|
LAYER CLOSURE-2.6 TO 7.5CM
|
Facility
|
OP
|
$1,141.00
|
|
|
Service Code
|
HCPCS 12032
|
| Hospital Charge Code |
4600122
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$250.00 |
| Max. Negotiated Rate |
$1,189.18 |
| Rate for Payer: Aetna of NY Commercial |
$955.00
|
| Rate for Payer: Aetna of NY Medicare |
$524.86
|
| 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 |
$422.17
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$570.50
|
| Rate for Payer: Cash Price |
$855.75
|
| Rate for Payer: Cash Price |
$855.75
|
| Rate for Payer: Cash Price |
$855.75
|
| Rate for Payer: Cash Price |
$855.75
|
| Rate for Payer: CDPHP Commercial |
$918.50
|
| Rate for Payer: CDPHP Medicare |
$422.17
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,182.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$912.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$912.80
|
| Rate for Payer: EmblemHealth Medicaid |
$912.80
|
| Rate for Payer: EmblemHealth Medicare |
$387.94
|
| 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 |
$434.84
|
| Rate for Payer: Galaxy Health Commercial |
$741.65
|
| Rate for Payer: Hamaspik Choice Medicare |
$422.17
|
| Rate for Payer: Humana Medicare |
$422.17
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$955.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$524.86
|
| 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 |
$443.28
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$980.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$379.92
|
| Rate for Payer: United Healthcare Commercial |
$980.00
|
| Rate for Payer: United Healthcare Medicare |
$422.17
|
| Rate for Payer: WellCare Medicare |
$627.55
|
|
|
LAYER CLOSURE-7.6 TO 12.5CM
|
Facility
|
OP
|
$1,141.00
|
|
|
Service Code
|
HCPCS 12034
|
| Hospital Charge Code |
4600128
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$250.00 |
| Max. Negotiated Rate |
$1,189.18 |
| Rate for Payer: Aetna of NY Commercial |
$955.00
|
| Rate for Payer: Aetna of NY Medicare |
$524.86
|
| 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 |
$422.17
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$570.50
|
| Rate for Payer: Cash Price |
$855.75
|
| Rate for Payer: Cash Price |
$855.75
|
| Rate for Payer: Cash Price |
$855.75
|
| Rate for Payer: Cash Price |
$855.75
|
| Rate for Payer: CDPHP Commercial |
$918.50
|
| Rate for Payer: CDPHP Medicare |
$422.17
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,182.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$912.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$912.80
|
| Rate for Payer: EmblemHealth Medicaid |
$912.80
|
| Rate for Payer: EmblemHealth Medicare |
$387.94
|
| 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 |
$434.84
|
| Rate for Payer: Galaxy Health Commercial |
$741.65
|
| Rate for Payer: Hamaspik Choice Medicare |
$422.17
|
| Rate for Payer: Humana Medicare |
$422.17
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$955.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$524.86
|
| 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 |
$443.28
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$980.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$379.92
|
| Rate for Payer: United Healthcare Commercial |
$980.00
|
| Rate for Payer: United Healthcare Medicare |
$422.17
|
| Rate for Payer: WellCare Medicare |
$627.55
|
|
|
LAYER CLOSURE-7.6 TO 12.5CM
|
Facility
|
IP
|
$1,141.00
|
|
|
Service Code
|
HCPCS 12034
|
| Hospital Charge Code |
4600128
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$741.65 |
| Max. Negotiated Rate |
$741.65 |
| Rate for Payer: Cash Price |
$855.75
|
| Rate for Payer: Galaxy Health Commercial |
$741.65
|
|
|
LDH
|
Facility
|
IP
|
$34.00
|
|
|
Service Code
|
HCPCS 83615
|
| Hospital Charge Code |
4300514
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$22.10 |
| Max. Negotiated Rate |
$22.10 |
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Galaxy Health Commercial |
$22.10
|
|
|
LDH
|
Facility
|
OP
|
$34.00
|
|
|
Service Code
|
HCPCS 83615
|
| Hospital Charge Code |
4300514
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.08 |
| Max. Negotiated Rate |
$27.37 |
| Rate for Payer: Aetna of NY Commercial |
$22.10
|
| Rate for Payer: Aetna of NY Medicare |
$15.64
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$25.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$25.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$12.58
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$17.00
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: CDPHP Commercial |
$27.37
|
| Rate for Payer: CDPHP Medicare |
$12.58
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$20.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$27.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$27.20
|
| Rate for Payer: EmblemHealth Medicaid |
$27.20
|
| Rate for Payer: EmblemHealth Medicare |
$11.56
|
| Rate for Payer: EmblemHealth Select Care |
$20.40
|
| Rate for Payer: Fidelis Medicare |
$12.96
|
| Rate for Payer: Galaxy Health Commercial |
$22.10
|
| Rate for Payer: Hamaspik Choice Medicare |
$12.58
|
| Rate for Payer: Humana Medicare |
$12.58
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$22.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$15.64
|
| Rate for Payer: MVP Health Care of NY Commercial |
$25.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$19.14
|
| Rate for Payer: MVP Health Care of NY Medicare |
$13.21
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$25.50
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$5.08
|
| Rate for Payer: United Healthcare Commercial |
$25.50
|
| Rate for Payer: United Healthcare Medicare |
$12.58
|
| Rate for Payer: WellCare Medicare |
$18.70
|
|
|
LEAD KITS
|
Facility
|
IP
|
$8,947.00
|
|
|
Service Code
|
HCPCS C1778
|
| Hospital Charge Code |
4471319
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,026.15 |
| Max. Negotiated Rate |
$6,262.90 |
| Rate for Payer: Aetna of NY Commercial |
$6,262.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$4,026.15
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$4,026.15
|
| Rate for Payer: Cash Price |
$6,710.25
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$4,473.50
|
| Rate for Payer: EmblemHealth Select Care |
$4,473.50
|
| Rate for Payer: Galaxy Health Commercial |
$5,815.55
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$6,262.90
|
| Rate for Payer: Multiplan Commercial |
$4,026.15
|
| Rate for Payer: MVP Health Care of NY Commercial |
$5,815.55
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$5,815.55
|
| Rate for Payer: WellCare Medicare |
$4,920.85
|
|
|
LEAD KITS
|
Facility
|
OP
|
$8,947.00
|
|
|
Service Code
|
HCPCS C1778
|
| Hospital Charge Code |
4471319
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,041.98 |
| Max. Negotiated Rate |
$7,202.34 |
| Rate for Payer: Aetna of NY Commercial |
$6,262.90
|
| Rate for Payer: Aetna of NY Medicare |
$4,115.62
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$4,026.15
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$4,026.15
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$3,310.39
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$4,473.50
|
| Rate for Payer: Cash Price |
$6,710.25
|
| Rate for Payer: CDPHP Commercial |
$7,202.34
|
| Rate for Payer: CDPHP Medicare |
$3,310.39
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$4,473.50
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$7,157.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$7,157.60
|
| Rate for Payer: EmblemHealth Medicaid |
$7,157.60
|
| Rate for Payer: EmblemHealth Medicare |
$3,041.98
|
| Rate for Payer: EmblemHealth Select Care |
$4,473.50
|
| Rate for Payer: Fidelis Medicare |
$3,409.70
|
| Rate for Payer: Galaxy Health Commercial |
$5,815.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$3,310.39
|
| Rate for Payer: Humana Medicare |
$3,310.39
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$6,262.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$4,115.62
|
| Rate for Payer: MVP Health Care of NY Commercial |
$5,815.55
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$5,815.55
|
| Rate for Payer: MVP Health Care of NY Medicare |
$3,475.91
|
| Rate for Payer: United Healthcare Medicare |
$3,310.39
|
| Rate for Payer: WellCare Medicare |
$4,920.85
|
|
|
LEFLUNOMIDE 10 MG TABLET 10 mg, 30 eaches
|
Facility
|
IP
|
$50.00
|
|
|
Service Code
|
NDC 23155004303
|
| Hospital Charge Code |
4401393
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$27.50 |
| Max. Negotiated Rate |
$32.50 |
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Galaxy Health Commercial |
$32.50
|
| Rate for Payer: WellCare Medicare |
$27.50
|
|
|
LEFLUNOMIDE 10 MG TABLET 10 mg, 30 eaches
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
NDC 23155004303
|
| Hospital Charge Code |
4401393
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.00 |
| Max. Negotiated Rate |
$40.25 |
| Rate for Payer: Aetna of NY Commercial |
$35.00
|
| Rate for Payer: Aetna of NY Medicare |
$23.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$37.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$37.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$18.50
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$25.00
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: CDPHP Commercial |
$40.25
|
| Rate for Payer: CDPHP Medicare |
$18.50
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$40.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$40.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$40.00
|
| Rate for Payer: EmblemHealth Medicaid |
$40.00
|
| Rate for Payer: EmblemHealth Medicare |
$17.00
|
| Rate for Payer: EmblemHealth Select Care |
$36.00
|
| Rate for Payer: Fidelis Medicare |
$19.06
|
| Rate for Payer: Galaxy Health Commercial |
$32.50
|
| Rate for Payer: Hamaspik Choice Medicare |
$18.50
|
| Rate for Payer: Humana Medicare |
$18.50
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$35.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$23.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$37.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$28.15
|
| Rate for Payer: MVP Health Care of NY Medicare |
$19.42
|
| Rate for Payer: United Healthcare Medicare |
$18.50
|
| Rate for Payer: WellCare Medicare |
$27.50
|
|
|
LEFLUNOMIDE 20 MG (GENERIC ARAVA ) TABL
|
Facility
|
IP
|
$50.73
|
|
|
Service Code
|
NDC 00955173730
|
| Hospital Charge Code |
4409204
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$27.90 |
| Max. Negotiated Rate |
$32.97 |
| Rate for Payer: Cash Price |
$38.05
|
| Rate for Payer: Galaxy Health Commercial |
$32.97
|
| Rate for Payer: WellCare Medicare |
$27.90
|
|
|
LEFLUNOMIDE 20 MG (GENERIC ARAVA ) TABL
|
Facility
|
OP
|
$50.73
|
|
|
Service Code
|
NDC 00955173730
|
| Hospital Charge Code |
4409204
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.25 |
| Max. Negotiated Rate |
$40.84 |
| Rate for Payer: Aetna of NY Commercial |
$35.51
|
| Rate for Payer: Aetna of NY Medicare |
$23.34
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$38.05
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$38.05
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$18.77
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$25.36
|
| Rate for Payer: Cash Price |
$38.05
|
| Rate for Payer: CDPHP Commercial |
$40.84
|
| Rate for Payer: CDPHP Medicare |
$18.77
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$40.58
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$40.58
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$40.58
|
| Rate for Payer: EmblemHealth Medicaid |
$40.58
|
| Rate for Payer: EmblemHealth Medicare |
$17.25
|
| Rate for Payer: EmblemHealth Select Care |
$36.53
|
| Rate for Payer: Fidelis Medicare |
$19.33
|
| Rate for Payer: Galaxy Health Commercial |
$32.97
|
| Rate for Payer: Hamaspik Choice Medicare |
$18.77
|
| Rate for Payer: Humana Medicare |
$18.77
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$35.51
|
| Rate for Payer: Local 1199SEIU Medicare |
$23.34
|
| Rate for Payer: MVP Health Care of NY Commercial |
$38.05
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$28.56
|
| Rate for Payer: MVP Health Care of NY Medicare |
$19.71
|
| Rate for Payer: United Healthcare Medicare |
$18.77
|
| Rate for Payer: WellCare Medicare |
$27.90
|
|
|
LEGIONELLA P AG BY DFA
|
Facility
|
IP
|
$122.00
|
|
|
Service Code
|
HCPCS 87278
|
| Hospital Charge Code |
4301257
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$79.30 |
| Max. Negotiated Rate |
$79.30 |
| Rate for Payer: Cash Price |
$91.50
|
| Rate for Payer: Galaxy Health Commercial |
$79.30
|
|
|
LEGIONELLA P AG BY DFA
|
Facility
|
OP
|
$122.00
|
|
|
Service Code
|
HCPCS 87278
|
| Hospital Charge Code |
4301257
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$15.60 |
| Max. Negotiated Rate |
$98.21 |
| Rate for Payer: Aetna of NY Commercial |
$79.30
|
| Rate for Payer: Aetna of NY Medicare |
$56.12
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$91.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$91.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$45.14
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$61.00
|
| Rate for Payer: Cash Price |
$91.50
|
| Rate for Payer: Cash Price |
$91.50
|
| Rate for Payer: CDPHP Commercial |
$98.21
|
| Rate for Payer: CDPHP Medicare |
$45.14
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$73.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$97.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$97.60
|
| Rate for Payer: EmblemHealth Medicaid |
$97.60
|
| Rate for Payer: EmblemHealth Medicare |
$41.48
|
| Rate for Payer: EmblemHealth Select Care |
$73.20
|
| Rate for Payer: Fidelis Medicare |
$46.49
|
| Rate for Payer: Galaxy Health Commercial |
$79.30
|
| Rate for Payer: Hamaspik Choice Medicare |
$45.14
|
| Rate for Payer: Humana Medicare |
$45.14
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$79.30
|
| Rate for Payer: Local 1199SEIU Medicare |
$56.12
|
| Rate for Payer: MVP Health Care of NY Commercial |
$91.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$68.69
|
| Rate for Payer: MVP Health Care of NY Medicare |
$47.40
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$91.50
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$15.60
|
| Rate for Payer: United Healthcare Commercial |
$91.50
|
| Rate for Payer: United Healthcare Medicare |
$45.14
|
| Rate for Payer: WellCare Medicare |
$67.10
|
|
|
LETROZOLE 2.5MG TABS 30 EA
|
Facility
|
OP
|
$55.88
|
|
|
Service Code
|
NDC 16729003410
|
| Hospital Charge Code |
4400423
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$19.00 |
| Max. Negotiated Rate |
$44.98 |
| Rate for Payer: Aetna of NY Commercial |
$39.12
|
| Rate for Payer: Aetna of NY Medicare |
$25.70
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$41.91
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$41.91
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$20.68
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$27.94
|
| Rate for Payer: Cash Price |
$41.91
|
| Rate for Payer: CDPHP Commercial |
$44.98
|
| Rate for Payer: CDPHP Medicare |
$20.68
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$44.70
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$44.70
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$44.70
|
| Rate for Payer: EmblemHealth Medicaid |
$44.70
|
| Rate for Payer: EmblemHealth Medicare |
$19.00
|
| Rate for Payer: EmblemHealth Select Care |
$40.23
|
| Rate for Payer: Fidelis Medicare |
$21.30
|
| Rate for Payer: Galaxy Health Commercial |
$36.32
|
| Rate for Payer: Hamaspik Choice Medicare |
$20.68
|
| Rate for Payer: Humana Medicare |
$20.68
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$39.12
|
| Rate for Payer: Local 1199SEIU Medicare |
$25.70
|
| Rate for Payer: MVP Health Care of NY Commercial |
$41.91
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$31.46
|
| Rate for Payer: MVP Health Care of NY Medicare |
$21.71
|
| Rate for Payer: United Healthcare Medicare |
$20.68
|
| Rate for Payer: WellCare Medicare |
$30.73
|
|
|
LETROZOLE 2.5MG TABS 30 EA
|
Facility
|
IP
|
$55.88
|
|
|
Service Code
|
NDC 16729003410
|
| Hospital Charge Code |
4400423
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$30.73 |
| Max. Negotiated Rate |
$36.32 |
| Rate for Payer: Cash Price |
$41.91
|
| Rate for Payer: Galaxy Health Commercial |
$36.32
|
| Rate for Payer: WellCare Medicare |
$30.73
|
|
|
LEUKOCYTE ASSMT FECAL QUAL/SEMIQUANTITATIVE
|
Facility
|
IP
|
$15.00
|
|
|
Service Code
|
HCPCS 89055
|
| Hospital Charge Code |
4302016
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.75 |
| Max. Negotiated Rate |
$9.75 |
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Galaxy Health Commercial |
$9.75
|
|
|
LEUKOCYTE ASSMT FECAL QUAL/SEMIQUANTITATIVE
|
Facility
|
OP
|
$15.00
|
|
|
Service Code
|
HCPCS 89055
|
| Hospital Charge Code |
4302016
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.43 |
| Max. Negotiated Rate |
$12.08 |
| Rate for Payer: Aetna of NY Commercial |
$9.75
|
| Rate for Payer: Aetna of NY Medicare |
$6.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$11.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$11.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$5.55
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$7.50
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: CDPHP Commercial |
$12.08
|
| Rate for Payer: CDPHP Medicare |
$5.55
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$9.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$12.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$12.00
|
| Rate for Payer: EmblemHealth Medicaid |
$12.00
|
| Rate for Payer: EmblemHealth Medicare |
$5.10
|
| Rate for Payer: EmblemHealth Select Care |
$9.00
|
| Rate for Payer: Fidelis Medicare |
$5.72
|
| Rate for Payer: Galaxy Health Commercial |
$9.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$5.55
|
| Rate for Payer: Humana Medicare |
$5.55
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$9.75
|
| Rate for Payer: Local 1199SEIU Medicare |
$6.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$11.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$8.44
|
| Rate for Payer: MVP Health Care of NY Medicare |
$5.83
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$11.25
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$3.43
|
| Rate for Payer: United Healthcare Commercial |
$11.25
|
| Rate for Payer: United Healthcare Medicare |
$5.55
|
| Rate for Payer: WellCare Medicare |
$8.25
|
|
|
LEUKO REDUCED PLATELETS EA UNIT
|
Facility
|
IP
|
$393.00
|
|
|
Service Code
|
HCPCS P9031
|
| Hospital Charge Code |
4302357
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$176.85 |
| Max. Negotiated Rate |
$255.45 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$176.85
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$176.85
|
| Rate for Payer: Cash Price |
$294.75
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$196.50
|
| Rate for Payer: EmblemHealth Select Care |
$196.50
|
| Rate for Payer: Galaxy Health Commercial |
$255.45
|
| Rate for Payer: WellCare Medicare |
$216.15
|
|
|
LEUKO REDUCED PLATELETS EA UNIT
|
Facility
|
OP
|
$393.00
|
|
|
Service Code
|
HCPCS P9031
|
| Hospital Charge Code |
4302357
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$130.88 |
| Max. Negotiated Rate |
$316.36 |
| Rate for Payer: Aetna of NY Commercial |
$275.10
|
| Rate for Payer: Aetna of NY Medicare |
$180.78
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$294.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$294.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$145.41
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$196.50
|
| Rate for Payer: Cash Price |
$294.75
|
| Rate for Payer: Cash Price |
$294.75
|
| Rate for Payer: CDPHP Commercial |
$316.36
|
| Rate for Payer: CDPHP Medicare |
$145.41
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$196.50
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$314.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$314.40
|
| Rate for Payer: EmblemHealth Medicaid |
$314.40
|
| Rate for Payer: EmblemHealth Medicare |
$133.62
|
| Rate for Payer: EmblemHealth Select Care |
$196.50
|
| Rate for Payer: Fidelis Medicare |
$149.77
|
| Rate for Payer: Galaxy Health Commercial |
$255.45
|
| Rate for Payer: Hamaspik Choice Medicare |
$145.41
|
| Rate for Payer: Humana Medicare |
$145.41
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$275.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$180.78
|
| Rate for Payer: MVP Health Care of NY Commercial |
$294.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$221.26
|
| Rate for Payer: MVP Health Care of NY Medicare |
$152.68
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$294.75
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$130.88
|
| Rate for Payer: United Healthcare Commercial |
$294.75
|
| Rate for Payer: United Healthcare Medicare |
$145.41
|
| Rate for Payer: WellCare Medicare |
$216.15
|
|
|
LEUKOREDUCED RBC
|
Facility
|
IP
|
$543.00
|
|
|
Service Code
|
HCPCS P9016
|
| Hospital Charge Code |
4300526
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$244.35 |
| Max. Negotiated Rate |
$352.95 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$244.35
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$244.35
|
| Rate for Payer: Cash Price |
$407.25
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$271.50
|
| Rate for Payer: EmblemHealth Select Care |
$271.50
|
| Rate for Payer: Galaxy Health Commercial |
$352.95
|
| Rate for Payer: WellCare Medicare |
$298.65
|
|
|
LEUKOREDUCED RBC
|
Facility
|
OP
|
$543.00
|
|
|
Service Code
|
HCPCS P9016
|
| Hospital Charge Code |
4300526
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$180.82 |
| Max. Negotiated Rate |
$437.12 |
| Rate for Payer: Aetna of NY Commercial |
$380.10
|
| Rate for Payer: Aetna of NY Medicare |
$249.78
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$407.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$407.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$200.91
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$271.50
|
| Rate for Payer: Cash Price |
$407.25
|
| Rate for Payer: Cash Price |
$407.25
|
| Rate for Payer: CDPHP Commercial |
$437.12
|
| Rate for Payer: CDPHP Medicare |
$200.91
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$271.50
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$434.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$434.40
|
| Rate for Payer: EmblemHealth Medicaid |
$434.40
|
| Rate for Payer: EmblemHealth Medicare |
$184.62
|
| Rate for Payer: EmblemHealth Select Care |
$271.50
|
| Rate for Payer: Fidelis Medicare |
$206.94
|
| Rate for Payer: Galaxy Health Commercial |
$352.95
|
| Rate for Payer: Hamaspik Choice Medicare |
$200.91
|
| Rate for Payer: Humana Medicare |
$200.91
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$380.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$249.78
|
| Rate for Payer: MVP Health Care of NY Commercial |
$407.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$305.71
|
| Rate for Payer: MVP Health Care of NY Medicare |
$210.96
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$407.25
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$180.82
|
| Rate for Payer: United Healthcare Commercial |
$407.25
|
| Rate for Payer: United Healthcare Medicare |
$200.91
|
| Rate for Payer: WellCare Medicare |
$298.65
|
|
|
LEUKOTAPE 1.5" X 15 YDS
|
Facility
|
OP
|
$41.00
|
|
| Hospital Charge Code |
4471451
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$13.94 |
| Max. Negotiated Rate |
$33.00 |
| Rate for Payer: Aetna of NY Commercial |
$28.70
|
| Rate for Payer: Aetna of NY Medicare |
$18.86
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$30.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$30.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$15.17
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$20.50
|
| Rate for Payer: Cash Price |
$30.75
|
| Rate for Payer: CDPHP Commercial |
$33.00
|
| Rate for Payer: CDPHP Medicare |
$15.17
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$32.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$32.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$32.80
|
| Rate for Payer: EmblemHealth Medicaid |
$32.80
|
| Rate for Payer: EmblemHealth Medicare |
$13.94
|
| Rate for Payer: EmblemHealth Select Care |
$29.52
|
| Rate for Payer: Fidelis Medicare |
$15.63
|
| Rate for Payer: Galaxy Health Commercial |
$26.65
|
| Rate for Payer: Hamaspik Choice Medicare |
$15.17
|
| Rate for Payer: Humana Medicare |
$15.17
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$28.70
|
| Rate for Payer: Local 1199SEIU Medicare |
$18.86
|
| Rate for Payer: MVP Health Care of NY Commercial |
$30.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$23.08
|
| Rate for Payer: MVP Health Care of NY Medicare |
$15.93
|
| Rate for Payer: United Healthcare Medicare |
$15.17
|
| Rate for Payer: WellCare Medicare |
$22.55
|
|
|
LEUKOTAPE 1.5" X 15 YDS
|
Facility
|
IP
|
$41.00
|
|
| Hospital Charge Code |
4471451
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$26.65 |
| Max. Negotiated Rate |
$26.65 |
| Rate for Payer: Cash Price |
$30.75
|
| Rate for Payer: Galaxy Health Commercial |
$26.65
|
|
|
LEVALBUTEROL HCL 0.63MG/3ML AMIH 24X3ML
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
NDC 76204080011
|
| Hospital Charge Code |
4400815
|
|
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
|
|
|
LEVALBUTEROL HCL 0.63MG/3ML AMIH 24X3ML
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 76204080011
|
| Hospital Charge Code |
4400815
|
|
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
|
|
