|
CBI CONT BLADDER IRRIG
|
Facility
|
OP
|
$707.00
|
|
|
Service Code
|
HCPCS 51700
|
| Hospital Charge Code |
4602143
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$235.48 |
| Max. Negotiated Rate |
$1,189.18 |
| Rate for Payer: Aetna of NY Commercial |
$955.00
|
| Rate for Payer: Aetna of NY Medicare |
$325.22
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$950.93
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,189.18
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$261.59
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$353.50
|
| Rate for Payer: Cash Price |
$530.25
|
| Rate for Payer: Cash Price |
$530.25
|
| Rate for Payer: Cash Price |
$530.25
|
| Rate for Payer: Cash Price |
$530.25
|
| Rate for Payer: CDPHP Commercial |
$569.14
|
| Rate for Payer: CDPHP Medicare |
$261.59
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,182.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$565.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$565.60
|
| Rate for Payer: EmblemHealth Medicaid |
$565.60
|
| Rate for Payer: EmblemHealth Medicare |
$240.38
|
| Rate for Payer: EmblemHealth Select Care |
$1,064.00
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$250.00
|
| Rate for Payer: Fidelis Medicare |
$269.44
|
| Rate for Payer: Galaxy Health Commercial |
$459.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$261.59
|
| Rate for Payer: Humana Medicare |
$261.59
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$955.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$325.22
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,174.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$881.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$274.67
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$980.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$235.48
|
| Rate for Payer: United Healthcare Commercial |
$980.00
|
| Rate for Payer: United Healthcare Medicare |
$261.59
|
| Rate for Payer: WellCare Medicare |
$388.85
|
|
|
CBI CONT BLADDER IRRIG
|
Facility
|
IP
|
$707.00
|
|
|
Service Code
|
HCPCS 51700
|
| Hospital Charge Code |
4602143
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$459.55 |
| Max. Negotiated Rate |
$459.55 |
| Rate for Payer: Cash Price |
$530.25
|
| Rate for Payer: Galaxy Health Commercial |
$459.55
|
|
|
CDC 2019 NOVEL CORONAVIRUS (2019-NCOV) REAL-TIME RT-PCR DIAGNOSTIC PANEL
|
Facility
|
IP
|
$115.00
|
|
|
Service Code
|
HCPCS U0001
|
| Hospital Charge Code |
4302019
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$74.75 |
| Max. Negotiated Rate |
$74.75 |
| Rate for Payer: Cash Price |
$86.25
|
| Rate for Payer: Galaxy Health Commercial |
$74.75
|
|
|
CDC 2019 NOVEL CORONAVIRUS (2019-NCOV) REAL-TIME RT-PCR DIAGNOSTIC PANEL
|
Facility
|
OP
|
$115.00
|
|
|
Service Code
|
HCPCS U0001
|
| Hospital Charge Code |
4302019
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.92 |
| Max. Negotiated Rate |
$92.58 |
| Rate for Payer: Aetna of NY Commercial |
$74.75
|
| Rate for Payer: Aetna of NY Medicare |
$52.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$86.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$86.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$42.55
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$57.50
|
| Rate for Payer: Cash Price |
$86.25
|
| Rate for Payer: Cash Price |
$86.25
|
| Rate for Payer: CDPHP Commercial |
$92.58
|
| Rate for Payer: CDPHP Medicare |
$42.55
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$69.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$92.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$92.00
|
| Rate for Payer: EmblemHealth Medicaid |
$92.00
|
| Rate for Payer: EmblemHealth Medicare |
$39.10
|
| Rate for Payer: EmblemHealth Select Care |
$69.00
|
| Rate for Payer: Fidelis Medicare |
$43.83
|
| Rate for Payer: Galaxy Health Commercial |
$74.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$42.55
|
| Rate for Payer: Humana Medicare |
$42.55
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$74.75
|
| Rate for Payer: Local 1199SEIU Medicare |
$52.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$86.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$64.74
|
| Rate for Payer: MVP Health Care of NY Medicare |
$44.68
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$86.25
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$35.92
|
| Rate for Payer: United Healthcare Commercial |
$86.25
|
| Rate for Payer: United Healthcare Medicare |
$42.55
|
| Rate for Payer: WellCare Medicare |
$63.25
|
|
|
C-DIFFICILE TOXIN
|
Facility
|
IP
|
$129.00
|
|
|
Service Code
|
HCPCS 87449
|
| Hospital Charge Code |
4300162
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$83.85 |
| Max. Negotiated Rate |
$83.85 |
| Rate for Payer: Cash Price |
$96.75
|
| Rate for Payer: Galaxy Health Commercial |
$83.85
|
|
|
C-DIFFICILE TOXIN
|
Facility
|
OP
|
$129.00
|
|
|
Service Code
|
HCPCS 87449
|
| Hospital Charge Code |
4300162
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$5.25 |
| Max. Negotiated Rate |
$103.84 |
| Rate for Payer: Aetna of NY Commercial |
$83.85
|
| Rate for Payer: Aetna of NY Medicare |
$59.34
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$96.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$96.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$47.73
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$64.50
|
| Rate for Payer: Cash Price |
$96.75
|
| Rate for Payer: Cash Price |
$96.75
|
| Rate for Payer: CDPHP Commercial |
$103.84
|
| Rate for Payer: CDPHP Medicare |
$47.73
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$77.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$103.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$103.20
|
| Rate for Payer: EmblemHealth Medicaid |
$103.20
|
| Rate for Payer: EmblemHealth Medicare |
$43.86
|
| Rate for Payer: EmblemHealth Select Care |
$77.40
|
| Rate for Payer: Fidelis Medicare |
$49.16
|
| Rate for Payer: Galaxy Health Commercial |
$83.85
|
| Rate for Payer: Hamaspik Choice Medicare |
$47.73
|
| Rate for Payer: Humana Medicare |
$47.73
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$83.85
|
| Rate for Payer: Local 1199SEIU Medicare |
$59.34
|
| Rate for Payer: MVP Health Care of NY Commercial |
$96.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$72.63
|
| Rate for Payer: MVP Health Care of NY Medicare |
$50.12
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$96.75
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$5.25
|
| Rate for Payer: United Healthcare Commercial |
$96.75
|
| Rate for Payer: United Healthcare Medicare |
$47.73
|
| Rate for Payer: WellCare Medicare |
$70.95
|
|
|
CEA
|
Facility
|
IP
|
$99.00
|
|
|
Service Code
|
HCPCS 82378
|
| Hospital Charge Code |
4300163
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$64.35 |
| Max. Negotiated Rate |
$64.35 |
| Rate for Payer: Cash Price |
$74.25
|
| Rate for Payer: Galaxy Health Commercial |
$64.35
|
|
|
CEA
|
Facility
|
OP
|
$99.00
|
|
|
Service Code
|
HCPCS 82378
|
| Hospital Charge Code |
4300163
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.96 |
| Max. Negotiated Rate |
$79.70 |
| Rate for Payer: Aetna of NY Commercial |
$64.35
|
| Rate for Payer: Aetna of NY Medicare |
$45.54
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$74.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$74.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$36.63
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$49.50
|
| Rate for Payer: Cash Price |
$74.25
|
| Rate for Payer: Cash Price |
$74.25
|
| Rate for Payer: CDPHP Commercial |
$79.70
|
| Rate for Payer: CDPHP Medicare |
$36.63
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$59.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$79.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$79.20
|
| Rate for Payer: EmblemHealth Medicaid |
$79.20
|
| Rate for Payer: EmblemHealth Medicare |
$33.66
|
| Rate for Payer: EmblemHealth Select Care |
$59.40
|
| Rate for Payer: Fidelis Medicare |
$37.73
|
| Rate for Payer: Galaxy Health Commercial |
$64.35
|
| Rate for Payer: Hamaspik Choice Medicare |
$36.63
|
| Rate for Payer: Humana Medicare |
$36.63
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$64.35
|
| Rate for Payer: Local 1199SEIU Medicare |
$45.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$74.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$55.74
|
| Rate for Payer: MVP Health Care of NY Medicare |
$38.46
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$74.25
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$18.96
|
| Rate for Payer: United Healthcare Commercial |
$74.25
|
| Rate for Payer: United Healthcare Medicare |
$36.63
|
| Rate for Payer: WellCare Medicare |
$54.45
|
|
|
cefaDROXiL 500 MG CAPSULE 500 mg, 50 eaches
|
Facility
|
IP
|
$6.00
|
|
|
Service Code
|
NDC 68180018008
|
| Hospital Charge Code |
4401515
|
|
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
|
|
|
cefaDROXiL 500 MG CAPSULE 500 mg, 50 eaches
|
Facility
|
OP
|
$6.00
|
|
|
Service Code
|
NDC 68180018008
|
| Hospital Charge Code |
4401515
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.04 |
| Max. Negotiated Rate |
$4.83 |
| Rate for Payer: Aetna of NY Commercial |
$4.20
|
| Rate for Payer: Aetna of NY Medicare |
$2.76
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$4.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$4.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2.22
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$3.00
|
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: CDPHP Commercial |
$4.83
|
| Rate for Payer: CDPHP Medicare |
$2.22
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$4.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$4.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$4.80
|
| Rate for Payer: EmblemHealth Medicaid |
$4.80
|
| Rate for Payer: EmblemHealth Medicare |
$2.04
|
| Rate for Payer: EmblemHealth Select Care |
$4.32
|
| Rate for Payer: Fidelis Medicare |
$2.29
|
| Rate for Payer: Galaxy Health Commercial |
$3.90
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.22
|
| Rate for Payer: Humana Medicare |
$2.22
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$4.20
|
| Rate for Payer: Local 1199SEIU Medicare |
$2.76
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3.38
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2.33
|
| Rate for Payer: United Healthcare Medicare |
$2.22
|
| Rate for Payer: WellCare Medicare |
$3.30
|
|
|
CEFAZOLIN SODIUM INJECTION 500 MG
|
Facility
|
IP
|
$6.76
|
|
|
Service Code
|
NDC 00264310511
|
| Hospital Charge Code |
4409236
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.72 |
| Max. Negotiated Rate |
$4.39 |
| Rate for Payer: Cash Price |
$5.07
|
| Rate for Payer: Galaxy Health Commercial |
$4.39
|
| Rate for Payer: WellCare Medicare |
$3.72
|
|
|
CEFAZOLIN SODIUM INJECTION 500 MG
|
Facility
|
OP
|
$6.76
|
|
|
Service Code
|
NDC 00264310511
|
| Hospital Charge Code |
4409236
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.30 |
| Max. Negotiated Rate |
$5.44 |
| Rate for Payer: Aetna of NY Commercial |
$4.73
|
| Rate for Payer: Aetna of NY Medicare |
$3.11
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$5.07
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$5.07
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2.50
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$3.38
|
| Rate for Payer: Cash Price |
$5.07
|
| Rate for Payer: CDPHP Commercial |
$5.44
|
| Rate for Payer: CDPHP Medicare |
$2.50
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$5.41
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$5.41
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$5.41
|
| Rate for Payer: EmblemHealth Medicaid |
$5.41
|
| Rate for Payer: EmblemHealth Medicare |
$2.30
|
| Rate for Payer: EmblemHealth Select Care |
$4.87
|
| Rate for Payer: Fidelis Medicare |
$2.58
|
| Rate for Payer: Galaxy Health Commercial |
$4.39
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.50
|
| Rate for Payer: Humana Medicare |
$2.50
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$4.73
|
| Rate for Payer: Local 1199SEIU Medicare |
$3.11
|
| Rate for Payer: MVP Health Care of NY Commercial |
$5.07
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3.81
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2.63
|
| Rate for Payer: United Healthcare Medicare |
$2.50
|
| Rate for Payer: WellCare Medicare |
$3.72
|
|
|
CEFAZOLIN SODIUM INJECTION 500 MG
|
Facility
|
OP
|
$8.00
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
4401249
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.82 |
| Max. Negotiated Rate |
$6.44 |
| Rate for Payer: Aetna of NY Commercial |
$4.40
|
| Rate for Payer: Aetna of NY Medicare |
$3.68
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$0.82
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$0.82
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2.96
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$4.00
|
| Rate for Payer: Cash Price |
$6.00
|
| Rate for Payer: Cash Price |
$6.00
|
| Rate for Payer: CDPHP Commercial |
$6.44
|
| Rate for Payer: CDPHP Medicare |
$2.96
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.82
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$6.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$6.40
|
| Rate for Payer: EmblemHealth Medicaid |
$6.40
|
| Rate for Payer: EmblemHealth Medicare |
$2.72
|
| Rate for Payer: EmblemHealth Select Care |
$0.82
|
| Rate for Payer: Fidelis Medicare |
$3.05
|
| Rate for Payer: Galaxy Health Commercial |
$5.20
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.96
|
| Rate for Payer: Humana Medicare |
$2.96
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$4.40
|
| Rate for Payer: Local 1199SEIU Medicare |
$3.68
|
| Rate for Payer: MVP Health Care of NY Commercial |
$6.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$4.50
|
| Rate for Payer: MVP Health Care of NY Medicare |
$3.11
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1.44
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$0.82
|
| Rate for Payer: United Healthcare Commercial |
$1.44
|
| Rate for Payer: United Healthcare Medicare |
$2.96
|
| Rate for Payer: WellCare Medicare |
$4.40
|
|
|
CEFAZOLIN SODIUM INJECTION 500 MG
|
Facility
|
OP
|
$3.09
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
4400140
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.82 |
| Max. Negotiated Rate |
$2.49 |
| Rate for Payer: Aetna of NY Commercial |
$1.70
|
| Rate for Payer: Aetna of NY Medicare |
$1.42
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$0.82
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$0.82
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1.14
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$1.54
|
| Rate for Payer: Cash Price |
$2.32
|
| Rate for Payer: Cash Price |
$2.32
|
| Rate for Payer: CDPHP Commercial |
$2.49
|
| Rate for Payer: CDPHP Medicare |
$1.14
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.82
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2.47
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$2.47
|
| Rate for Payer: EmblemHealth Medicaid |
$2.47
|
| Rate for Payer: EmblemHealth Medicare |
$1.05
|
| Rate for Payer: EmblemHealth Select Care |
$0.82
|
| Rate for Payer: Fidelis Medicare |
$1.18
|
| Rate for Payer: Galaxy Health Commercial |
$2.01
|
| Rate for Payer: Hamaspik Choice Medicare |
$1.14
|
| Rate for Payer: Humana Medicare |
$1.14
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1.70
|
| Rate for Payer: Local 1199SEIU Medicare |
$1.42
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2.32
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1.74
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1.20
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1.44
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$0.82
|
| Rate for Payer: United Healthcare Commercial |
$1.44
|
| Rate for Payer: United Healthcare Medicare |
$1.14
|
| Rate for Payer: WellCare Medicare |
$1.70
|
|
|
CEFAZOLIN SODIUM INJECTION 500 MG
|
Facility
|
IP
|
$3.09
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
4400140
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.82 |
| Max. Negotiated Rate |
$2.01 |
| Rate for Payer: Aetna of NY Commercial |
$1.70
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$0.82
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$0.82
|
| Rate for Payer: Cash Price |
$2.32
|
| Rate for Payer: Cash Price |
$2.32
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.82
|
| Rate for Payer: EmblemHealth Select Care |
$0.82
|
| Rate for Payer: Galaxy Health Commercial |
$2.01
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1.70
|
| Rate for Payer: WellCare Medicare |
$1.70
|
|
|
CEFAZOLIN SODIUM INJECTION 500 MG
|
Facility
|
IP
|
$8.00
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
4401249
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.82 |
| Max. Negotiated Rate |
$5.20 |
| Rate for Payer: Aetna of NY Commercial |
$4.40
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$0.82
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$0.82
|
| Rate for Payer: Cash Price |
$6.00
|
| Rate for Payer: Cash Price |
$6.00
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.82
|
| Rate for Payer: EmblemHealth Select Care |
$0.82
|
| Rate for Payer: Galaxy Health Commercial |
$5.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$4.40
|
| Rate for Payer: WellCare Medicare |
$4.40
|
|
|
CEFDINIR 125 MG/5 ML SUSP 125 mg, 60 mL
|
Facility
|
IP
|
$153.00
|
|
|
Service Code
|
NDC 67877054798
|
| Hospital Charge Code |
4401559
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$84.15 |
| Max. Negotiated Rate |
$99.45 |
| Rate for Payer: Cash Price |
$114.75
|
| Rate for Payer: Galaxy Health Commercial |
$99.45
|
| Rate for Payer: WellCare Medicare |
$84.15
|
|
|
CEFDINIR 125 MG/5 ML SUSP 125 mg, 60 mL
|
Facility
|
OP
|
$153.00
|
|
|
Service Code
|
NDC 67877054798
|
| Hospital Charge Code |
4401559
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$52.02 |
| Max. Negotiated Rate |
$123.16 |
| Rate for Payer: Aetna of NY Commercial |
$107.10
|
| Rate for Payer: Aetna of NY Medicare |
$70.38
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$114.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$114.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$56.61
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$76.50
|
| Rate for Payer: Cash Price |
$114.75
|
| Rate for Payer: CDPHP Commercial |
$123.16
|
| Rate for Payer: CDPHP Medicare |
$56.61
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$122.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$122.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$122.40
|
| Rate for Payer: EmblemHealth Medicaid |
$122.40
|
| Rate for Payer: EmblemHealth Medicare |
$52.02
|
| Rate for Payer: EmblemHealth Select Care |
$110.16
|
| Rate for Payer: Fidelis Medicare |
$58.31
|
| Rate for Payer: Galaxy Health Commercial |
$99.45
|
| Rate for Payer: Hamaspik Choice Medicare |
$56.61
|
| Rate for Payer: Humana Medicare |
$56.61
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$107.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$70.38
|
| Rate for Payer: MVP Health Care of NY Commercial |
$114.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$86.14
|
| Rate for Payer: MVP Health Care of NY Medicare |
$59.44
|
| Rate for Payer: United Healthcare Medicare |
$56.61
|
| Rate for Payer: WellCare Medicare |
$84.15
|
|
|
CEFDINIR 250 MG/5 ML SUSP 250 mg, 60 mL
|
Facility
|
OP
|
$298.00
|
|
|
Service Code
|
NDC 67877054898
|
| Hospital Charge Code |
4401560
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$101.32 |
| Max. Negotiated Rate |
$239.89 |
| Rate for Payer: Aetna of NY Commercial |
$208.60
|
| Rate for Payer: Aetna of NY Medicare |
$137.08
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$223.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$223.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$110.26
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$149.00
|
| Rate for Payer: Cash Price |
$223.50
|
| Rate for Payer: CDPHP Commercial |
$239.89
|
| Rate for Payer: CDPHP Medicare |
$110.26
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$238.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$238.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$238.40
|
| Rate for Payer: EmblemHealth Medicaid |
$238.40
|
| Rate for Payer: EmblemHealth Medicare |
$101.32
|
| Rate for Payer: EmblemHealth Select Care |
$214.56
|
| Rate for Payer: Fidelis Medicare |
$113.57
|
| Rate for Payer: Galaxy Health Commercial |
$193.70
|
| Rate for Payer: Hamaspik Choice Medicare |
$110.26
|
| Rate for Payer: Humana Medicare |
$110.26
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$208.60
|
| Rate for Payer: Local 1199SEIU Medicare |
$137.08
|
| Rate for Payer: MVP Health Care of NY Commercial |
$223.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$167.77
|
| Rate for Payer: MVP Health Care of NY Medicare |
$115.77
|
| Rate for Payer: United Healthcare Medicare |
$110.26
|
| Rate for Payer: WellCare Medicare |
$163.90
|
|
|
CEFDINIR 250 MG/5 ML SUSP 250 mg, 60 mL
|
Facility
|
IP
|
$298.00
|
|
|
Service Code
|
NDC 67877054898
|
| Hospital Charge Code |
4401560
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$163.90 |
| Max. Negotiated Rate |
$193.70 |
| Rate for Payer: Cash Price |
$223.50
|
| Rate for Payer: Galaxy Health Commercial |
$193.70
|
| Rate for Payer: WellCare Medicare |
$163.90
|
|
|
CEFDINIR 300MG CAPSULE
|
Facility
|
IP
|
$2.40
|
|
|
Service Code
|
NDC 65862017760
|
| Hospital Charge Code |
4400845
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.32 |
| Max. Negotiated Rate |
$1.56 |
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Galaxy Health Commercial |
$1.56
|
| Rate for Payer: WellCare Medicare |
$1.32
|
|
|
CEFDINIR 300MG CAPSULE
|
Facility
|
OP
|
$2.40
|
|
|
Service Code
|
NDC 65862017760
|
| Hospital Charge Code |
4400845
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.82 |
| Max. Negotiated Rate |
$1.93 |
| Rate for Payer: Aetna of NY Commercial |
$1.68
|
| Rate for Payer: Aetna of NY Medicare |
$1.10
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1.80
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1.80
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$0.89
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$1.20
|
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: CDPHP Commercial |
$1.93
|
| Rate for Payer: CDPHP Medicare |
$0.89
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1.92
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1.92
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1.92
|
| Rate for Payer: EmblemHealth Medicaid |
$1.92
|
| Rate for Payer: EmblemHealth Medicare |
$0.82
|
| Rate for Payer: EmblemHealth Select Care |
$1.73
|
| Rate for Payer: Fidelis Medicare |
$0.91
|
| Rate for Payer: Galaxy Health Commercial |
$1.56
|
| Rate for Payer: Hamaspik Choice Medicare |
$0.89
|
| Rate for Payer: Humana Medicare |
$0.89
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1.68
|
| Rate for Payer: Local 1199SEIU Medicare |
$1.10
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1.80
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1.35
|
| Rate for Payer: MVP Health Care of NY Medicare |
$0.93
|
| Rate for Payer: United Healthcare Medicare |
$0.89
|
| Rate for Payer: WellCare Medicare |
$1.32
|
|
|
CEFEPIME-DEXTROSE 1 GM/50 ML 1 g, 1 each
|
Facility
|
IP
|
$36.00
|
|
|
Service Code
|
HCPCS J0703
|
| Hospital Charge Code |
4401571
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.95 |
| Max. Negotiated Rate |
$23.40 |
| Rate for Payer: Aetna of NY Commercial |
$19.80
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$4.95
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$4.95
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$4.95
|
| Rate for Payer: EmblemHealth Select Care |
$4.95
|
| Rate for Payer: Galaxy Health Commercial |
$23.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$19.80
|
| Rate for Payer: WellCare Medicare |
$19.80
|
|
|
CEFEPIME-DEXTROSE 1 GM/50 ML 1 g, 1 each
|
Facility
|
OP
|
$36.00
|
|
|
Service Code
|
HCPCS J0703
|
| Hospital Charge Code |
4401571
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.95 |
| Max. Negotiated Rate |
$28.98 |
| Rate for Payer: Aetna of NY Commercial |
$19.80
|
| Rate for Payer: Aetna of NY Medicare |
$16.56
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$4.95
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$4.95
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$13.32
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$18.00
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: CDPHP Commercial |
$28.98
|
| Rate for Payer: CDPHP Medicare |
$13.32
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$4.95
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$28.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$28.80
|
| Rate for Payer: EmblemHealth Medicaid |
$28.80
|
| Rate for Payer: EmblemHealth Medicare |
$12.24
|
| Rate for Payer: EmblemHealth Select Care |
$4.95
|
| Rate for Payer: Fidelis Medicare |
$13.72
|
| Rate for Payer: Galaxy Health Commercial |
$23.40
|
| Rate for Payer: Hamaspik Choice Medicare |
$13.32
|
| Rate for Payer: Humana Medicare |
$13.32
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$19.80
|
| Rate for Payer: Local 1199SEIU Medicare |
$16.56
|
| Rate for Payer: MVP Health Care of NY Commercial |
$27.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$20.27
|
| Rate for Payer: MVP Health Care of NY Medicare |
$13.99
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$8.42
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$4.95
|
| Rate for Payer: United Healthcare Commercial |
$8.42
|
| Rate for Payer: United Healthcare Medicare |
$13.32
|
| Rate for Payer: WellCare Medicare |
$19.80
|
|
|
CEFEPIME-DEXTROSE 2 GM/50 ML 2 g, 1 each
|
Facility
|
OP
|
$27.00
|
|
|
Service Code
|
HCPCS J0703
|
| Hospital Charge Code |
4401572
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.95 |
| Max. Negotiated Rate |
$21.74 |
| Rate for Payer: Aetna of NY Commercial |
$14.85
|
| Rate for Payer: Aetna of NY Medicare |
$12.42
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$4.95
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$4.95
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$9.99
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$13.50
|
| Rate for Payer: Cash Price |
$20.25
|
| Rate for Payer: Cash Price |
$20.25
|
| Rate for Payer: CDPHP Commercial |
$21.74
|
| Rate for Payer: CDPHP Medicare |
$9.99
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$4.95
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$21.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$21.60
|
| Rate for Payer: EmblemHealth Medicaid |
$21.60
|
| Rate for Payer: EmblemHealth Medicare |
$9.18
|
| Rate for Payer: EmblemHealth Select Care |
$4.95
|
| Rate for Payer: Fidelis Medicare |
$10.29
|
| Rate for Payer: Galaxy Health Commercial |
$17.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$9.99
|
| Rate for Payer: Humana Medicare |
$9.99
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$14.85
|
| Rate for Payer: Local 1199SEIU Medicare |
$12.42
|
| Rate for Payer: MVP Health Care of NY Commercial |
$20.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$15.20
|
| Rate for Payer: MVP Health Care of NY Medicare |
$10.49
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$8.42
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$4.95
|
| Rate for Payer: United Healthcare Commercial |
$8.42
|
| Rate for Payer: United Healthcare Medicare |
$9.99
|
| Rate for Payer: WellCare Medicare |
$14.85
|
|
