|
CBC WITH DIFF (AUTO)
|
Facility
|
OP
|
$43.00
|
|
|
Service Code
|
HCPCS 85025
|
| Hospital Charge Code |
4300161
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$6.45 |
| Max. Negotiated Rate |
$34.40 |
| Rate for Payer: Aetna of NY Commercial |
$27.95
|
| Rate for Payer: Aetna of NY Medicare |
$19.78
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$17.20
|
| Rate for Payer: Cash Price |
$32.25
|
| Rate for Payer: CDPHP Medicare |
$15.91
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$25.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$34.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$34.40
|
| Rate for Payer: EmblemHealth Medicaid |
$34.40
|
| Rate for Payer: EmblemHealth Medicare |
$14.62
|
| Rate for Payer: EmblemHealth Select Care |
$25.80
|
| Rate for Payer: Fidelis Medicare |
$17.20
|
| Rate for Payer: Galaxy Health Commercial |
$27.95
|
| Rate for Payer: Hamaspik Choice Medicare |
$17.20
|
| Rate for Payer: Humana Medicare |
$17.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$27.95
|
| Rate for Payer: Local 1199SEIU Medicare |
$19.78
|
| Rate for Payer: MVP Health Care of NY Commercial |
$32.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$24.21
|
| Rate for Payer: MVP Health Care of NY Medicare |
$18.06
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$32.25
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$6.45
|
| Rate for Payer: United Healthcare Commercial |
$32.25
|
| Rate for Payer: United Healthcare Medicare |
$17.20
|
| Rate for Payer: WellCare Medicare |
$23.65
|
|
|
CBI CONT BLADDER IRRIG
|
Facility
|
IP
|
$766.00
|
|
|
Service Code
|
HCPCS 51700
|
| Hospital Charge Code |
4602143
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$497.90 |
| Max. Negotiated Rate |
$497.90 |
| Rate for Payer: Cash Price |
$574.50
|
| Rate for Payer: Galaxy Health Commercial |
$497.90
|
|
|
CBI CONT BLADDER IRRIG
|
Facility
|
OP
|
$766.00
|
|
|
Service Code
|
HCPCS 51700
|
| Hospital Charge Code |
4602143
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$114.90 |
| Max. Negotiated Rate |
$1,234.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,000.00
|
| Rate for Payer: Aetna of NY Medicare |
$352.36
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$306.40
|
| Rate for Payer: Cash Price |
$574.50
|
| Rate for Payer: Cash Price |
$574.50
|
| Rate for Payer: Cash Price |
$574.50
|
| Rate for Payer: CDPHP Medicare |
$283.42
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,206.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$612.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$612.80
|
| Rate for Payer: EmblemHealth Medicaid |
$612.80
|
| Rate for Payer: EmblemHealth Medicare |
$260.44
|
| Rate for Payer: EmblemHealth Select Care |
$1,085.00
|
| Rate for Payer: Fidelis Medicare |
$306.40
|
| Rate for Payer: Galaxy Health Commercial |
$497.90
|
| Rate for Payer: Hamaspik Choice Medicare |
$306.40
|
| Rate for Payer: Humana Medicare |
$306.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,000.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$352.36
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,234.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$925.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$321.72
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,009.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$114.90
|
| Rate for Payer: United Healthcare Commercial |
$1,009.00
|
| Rate for Payer: United Healthcare Medicare |
$306.40
|
| Rate for Payer: WellCare Medicare |
$421.30
|
|
|
CDC 2019 NOVEL CORONAVIRUS (2019-NCOV) REAL-TIME RT-PCR DIAGNOSTIC PANEL
|
Facility
|
IP
|
$108.00
|
|
|
Service Code
|
HCPCS U0001
|
| Hospital Charge Code |
4302019
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$70.20 |
| Max. Negotiated Rate |
$70.20 |
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Galaxy Health Commercial |
$70.20
|
|
|
CDC 2019 NOVEL CORONAVIRUS (2019-NCOV) REAL-TIME RT-PCR DIAGNOSTIC PANEL
|
Facility
|
OP
|
$108.00
|
|
|
Service Code
|
HCPCS U0001
|
| Hospital Charge Code |
4302019
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.20 |
| Max. Negotiated Rate |
$86.40 |
| Rate for Payer: Aetna of NY Commercial |
$70.20
|
| Rate for Payer: Aetna of NY Medicare |
$49.68
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$43.20
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: CDPHP Medicare |
$39.96
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$64.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$86.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$86.40
|
| Rate for Payer: EmblemHealth Medicaid |
$86.40
|
| Rate for Payer: EmblemHealth Medicare |
$36.72
|
| Rate for Payer: EmblemHealth Select Care |
$64.80
|
| Rate for Payer: Fidelis Medicare |
$43.20
|
| Rate for Payer: Galaxy Health Commercial |
$70.20
|
| Rate for Payer: Hamaspik Choice Medicare |
$43.20
|
| Rate for Payer: Humana Medicare |
$43.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$70.20
|
| Rate for Payer: Local 1199SEIU Medicare |
$49.68
|
| Rate for Payer: MVP Health Care of NY Commercial |
$81.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$60.80
|
| Rate for Payer: MVP Health Care of NY Medicare |
$45.36
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$81.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$16.20
|
| Rate for Payer: United Healthcare Commercial |
$81.00
|
| Rate for Payer: United Healthcare Medicare |
$43.20
|
| Rate for Payer: WellCare Medicare |
$59.40
|
|
|
C-DIFFICILE TOXIN
|
Facility
|
OP
|
$36.00
|
|
|
Service Code
|
HCPCS 87449
|
| Hospital Charge Code |
4300162
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$5.40 |
| Max. Negotiated Rate |
$28.80 |
| Rate for Payer: Aetna of NY Commercial |
$23.40
|
| Rate for Payer: Aetna of NY Medicare |
$16.56
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$14.40
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: CDPHP Medicare |
$13.32
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$21.60
|
| 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 |
$21.60
|
| Rate for Payer: Fidelis Medicare |
$14.40
|
| Rate for Payer: Galaxy Health Commercial |
$23.40
|
| Rate for Payer: Hamaspik Choice Medicare |
$14.40
|
| Rate for Payer: Humana Medicare |
$14.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$23.40
|
| 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 |
$15.12
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$27.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$5.40
|
| Rate for Payer: United Healthcare Commercial |
$27.00
|
| Rate for Payer: United Healthcare Medicare |
$14.40
|
| Rate for Payer: WellCare Medicare |
$19.80
|
|
|
C-DIFFICILE TOXIN
|
Facility
|
IP
|
$36.00
|
|
|
Service Code
|
HCPCS 87449
|
| Hospital Charge Code |
4300162
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$23.40 |
| Max. Negotiated Rate |
$23.40 |
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Galaxy Health Commercial |
$23.40
|
|
|
CEA
|
Facility
|
OP
|
$57.00
|
|
|
Service Code
|
HCPCS 82378
|
| Hospital Charge Code |
4300163
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.55 |
| Max. Negotiated Rate |
$45.60 |
| Rate for Payer: Aetna of NY Commercial |
$37.05
|
| Rate for Payer: Aetna of NY Medicare |
$26.22
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$22.80
|
| Rate for Payer: Cash Price |
$42.75
|
| Rate for Payer: CDPHP Medicare |
$21.09
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$34.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$45.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$45.60
|
| Rate for Payer: EmblemHealth Medicaid |
$45.60
|
| Rate for Payer: EmblemHealth Medicare |
$19.38
|
| Rate for Payer: EmblemHealth Select Care |
$34.20
|
| Rate for Payer: Fidelis Medicare |
$22.80
|
| Rate for Payer: Galaxy Health Commercial |
$37.05
|
| Rate for Payer: Hamaspik Choice Medicare |
$22.80
|
| Rate for Payer: Humana Medicare |
$22.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$37.05
|
| Rate for Payer: Local 1199SEIU Medicare |
$26.22
|
| Rate for Payer: MVP Health Care of NY Commercial |
$42.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$32.09
|
| Rate for Payer: MVP Health Care of NY Medicare |
$23.94
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$42.75
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$8.55
|
| Rate for Payer: United Healthcare Commercial |
$42.75
|
| Rate for Payer: United Healthcare Medicare |
$22.80
|
| Rate for Payer: WellCare Medicare |
$31.35
|
|
|
CEA
|
Facility
|
IP
|
$57.00
|
|
|
Service Code
|
HCPCS 82378
|
| Hospital Charge Code |
4300163
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$37.05 |
| Max. Negotiated Rate |
$37.05 |
| Rate for Payer: Cash Price |
$42.75
|
| Rate for Payer: Galaxy Health Commercial |
$37.05
|
|
|
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 |
$0.90 |
| Max. Negotiated Rate |
$4.80 |
| 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) Medicare |
$2.40
|
| Rate for Payer: Cash Price |
$4.50
|
| 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 |
$2.40
|
| Rate for Payer: Galaxy Health Commercial |
$3.90
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.40
|
| Rate for Payer: Humana Medicare |
$2.40
|
| 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 |
$2.52
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$0.90
|
| Rate for Payer: United Healthcare Medicare |
$2.40
|
| Rate for Payer: WellCare Medicare |
$3.30
|
|
|
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
|
|
|
CEFAZOLIN SODIUM INJECTION 500 MG
|
Facility
|
IP
|
$6.76
|
|
|
Service Code
|
NDC 264310511
|
| 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
|
IP
|
$3.09
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
4400140
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.85 |
| Max. Negotiated Rate |
$2.01 |
| Rate for Payer: Aetna of NY Commercial |
$1.70
|
| Rate for Payer: Cash Price |
$2.32
|
| Rate for Payer: Cash Price |
$2.32
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.85
|
| Rate for Payer: EmblemHealth Select Care |
$0.85
|
| 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 |
$0.85 |
| Max. Negotiated Rate |
$5.20 |
| Rate for Payer: Aetna of NY Commercial |
$4.40
|
| Rate for Payer: Cash Price |
$6.00
|
| Rate for Payer: Cash Price |
$6.00
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.85
|
| Rate for Payer: EmblemHealth Select Care |
$0.85
|
| 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
|
|
|
CEFAZOLIN SODIUM INJECTION 500 MG
|
Facility
|
OP
|
$8.00
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
4401249
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.85 |
| Max. Negotiated Rate |
$6.40 |
| Rate for Payer: Aetna of NY Medicare |
$3.68
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$3.20
|
| Rate for Payer: Cash Price |
$6.00
|
| Rate for Payer: Cash Price |
$6.00
|
| Rate for Payer: CDPHP Medicare |
$2.96
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.85
|
| 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 |
$0.85
|
| Rate for Payer: Fidelis Medicare |
$3.20
|
| Rate for Payer: Galaxy Health Commercial |
$5.20
|
| Rate for Payer: Hamaspik Choice Medicare |
$3.20
|
| Rate for Payer: Humana Medicare |
$3.20
|
| 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 |
$3.36
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1.44
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1.20
|
| Rate for Payer: United Healthcare Commercial |
$1.44
|
| Rate for Payer: United Healthcare Medicare |
$3.20
|
| 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 |
$0.46 |
| Max. Negotiated Rate |
$2.47 |
| Rate for Payer: Aetna of NY Medicare |
$1.42
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1.24
|
| Rate for Payer: Cash Price |
$2.32
|
| Rate for Payer: Cash Price |
$2.32
|
| Rate for Payer: CDPHP Medicare |
$1.14
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.85
|
| 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 |
$0.85
|
| Rate for Payer: Fidelis Medicare |
$1.24
|
| Rate for Payer: Galaxy Health Commercial |
$2.01
|
| Rate for Payer: Hamaspik Choice Medicare |
$1.24
|
| Rate for Payer: Humana Medicare |
$1.24
|
| 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 |
$1.30
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1.44
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$0.46
|
| Rate for Payer: United Healthcare Commercial |
$1.44
|
| Rate for Payer: United Healthcare Medicare |
$1.24
|
| Rate for Payer: WellCare Medicare |
$1.70
|
|
|
CEFAZOLIN SODIUM INJECTION 500 MG
|
Facility
|
OP
|
$6.76
|
|
|
Service Code
|
NDC 264310511
|
| Hospital Charge Code |
4409236
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.01 |
| Max. Negotiated Rate |
$5.41 |
| 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) Medicare |
$2.70
|
| Rate for Payer: Cash Price |
$5.07
|
| 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 |
$2.70
|
| Rate for Payer: Galaxy Health Commercial |
$4.39
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.70
|
| Rate for Payer: Humana Medicare |
$2.70
|
| 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 |
$2.84
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1.01
|
| Rate for Payer: United Healthcare Medicare |
$2.70
|
| Rate for Payer: WellCare Medicare |
$3.72
|
|
|
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 |
$22.95 |
| Max. Negotiated Rate |
$122.40 |
| 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) Medicare |
$61.20
|
| Rate for Payer: Cash Price |
$114.75
|
| 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 |
$61.20
|
| Rate for Payer: Galaxy Health Commercial |
$99.45
|
| Rate for Payer: Hamaspik Choice Medicare |
$61.20
|
| Rate for Payer: Humana Medicare |
$61.20
|
| 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 |
$64.26
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$22.95
|
| Rate for Payer: United Healthcare Medicare |
$61.20
|
| Rate for Payer: WellCare Medicare |
$84.15
|
|
|
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 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 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 |
$44.70 |
| Max. Negotiated Rate |
$238.40 |
| 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) Medicare |
$119.20
|
| Rate for Payer: Cash Price |
$223.50
|
| 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 |
$119.20
|
| Rate for Payer: Galaxy Health Commercial |
$193.70
|
| Rate for Payer: Hamaspik Choice Medicare |
$119.20
|
| Rate for Payer: Humana Medicare |
$119.20
|
| 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 |
$125.16
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$44.70
|
| Rate for Payer: United Healthcare Medicare |
$119.20
|
| Rate for Payer: WellCare Medicare |
$163.90
|
|
|
CEFDINIR 300MG CAPSULE
|
Facility
|
OP
|
$2.40
|
|
|
Service Code
|
NDC 65862017760
|
| Hospital Charge Code |
4400845
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$1.92 |
| 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) Medicare |
$0.96
|
| Rate for Payer: Cash Price |
$1.80
|
| 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 |
$0.96
|
| Rate for Payer: Galaxy Health Commercial |
$1.56
|
| Rate for Payer: Hamaspik Choice Medicare |
$0.96
|
| Rate for Payer: Humana Medicare |
$0.96
|
| 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 |
$1.01
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$0.36
|
| Rate for Payer: United Healthcare Medicare |
$0.96
|
| Rate for Payer: WellCare Medicare |
$1.32
|
|
|
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
|
|
|
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 |
$4.89 |
| Max. Negotiated Rate |
$23.40 |
| Rate for Payer: Aetna of NY Commercial |
$19.80
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$4.89
|
| Rate for Payer: EmblemHealth Select Care |
$4.89
|
| 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 |
$4.89 |
| Max. Negotiated Rate |
$28.80 |
| Rate for Payer: Aetna of NY Medicare |
$16.56
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$14.40
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: CDPHP Medicare |
$13.32
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$4.89
|
| 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 |
$4.89
|
| Rate for Payer: Fidelis Medicare |
$14.40
|
| Rate for Payer: Galaxy Health Commercial |
$23.40
|
| Rate for Payer: Hamaspik Choice Medicare |
$14.40
|
| Rate for Payer: Humana Medicare |
$14.40
|
| 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 |
$15.12
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$8.42
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$5.40
|
| Rate for Payer: United Healthcare Commercial |
$8.42
|
| Rate for Payer: United Healthcare Medicare |
$14.40
|
| Rate for Payer: WellCare Medicare |
$19.80
|
|
