|
ZOSYN INJ 1 GM/0.125 GM
|
Facility
|
OP
|
$50.47
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
4409231
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.05 |
| Max. Negotiated Rate |
$40.63 |
| Rate for Payer: Aetna of NY Commercial |
$27.76
|
| Rate for Payer: Aetna of NY Medicare |
$23.22
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1.05
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1.05
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$18.67
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$25.24
|
| Rate for Payer: Cash Price |
$37.85
|
| Rate for Payer: Cash Price |
$37.85
|
| Rate for Payer: CDPHP Commercial |
$40.63
|
| Rate for Payer: CDPHP Medicare |
$18.67
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1.05
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$40.38
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$40.38
|
| Rate for Payer: EmblemHealth Medicaid |
$40.38
|
| Rate for Payer: EmblemHealth Medicare |
$17.16
|
| Rate for Payer: EmblemHealth Select Care |
$1.05
|
| Rate for Payer: Fidelis Medicare |
$19.23
|
| Rate for Payer: Galaxy Health Commercial |
$32.81
|
| Rate for Payer: Hamaspik Choice Medicare |
$18.67
|
| Rate for Payer: Humana Medicare |
$18.67
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$27.76
|
| Rate for Payer: Local 1199SEIU Medicare |
$23.22
|
| Rate for Payer: MVP Health Care of NY Commercial |
$37.85
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$28.41
|
| Rate for Payer: MVP Health Care of NY Medicare |
$19.61
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$2.24
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1.05
|
| Rate for Payer: United Healthcare Commercial |
$2.24
|
| Rate for Payer: United Healthcare Medicare |
$18.67
|
| Rate for Payer: WellCare Medicare |
$27.76
|
|
|
ZOSYN INJ 1 GM/0.125 GM
|
Facility
|
IP
|
$50.47
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
4409231
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.05 |
| Max. Negotiated Rate |
$32.81 |
| Rate for Payer: Aetna of NY Commercial |
$27.76
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1.05
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1.05
|
| Rate for Payer: Cash Price |
$37.85
|
| Rate for Payer: Cash Price |
$37.85
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1.05
|
| Rate for Payer: EmblemHealth Select Care |
$1.05
|
| Rate for Payer: Galaxy Health Commercial |
$32.81
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$27.76
|
| Rate for Payer: WellCare Medicare |
$27.76
|
|
|
ZYNRELEF 200-6 MG/7 ML VIAL 200 mg, 7 mL
|
Facility
|
OP
|
$408.00
|
|
|
Service Code
|
HCPCS C9088
|
| Hospital Charge Code |
4401504
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.73 |
| Max. Negotiated Rate |
$328.44 |
| Rate for Payer: Aetna of NY Commercial |
$224.40
|
| Rate for Payer: Aetna of NY Medicare |
$187.68
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$183.60
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$183.60
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$150.96
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$204.00
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: CDPHP Commercial |
$328.44
|
| Rate for Payer: CDPHP Medicare |
$150.96
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$326.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$326.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$326.40
|
| Rate for Payer: EmblemHealth Medicaid |
$326.40
|
| Rate for Payer: EmblemHealth Medicare |
$138.72
|
| Rate for Payer: EmblemHealth Select Care |
$293.76
|
| Rate for Payer: Fidelis Medicare |
$155.49
|
| Rate for Payer: Galaxy Health Commercial |
$265.20
|
| Rate for Payer: Hamaspik Choice Medicare |
$150.96
|
| Rate for Payer: Humana Medicare |
$150.96
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$224.40
|
| Rate for Payer: Local 1199SEIU Medicare |
$187.68
|
| Rate for Payer: MVP Health Care of NY Commercial |
$306.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$229.70
|
| Rate for Payer: MVP Health Care of NY Medicare |
$158.51
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1.20
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$0.73
|
| Rate for Payer: United Healthcare Commercial |
$1.20
|
| Rate for Payer: United Healthcare Medicare |
$150.96
|
| Rate for Payer: WellCare Medicare |
$224.40
|
|
|
ZYNRELEF 200-6 MG/7 ML VIAL 200 mg, 7 mL
|
Facility
|
IP
|
$408.00
|
|
|
Service Code
|
HCPCS C9088
|
| Hospital Charge Code |
4401504
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$183.60 |
| Max. Negotiated Rate |
$265.20 |
| Rate for Payer: Aetna of NY Commercial |
$224.40
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$183.60
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$183.60
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Galaxy Health Commercial |
$265.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$224.40
|
| Rate for Payer: WellCare Medicare |
$224.40
|
|
|
ZYPREXA INJ
|
Facility
|
IP
|
$144.72
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
4408993
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$65.12 |
| Max. Negotiated Rate |
$94.07 |
| Rate for Payer: Aetna of NY Commercial |
$79.60
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$65.12
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$65.12
|
| Rate for Payer: Cash Price |
$108.54
|
| Rate for Payer: Galaxy Health Commercial |
$94.07
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$79.60
|
| Rate for Payer: WellCare Medicare |
$79.60
|
|
|
ZYPREXA INJ
|
Facility
|
OP
|
$144.72
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
4408993
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$49.20 |
| Max. Negotiated Rate |
$116.50 |
| Rate for Payer: Aetna of NY Commercial |
$79.60
|
| Rate for Payer: Aetna of NY Medicare |
$66.57
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$65.12
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$65.12
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$53.55
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$72.36
|
| Rate for Payer: Cash Price |
$108.54
|
| Rate for Payer: CDPHP Commercial |
$116.50
|
| Rate for Payer: CDPHP Medicare |
$53.55
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$115.78
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$115.78
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$115.78
|
| Rate for Payer: EmblemHealth Medicaid |
$115.78
|
| Rate for Payer: EmblemHealth Medicare |
$49.20
|
| Rate for Payer: EmblemHealth Select Care |
$104.20
|
| Rate for Payer: Fidelis Medicare |
$55.15
|
| Rate for Payer: Galaxy Health Commercial |
$94.07
|
| Rate for Payer: Hamaspik Choice Medicare |
$53.55
|
| Rate for Payer: Humana Medicare |
$53.55
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$79.60
|
| Rate for Payer: Local 1199SEIU Medicare |
$66.57
|
| Rate for Payer: MVP Health Care of NY Commercial |
$108.54
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$81.48
|
| Rate for Payer: MVP Health Care of NY Medicare |
$56.22
|
| Rate for Payer: United Healthcare Medicare |
$53.55
|
| Rate for Payer: WellCare Medicare |
$79.60
|
|
|
ZYVOX 600 MG TAB
|
Facility
|
IP
|
$567.53
|
|
|
Service Code
|
NDC 00904655304
|
| Hospital Charge Code |
4408958
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$312.14 |
| Max. Negotiated Rate |
$368.89 |
| Rate for Payer: Cash Price |
$425.65
|
| Rate for Payer: Galaxy Health Commercial |
$368.89
|
| Rate for Payer: WellCare Medicare |
$312.14
|
|
|
ZYVOX 600 MG TAB
|
Facility
|
OP
|
$567.53
|
|
|
Service Code
|
NDC 00904655304
|
| Hospital Charge Code |
4408958
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$192.96 |
| Max. Negotiated Rate |
$456.86 |
| Rate for Payer: Aetna of NY Commercial |
$397.27
|
| Rate for Payer: Aetna of NY Medicare |
$261.06
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$425.65
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$425.65
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$209.99
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$283.76
|
| Rate for Payer: Cash Price |
$425.65
|
| Rate for Payer: CDPHP Commercial |
$456.86
|
| Rate for Payer: CDPHP Medicare |
$209.99
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$454.02
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$454.02
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$454.02
|
| Rate for Payer: EmblemHealth Medicaid |
$454.02
|
| Rate for Payer: EmblemHealth Medicare |
$192.96
|
| Rate for Payer: EmblemHealth Select Care |
$408.62
|
| Rate for Payer: Fidelis Medicare |
$216.29
|
| Rate for Payer: Galaxy Health Commercial |
$368.89
|
| Rate for Payer: Hamaspik Choice Medicare |
$209.99
|
| Rate for Payer: Humana Medicare |
$209.99
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$397.27
|
| Rate for Payer: Local 1199SEIU Medicare |
$261.06
|
| Rate for Payer: MVP Health Care of NY Commercial |
$425.65
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$319.52
|
| Rate for Payer: MVP Health Care of NY Medicare |
$220.49
|
| Rate for Payer: United Healthcare Medicare |
$209.99
|
| Rate for Payer: WellCare Medicare |
$312.14
|
|
