|
CEFEPIME-DEXTROSE 2 GM/50 ML 2 g, 1 each
|
Facility
|
IP
|
$27.00
|
|
|
Service Code
|
HCPCS J0703
|
| Hospital Charge Code |
4401572
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.95 |
| Max. Negotiated Rate |
$17.55 |
| Rate for Payer: Aetna of NY Commercial |
$14.85
|
| 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 |
$20.25
|
| Rate for Payer: Cash Price |
$20.25
|
| 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 |
$17.55
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$14.85
|
| Rate for Payer: WellCare Medicare |
$14.85
|
|
|
CEFEPIME HCL INJ 500 MG
|
Facility
|
OP
|
$22.15
|
|
|
Service Code
|
HCPCS J0692
|
| Hospital Charge Code |
4400141
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.34 |
| Max. Negotiated Rate |
$17.83 |
| Rate for Payer: Aetna of NY Commercial |
$12.18
|
| Rate for Payer: Aetna of NY Medicare |
$10.19
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1.34
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1.34
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$8.20
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$11.08
|
| Rate for Payer: Cash Price |
$16.61
|
| Rate for Payer: Cash Price |
$16.61
|
| Rate for Payer: CDPHP Commercial |
$17.83
|
| Rate for Payer: CDPHP Medicare |
$8.20
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1.34
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$17.72
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$17.72
|
| Rate for Payer: EmblemHealth Medicaid |
$17.72
|
| Rate for Payer: EmblemHealth Medicare |
$7.53
|
| Rate for Payer: EmblemHealth Select Care |
$1.34
|
| Rate for Payer: Fidelis Medicare |
$8.44
|
| Rate for Payer: Galaxy Health Commercial |
$14.40
|
| Rate for Payer: Hamaspik Choice Medicare |
$8.20
|
| Rate for Payer: Humana Medicare |
$8.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$12.18
|
| Rate for Payer: Local 1199SEIU Medicare |
$10.19
|
| Rate for Payer: MVP Health Care of NY Commercial |
$16.61
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$12.47
|
| Rate for Payer: MVP Health Care of NY Medicare |
$8.61
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$2.03
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1.34
|
| Rate for Payer: United Healthcare Commercial |
$2.03
|
| Rate for Payer: United Healthcare Medicare |
$8.20
|
| Rate for Payer: WellCare Medicare |
$12.18
|
|
|
CEFEPIME HCL INJ 500 MG
|
Facility
|
IP
|
$36.31
|
|
|
Service Code
|
HCPCS J0692
|
| Hospital Charge Code |
4409210
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.34 |
| Max. Negotiated Rate |
$23.60 |
| Rate for Payer: Aetna of NY Commercial |
$19.97
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1.34
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1.34
|
| Rate for Payer: Cash Price |
$27.23
|
| Rate for Payer: Cash Price |
$27.23
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1.34
|
| Rate for Payer: EmblemHealth Select Care |
$1.34
|
| Rate for Payer: Galaxy Health Commercial |
$23.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$19.97
|
| Rate for Payer: WellCare Medicare |
$19.97
|
|
|
CEFEPIME HCL INJ 500 MG
|
Facility
|
IP
|
$22.15
|
|
|
Service Code
|
HCPCS J0692
|
| Hospital Charge Code |
4400141
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.34 |
| Max. Negotiated Rate |
$14.40 |
| Rate for Payer: Aetna of NY Commercial |
$12.18
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1.34
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1.34
|
| Rate for Payer: Cash Price |
$16.61
|
| Rate for Payer: Cash Price |
$16.61
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1.34
|
| Rate for Payer: EmblemHealth Select Care |
$1.34
|
| Rate for Payer: Galaxy Health Commercial |
$14.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$12.18
|
| Rate for Payer: WellCare Medicare |
$12.18
|
|
|
CEFEPIME HCL INJ 500 MG
|
Facility
|
OP
|
$36.31
|
|
|
Service Code
|
HCPCS J0692
|
| Hospital Charge Code |
4409210
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.34 |
| Max. Negotiated Rate |
$29.23 |
| Rate for Payer: Aetna of NY Commercial |
$19.97
|
| Rate for Payer: Aetna of NY Medicare |
$16.70
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1.34
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1.34
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$13.43
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$18.16
|
| Rate for Payer: Cash Price |
$27.23
|
| Rate for Payer: Cash Price |
$27.23
|
| Rate for Payer: CDPHP Commercial |
$29.23
|
| Rate for Payer: CDPHP Medicare |
$13.43
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1.34
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$29.05
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$29.05
|
| Rate for Payer: EmblemHealth Medicaid |
$29.05
|
| Rate for Payer: EmblemHealth Medicare |
$12.35
|
| Rate for Payer: EmblemHealth Select Care |
$1.34
|
| Rate for Payer: Fidelis Medicare |
$13.84
|
| Rate for Payer: Galaxy Health Commercial |
$23.60
|
| Rate for Payer: Hamaspik Choice Medicare |
$13.43
|
| Rate for Payer: Humana Medicare |
$13.43
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$19.97
|
| Rate for Payer: Local 1199SEIU Medicare |
$16.70
|
| Rate for Payer: MVP Health Care of NY Commercial |
$27.23
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$20.44
|
| Rate for Payer: MVP Health Care of NY Medicare |
$14.11
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$2.03
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1.34
|
| Rate for Payer: United Healthcare Commercial |
$2.03
|
| Rate for Payer: United Healthcare Medicare |
$13.43
|
| Rate for Payer: WellCare Medicare |
$19.97
|
|
|
cefOXitin 1 GM PIGGYBACK BAG 1 g, 1 each
|
Facility
|
OP
|
$75.50
|
|
|
Service Code
|
HCPCS J0694
|
| Hospital Charge Code |
4401508
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.90 |
| Max. Negotiated Rate |
$60.78 |
| Rate for Payer: Aetna of NY Commercial |
$41.52
|
| Rate for Payer: Aetna of NY Medicare |
$34.73
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$4.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$4.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$27.94
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$37.75
|
| Rate for Payer: Cash Price |
$56.63
|
| Rate for Payer: Cash Price |
$56.63
|
| Rate for Payer: CDPHP Commercial |
$60.78
|
| Rate for Payer: CDPHP Medicare |
$27.94
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$4.90
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$60.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$60.40
|
| Rate for Payer: EmblemHealth Medicaid |
$60.40
|
| Rate for Payer: EmblemHealth Medicare |
$25.67
|
| Rate for Payer: EmblemHealth Select Care |
$4.90
|
| Rate for Payer: Fidelis Medicare |
$28.77
|
| Rate for Payer: Galaxy Health Commercial |
$49.08
|
| Rate for Payer: Hamaspik Choice Medicare |
$27.94
|
| Rate for Payer: Humana Medicare |
$27.94
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$41.52
|
| Rate for Payer: Local 1199SEIU Medicare |
$34.73
|
| Rate for Payer: MVP Health Care of NY Commercial |
$56.62
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$42.51
|
| Rate for Payer: MVP Health Care of NY Medicare |
$29.33
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$8.25
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$4.90
|
| Rate for Payer: United Healthcare Commercial |
$8.25
|
| Rate for Payer: United Healthcare Medicare |
$27.94
|
| Rate for Payer: WellCare Medicare |
$41.52
|
|
|
cefOXitin 1 GM PIGGYBACK BAG 1 g, 1 each
|
Facility
|
IP
|
$75.50
|
|
|
Service Code
|
HCPCS J0694
|
| Hospital Charge Code |
4401508
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.90 |
| Max. Negotiated Rate |
$49.08 |
| Rate for Payer: Aetna of NY Commercial |
$41.52
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$4.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$4.90
|
| Rate for Payer: Cash Price |
$56.63
|
| Rate for Payer: Cash Price |
$56.63
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$4.90
|
| Rate for Payer: EmblemHealth Select Care |
$4.90
|
| Rate for Payer: Galaxy Health Commercial |
$49.08
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$41.52
|
| Rate for Payer: WellCare Medicare |
$41.52
|
|
|
cefOXitin 2 GM PIGGYBACK BAG 2 g, 1 each
|
Facility
|
OP
|
$135.15
|
|
|
Service Code
|
HCPCS J0694
|
| Hospital Charge Code |
4401509
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.90 |
| Max. Negotiated Rate |
$108.80 |
| Rate for Payer: Aetna of NY Commercial |
$74.33
|
| Rate for Payer: Aetna of NY Medicare |
$62.17
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$4.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$4.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$50.01
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$67.58
|
| Rate for Payer: Cash Price |
$101.36
|
| Rate for Payer: Cash Price |
$101.36
|
| Rate for Payer: CDPHP Commercial |
$108.80
|
| Rate for Payer: CDPHP Medicare |
$50.01
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$4.90
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$108.12
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$108.12
|
| Rate for Payer: EmblemHealth Medicaid |
$108.12
|
| Rate for Payer: EmblemHealth Medicare |
$45.95
|
| Rate for Payer: EmblemHealth Select Care |
$4.90
|
| Rate for Payer: Fidelis Medicare |
$51.51
|
| Rate for Payer: Galaxy Health Commercial |
$87.85
|
| Rate for Payer: Hamaspik Choice Medicare |
$50.01
|
| Rate for Payer: Humana Medicare |
$50.01
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$74.33
|
| Rate for Payer: Local 1199SEIU Medicare |
$62.17
|
| Rate for Payer: MVP Health Care of NY Commercial |
$101.36
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$76.09
|
| Rate for Payer: MVP Health Care of NY Medicare |
$52.51
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$8.25
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$4.90
|
| Rate for Payer: United Healthcare Commercial |
$8.25
|
| Rate for Payer: United Healthcare Medicare |
$50.01
|
| Rate for Payer: WellCare Medicare |
$74.33
|
|
|
cefOXitin 2 GM PIGGYBACK BAG 2 g, 1 each
|
Facility
|
IP
|
$135.15
|
|
|
Service Code
|
HCPCS J0694
|
| Hospital Charge Code |
4401509
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.90 |
| Max. Negotiated Rate |
$87.85 |
| Rate for Payer: Aetna of NY Commercial |
$74.33
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$4.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$4.90
|
| Rate for Payer: Cash Price |
$101.36
|
| Rate for Payer: Cash Price |
$101.36
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$4.90
|
| Rate for Payer: EmblemHealth Select Care |
$4.90
|
| Rate for Payer: Galaxy Health Commercial |
$87.85
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$74.33
|
| Rate for Payer: WellCare Medicare |
$74.33
|
|
|
CEFOXITIN SODIUM INJECTION 1 GM
|
Facility
|
IP
|
$22.15
|
|
|
Service Code
|
HCPCS J0694
|
| Hospital Charge Code |
4400143
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.90 |
| Max. Negotiated Rate |
$14.40 |
| Rate for Payer: Aetna of NY Commercial |
$12.18
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$4.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$4.90
|
| Rate for Payer: Cash Price |
$16.61
|
| Rate for Payer: Cash Price |
$16.61
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$4.90
|
| Rate for Payer: EmblemHealth Select Care |
$4.90
|
| Rate for Payer: Galaxy Health Commercial |
$14.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$12.18
|
| Rate for Payer: WellCare Medicare |
$12.18
|
|
|
CEFOXITIN SODIUM INJECTION 1 GM
|
Facility
|
OP
|
$22.15
|
|
|
Service Code
|
HCPCS J0694
|
| Hospital Charge Code |
4400143
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.90 |
| Max. Negotiated Rate |
$17.83 |
| Rate for Payer: Aetna of NY Commercial |
$12.18
|
| Rate for Payer: Aetna of NY Medicare |
$10.19
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$4.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$4.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$8.20
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$11.08
|
| Rate for Payer: Cash Price |
$16.61
|
| Rate for Payer: Cash Price |
$16.61
|
| Rate for Payer: CDPHP Commercial |
$17.83
|
| Rate for Payer: CDPHP Medicare |
$8.20
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$4.90
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$17.72
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$17.72
|
| Rate for Payer: EmblemHealth Medicaid |
$17.72
|
| Rate for Payer: EmblemHealth Medicare |
$7.53
|
| Rate for Payer: EmblemHealth Select Care |
$4.90
|
| Rate for Payer: Fidelis Medicare |
$8.44
|
| Rate for Payer: Galaxy Health Commercial |
$14.40
|
| Rate for Payer: Hamaspik Choice Medicare |
$8.20
|
| Rate for Payer: Humana Medicare |
$8.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$12.18
|
| Rate for Payer: Local 1199SEIU Medicare |
$10.19
|
| Rate for Payer: MVP Health Care of NY Commercial |
$16.61
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$12.47
|
| Rate for Payer: MVP Health Care of NY Medicare |
$8.61
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$8.25
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$4.90
|
| Rate for Payer: United Healthcare Commercial |
$8.25
|
| Rate for Payer: United Healthcare Medicare |
$8.20
|
| Rate for Payer: WellCare Medicare |
$12.18
|
|
|
cefPODOXime 200 MG TABLET 200 mg, 20 eaches
|
Facility
|
OP
|
$38.00
|
|
|
Service Code
|
NDC 00781543920
|
| Hospital Charge Code |
4401521
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.92 |
| Max. Negotiated Rate |
$30.59 |
| Rate for Payer: Aetna of NY Commercial |
$26.60
|
| Rate for Payer: Aetna of NY Medicare |
$17.48
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$28.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$28.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$14.06
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$19.00
|
| Rate for Payer: Cash Price |
$28.50
|
| Rate for Payer: CDPHP Commercial |
$30.59
|
| Rate for Payer: CDPHP Medicare |
$14.06
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$30.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$30.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$30.40
|
| Rate for Payer: EmblemHealth Medicaid |
$30.40
|
| Rate for Payer: EmblemHealth Medicare |
$12.92
|
| Rate for Payer: EmblemHealth Select Care |
$27.36
|
| Rate for Payer: Fidelis Medicare |
$14.48
|
| Rate for Payer: Galaxy Health Commercial |
$24.70
|
| Rate for Payer: Hamaspik Choice Medicare |
$14.06
|
| Rate for Payer: Humana Medicare |
$14.06
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$26.60
|
| Rate for Payer: Local 1199SEIU Medicare |
$17.48
|
| Rate for Payer: MVP Health Care of NY Commercial |
$28.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$21.39
|
| Rate for Payer: MVP Health Care of NY Medicare |
$14.76
|
| Rate for Payer: United Healthcare Medicare |
$14.06
|
| Rate for Payer: WellCare Medicare |
$20.90
|
|
|
cefPODOXime 200 MG TABLET 200 mg, 20 eaches
|
Facility
|
IP
|
$38.00
|
|
|
Service Code
|
NDC 00781543920
|
| Hospital Charge Code |
4401521
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$20.90 |
| Max. Negotiated Rate |
$24.70 |
| Rate for Payer: Cash Price |
$28.50
|
| Rate for Payer: Galaxy Health Commercial |
$24.70
|
| Rate for Payer: WellCare Medicare |
$20.90
|
|
|
CEFTAROLINE FOSAMIL INJ 10 MG
|
Facility
|
IP
|
$11.00
|
|
|
Service Code
|
HCPCS J0712
|
| Hospital Charge Code |
4409105
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.86 |
| Max. Negotiated Rate |
$7.15 |
| Rate for Payer: Aetna of NY Commercial |
$6.05
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$3.86
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$3.86
|
| Rate for Payer: Cash Price |
$8.25
|
| Rate for Payer: Cash Price |
$8.25
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$3.86
|
| Rate for Payer: EmblemHealth Select Care |
$3.86
|
| Rate for Payer: Galaxy Health Commercial |
$7.15
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$6.05
|
| Rate for Payer: WellCare Medicare |
$6.05
|
|
|
CEFTAROLINE FOSAMIL INJ 10 MG
|
Facility
|
OP
|
$11.00
|
|
|
Service Code
|
HCPCS J0712
|
| Hospital Charge Code |
4409105
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.74 |
| Max. Negotiated Rate |
$8.86 |
| Rate for Payer: Aetna of NY Commercial |
$6.05
|
| Rate for Payer: Aetna of NY Medicare |
$5.06
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$3.86
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$3.86
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$4.07
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$5.50
|
| Rate for Payer: Cash Price |
$8.25
|
| Rate for Payer: Cash Price |
$8.25
|
| Rate for Payer: CDPHP Commercial |
$8.86
|
| Rate for Payer: CDPHP Medicare |
$4.07
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$3.86
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$8.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$8.80
|
| Rate for Payer: EmblemHealth Medicaid |
$8.80
|
| Rate for Payer: EmblemHealth Medicare |
$3.74
|
| Rate for Payer: EmblemHealth Select Care |
$3.86
|
| Rate for Payer: Fidelis Medicare |
$4.19
|
| Rate for Payer: Galaxy Health Commercial |
$7.15
|
| Rate for Payer: Hamaspik Choice Medicare |
$4.07
|
| Rate for Payer: Humana Medicare |
$4.07
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$6.05
|
| Rate for Payer: Local 1199SEIU Medicare |
$5.06
|
| Rate for Payer: MVP Health Care of NY Commercial |
$8.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$6.19
|
| Rate for Payer: MVP Health Care of NY Medicare |
$4.27
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$6.42
|
| Rate for Payer: United Healthcare Commercial |
$6.42
|
| Rate for Payer: United Healthcare Medicare |
$4.07
|
| Rate for Payer: WellCare Medicare |
$6.05
|
|
|
cefTAZidime 2 GM VIAL 2 g, 1 each
|
Facility
|
IP
|
$10.00
|
|
|
Service Code
|
HCPCS J0713
|
| Hospital Charge Code |
4401401
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.66 |
| Max. Negotiated Rate |
$6.50 |
| Rate for Payer: Aetna of NY Commercial |
$5.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1.66
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1.66
|
| Rate for Payer: Cash Price |
$7.50
|
| Rate for Payer: Cash Price |
$7.50
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1.66
|
| Rate for Payer: EmblemHealth Select Care |
$1.66
|
| Rate for Payer: Galaxy Health Commercial |
$6.50
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$5.50
|
| Rate for Payer: WellCare Medicare |
$5.50
|
|
|
cefTAZidime 2 GM VIAL 2 g, 1 each
|
Facility
|
OP
|
$10.00
|
|
|
Service Code
|
HCPCS J0713
|
| Hospital Charge Code |
4401401
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.66 |
| Max. Negotiated Rate |
$8.05 |
| Rate for Payer: Aetna of NY Commercial |
$5.50
|
| Rate for Payer: Aetna of NY Medicare |
$4.60
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1.66
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1.66
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$3.70
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$5.00
|
| Rate for Payer: Cash Price |
$7.50
|
| Rate for Payer: Cash Price |
$7.50
|
| Rate for Payer: CDPHP Commercial |
$8.05
|
| Rate for Payer: CDPHP Medicare |
$3.70
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1.66
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$8.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$8.00
|
| Rate for Payer: EmblemHealth Medicaid |
$8.00
|
| Rate for Payer: EmblemHealth Medicare |
$3.40
|
| Rate for Payer: EmblemHealth Select Care |
$1.66
|
| Rate for Payer: Fidelis Medicare |
$3.81
|
| Rate for Payer: Galaxy Health Commercial |
$6.50
|
| Rate for Payer: Hamaspik Choice Medicare |
$3.70
|
| Rate for Payer: Humana Medicare |
$3.70
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$5.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$4.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$7.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$5.63
|
| Rate for Payer: MVP Health Care of NY Medicare |
$3.88
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$3.04
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1.66
|
| Rate for Payer: United Healthcare Commercial |
$3.04
|
| Rate for Payer: United Healthcare Medicare |
$3.70
|
| Rate for Payer: WellCare Medicare |
$5.50
|
|
|
cefTRIAXone 2 GM-D5W BAG, 1 each
|
Facility
|
OP
|
$7.50
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
4401305
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$6.04 |
| Rate for Payer: Aetna of NY Commercial |
$4.12
|
| Rate for Payer: Aetna of NY Medicare |
$3.45
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$0.45
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$0.45
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2.78
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$3.75
|
| Rate for Payer: Cash Price |
$5.63
|
| Rate for Payer: Cash Price |
$5.63
|
| Rate for Payer: CDPHP Commercial |
$6.04
|
| Rate for Payer: CDPHP Medicare |
$2.78
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.45
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$6.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$6.00
|
| Rate for Payer: EmblemHealth Medicaid |
$6.00
|
| Rate for Payer: EmblemHealth Medicare |
$2.55
|
| Rate for Payer: EmblemHealth Select Care |
$0.45
|
| Rate for Payer: Fidelis Medicare |
$2.86
|
| Rate for Payer: Galaxy Health Commercial |
$4.88
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.78
|
| Rate for Payer: Humana Medicare |
$2.78
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$4.12
|
| Rate for Payer: Local 1199SEIU Medicare |
$3.45
|
| Rate for Payer: MVP Health Care of NY Commercial |
$5.62
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$4.22
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2.91
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$0.94
|
| Rate for Payer: United Healthcare Commercial |
$0.94
|
| Rate for Payer: United Healthcare Medicare |
$2.78
|
| Rate for Payer: WellCare Medicare |
$4.12
|
|
|
cefTRIAXone 2 GM-D5W BAG, 1 each
|
Facility
|
IP
|
$7.50
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
4401305
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$4.88 |
| Rate for Payer: Aetna of NY Commercial |
$4.12
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$0.45
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$0.45
|
| Rate for Payer: Cash Price |
$5.63
|
| Rate for Payer: Cash Price |
$5.63
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.45
|
| Rate for Payer: EmblemHealth Select Care |
$0.45
|
| Rate for Payer: Galaxy Health Commercial |
$4.88
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$4.12
|
| Rate for Payer: WellCare Medicare |
$4.12
|
|
|
CEFTRIAXONE SODIUM
|
Facility
|
IP
|
$3.00
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
4400147
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$1.95 |
| Rate for Payer: Aetna of NY Commercial |
$1.65
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$0.45
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$0.45
|
| Rate for Payer: Cash Price |
$2.25
|
| Rate for Payer: Cash Price |
$2.25
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.45
|
| Rate for Payer: EmblemHealth Select Care |
$0.45
|
| Rate for Payer: Galaxy Health Commercial |
$1.95
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1.65
|
| Rate for Payer: WellCare Medicare |
$1.65
|
|
|
CEFTRIAXONE SODIUM
|
Facility
|
OP
|
$3.00
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
4400147
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$2.42 |
| Rate for Payer: Aetna of NY Commercial |
$1.65
|
| Rate for Payer: Aetna of NY Medicare |
$1.38
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$0.45
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$0.45
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1.11
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$1.50
|
| Rate for Payer: Cash Price |
$2.25
|
| Rate for Payer: Cash Price |
$2.25
|
| Rate for Payer: CDPHP Commercial |
$2.42
|
| Rate for Payer: CDPHP Medicare |
$1.11
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.45
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$2.40
|
| Rate for Payer: EmblemHealth Medicaid |
$2.40
|
| Rate for Payer: EmblemHealth Medicare |
$1.02
|
| Rate for Payer: EmblemHealth Select Care |
$0.45
|
| Rate for Payer: Fidelis Medicare |
$1.14
|
| Rate for Payer: Galaxy Health Commercial |
$1.95
|
| Rate for Payer: Hamaspik Choice Medicare |
$1.11
|
| Rate for Payer: Humana Medicare |
$1.11
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1.65
|
| Rate for Payer: Local 1199SEIU Medicare |
$1.38
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1.69
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1.17
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$0.94
|
| Rate for Payer: United Healthcare Commercial |
$0.94
|
| Rate for Payer: United Healthcare Medicare |
$1.11
|
| Rate for Payer: WellCare Medicare |
$1.65
|
|
|
CEFTRIAXONE SODIUM, PER 250 MG
|
Facility
|
IP
|
$3.49
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
4400146
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$2.27 |
| Rate for Payer: Aetna of NY Commercial |
$1.92
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$0.45
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$0.45
|
| Rate for Payer: Cash Price |
$2.62
|
| Rate for Payer: Cash Price |
$2.62
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.45
|
| Rate for Payer: EmblemHealth Select Care |
$0.45
|
| Rate for Payer: Galaxy Health Commercial |
$2.27
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1.92
|
| Rate for Payer: WellCare Medicare |
$1.92
|
|
|
CEFTRIAXONE SODIUM, PER 250 MG
|
Facility
|
OP
|
$3.09
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
4408961
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.45 |
| 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 |
$0.45
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$0.45
|
| 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 |
$0.45
|
| 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 |
$0.45
|
| 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 |
$0.94
|
| Rate for Payer: United Healthcare Commercial |
$0.94
|
| Rate for Payer: United Healthcare Medicare |
$1.14
|
| Rate for Payer: WellCare Medicare |
$1.70
|
|
|
CEFTRIAXONE SODIUM, PER 250 MG
|
Facility
|
IP
|
$3.09
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
4408961
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.45 |
| 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 |
$0.45
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$0.45
|
| Rate for Payer: Cash Price |
$2.32
|
| Rate for Payer: Cash Price |
$2.32
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.45
|
| Rate for Payer: EmblemHealth Select Care |
$0.45
|
| 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
|
|
|
CEFTRIAXONE SODIUM, PER 250 MG
|
Facility
|
OP
|
$3.49
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
4400146
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$2.81 |
| Rate for Payer: Aetna of NY Commercial |
$1.92
|
| Rate for Payer: Aetna of NY Medicare |
$1.61
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$0.45
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$0.45
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1.29
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$1.74
|
| Rate for Payer: Cash Price |
$2.62
|
| Rate for Payer: Cash Price |
$2.62
|
| Rate for Payer: CDPHP Commercial |
$2.81
|
| Rate for Payer: CDPHP Medicare |
$1.29
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.45
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2.79
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$2.79
|
| Rate for Payer: EmblemHealth Medicaid |
$2.79
|
| Rate for Payer: EmblemHealth Medicare |
$1.19
|
| Rate for Payer: EmblemHealth Select Care |
$0.45
|
| Rate for Payer: Fidelis Medicare |
$1.33
|
| Rate for Payer: Galaxy Health Commercial |
$2.27
|
| Rate for Payer: Hamaspik Choice Medicare |
$1.29
|
| Rate for Payer: Humana Medicare |
$1.29
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1.92
|
| Rate for Payer: Local 1199SEIU Medicare |
$1.61
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2.62
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1.96
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1.36
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$0.94
|
| Rate for Payer: United Healthcare Commercial |
$0.94
|
| Rate for Payer: United Healthcare Medicare |
$1.29
|
| Rate for Payer: WellCare Medicare |
$1.92
|
|
