|
LONG ARM SPLINTS APPLICATION
|
Facility
|
OP
|
$451.00
|
|
|
Service Code
|
HCPCS 29105
|
| Hospital Charge Code |
4850020
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$150.13 |
| Max. Negotiated Rate |
$2,521.93 |
| Rate for Payer: Aetna of NY Commercial |
$315.70
|
| Rate for Payer: Aetna of NY Medicare |
$207.46
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$2,017.33
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$2,521.93
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$166.87
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$225.50
|
| Rate for Payer: Cash Price |
$338.25
|
| Rate for Payer: Cash Price |
$338.25
|
| Rate for Payer: Cash Price |
$338.25
|
| Rate for Payer: CDPHP Commercial |
$363.06
|
| Rate for Payer: CDPHP Medicare |
$166.87
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$360.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$360.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$360.80
|
| Rate for Payer: EmblemHealth Medicaid |
$360.80
|
| Rate for Payer: EmblemHealth Medicare |
$153.34
|
| Rate for Payer: EmblemHealth Select Care |
$324.72
|
| Rate for Payer: Fidelis Medicare |
$171.88
|
| Rate for Payer: Galaxy Health Commercial |
$293.15
|
| Rate for Payer: Hamaspik Choice Medicare |
$166.87
|
| Rate for Payer: Humana Medicare |
$166.87
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$315.70
|
| Rate for Payer: Local 1199SEIU Medicare |
$207.46
|
| Rate for Payer: MVP Health Care of NY Commercial |
$338.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$253.91
|
| Rate for Payer: MVP Health Care of NY Medicare |
$175.21
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$150.13
|
| Rate for Payer: United Healthcare Medicare |
$166.87
|
| Rate for Payer: WellCare Medicare |
$248.05
|
|
|
LONG LEG CAST APPLICATION
|
Facility
|
OP
|
$768.00
|
|
|
Service Code
|
HCPCS 29345
|
| Hospital Charge Code |
4850018
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$255.88 |
| Max. Negotiated Rate |
$2,521.93 |
| Rate for Payer: Aetna of NY Commercial |
$537.60
|
| Rate for Payer: Aetna of NY Medicare |
$353.28
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$2,017.33
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$2,521.93
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$284.16
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$384.00
|
| Rate for Payer: Cash Price |
$576.00
|
| Rate for Payer: Cash Price |
$576.00
|
| Rate for Payer: Cash Price |
$576.00
|
| Rate for Payer: CDPHP Commercial |
$618.24
|
| Rate for Payer: CDPHP Medicare |
$284.16
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$614.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$614.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$614.40
|
| Rate for Payer: EmblemHealth Medicaid |
$614.40
|
| Rate for Payer: EmblemHealth Medicare |
$261.12
|
| Rate for Payer: EmblemHealth Select Care |
$552.96
|
| Rate for Payer: Fidelis Medicare |
$292.68
|
| Rate for Payer: Galaxy Health Commercial |
$499.20
|
| Rate for Payer: Hamaspik Choice Medicare |
$284.16
|
| Rate for Payer: Humana Medicare |
$284.16
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$537.60
|
| Rate for Payer: Local 1199SEIU Medicare |
$353.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$576.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$432.38
|
| Rate for Payer: MVP Health Care of NY Medicare |
$298.37
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$255.88
|
| Rate for Payer: United Healthcare Medicare |
$284.16
|
| Rate for Payer: WellCare Medicare |
$422.40
|
|
|
LONG LEG CAST APPLICATION
|
Facility
|
IP
|
$768.00
|
|
|
Service Code
|
HCPCS 29345
|
| Hospital Charge Code |
4850018
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$499.20 |
| Max. Negotiated Rate |
$499.20 |
| Rate for Payer: Cash Price |
$576.00
|
| Rate for Payer: Galaxy Health Commercial |
$499.20
|
|
|
LONG LEG SPLINT APPLICATION
|
Facility
|
IP
|
$451.00
|
|
|
Service Code
|
HCPCS 29505
|
| Hospital Charge Code |
4850023
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$293.15 |
| Max. Negotiated Rate |
$293.15 |
| Rate for Payer: Cash Price |
$338.25
|
| Rate for Payer: Galaxy Health Commercial |
$293.15
|
|
|
LONG LEG SPLINT APPLICATION
|
Facility
|
OP
|
$451.00
|
|
|
Service Code
|
HCPCS 29505
|
| Hospital Charge Code |
4850023
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$150.13 |
| Max. Negotiated Rate |
$2,521.93 |
| Rate for Payer: Aetna of NY Commercial |
$315.70
|
| Rate for Payer: Aetna of NY Medicare |
$207.46
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$2,017.33
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$2,521.93
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$166.87
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$225.50
|
| Rate for Payer: Cash Price |
$338.25
|
| Rate for Payer: Cash Price |
$338.25
|
| Rate for Payer: Cash Price |
$338.25
|
| Rate for Payer: CDPHP Commercial |
$363.06
|
| Rate for Payer: CDPHP Medicare |
$166.87
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$360.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$360.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$360.80
|
| Rate for Payer: EmblemHealth Medicaid |
$360.80
|
| Rate for Payer: EmblemHealth Medicare |
$153.34
|
| Rate for Payer: EmblemHealth Select Care |
$324.72
|
| Rate for Payer: Fidelis Medicare |
$171.88
|
| Rate for Payer: Galaxy Health Commercial |
$293.15
|
| Rate for Payer: Hamaspik Choice Medicare |
$166.87
|
| Rate for Payer: Humana Medicare |
$166.87
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$315.70
|
| Rate for Payer: Local 1199SEIU Medicare |
$207.46
|
| Rate for Payer: MVP Health Care of NY Commercial |
$338.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$253.91
|
| Rate for Payer: MVP Health Care of NY Medicare |
$175.21
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$150.13
|
| Rate for Payer: United Healthcare Medicare |
$166.87
|
| Rate for Payer: WellCare Medicare |
$248.05
|
|
|
LOPERAMIDE HCL 2MG CAPS 100 EA
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 51079069020
|
| Hospital Charge Code |
4400462
|
|
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
|
|
|
LOPERAMIDE HCL 2MG CAPS 100 EA
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
NDC 51079069020
|
| Hospital Charge Code |
4400462
|
|
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
|
|
|
LORATADINE 10MG TABS 10X10EA
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
NDC 68084024811
|
| Hospital Charge Code |
4400463
|
|
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
|
|
|
LORATADINE 10MG TABS 10X10EA
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 68084024811
|
| Hospital Charge Code |
4400463
|
|
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
|
|
|
LORAZEPAM 0.5MG TABS 100 EA
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
NDC 00904600761
|
| Hospital Charge Code |
4400465
|
|
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
|
|
|
LORAZEPAM 0.5MG TABS 100 EA
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 00904600761
|
| Hospital Charge Code |
4400465
|
|
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
|
|
|
LORazepam 2 MG/ML CARPUJECT 2 mg, 1 mL
|
Facility
|
IP
|
$13.00
|
|
|
Service Code
|
HCPCS J2060
|
| Hospital Charge Code |
4401519
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.96 |
| Max. Negotiated Rate |
$8.45 |
| Rate for Payer: Aetna of NY Commercial |
$7.15
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$0.96
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$0.96
|
| Rate for Payer: Cash Price |
$9.75
|
| Rate for Payer: Cash Price |
$9.75
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.96
|
| Rate for Payer: EmblemHealth Select Care |
$0.96
|
| Rate for Payer: Galaxy Health Commercial |
$8.45
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$7.15
|
| Rate for Payer: WellCare Medicare |
$7.15
|
|
|
LORazepam 2 MG/ML CARPUJECT 2 mg, 1 mL
|
Facility
|
OP
|
$13.00
|
|
|
Service Code
|
HCPCS J2060
|
| Hospital Charge Code |
4401519
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.96 |
| Max. Negotiated Rate |
$10.46 |
| Rate for Payer: Aetna of NY Commercial |
$7.15
|
| Rate for Payer: Aetna of NY Medicare |
$5.98
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$0.96
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$0.96
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$4.81
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$6.50
|
| Rate for Payer: Cash Price |
$9.75
|
| Rate for Payer: Cash Price |
$9.75
|
| Rate for Payer: CDPHP Commercial |
$10.46
|
| Rate for Payer: CDPHP Medicare |
$4.81
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.96
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$10.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$10.40
|
| Rate for Payer: EmblemHealth Medicaid |
$10.40
|
| Rate for Payer: EmblemHealth Medicare |
$4.42
|
| Rate for Payer: EmblemHealth Select Care |
$0.96
|
| Rate for Payer: Fidelis Medicare |
$4.95
|
| Rate for Payer: Galaxy Health Commercial |
$8.45
|
| Rate for Payer: Hamaspik Choice Medicare |
$4.81
|
| Rate for Payer: Humana Medicare |
$4.81
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$7.15
|
| Rate for Payer: Local 1199SEIU Medicare |
$5.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$9.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$7.32
|
| Rate for Payer: MVP Health Care of NY Medicare |
$5.05
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1.40
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$0.96
|
| Rate for Payer: United Healthcare Commercial |
$1.40
|
| Rate for Payer: United Healthcare Medicare |
$4.81
|
| Rate for Payer: WellCare Medicare |
$7.15
|
|
|
LORAZEPAM INJ 2 MG
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
HCPCS J2060
|
| Hospital Charge Code |
4400466
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.96 |
| Max. Negotiated Rate |
$4.97 |
| Rate for Payer: Aetna of NY Commercial |
$3.40
|
| Rate for Payer: Aetna of NY Medicare |
$2.84
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$0.96
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$0.96
|
| 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: 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 |
$0.96
|
| 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 |
$0.96
|
| 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 |
$3.40
|
| 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: Oxford Health Plans Freedom/Liberty/Metro |
$1.40
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$0.96
|
| Rate for Payer: United Healthcare Commercial |
$1.40
|
| Rate for Payer: United Healthcare Medicare |
$2.29
|
| Rate for Payer: WellCare Medicare |
$3.40
|
|
|
LORAZEPAM INJ 2 MG
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
HCPCS J2060
|
| Hospital Charge Code |
4400466
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.96 |
| Max. Negotiated Rate |
$4.02 |
| Rate for Payer: Aetna of NY Commercial |
$3.40
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$0.96
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$0.96
|
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.96
|
| Rate for Payer: EmblemHealth Select Care |
$0.96
|
| Rate for Payer: Galaxy Health Commercial |
$4.02
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$3.40
|
| Rate for Payer: WellCare Medicare |
$3.40
|
|
|
LOSARTAN 25 MG TAB NDC 68084-0346-01
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
NDC 68084034601
|
| Hospital Charge Code |
4409226
|
|
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
|
|
|
LOSARTAN 25 MG TAB NDC 68084-0346-01
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 68084034601
|
| Hospital Charge Code |
4409226
|
|
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
|
|
|
LOSARTAN 50 MG TABLET, NDC 00904-6390-61
|
Facility
|
OP
|
$6.95
|
|
|
Service Code
|
NDC 00904639061
|
| Hospital Charge Code |
4409228
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.36 |
| Max. Negotiated Rate |
$5.59 |
| Rate for Payer: Aetna of NY Commercial |
$4.86
|
| Rate for Payer: Aetna of NY Medicare |
$3.20
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$5.21
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$5.21
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2.57
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$3.48
|
| Rate for Payer: Cash Price |
$5.21
|
| Rate for Payer: CDPHP Commercial |
$5.59
|
| Rate for Payer: CDPHP Medicare |
$2.57
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$5.56
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$5.56
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$5.56
|
| Rate for Payer: EmblemHealth Medicaid |
$5.56
|
| Rate for Payer: EmblemHealth Medicare |
$2.36
|
| Rate for Payer: EmblemHealth Select Care |
$5.00
|
| Rate for Payer: Fidelis Medicare |
$2.65
|
| Rate for Payer: Galaxy Health Commercial |
$4.52
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.57
|
| Rate for Payer: Humana Medicare |
$2.57
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$4.86
|
| Rate for Payer: Local 1199SEIU Medicare |
$3.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$5.21
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3.91
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2.70
|
| Rate for Payer: United Healthcare Medicare |
$2.57
|
| Rate for Payer: WellCare Medicare |
$3.82
|
|
|
LOSARTAN 50 MG TABLET, NDC 00904-6390-61
|
Facility
|
IP
|
$6.95
|
|
|
Service Code
|
NDC 00904639061
|
| Hospital Charge Code |
4409228
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.82 |
| Max. Negotiated Rate |
$4.52 |
| Rate for Payer: Cash Price |
$5.21
|
| Rate for Payer: Galaxy Health Commercial |
$4.52
|
| Rate for Payer: WellCare Medicare |
$3.82
|
|
|
LOVASTATIN 20MG TABS 10X10EA
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
NDC 68084055901
|
| Hospital Charge Code |
4400469
|
|
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
|
|
|
LOVASTATIN 20MG TABS 10X10EA
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 68084055901
|
| Hospital Charge Code |
4400469
|
|
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
|
|
|
LOVENOX INJ 10 MG
|
Facility
|
OP
|
$2.79
|
|
|
Service Code
|
HCPCS J1650
|
| Hospital Charge Code |
4401243
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$2.25 |
| Rate for Payer: Aetna of NY Commercial |
$1.53
|
| Rate for Payer: Aetna of NY Medicare |
$1.28
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$0.62
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$0.62
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1.03
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$1.40
|
| Rate for Payer: Cash Price |
$2.09
|
| Rate for Payer: Cash Price |
$2.09
|
| Rate for Payer: CDPHP Commercial |
$2.25
|
| Rate for Payer: CDPHP Medicare |
$1.03
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.62
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2.23
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$2.23
|
| Rate for Payer: EmblemHealth Medicaid |
$2.23
|
| Rate for Payer: EmblemHealth Medicare |
$0.95
|
| Rate for Payer: EmblemHealth Select Care |
$0.62
|
| Rate for Payer: Fidelis Medicare |
$1.06
|
| Rate for Payer: Galaxy Health Commercial |
$1.81
|
| Rate for Payer: Hamaspik Choice Medicare |
$1.03
|
| Rate for Payer: Humana Medicare |
$1.03
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1.53
|
| Rate for Payer: Local 1199SEIU Medicare |
$1.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2.09
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1.57
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1.08
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1.12
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$0.62
|
| Rate for Payer: United Healthcare Commercial |
$1.12
|
| Rate for Payer: United Healthcare Medicare |
$1.03
|
| Rate for Payer: WellCare Medicare |
$1.53
|
|
|
LOVENOX INJ 10 MG
|
Facility
|
OP
|
$2.79
|
|
|
Service Code
|
HCPCS J1650
|
| Hospital Charge Code |
4401242
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$2.25 |
| Rate for Payer: Aetna of NY Commercial |
$1.53
|
| Rate for Payer: Aetna of NY Medicare |
$1.28
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$0.62
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$0.62
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1.03
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$1.40
|
| Rate for Payer: Cash Price |
$2.09
|
| Rate for Payer: Cash Price |
$2.09
|
| Rate for Payer: CDPHP Commercial |
$2.25
|
| Rate for Payer: CDPHP Medicare |
$1.03
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.62
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2.23
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$2.23
|
| Rate for Payer: EmblemHealth Medicaid |
$2.23
|
| Rate for Payer: EmblemHealth Medicare |
$0.95
|
| Rate for Payer: EmblemHealth Select Care |
$0.62
|
| Rate for Payer: Fidelis Medicare |
$1.06
|
| Rate for Payer: Galaxy Health Commercial |
$1.81
|
| Rate for Payer: Hamaspik Choice Medicare |
$1.03
|
| Rate for Payer: Humana Medicare |
$1.03
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1.53
|
| Rate for Payer: Local 1199SEIU Medicare |
$1.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2.09
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1.57
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1.08
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1.12
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$0.62
|
| Rate for Payer: United Healthcare Commercial |
$1.12
|
| Rate for Payer: United Healthcare Medicare |
$1.03
|
| Rate for Payer: WellCare Medicare |
$1.53
|
|
|
LOVENOX INJ 10 MG
|
Facility
|
IP
|
$2.79
|
|
|
Service Code
|
HCPCS J1650
|
| Hospital Charge Code |
4451240
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$1.81 |
| Rate for Payer: Aetna of NY Commercial |
$1.53
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$0.62
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$0.62
|
| Rate for Payer: Cash Price |
$2.09
|
| Rate for Payer: Cash Price |
$2.09
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.62
|
| Rate for Payer: EmblemHealth Select Care |
$0.62
|
| Rate for Payer: Galaxy Health Commercial |
$1.81
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1.53
|
| Rate for Payer: WellCare Medicare |
$1.53
|
|
|
LOVENOX INJ 10 MG
|
Facility
|
OP
|
$2.79
|
|
|
Service Code
|
HCPCS J1650
|
| Hospital Charge Code |
4451240
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$2.25 |
| Rate for Payer: Aetna of NY Commercial |
$1.53
|
| Rate for Payer: Aetna of NY Medicare |
$1.28
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$0.62
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$0.62
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1.03
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$1.40
|
| Rate for Payer: Cash Price |
$2.09
|
| Rate for Payer: Cash Price |
$2.09
|
| Rate for Payer: CDPHP Commercial |
$2.25
|
| Rate for Payer: CDPHP Medicare |
$1.03
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.62
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2.23
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$2.23
|
| Rate for Payer: EmblemHealth Medicaid |
$2.23
|
| Rate for Payer: EmblemHealth Medicare |
$0.95
|
| Rate for Payer: EmblemHealth Select Care |
$0.62
|
| Rate for Payer: Fidelis Medicare |
$1.06
|
| Rate for Payer: Galaxy Health Commercial |
$1.81
|
| Rate for Payer: Hamaspik Choice Medicare |
$1.03
|
| Rate for Payer: Humana Medicare |
$1.03
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1.53
|
| Rate for Payer: Local 1199SEIU Medicare |
$1.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2.09
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1.57
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1.08
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1.12
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$0.62
|
| Rate for Payer: United Healthcare Commercial |
$1.12
|
| Rate for Payer: United Healthcare Medicare |
$1.03
|
| Rate for Payer: WellCare Medicare |
$1.53
|
|
