|
LOVENOX INJ 10 MG
|
Facility
|
IP
|
$2.79
|
|
|
Service Code
|
HCPCS J1650
|
| Hospital Charge Code |
4401242
|
|
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
|
IP
|
$2.79
|
|
|
Service Code
|
HCPCS J1650
|
| Hospital Charge Code |
4401243
|
|
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
|
|
|
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
|
|
|
LOW-LEVEL LASER TRMT 15 MIN
|
Facility
|
IP
|
$73.00
|
|
|
Service Code
|
HCPCS S8948 GP
|
| Hospital Charge Code |
4650071
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$47.45 |
| Max. Negotiated Rate |
$47.45 |
| Rate for Payer: Cash Price |
$54.75
|
| Rate for Payer: Galaxy Health Commercial |
$47.45
|
|
|
LOW-LEVEL LASER TRMT 15 MIN
|
Facility
|
OP
|
$73.00
|
|
|
Service Code
|
HCPCS S8948 GP
|
| Hospital Charge Code |
4650071
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$24.82 |
| Max. Negotiated Rate |
$179.00 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$33.58
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$54.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$54.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$27.01
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$54.75
|
| Rate for Payer: Cash Price |
$54.75
|
| Rate for Payer: Cash Price |
$54.75
|
| Rate for Payer: CDPHP Commercial |
$58.76
|
| Rate for Payer: CDPHP Medicare |
$27.01
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$58.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$58.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$58.40
|
| Rate for Payer: EmblemHealth Medicaid |
$58.40
|
| Rate for Payer: EmblemHealth Medicare |
$24.82
|
| Rate for Payer: EmblemHealth Select Care |
$52.56
|
| Rate for Payer: Fidelis Medicare |
$27.82
|
| Rate for Payer: Galaxy Health Commercial |
$47.45
|
| Rate for Payer: Hamaspik Choice Medicare |
$27.01
|
| Rate for Payer: Humana Medicare |
$27.01
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$33.58
|
| Rate for Payer: MVP Health Care of NY Commercial |
$179.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$134.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$28.36
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$156.00
|
| Rate for Payer: United Healthcare Commercial |
$156.00
|
| Rate for Payer: United Healthcare Medicare |
$27.01
|
| Rate for Payer: WellCare Medicare |
$40.15
|
|
|
LPT REG GREAT TOE
|
Facility
|
IP
|
$6,232.00
|
|
| Hospital Charge Code |
4471388
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4,050.80 |
| Max. Negotiated Rate |
$4,050.80 |
| Rate for Payer: Cash Price |
$4,674.00
|
| Rate for Payer: Galaxy Health Commercial |
$4,050.80
|
|
|
LPT REG GREAT TOE
|
Facility
|
OP
|
$6,232.00
|
|
| Hospital Charge Code |
4471388
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2,118.88 |
| Max. Negotiated Rate |
$5,016.76 |
| Rate for Payer: Aetna of NY Commercial |
$4,362.40
|
| Rate for Payer: Aetna of NY Medicare |
$2,866.72
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$4,674.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$4,674.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2,305.84
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$3,116.00
|
| Rate for Payer: Cash Price |
$4,674.00
|
| Rate for Payer: CDPHP Commercial |
$5,016.76
|
| Rate for Payer: CDPHP Medicare |
$2,305.84
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$4,985.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$4,985.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$4,985.60
|
| Rate for Payer: EmblemHealth Medicaid |
$4,985.60
|
| Rate for Payer: EmblemHealth Medicare |
$2,118.88
|
| Rate for Payer: EmblemHealth Select Care |
$4,487.04
|
| Rate for Payer: Fidelis Medicare |
$2,375.02
|
| Rate for Payer: Galaxy Health Commercial |
$4,050.80
|
| Rate for Payer: Hamaspik Choice Medicare |
$2,305.84
|
| Rate for Payer: Humana Medicare |
$2,305.84
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$4,362.40
|
| Rate for Payer: Local 1199SEIU Medicare |
$2,866.72
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4,674.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3,508.62
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2,421.13
|
| Rate for Payer: United Healthcare Medicare |
$2,305.84
|
| Rate for Payer: WellCare Medicare |
$3,427.60
|
|
|
L SMALL WRIST W/ABDUCTED THUMB
|
Facility
|
IP
|
$57.00
|
|
| Hospital Charge Code |
4471580
|
|
Hospital Revenue Code
|
270
|
| 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
|
|
|
L SMALL WRIST W/ABDUCTED THUMB
|
Facility
|
OP
|
$57.00
|
|
| Hospital Charge Code |
4471580
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$19.38 |
| Max. Negotiated Rate |
$45.88 |
| Rate for Payer: Aetna of NY Commercial |
$39.90
|
| Rate for Payer: Aetna of NY Medicare |
$26.22
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$42.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$42.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$21.09
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$28.50
|
| Rate for Payer: Cash Price |
$42.75
|
| Rate for Payer: CDPHP Commercial |
$45.88
|
| Rate for Payer: CDPHP Medicare |
$21.09
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$45.60
|
| 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 |
$41.04
|
| Rate for Payer: Fidelis Medicare |
$21.72
|
| Rate for Payer: Galaxy Health Commercial |
$37.05
|
| Rate for Payer: Hamaspik Choice Medicare |
$21.09
|
| Rate for Payer: Humana Medicare |
$21.09
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$39.90
|
| 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 |
$22.14
|
| Rate for Payer: United Healthcare Medicare |
$21.09
|
| Rate for Payer: WellCare Medicare |
$31.35
|
|
|
LUBIPROSTONE 8 MCG CAPSULE 8 mcg, 60 eaches
|
Facility
|
IP
|
$22.00
|
|
|
Service Code
|
NDC 00254302802
|
| Hospital Charge Code |
4401474
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.10 |
| Max. Negotiated Rate |
$14.30 |
| Rate for Payer: Cash Price |
$16.50
|
| Rate for Payer: Galaxy Health Commercial |
$14.30
|
| Rate for Payer: WellCare Medicare |
$12.10
|
|
|
LUBIPROSTONE 8 MCG CAPSULE 8 mcg, 60 eaches
|
Facility
|
OP
|
$22.00
|
|
|
Service Code
|
NDC 00254302802
|
| Hospital Charge Code |
4401474
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.48 |
| Max. Negotiated Rate |
$17.71 |
| Rate for Payer: Aetna of NY Commercial |
$15.40
|
| Rate for Payer: Aetna of NY Medicare |
$10.12
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$16.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$16.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$8.14
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$11.00
|
| Rate for Payer: Cash Price |
$16.50
|
| Rate for Payer: CDPHP Commercial |
$17.71
|
| Rate for Payer: CDPHP Medicare |
$8.14
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$17.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$17.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$17.60
|
| Rate for Payer: EmblemHealth Medicaid |
$17.60
|
| Rate for Payer: EmblemHealth Medicare |
$7.48
|
| Rate for Payer: EmblemHealth Select Care |
$15.84
|
| Rate for Payer: Fidelis Medicare |
$8.38
|
| Rate for Payer: Galaxy Health Commercial |
$14.30
|
| Rate for Payer: Hamaspik Choice Medicare |
$8.14
|
| Rate for Payer: Humana Medicare |
$8.14
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$15.40
|
| Rate for Payer: Local 1199SEIU Medicare |
$10.12
|
| Rate for Payer: MVP Health Care of NY Commercial |
$16.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$12.39
|
| Rate for Payer: MVP Health Care of NY Medicare |
$8.55
|
| Rate for Payer: United Healthcare Medicare |
$8.14
|
| Rate for Payer: WellCare Medicare |
$12.10
|
|
|
LUMBAR COOLED INTRODUCER LUI-17-100
|
Facility
|
IP
|
$407.00
|
|
| Hospital Charge Code |
4479243
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$264.55 |
| Max. Negotiated Rate |
$264.55 |
| Rate for Payer: Cash Price |
$305.25
|
| Rate for Payer: Galaxy Health Commercial |
$264.55
|
|
|
LUMBAR COOLED INTRODUCER LUI-17-100
|
Facility
|
OP
|
$407.00
|
|
| Hospital Charge Code |
4479243
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$138.38 |
| Max. Negotiated Rate |
$327.64 |
| Rate for Payer: Aetna of NY Commercial |
$284.90
|
| Rate for Payer: Aetna of NY Medicare |
$187.22
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$305.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$305.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$150.59
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$203.50
|
| Rate for Payer: Cash Price |
$305.25
|
| Rate for Payer: CDPHP Commercial |
$327.64
|
| Rate for Payer: CDPHP Medicare |
$150.59
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$325.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$325.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$325.60
|
| Rate for Payer: EmblemHealth Medicaid |
$325.60
|
| Rate for Payer: EmblemHealth Medicare |
$138.38
|
| Rate for Payer: EmblemHealth Select Care |
$293.04
|
| Rate for Payer: Fidelis Medicare |
$155.11
|
| Rate for Payer: Galaxy Health Commercial |
$264.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$150.59
|
| Rate for Payer: Humana Medicare |
$150.59
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$284.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$187.22
|
| Rate for Payer: MVP Health Care of NY Commercial |
$305.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$229.14
|
| Rate for Payer: MVP Health Care of NY Medicare |
$158.12
|
| Rate for Payer: United Healthcare Medicare |
$150.59
|
| Rate for Payer: WellCare Medicare |
$223.85
|
|
|
LUMBAR KIT (CERVICOOL)GENIC LUK-17-100-4
|
Facility
|
IP
|
$3,040.00
|
|
| Hospital Charge Code |
4479191
|
|
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
|
|
|
LUMBAR KIT (CERVICOOL)GENIC LUK-17-100-4
|
Facility
|
OP
|
$3,040.00
|
|
| Hospital Charge Code |
4479191
|
|
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
|
|
|
LUMBAR PROBE LUP-17-150-4
|
Facility
|
IP
|
$2,127.00
|
|
| Hospital Charge Code |
4479263
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,382.55 |
| Max. Negotiated Rate |
$1,382.55 |
| Rate for Payer: Cash Price |
$1,595.25
|
| Rate for Payer: Galaxy Health Commercial |
$1,382.55
|
|
|
LUMBAR PROBE LUP-17-150-4
|
Facility
|
OP
|
$2,127.00
|
|
| Hospital Charge Code |
4479263
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$723.18 |
| Max. Negotiated Rate |
$1,712.24 |
| Rate for Payer: Aetna of NY Commercial |
$1,488.90
|
| Rate for Payer: Aetna of NY Medicare |
$978.42
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1,595.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,595.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$786.99
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$1,063.50
|
| Rate for Payer: Cash Price |
$1,595.25
|
| Rate for Payer: CDPHP Commercial |
$1,712.24
|
| Rate for Payer: CDPHP Medicare |
$786.99
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,701.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,701.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,701.60
|
| Rate for Payer: EmblemHealth Medicaid |
$1,701.60
|
| Rate for Payer: EmblemHealth Medicare |
$723.18
|
| Rate for Payer: EmblemHealth Select Care |
$1,531.44
|
| Rate for Payer: Fidelis Medicare |
$810.60
|
| Rate for Payer: Galaxy Health Commercial |
$1,382.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$786.99
|
| Rate for Payer: Humana Medicare |
$786.99
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,488.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$978.42
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,595.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1,197.50
|
| Rate for Payer: MVP Health Care of NY Medicare |
$826.34
|
| Rate for Payer: United Healthcare Medicare |
$786.99
|
| Rate for Payer: WellCare Medicare |
$1,169.85
|
|
|
LUMBAR PUNCTURE TRAY 20GX3 1
|
Facility
|
IP
|
$57.00
|
|
| Hospital Charge Code |
4471853
|
|
Hospital Revenue Code
|
270
|
| 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
|
|
|
LUMBAR PUNCTURE TRAY 20GX3 1
|
Facility
|
OP
|
$57.00
|
|
| Hospital Charge Code |
4471853
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$19.38 |
| Max. Negotiated Rate |
$45.88 |
| Rate for Payer: Aetna of NY Commercial |
$39.90
|
| Rate for Payer: Aetna of NY Medicare |
$26.22
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$42.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$42.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$21.09
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$28.50
|
| Rate for Payer: Cash Price |
$42.75
|
| Rate for Payer: CDPHP Commercial |
$45.88
|
| Rate for Payer: CDPHP Medicare |
$21.09
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$45.60
|
| 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 |
$41.04
|
| Rate for Payer: Fidelis Medicare |
$21.72
|
| Rate for Payer: Galaxy Health Commercial |
$37.05
|
| Rate for Payer: Hamaspik Choice Medicare |
$21.09
|
| Rate for Payer: Humana Medicare |
$21.09
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$39.90
|
| 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 |
$22.14
|
| Rate for Payer: United Healthcare Medicare |
$21.09
|
| Rate for Payer: WellCare Medicare |
$31.35
|
|
|
LUMBAR PUNCTURE TRAY ADULT 2
|
Facility
|
IP
|
$36.00
|
|
| Hospital Charge Code |
4471222
|
|
Hospital Revenue Code
|
270
|
| 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
|
|
|
LUMBAR PUNCTURE TRAY ADULT 2
|
Facility
|
OP
|
$36.00
|
|
| Hospital Charge Code |
4471222
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$12.24 |
| Max. Negotiated Rate |
$28.98 |
| Rate for Payer: Aetna of NY Commercial |
$25.20
|
| Rate for Payer: Aetna of NY Medicare |
$16.56
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$27.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$27.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$13.32
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$18.00
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: CDPHP Commercial |
$28.98
|
| Rate for Payer: CDPHP Medicare |
$13.32
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$28.80
|
| 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 |
$25.92
|
| Rate for Payer: Fidelis Medicare |
$13.72
|
| Rate for Payer: Galaxy Health Commercial |
$23.40
|
| Rate for Payer: Hamaspik Choice Medicare |
$13.32
|
| Rate for Payer: Humana Medicare |
$13.32
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$25.20
|
| 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 |
$13.99
|
| Rate for Payer: United Healthcare Medicare |
$13.32
|
| Rate for Payer: WellCare Medicare |
$19.80
|
|
|
_LUMBAR PUNCTURE TRAY PEDIATR
|
Facility
|
OP
|
$46.00
|
|
| Hospital Charge Code |
4471223
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$15.64 |
| Max. Negotiated Rate |
$37.03 |
| Rate for Payer: Aetna of NY Commercial |
$32.20
|
| Rate for Payer: Aetna of NY Medicare |
$21.16
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$34.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$34.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$17.02
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$23.00
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: CDPHP Commercial |
$37.03
|
| Rate for Payer: CDPHP Medicare |
$17.02
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$36.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$36.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$36.80
|
| Rate for Payer: EmblemHealth Medicaid |
$36.80
|
| Rate for Payer: EmblemHealth Medicare |
$15.64
|
| Rate for Payer: EmblemHealth Select Care |
$33.12
|
| Rate for Payer: Fidelis Medicare |
$17.53
|
| Rate for Payer: Galaxy Health Commercial |
$29.90
|
| Rate for Payer: Hamaspik Choice Medicare |
$17.02
|
| Rate for Payer: Humana Medicare |
$17.02
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$32.20
|
| Rate for Payer: Local 1199SEIU Medicare |
$21.16
|
| Rate for Payer: MVP Health Care of NY Commercial |
$34.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$25.90
|
| Rate for Payer: MVP Health Care of NY Medicare |
$17.87
|
| Rate for Payer: United Healthcare Medicare |
$17.02
|
| Rate for Payer: WellCare Medicare |
$25.30
|
|
|
_LUMBAR PUNCTURE TRAY PEDIATR
|
Facility
|
IP
|
$46.00
|
|
| Hospital Charge Code |
4471223
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$29.90 |
| Max. Negotiated Rate |
$29.90 |
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Galaxy Health Commercial |
$29.90
|
|
|
LUMBAR RF KIT_LUK-17-150-4
|
Facility
|
OP
|
$3,040.00
|
|
| Hospital Charge Code |
4479242
|
|
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
|
|
