
|
| Rate for Payer: MVP Health Care of NY Medicare |
$42.35
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$81.75
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$15.15
|
| Rate for Payer: United Healthcare Commercial |
$81.75
|
| Rate for Payer: United Healthcare Medicare |
$40.33
|
| Rate for Payer: WellCare Medicare |
$59.95
|
|
|
VITAMIN B-12 CYANOCOBALAMIN INJ, UP TO 1000 MCG
|
Facility
|
OP
|
$37.08
|
|
|
Service Code
|
HCPCS J3420
|
| Hospital Charge Code |
4400200
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.42 |
| Max. Negotiated Rate |
$29.85 |
| Rate for Payer: Aetna of NY Commercial |
$20.39
|
| Rate for Payer: Aetna of NY Medicare |
$17.06
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1.42
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1.42
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$13.72
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$18.54
|
| Rate for Payer: Cash Price |
$27.81
|
| Rate for Payer: Cash Price |
$27.81
|
| Rate for Payer: CDPHP Commercial |
$29.85
|
| Rate for Payer: CDPHP Medicare |
$13.72
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1.42
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$29.66
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$29.66
|
| Rate for Payer: EmblemHealth Medicaid |
$29.66
|
| Rate for Payer: EmblemHealth Medicare |
$12.61
|
| Rate for Payer: EmblemHealth Select Care |
$1.42
|
| Rate for Payer: Fidelis Medicare |
$14.13
|
| Rate for Payer: Galaxy Health Commercial |
$24.10
|
| Rate for Payer: Hamaspik Choice Medicare |
$13.72
|
| Rate for Payer: Humana Medicare |
$13.72
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$20.39
|
| Rate for Payer: Local 1199SEIU Medicare |
$17.06
|
| Rate for Payer: MVP Health Care of NY Commercial |
$27.81
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$20.88
|
| Rate for Payer: MVP Health Care of NY Medicare |
$14.41
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$2.16
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1.42
|
| Rate for Payer: United Healthcare Commercial |
$2.16
|
| Rate for Payer: United Healthcare Medicare |
$13.72
|
| Rate for Payer: WellCare Medicare |
$20.39
|
|
|
VITAMIN B-12 CYANOCOBALAMIN INJ, UP TO 1000 MCG
|
Facility
|
IP
|
$37.08
|
|
|
Service Code
|
HCPCS J3420
|
| Hospital Charge Code |
4400200
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.42 |
| Max. Negotiated Rate |
$24.10 |
| Rate for Payer: Aetna of NY Commercial |
$20.39
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1.42
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1.42
|
| Rate for Payer: Cash Price |
$27.81
|
| Rate for Payer: Cash Price |
$27.81
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1.42
|
| Rate for Payer: EmblemHealth Select Care |
$1.42
|
| Rate for Payer: Galaxy Health Commercial |
$24.10
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$20.39
|
| Rate for Payer: WellCare Medicare |
$20.39
|
|
|
VITAMIN B-12 INJECTION TO 1000 MCG
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
HCPCS J3420
|
| Hospital Charge Code |
4400803
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.42 |
| Max. Negotiated Rate |
$4.02 |
| Rate for Payer: Aetna of NY Commercial |
$3.40
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1.42
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1.42
|
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1.42
|
| Rate for Payer: EmblemHealth Select Care |
$1.42
|
| 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
|
|
|
VITAMIN B-12 INJECTION TO 1000 MCG
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
HCPCS J3420
|
| Hospital Charge Code |
4400803
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.42 |
| Max. Negotiated Rate |
$4.97 |
| Rate for Payer: Aetna of NY Commercial |
$3.40
|
| Rate for Payer: Aetna of NY Medicare |
$2.84
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1.42
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1.42
|
| 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: 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 |
$1.42
|
| 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 |
$1.42
|
| 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 |
$3.40
|
| 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: Oxford Health Plans Freedom/Liberty/Metro |
$2.16
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1.42
|
| Rate for Payer: United Healthcare Commercial |
$2.16
|
| Rate for Payer: United Healthcare Medicare |
$2.29
|
| Rate for Payer: WellCare Medicare |
$3.40
|
|
|
VITAMIN B12/INTRINSIC FACTOR 1000MCG TAB
|
Facility
|
IP
|
$6.00
|
|
| Hospital Charge Code |
4400091
|
|
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
|
|
|
VITAMIN B12/INTRINSIC FACTOR 1000MCG TAB
|
Facility
|
OP
|
$6.00
|
|
| Hospital Charge Code |
4400091
|
|
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
|
|
|
VITAMIN B-12 LEVEL
|
Facility
|
IP
|
$77.00
|
|
|
Service Code
|
HCPCS 82607
|
| Hospital Charge Code |
4300827
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$50.05 |
| Max. Negotiated Rate |
$50.05 |
| Rate for Payer: Cash Price |
$57.75
|
| Rate for Payer: Galaxy Health Commercial |
$50.05
|
|
|
VITAMIN B-12 LEVEL
|
Facility
|
OP
|
$77.00
|
|
|
Service Code
|
HCPCS 82607
|
| Hospital Charge Code |
4300827
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.63 |
| Max. Negotiated Rate |
$61.98 |
| Rate for Payer: Aetna of NY Commercial |
$50.05
|
| Rate for Payer: Aetna of NY Medicare |
$35.42
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$57.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$57.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$28.49
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$38.50
|
| Rate for Payer: Cash Price |
$57.75
|
| Rate for Payer: Cash Price |
$57.75
|
| Rate for Payer: CDPHP Commercial |
$61.98
|
| Rate for Payer: CDPHP Medicare |
$28.49
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$46.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$61.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$61.60
|
| Rate for Payer: EmblemHealth Medicaid |
$61.60
|
| Rate for Payer: EmblemHealth Medicare |
$26.18
|
| Rate for Payer: EmblemHealth Select Care |
$46.20
|
| Rate for Payer: Fidelis Medicare |
$29.34
|
| Rate for Payer: Galaxy Health Commercial |
$50.05
|
| Rate for Payer: Hamaspik Choice Medicare |
$28.49
|
| Rate for Payer: Humana Medicare |
$28.49
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$50.05
|
| Rate for Payer: Local 1199SEIU Medicare |
$35.42
|
| Rate for Payer: MVP Health Care of NY Commercial |
$57.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$43.35
|
| Rate for Payer: MVP Health Care of NY Medicare |
$29.91
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$57.75
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$12.63
|
| Rate for Payer: United Healthcare Commercial |
$57.75
|
| Rate for Payer: United Healthcare Medicare |
$28.49
|
| Rate for Payer: WellCare Medicare |
$42.35
|
|
|
VITAMIN B 1 (THIAMINE) 100 MG TAB
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
NDC 77333093410
|
| Hospital Charge Code |
4409023
|
|
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
|
|
|
VITAMIN B 1 (THIAMINE) 100 MG TAB
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 77333093410
|
| Hospital Charge Code |
4409023
|
|
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
|
|
|
VITAMIN B6
|
Facility
|
OP
|
$218.00
|
|
|
Service Code
|
HCPCS 84207
|
| Hospital Charge Code |
4301199
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$28.10 |
| Max. Negotiated Rate |
$175.49 |
| Rate for Payer: Aetna of NY Commercial |
$141.70
|
| Rate for Payer: Aetna of NY Medicare |
$100.28
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$163.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$163.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$80.66
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$109.00
|
| Rate for Payer: Cash Price |
$163.50
|
| Rate for Payer: Cash Price |
$163.50
|
| Rate for Payer: CDPHP Commercial |
$175.49
|
| Rate for Payer: CDPHP Medicare |
$80.66
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$130.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$174.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$174.40
|
| Rate for Payer: EmblemHealth Medicaid |
$174.40
|
| Rate for Payer: EmblemHealth Medicare |
$74.12
|
| Rate for Payer: EmblemHealth Select Care |
$130.80
|
| Rate for Payer: Fidelis Medicare |
$83.08
|
| Rate for Payer: Galaxy Health Commercial |
$141.70
|
| Rate for Payer: Hamaspik Choice Medicare |
$80.66
|
| Rate for Payer: Humana Medicare |
$80.66
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$141.70
|
| Rate for Payer: Local 1199SEIU Medicare |
$100.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$163.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$122.73
|
| Rate for Payer: MVP Health Care of NY Medicare |
$84.69
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$163.50
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$28.10
|
| Rate for Payer: United Healthcare Commercial |
$163.50
|
| Rate for Payer: United Healthcare Medicare |
$80.66
|
| Rate for Payer: WellCare Medicare |
$119.90
|
|
|
VITAMIN B6
|
Facility
|
IP
|
$218.00
|
|
|
Service Code
|
HCPCS 84207
|
| Hospital Charge Code |
4301199
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$141.70 |
| Max. Negotiated Rate |
$141.70 |
| Rate for Payer: Cash Price |
$163.50
|
| Rate for Payer: Galaxy Health Commercial |
$141.70
|
|
|
VITAMIN B 6 (PYRIDOXINE) 100 MG TAB
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 00536440901
|
| Hospital Charge Code |
4409024
|
|
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
|
|
|
VITAMIN B 6 (PYRIDOXINE) 100 MG TAB
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
NDC 00536440901
|
| Hospital Charge Code |
4409024
|
|
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
|
|
|
VITAMIN D 1000U TABS 100 EA
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
NDC 48433010401
|
| Hospital Charge Code |
4400805
|
|
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
|
|
|
VITAMIN D 1000U TABS 100 EA
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 48433010401
|
| Hospital Charge Code |
4400805
|
|
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
|
|
|
VITAMIN D 25 HYDROXY
|
Facility
|
OP
|
$320.00
|
|
|
Service Code
|
HCPCS 82306
|
| Hospital Charge Code |
4301198
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$29.60 |
| Max. Negotiated Rate |
$257.60 |
| Rate for Payer: Aetna of NY Commercial |
$208.00
|
| Rate for Payer: Aetna of NY Medicare |
$147.20
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$240.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$240.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$118.40
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$160.00
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: CDPHP Commercial |
$257.60
|
| Rate for Payer: CDPHP Medicare |
$118.40
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$192.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$256.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$256.00
|
| Rate for Payer: EmblemHealth Medicaid |
$256.00
|
| Rate for Payer: EmblemHealth Medicare |
$108.80
|
| Rate for Payer: EmblemHealth Select Care |
$192.00
|
| Rate for Payer: Fidelis Medicare |
$121.95
|
| Rate for Payer: Galaxy Health Commercial |
$208.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$118.40
|
| Rate for Payer: Humana Medicare |
$118.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$208.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$147.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$240.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$180.16
|
| Rate for Payer: MVP Health Care of NY Medicare |
$124.32
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$240.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$29.60
|
| Rate for Payer: United Healthcare Commercial |
$240.00
|
| Rate for Payer: United Healthcare Medicare |
$118.40
|
| Rate for Payer: WellCare Medicare |
$176.00
|
|
