|
ZENPEP DR 15,000 UNIT CAPSULE 15000 unit, 100 eaches
|
Facility
|
IP
|
$21.24
|
|
|
Service Code
|
NDC 73562011101
|
| Hospital Charge Code |
4401574
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.68 |
| Max. Negotiated Rate |
$13.81 |
| Rate for Payer: Cash Price |
$15.93
|
| Rate for Payer: Galaxy Health Commercial |
$13.81
|
| Rate for Payer: WellCare Medicare |
$11.68
|
|
|
ZENPEP DR 15,000 UNIT CAPSULE 15000 unit, 100 eaches
|
Facility
|
OP
|
$21.24
|
|
|
Service Code
|
NDC 73562011101
|
| Hospital Charge Code |
4401574
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.19 |
| Max. Negotiated Rate |
$16.99 |
| Rate for Payer: Aetna of NY Commercial |
$14.87
|
| Rate for Payer: Aetna of NY Medicare |
$9.77
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$8.50
|
| Rate for Payer: Cash Price |
$15.93
|
| Rate for Payer: CDPHP Medicare |
$7.86
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$16.99
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$16.99
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$16.99
|
| Rate for Payer: EmblemHealth Medicaid |
$16.99
|
| Rate for Payer: EmblemHealth Medicare |
$7.22
|
| Rate for Payer: EmblemHealth Select Care |
$15.29
|
| Rate for Payer: Fidelis Medicare |
$8.50
|
| Rate for Payer: Galaxy Health Commercial |
$13.81
|
| Rate for Payer: Hamaspik Choice Medicare |
$8.50
|
| Rate for Payer: Humana Medicare |
$8.50
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$14.87
|
| Rate for Payer: Local 1199SEIU Medicare |
$9.77
|
| Rate for Payer: MVP Health Care of NY Commercial |
$15.93
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$11.96
|
| Rate for Payer: MVP Health Care of NY Medicare |
$8.92
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$3.19
|
| Rate for Payer: United Healthcare Medicare |
$8.50
|
| Rate for Payer: WellCare Medicare |
$11.68
|
|
|
ZIMMER BIOMET JUGGERKNOT SOFT ANCHOR 1.45MM
|
Facility
|
IP
|
$2,365.91
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4473012
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,064.66 |
| Max. Negotiated Rate |
$1,656.14 |
| Rate for Payer: Aetna of NY Commercial |
$1,656.14
|
| Rate for Payer: Cash Price |
$1,774.43
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,182.95
|
| Rate for Payer: EmblemHealth Select Care |
$1,182.95
|
| Rate for Payer: Galaxy Health Commercial |
$1,537.84
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,656.14
|
| Rate for Payer: Multiplan Commercial |
$1,064.66
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,537.84
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1,537.84
|
| Rate for Payer: WellCare Medicare |
$1,301.25
|
|
|
ZIMMER BIOMET JUGGERKNOT SOFT ANCHOR 1.45MM
|
Facility
|
OP
|
$2,365.91
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4473012
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$354.89 |
| Max. Negotiated Rate |
$1,892.73 |
| Rate for Payer: Aetna of NY Commercial |
$1,656.14
|
| Rate for Payer: Aetna of NY Medicare |
$1,088.32
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$946.36
|
| Rate for Payer: Cash Price |
$1,774.43
|
| Rate for Payer: CDPHP Medicare |
$875.39
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,182.95
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,892.73
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,892.73
|
| Rate for Payer: EmblemHealth Medicaid |
$1,892.73
|
| Rate for Payer: EmblemHealth Medicare |
$804.41
|
| Rate for Payer: EmblemHealth Select Care |
$1,182.95
|
| Rate for Payer: Fidelis Medicare |
$946.36
|
| Rate for Payer: Galaxy Health Commercial |
$1,537.84
|
| Rate for Payer: Hamaspik Choice Medicare |
$946.36
|
| Rate for Payer: Humana Medicare |
$946.36
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,656.14
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,088.32
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,537.84
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1,537.84
|
| Rate for Payer: MVP Health Care of NY Medicare |
$993.68
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$354.89
|
| Rate for Payer: United Healthcare Medicare |
$946.36
|
| Rate for Payer: WellCare Medicare |
$1,301.25
|
|
|
ZINC SULFATE 220MG CAPS 100 EA
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
NDC 731040106
|
| Hospital Charge Code |
4400822
|
|
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
|
|
|
ZINC SULFATE 220MG CAPS 100 EA
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 731040106
|
| Hospital Charge Code |
4400822
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.93 |
| Max. Negotiated Rate |
$4.94 |
| Rate for Payer: Aetna of NY Commercial |
$4.33
|
| Rate for Payer: Aetna of NY Medicare |
$2.84
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2.47
|
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: CDPHP Medicare |
$2.29
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$4.94
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$4.94
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$4.94
|
| Rate for Payer: EmblemHealth Medicaid |
$4.94
|
| Rate for Payer: EmblemHealth Medicare |
$2.10
|
| Rate for Payer: EmblemHealth Select Care |
$4.45
|
| Rate for Payer: Fidelis Medicare |
$2.47
|
| Rate for Payer: Galaxy Health Commercial |
$4.02
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.47
|
| Rate for Payer: Humana Medicare |
$2.47
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$4.33
|
| Rate for Payer: Local 1199SEIU Medicare |
$2.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4.63
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3.48
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2.60
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$0.93
|
| Rate for Payer: United Healthcare Medicare |
$2.47
|
| Rate for Payer: WellCare Medicare |
$3.40
|
|
|
ZOLEDRONIC ACID 5 MG/100 ML 1 mg, 100 mL
|
Facility
|
IP
|
$169.20
|
|
|
Service Code
|
HCPCS J3489
|
| Hospital Charge Code |
4401452
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30.88 |
| Max. Negotiated Rate |
$109.98 |
| Rate for Payer: Aetna of NY Commercial |
$93.06
|
| Rate for Payer: Cash Price |
$126.90
|
| Rate for Payer: Cash Price |
$126.90
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$30.88
|
| Rate for Payer: EmblemHealth Select Care |
$30.88
|
| Rate for Payer: Galaxy Health Commercial |
$109.98
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$93.06
|
| Rate for Payer: WellCare Medicare |
$93.06
|
|
|
ZOLEDRONIC ACID 5 MG/100 ML 1 mg, 100 mL
|
Facility
|
OP
|
$169.20
|
|
|
Service Code
|
HCPCS J3489
|
| Hospital Charge Code |
4401452
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.00 |
| Max. Negotiated Rate |
$126.90 |
| Rate for Payer: Aetna of NY Medicare |
$77.83
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$67.68
|
| Rate for Payer: Cash Price |
$126.90
|
| Rate for Payer: Cash Price |
$126.90
|
| Rate for Payer: CDPHP Medicare |
$62.60
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$30.88
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$39.07
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$32.56
|
| Rate for Payer: EmblemHealth Medicaid |
$32.56
|
| Rate for Payer: EmblemHealth Medicare |
$57.53
|
| Rate for Payer: EmblemHealth Select Care |
$30.88
|
| Rate for Payer: Fidelis Medicare |
$67.68
|
| Rate for Payer: Galaxy Health Commercial |
$109.98
|
| Rate for Payer: Galaxy Health Workers Comp |
$31.91
|
| Rate for Payer: Hamaspik Choice Medicaid |
$32.56
|
| Rate for Payer: Hamaspik Choice Medicare |
$67.68
|
| Rate for Payer: Humana Medicare |
$67.68
|
| Rate for Payer: Local 1199SEIU Medicare |
$77.83
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$34.19
|
| Rate for Payer: MVP Health Care of NY Commercial |
$126.90
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$70.00
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$70.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$95.26
|
| Rate for Payer: MVP Health Care of NY Medicare |
$71.06
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$15.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$25.38
|
| Rate for Payer: United Healthcare Commercial |
$15.00
|
| Rate for Payer: United Healthcare Medicare |
$67.68
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$34.19
|
| Rate for Payer: WellCare Medicare |
$93.06
|
|
|
ZOLEDRONIC ACID INJ, 1MG
|
Facility
|
OP
|
$3,071.72
|
|
|
Service Code
|
HCPCS J3489
|
| Hospital Charge Code |
4409074
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.00 |
| Max. Negotiated Rate |
$2,303.79 |
| Rate for Payer: Aetna of NY Medicare |
$1,412.99
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1,228.69
|
| Rate for Payer: Cash Price |
$2,303.79
|
| Rate for Payer: Cash Price |
$2,303.79
|
| Rate for Payer: CDPHP Medicare |
$1,136.54
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$30.88
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$39.07
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$32.56
|
| Rate for Payer: EmblemHealth Medicaid |
$32.56
|
| Rate for Payer: EmblemHealth Medicare |
$1,044.38
|
| Rate for Payer: EmblemHealth Select Care |
$30.88
|
| Rate for Payer: Fidelis Medicare |
$1,228.69
|
| Rate for Payer: Galaxy Health Commercial |
$1,996.62
|
| Rate for Payer: Galaxy Health Workers Comp |
$31.91
|
| Rate for Payer: Hamaspik Choice Medicaid |
$32.56
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,228.69
|
| Rate for Payer: Humana Medicare |
$1,228.69
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,412.99
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$34.19
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,303.79
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$70.00
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$70.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1,729.38
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1,290.12
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$15.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$460.76
|
| Rate for Payer: United Healthcare Commercial |
$15.00
|
| Rate for Payer: United Healthcare Medicare |
$1,228.69
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$34.19
|
| Rate for Payer: WellCare Medicare |
$1,689.45
|
|
|
ZOLEDRONIC ACID INJ, 1MG
|
Facility
|
IP
|
$3,071.72
|
|
|
Service Code
|
HCPCS J3489
|
| Hospital Charge Code |
4409074
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30.88 |
| Max. Negotiated Rate |
$1,996.62 |
| Rate for Payer: Aetna of NY Commercial |
$1,689.45
|
| Rate for Payer: Cash Price |
$2,303.79
|
| Rate for Payer: Cash Price |
$2,303.79
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$30.88
|
| Rate for Payer: EmblemHealth Select Care |
$30.88
|
| Rate for Payer: Galaxy Health Commercial |
$1,996.62
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,689.45
|
| Rate for Payer: WellCare Medicare |
$1,689.45
|
|
|
ZOLPIDEM TARTRATE 5MG TABS 10X10EA
|
Facility
|
IP
|
$14.16
|
|
|
Service Code
|
NDC 904608261
|
| Hospital Charge Code |
4400824
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.79 |
| Max. Negotiated Rate |
$9.20 |
| Rate for Payer: Cash Price |
$10.62
|
| Rate for Payer: Galaxy Health Commercial |
$9.20
|
| Rate for Payer: WellCare Medicare |
$7.79
|
|
|
ZOLPIDEM TARTRATE 5MG TABS 10X10EA
|
Facility
|
OP
|
$14.16
|
|
|
Service Code
|
NDC 904608261
|
| Hospital Charge Code |
4400824
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.12 |
| Max. Negotiated Rate |
$11.33 |
| Rate for Payer: Aetna of NY Commercial |
$9.91
|
| Rate for Payer: Aetna of NY Medicare |
$6.51
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$5.66
|
| Rate for Payer: Cash Price |
$10.62
|
| Rate for Payer: CDPHP Medicare |
$5.24
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$11.33
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$11.33
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$11.33
|
| Rate for Payer: EmblemHealth Medicaid |
$11.33
|
| Rate for Payer: EmblemHealth Medicare |
$4.81
|
| Rate for Payer: EmblemHealth Select Care |
$10.20
|
| Rate for Payer: Fidelis Medicare |
$5.66
|
| Rate for Payer: Galaxy Health Commercial |
$9.20
|
| Rate for Payer: Hamaspik Choice Medicare |
$5.66
|
| Rate for Payer: Humana Medicare |
$5.66
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$9.91
|
| Rate for Payer: Local 1199SEIU Medicare |
$6.51
|
| Rate for Payer: MVP Health Care of NY Commercial |
$10.62
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$7.97
|
| Rate for Payer: MVP Health Care of NY Medicare |
$5.95
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$2.12
|
| Rate for Payer: United Healthcare Medicare |
$5.66
|
| Rate for Payer: WellCare Medicare |
$7.79
|
|
|
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 |
$1.08 |
| Max. Negotiated Rate |
$32.81 |
| Rate for Payer: Aetna of NY Commercial |
$27.76
|
| Rate for Payer: Cash Price |
$37.85
|
| Rate for Payer: Cash Price |
$37.85
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1.08
|
| Rate for Payer: EmblemHealth Select Care |
$1.08
|
| 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
|
|
|
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 |
$1.08 |
| Max. Negotiated Rate |
$40.38 |
| Rate for Payer: Aetna of NY Medicare |
$23.22
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$20.19
|
| Rate for Payer: Cash Price |
$37.85
|
| Rate for Payer: Cash Price |
$37.85
|
| Rate for Payer: CDPHP Medicare |
$18.67
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1.08
|
| 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 |
$1.08
|
| Rate for Payer: Fidelis Medicare |
$20.19
|
| Rate for Payer: Galaxy Health Commercial |
$32.81
|
| Rate for Payer: Hamaspik Choice Medicare |
$20.19
|
| Rate for Payer: Humana Medicare |
$20.19
|
| 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 |
$21.20
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$2.24
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$7.57
|
| Rate for Payer: United Healthcare Commercial |
$2.24
|
| Rate for Payer: United Healthcare Medicare |
$20.19
|
| Rate for Payer: WellCare Medicare |
$27.76
|
|
|
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 |
$224.40 |
| Max. Negotiated Rate |
$265.20 |
| Rate for Payer: Aetna of NY Commercial |
$224.40
|
| 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
|
|
|
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 |
$1.20 |
| Max. Negotiated Rate |
$326.40 |
| 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) Medicare |
$163.20
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Cash Price |
$306.00
|
| 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 |
$163.20
|
| Rate for Payer: Galaxy Health Commercial |
$265.20
|
| Rate for Payer: Hamaspik Choice Medicare |
$163.20
|
| Rate for Payer: Humana Medicare |
$163.20
|
| 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 |
$171.36
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1.20
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$61.20
|
| Rate for Payer: United Healthcare Commercial |
$1.20
|
| Rate for Payer: United Healthcare Medicare |
$163.20
|
| Rate for Payer: WellCare Medicare |
$224.40
|
|
|
ZYPREXA INJ
|
Facility
|
OP
|
$144.72
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
4408993
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.71 |
| Max. Negotiated Rate |
$115.78 |
| Rate for Payer: Aetna of NY Medicare |
$66.57
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$57.89
|
| Rate for Payer: Cash Price |
$108.54
|
| 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 |
$57.89
|
| Rate for Payer: Galaxy Health Commercial |
$94.07
|
| Rate for Payer: Hamaspik Choice Medicare |
$57.89
|
| Rate for Payer: Humana Medicare |
$57.89
|
| 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 |
$60.78
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$21.71
|
| Rate for Payer: United Healthcare Medicare |
$57.89
|
| Rate for Payer: WellCare Medicare |
$79.60
|
|
|
ZYPREXA INJ
|
Facility
|
IP
|
$144.72
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
4408993
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$79.60 |
| Max. Negotiated Rate |
$94.07 |
| Rate for Payer: Aetna of NY Commercial |
$79.60
|
| 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
|
|
|
ZYVOX 600 MG TAB
|
Facility
|
IP
|
$567.53
|
|
|
Service Code
|
NDC 904655304
|
| 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 904655304
|
| Hospital Charge Code |
4408958
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$85.13 |
| Max. Negotiated Rate |
$454.02 |
| 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) Medicare |
$227.01
|
| Rate for Payer: Cash Price |
$425.65
|
| 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 |
$227.01
|
| Rate for Payer: Galaxy Health Commercial |
$368.89
|
| Rate for Payer: Hamaspik Choice Medicare |
$227.01
|
| Rate for Payer: Humana Medicare |
$227.01
|
| 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 |
$238.36
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$85.13
|
| Rate for Payer: United Healthcare Medicare |
$227.01
|
| Rate for Payer: WellCare Medicare |
$312.14
|
|
