|
CEFTRIAXONE SODIUM, Per 50 ml
|
Facility
|
OP
|
$10.75
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
4401248
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$8.65 |
| Rate for Payer: Aetna of NY Commercial |
$5.91
|
| Rate for Payer: Aetna of NY Medicare |
$4.94
|
| 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 |
$3.98
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$5.38
|
| Rate for Payer: Cash Price |
$8.06
|
| Rate for Payer: Cash Price |
$8.06
|
| Rate for Payer: CDPHP Commercial |
$8.65
|
| Rate for Payer: CDPHP Medicare |
$3.98
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.45
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$8.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$8.60
|
| Rate for Payer: EmblemHealth Medicaid |
$8.60
|
| Rate for Payer: EmblemHealth Medicare |
$3.66
|
| Rate for Payer: EmblemHealth Select Care |
$0.45
|
| Rate for Payer: Fidelis Medicare |
$4.10
|
| Rate for Payer: Galaxy Health Commercial |
$6.99
|
| Rate for Payer: Hamaspik Choice Medicare |
$3.98
|
| Rate for Payer: Humana Medicare |
$3.98
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$5.91
|
| Rate for Payer: Local 1199SEIU Medicare |
$4.94
|
| Rate for Payer: MVP Health Care of NY Commercial |
$8.06
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$6.05
|
| Rate for Payer: MVP Health Care of NY Medicare |
$4.18
|
| 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 |
$3.98
|
| Rate for Payer: WellCare Medicare |
$5.91
|
|
|
CEFTRIAXONE SODIUM, Per 50 ml
|
Facility
|
IP
|
$10.75
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
4401248
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$6.99 |
| Rate for Payer: Aetna of NY Commercial |
$5.91
|
| 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 |
$8.06
|
| Rate for Payer: Cash Price |
$8.06
|
| 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 |
$6.99
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$5.91
|
| Rate for Payer: WellCare Medicare |
$5.91
|
|
|
CEFUROXIME 250 MG TABLET
|
Facility
|
OP
|
$12.50
|
|
|
Service Code
|
NDC 65862069920
|
| Hospital Charge Code |
4401292
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.25 |
| Max. Negotiated Rate |
$10.06 |
| Rate for Payer: Aetna of NY Commercial |
$8.75
|
| Rate for Payer: Aetna of NY Medicare |
$5.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$9.38
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$9.38
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$4.62
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$6.25
|
| Rate for Payer: Cash Price |
$9.38
|
| Rate for Payer: CDPHP Commercial |
$10.06
|
| Rate for Payer: CDPHP Medicare |
$4.62
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$10.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$10.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$10.00
|
| Rate for Payer: EmblemHealth Medicaid |
$10.00
|
| Rate for Payer: EmblemHealth Medicare |
$4.25
|
| Rate for Payer: EmblemHealth Select Care |
$9.00
|
| Rate for Payer: Fidelis Medicare |
$4.76
|
| Rate for Payer: Galaxy Health Commercial |
$8.12
|
| Rate for Payer: Hamaspik Choice Medicare |
$4.62
|
| Rate for Payer: Humana Medicare |
$4.62
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$8.75
|
| Rate for Payer: Local 1199SEIU Medicare |
$5.75
|
| Rate for Payer: MVP Health Care of NY Commercial |
$9.38
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$7.04
|
| Rate for Payer: MVP Health Care of NY Medicare |
$4.86
|
| Rate for Payer: United Healthcare Medicare |
$4.62
|
| Rate for Payer: WellCare Medicare |
$6.88
|
|
|
CEFUROXIME 250 MG TABLET
|
Facility
|
IP
|
$12.50
|
|
|
Service Code
|
NDC 65862069920
|
| Hospital Charge Code |
4401292
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.88 |
| Max. Negotiated Rate |
$8.12 |
| Rate for Payer: Cash Price |
$9.38
|
| Rate for Payer: Galaxy Health Commercial |
$8.12
|
| Rate for Payer: WellCare Medicare |
$6.88
|
|
|
CEFUROXIME AXETIL 500MG TABS 60 EA
|
Facility
|
OP
|
$24.72
|
|
|
Service Code
|
NDC 68180030360
|
| Hospital Charge Code |
4400148
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.40 |
| Max. Negotiated Rate |
$19.90 |
| Rate for Payer: Aetna of NY Commercial |
$17.30
|
| Rate for Payer: Aetna of NY Medicare |
$11.37
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$18.54
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$18.54
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$9.15
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$12.36
|
| Rate for Payer: Cash Price |
$18.54
|
| Rate for Payer: CDPHP Commercial |
$19.90
|
| Rate for Payer: CDPHP Medicare |
$9.15
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$19.78
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$19.78
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$19.78
|
| Rate for Payer: EmblemHealth Medicaid |
$19.78
|
| Rate for Payer: EmblemHealth Medicare |
$8.40
|
| Rate for Payer: EmblemHealth Select Care |
$17.80
|
| Rate for Payer: Fidelis Medicare |
$9.42
|
| Rate for Payer: Galaxy Health Commercial |
$16.07
|
| Rate for Payer: Hamaspik Choice Medicare |
$9.15
|
| Rate for Payer: Humana Medicare |
$9.15
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$17.30
|
| Rate for Payer: Local 1199SEIU Medicare |
$11.37
|
| Rate for Payer: MVP Health Care of NY Commercial |
$18.54
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$13.92
|
| Rate for Payer: MVP Health Care of NY Medicare |
$9.60
|
| Rate for Payer: United Healthcare Medicare |
$9.15
|
| Rate for Payer: WellCare Medicare |
$13.60
|
|
|
CEFUROXIME AXETIL 500MG TABS 60 EA
|
Facility
|
IP
|
$24.72
|
|
|
Service Code
|
NDC 68180030360
|
| Hospital Charge Code |
4400148
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.60 |
| Max. Negotiated Rate |
$16.07 |
| Rate for Payer: Cash Price |
$18.54
|
| Rate for Payer: Galaxy Health Commercial |
$16.07
|
| Rate for Payer: WellCare Medicare |
$13.60
|
|
|
CELECOXIB 100MG CAPS 100 EA
|
Facility
|
IP
|
$22.66
|
|
|
Service Code
|
NDC 00904650261
|
| Hospital Charge Code |
4400150
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.46 |
| Max. Negotiated Rate |
$14.73 |
| Rate for Payer: Cash Price |
$17.00
|
| Rate for Payer: Galaxy Health Commercial |
$14.73
|
| Rate for Payer: WellCare Medicare |
$12.46
|
|
|
CELECOXIB 100MG CAPS 100 EA
|
Facility
|
OP
|
$22.66
|
|
|
Service Code
|
NDC 00904650261
|
| Hospital Charge Code |
4400150
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.70 |
| Max. Negotiated Rate |
$18.24 |
| Rate for Payer: Aetna of NY Commercial |
$15.86
|
| Rate for Payer: Aetna of NY Medicare |
$10.42
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$17.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$17.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$8.38
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$11.33
|
| Rate for Payer: Cash Price |
$17.00
|
| Rate for Payer: CDPHP Commercial |
$18.24
|
| Rate for Payer: CDPHP Medicare |
$8.38
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$18.13
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$18.13
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$18.13
|
| Rate for Payer: EmblemHealth Medicaid |
$18.13
|
| Rate for Payer: EmblemHealth Medicare |
$7.70
|
| Rate for Payer: EmblemHealth Select Care |
$16.32
|
| Rate for Payer: Fidelis Medicare |
$8.64
|
| Rate for Payer: Galaxy Health Commercial |
$14.73
|
| Rate for Payer: Hamaspik Choice Medicare |
$8.38
|
| Rate for Payer: Humana Medicare |
$8.38
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$15.86
|
| Rate for Payer: Local 1199SEIU Medicare |
$10.42
|
| Rate for Payer: MVP Health Care of NY Commercial |
$17.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$12.76
|
| Rate for Payer: MVP Health Care of NY Medicare |
$8.80
|
| Rate for Payer: United Healthcare Medicare |
$8.38
|
| Rate for Payer: WellCare Medicare |
$12.46
|
|
|
CELERO HANDPIECES / CELERO-12
|
Facility
|
IP
|
$449.00
|
|
| Hospital Charge Code |
4473013
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$291.85 |
| Max. Negotiated Rate |
$291.85 |
| Rate for Payer: Cash Price |
$336.75
|
| Rate for Payer: Galaxy Health Commercial |
$291.85
|
|
|
CELERO HANDPIECES / CELERO-12
|
Facility
|
OP
|
$449.00
|
|
| Hospital Charge Code |
4473013
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$152.66 |
| Max. Negotiated Rate |
$361.44 |
| Rate for Payer: Aetna of NY Commercial |
$314.30
|
| Rate for Payer: Aetna of NY Medicare |
$206.54
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$336.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$336.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$166.13
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$224.50
|
| Rate for Payer: Cash Price |
$336.75
|
| Rate for Payer: CDPHP Commercial |
$361.44
|
| Rate for Payer: CDPHP Medicare |
$166.13
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$359.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$359.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$359.20
|
| Rate for Payer: EmblemHealth Medicaid |
$359.20
|
| Rate for Payer: EmblemHealth Medicare |
$152.66
|
| Rate for Payer: EmblemHealth Select Care |
$323.28
|
| Rate for Payer: Fidelis Medicare |
$171.11
|
| Rate for Payer: Galaxy Health Commercial |
$291.85
|
| Rate for Payer: Hamaspik Choice Medicare |
$166.13
|
| Rate for Payer: Humana Medicare |
$166.13
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$314.30
|
| Rate for Payer: Local 1199SEIU Medicare |
$206.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$336.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$252.79
|
| Rate for Payer: MVP Health Care of NY Medicare |
$174.44
|
| Rate for Payer: United Healthcare Medicare |
$166.13
|
| Rate for Payer: WellCare Medicare |
$246.95
|
|
|
CELERO INTRO-12 / INTRODUCER
|
Facility
|
OP
|
$42.00
|
|
| Hospital Charge Code |
4473014
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.28 |
| Max. Negotiated Rate |
$33.81 |
| Rate for Payer: Aetna of NY Commercial |
$29.40
|
| Rate for Payer: Aetna of NY Medicare |
$19.32
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$31.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$31.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$15.54
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$21.00
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: CDPHP Commercial |
$33.81
|
| Rate for Payer: CDPHP Medicare |
$15.54
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$33.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$33.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$33.60
|
| Rate for Payer: EmblemHealth Medicaid |
$33.60
|
| Rate for Payer: EmblemHealth Medicare |
$14.28
|
| Rate for Payer: EmblemHealth Select Care |
$30.24
|
| Rate for Payer: Fidelis Medicare |
$16.01
|
| Rate for Payer: Galaxy Health Commercial |
$27.30
|
| Rate for Payer: Hamaspik Choice Medicare |
$15.54
|
| Rate for Payer: Humana Medicare |
$15.54
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$29.40
|
| Rate for Payer: Local 1199SEIU Medicare |
$19.32
|
| Rate for Payer: MVP Health Care of NY Commercial |
$31.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$23.65
|
| Rate for Payer: MVP Health Care of NY Medicare |
$16.32
|
| Rate for Payer: United Healthcare Medicare |
$15.54
|
| Rate for Payer: WellCare Medicare |
$23.10
|
|
|
CELERO INTRO-12 / INTRODUCER
|
Facility
|
IP
|
$42.00
|
|
| Hospital Charge Code |
4473014
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$27.30 |
| Max. Negotiated Rate |
$27.30 |
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Galaxy Health Commercial |
$27.30
|
|
|
CELERO SECURMARK
|
Facility
|
IP
|
$224.00
|
|
| Hospital Charge Code |
4473016
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$145.60 |
| Max. Negotiated Rate |
$145.60 |
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Galaxy Health Commercial |
$145.60
|
|
|
CELERO SECURMARK
|
Facility
|
OP
|
$224.00
|
|
| Hospital Charge Code |
4473016
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$76.16 |
| Max. Negotiated Rate |
$180.32 |
| Rate for Payer: Aetna of NY Commercial |
$156.80
|
| Rate for Payer: Aetna of NY Medicare |
$103.04
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$168.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$168.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$82.88
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$112.00
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: CDPHP Commercial |
$180.32
|
| Rate for Payer: CDPHP Medicare |
$82.88
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$179.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$179.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$179.20
|
| Rate for Payer: EmblemHealth Medicaid |
$179.20
|
| Rate for Payer: EmblemHealth Medicare |
$76.16
|
| Rate for Payer: EmblemHealth Select Care |
$161.28
|
| Rate for Payer: Fidelis Medicare |
$85.37
|
| Rate for Payer: Galaxy Health Commercial |
$145.60
|
| Rate for Payer: Hamaspik Choice Medicare |
$82.88
|
| Rate for Payer: Humana Medicare |
$82.88
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$156.80
|
| Rate for Payer: Local 1199SEIU Medicare |
$103.04
|
| Rate for Payer: MVP Health Care of NY Commercial |
$168.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$126.11
|
| Rate for Payer: MVP Health Care of NY Medicare |
$87.02
|
| Rate for Payer: United Healthcare Medicare |
$82.88
|
| Rate for Payer: WellCare Medicare |
$123.20
|
|
|
CEPACOL 3 MG
|
Facility
|
OP
|
$6.00
|
|
| Hospital Charge Code |
4401235
|
|
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
|
|
|
CEPACOL 3 MG
|
Facility
|
IP
|
$6.00
|
|
| Hospital Charge Code |
4401235
|
|
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
|
|
|
CEPHALEXIN MONOHYDRATE 250MG/5ML POSR 10
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 00093417773
|
| Hospital Charge Code |
4400154
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.10 |
| Max. Negotiated Rate |
$4.97 |
| Rate for Payer: Aetna of NY Commercial |
$4.33
|
| Rate for Payer: Aetna of NY Medicare |
$2.84
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$4.64
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$4.64
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2.29
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$3.09
|
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: CDPHP Commercial |
$4.97
|
| Rate for Payer: CDPHP Medicare |
$2.29
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$4.94
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$4.94
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$4.94
|
| Rate for Payer: EmblemHealth Medicaid |
$4.94
|
| Rate for Payer: EmblemHealth Medicare |
$2.10
|
| Rate for Payer: EmblemHealth Select Care |
$4.45
|
| Rate for Payer: Fidelis Medicare |
$2.36
|
| Rate for Payer: Galaxy Health Commercial |
$4.02
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.29
|
| Rate for Payer: Humana Medicare |
$2.29
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$4.33
|
| Rate for Payer: Local 1199SEIU Medicare |
$2.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4.64
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3.48
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2.40
|
| Rate for Payer: United Healthcare Medicare |
$2.29
|
| Rate for Payer: WellCare Medicare |
$3.40
|
|
|
CEPHALEXIN MONOHYDRATE 250MG/5ML POSR 10
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
NDC 00093417773
|
| Hospital Charge Code |
4400154
|
|
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
|
|
|
CEPHALEXIN MONOHYDRATE 250MG CAPS 100 EA
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
NDC 00093314501
|
| Hospital Charge Code |
4400153
|
|
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
|
|
|
CEPHALEXIN MONOHYDRATE 250MG CAPS 100 EA
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 00093314501
|
| Hospital Charge Code |
4400153
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.10 |
| Max. Negotiated Rate |
$4.97 |
| Rate for Payer: Aetna of NY Commercial |
$4.33
|
| Rate for Payer: Aetna of NY Medicare |
$2.84
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$4.64
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$4.64
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2.29
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$3.09
|
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: CDPHP Commercial |
$4.97
|
| Rate for Payer: CDPHP Medicare |
$2.29
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$4.94
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$4.94
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$4.94
|
| Rate for Payer: EmblemHealth Medicaid |
$4.94
|
| Rate for Payer: EmblemHealth Medicare |
$2.10
|
| Rate for Payer: EmblemHealth Select Care |
$4.45
|
| Rate for Payer: Fidelis Medicare |
$2.36
|
| Rate for Payer: Galaxy Health Commercial |
$4.02
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.29
|
| Rate for Payer: Humana Medicare |
$2.29
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$4.33
|
| Rate for Payer: Local 1199SEIU Medicare |
$2.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4.64
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3.48
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2.40
|
| Rate for Payer: United Healthcare Medicare |
$2.29
|
| Rate for Payer: WellCare Medicare |
$3.40
|
|
|
CEPHALEXIN MONOHYDRATE 500MG CAPS 100 EA
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 50268015215
|
| Hospital Charge Code |
4400155
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.10 |
| Max. Negotiated Rate |
$4.97 |
| Rate for Payer: Aetna of NY Commercial |
$4.33
|
| Rate for Payer: Aetna of NY Medicare |
$2.84
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$4.64
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$4.64
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2.29
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$3.09
|
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: CDPHP Commercial |
$4.97
|
| Rate for Payer: CDPHP Medicare |
$2.29
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$4.94
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$4.94
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$4.94
|
| Rate for Payer: EmblemHealth Medicaid |
$4.94
|
| Rate for Payer: EmblemHealth Medicare |
$2.10
|
| Rate for Payer: EmblemHealth Select Care |
$4.45
|
| Rate for Payer: Fidelis Medicare |
$2.36
|
| Rate for Payer: Galaxy Health Commercial |
$4.02
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.29
|
| Rate for Payer: Humana Medicare |
$2.29
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$4.33
|
| Rate for Payer: Local 1199SEIU Medicare |
$2.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4.64
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3.48
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2.40
|
| Rate for Payer: United Healthcare Medicare |
$2.29
|
| Rate for Payer: WellCare Medicare |
$3.40
|
|
|
CEPHALEXIN MONOHYDRATE 500MG CAPS 100 EA
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
NDC 50268015215
|
| Hospital Charge Code |
4400155
|
|
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
|
|
|
CERVICOLL KIT CEK-17-50-2
|
Facility
|
IP
|
$3,040.00
|
|
| Hospital Charge Code |
4479256
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,976.00 |
| Max. Negotiated Rate |
$1,976.00 |
| Rate for Payer: Cash Price |
$2,280.00
|
| Rate for Payer: Galaxy Health Commercial |
$1,976.00
|
|
|
CERVICOLL KIT CEK-17-50-2
|
Facility
|
OP
|
$3,040.00
|
|
| Hospital Charge Code |
4479256
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,033.60 |
| Max. Negotiated Rate |
$2,447.20 |
| Rate for Payer: Aetna of NY Commercial |
$2,128.00
|
| Rate for Payer: Aetna of NY Medicare |
$1,398.40
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$2,280.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$2,280.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1,124.80
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$1,520.00
|
| Rate for Payer: Cash Price |
$2,280.00
|
| Rate for Payer: CDPHP Commercial |
$2,447.20
|
| Rate for Payer: CDPHP Medicare |
$1,124.80
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$2,432.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2,432.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$2,432.00
|
| Rate for Payer: EmblemHealth Medicaid |
$2,432.00
|
| Rate for Payer: EmblemHealth Medicare |
$1,033.60
|
| Rate for Payer: EmblemHealth Select Care |
$2,188.80
|
| Rate for Payer: Fidelis Medicare |
$1,158.54
|
| Rate for Payer: Galaxy Health Commercial |
$1,976.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,124.80
|
| Rate for Payer: Humana Medicare |
$1,124.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$2,128.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,398.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,280.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1,711.52
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1,181.04
|
| Rate for Payer: United Healthcare Medicare |
$1,124.80
|
| Rate for Payer: WellCare Medicare |
$1,672.00
|
|
|
CERVICOLL KIT CEK-17-75-2
|
Facility
|
OP
|
$3,040.00
|
|
| Hospital Charge Code |
4479190
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,033.60 |
| Max. Negotiated Rate |
$2,447.20 |
| Rate for Payer: Aetna of NY Commercial |
$2,128.00
|
| Rate for Payer: Aetna of NY Medicare |
$1,398.40
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$2,280.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$2,280.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1,124.80
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$1,520.00
|
| Rate for Payer: Cash Price |
$2,280.00
|
| Rate for Payer: CDPHP Commercial |
$2,447.20
|
| Rate for Payer: CDPHP Medicare |
$1,124.80
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$2,432.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2,432.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$2,432.00
|
| Rate for Payer: EmblemHealth Medicaid |
$2,432.00
|
| Rate for Payer: EmblemHealth Medicare |
$1,033.60
|
| Rate for Payer: EmblemHealth Select Care |
$2,188.80
|
| Rate for Payer: Fidelis Medicare |
$1,158.54
|
| Rate for Payer: Galaxy Health Commercial |
$1,976.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,124.80
|
| Rate for Payer: Humana Medicare |
$1,124.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$2,128.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,398.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,280.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1,711.52
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1,181.04
|
| Rate for Payer: United Healthcare Medicare |
$1,124.80
|
| Rate for Payer: WellCare Medicare |
$1,672.00
|
|
