|
LABETALOL HCL 5MG/ML MDV 20 ML
|
Facility
|
IP
|
$45.00
|
|
|
Service Code
|
NDC 409226720
|
| Hospital Charge Code |
4400412
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$24.75 |
| Max. Negotiated Rate |
$29.25 |
| Rate for Payer: Cash Price |
$33.75
|
| Rate for Payer: Galaxy Health Commercial |
$29.25
|
| Rate for Payer: WellCare Medicare |
$24.75
|
|
|
LACERATION TRAY SS INSTRU
|
Facility
|
OP
|
$20.60
|
|
| Hospital Charge Code |
4471272
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.09 |
| Max. Negotiated Rate |
$16.48 |
| Rate for Payer: Aetna of NY Commercial |
$14.42
|
| Rate for Payer: Aetna of NY Medicare |
$9.48
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$8.24
|
| Rate for Payer: Cash Price |
$15.45
|
| Rate for Payer: CDPHP Medicare |
$7.62
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$16.48
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$16.48
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$16.48
|
| Rate for Payer: EmblemHealth Medicaid |
$16.48
|
| Rate for Payer: EmblemHealth Medicare |
$7.00
|
| Rate for Payer: EmblemHealth Select Care |
$14.83
|
| Rate for Payer: Fidelis Medicare |
$8.24
|
| Rate for Payer: Galaxy Health Commercial |
$13.39
|
| Rate for Payer: Hamaspik Choice Medicare |
$8.24
|
| Rate for Payer: Humana Medicare |
$8.24
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$14.42
|
| Rate for Payer: Local 1199SEIU Medicare |
$9.48
|
| Rate for Payer: MVP Health Care of NY Commercial |
$15.45
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$11.60
|
| Rate for Payer: MVP Health Care of NY Medicare |
$8.65
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$3.09
|
| Rate for Payer: United Healthcare Medicare |
$8.24
|
| Rate for Payer: WellCare Medicare |
$11.33
|
|
|
LACERATION TRAY SS INSTRU
|
Facility
|
IP
|
$20.60
|
|
| Hospital Charge Code |
4471272
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$13.39 |
| Max. Negotiated Rate |
$13.39 |
| Rate for Payer: Cash Price |
$15.45
|
| Rate for Payer: Galaxy Health Commercial |
$13.39
|
|
|
LACTATED RINGER'S 1000 ML
|
Facility
|
IP
|
$19.57
|
|
|
Service Code
|
HCPCS J7120
|
| Hospital Charge Code |
4450039
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.60 |
| Max. Negotiated Rate |
$12.72 |
| Rate for Payer: Aetna of NY Commercial |
$10.76
|
| Rate for Payer: Cash Price |
$14.68
|
| Rate for Payer: Cash Price |
$14.68
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$2.60
|
| Rate for Payer: EmblemHealth Select Care |
$2.60
|
| Rate for Payer: Galaxy Health Commercial |
$12.72
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$10.76
|
| Rate for Payer: WellCare Medicare |
$10.76
|
|
|
LACTATED RINGER'S 1000 ML
|
Facility
|
OP
|
$19.57
|
|
|
Service Code
|
HCPCS J7120
|
| Hospital Charge Code |
4450039
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.60 |
| Max. Negotiated Rate |
$15.66 |
| Rate for Payer: Aetna of NY Medicare |
$9.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$7.83
|
| Rate for Payer: Cash Price |
$14.68
|
| Rate for Payer: Cash Price |
$14.68
|
| Rate for Payer: CDPHP Medicare |
$7.24
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$2.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$15.66
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$15.66
|
| Rate for Payer: EmblemHealth Medicaid |
$15.66
|
| Rate for Payer: EmblemHealth Medicare |
$6.65
|
| Rate for Payer: EmblemHealth Select Care |
$2.60
|
| Rate for Payer: Fidelis Medicare |
$7.83
|
| Rate for Payer: Galaxy Health Commercial |
$12.72
|
| Rate for Payer: Hamaspik Choice Medicare |
$7.83
|
| Rate for Payer: Humana Medicare |
$7.83
|
| Rate for Payer: Local 1199SEIU Medicare |
$9.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$14.68
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$11.02
|
| Rate for Payer: MVP Health Care of NY Medicare |
$8.22
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$3.94
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$2.94
|
| Rate for Payer: United Healthcare Commercial |
$3.94
|
| Rate for Payer: United Healthcare Medicare |
$7.83
|
| Rate for Payer: WellCare Medicare |
$10.76
|
|
|
LACTATED RINGER'S + 5 % DEXTROSE 1000 ML
|
Facility
|
IP
|
$19.57
|
|
|
Service Code
|
HCPCS J7120
|
| Hospital Charge Code |
4450040
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.60 |
| Max. Negotiated Rate |
$12.72 |
| Rate for Payer: Aetna of NY Commercial |
$10.76
|
| Rate for Payer: Cash Price |
$14.68
|
| Rate for Payer: Cash Price |
$14.68
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$2.60
|
| Rate for Payer: EmblemHealth Select Care |
$2.60
|
| Rate for Payer: Galaxy Health Commercial |
$12.72
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$10.76
|
| Rate for Payer: WellCare Medicare |
$10.76
|
|
|
LACTATED RINGER'S + 5 % DEXTROSE 1000 ML
|
Facility
|
OP
|
$19.57
|
|
|
Service Code
|
HCPCS J7120
|
| Hospital Charge Code |
4450040
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.60 |
| Max. Negotiated Rate |
$15.66 |
| Rate for Payer: Aetna of NY Medicare |
$9.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$7.83
|
| Rate for Payer: Cash Price |
$14.68
|
| Rate for Payer: Cash Price |
$14.68
|
| Rate for Payer: CDPHP Medicare |
$7.24
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$2.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$15.66
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$15.66
|
| Rate for Payer: EmblemHealth Medicaid |
$15.66
|
| Rate for Payer: EmblemHealth Medicare |
$6.65
|
| Rate for Payer: EmblemHealth Select Care |
$2.60
|
| Rate for Payer: Fidelis Medicare |
$7.83
|
| Rate for Payer: Galaxy Health Commercial |
$12.72
|
| Rate for Payer: Hamaspik Choice Medicare |
$7.83
|
| Rate for Payer: Humana Medicare |
$7.83
|
| Rate for Payer: Local 1199SEIU Medicare |
$9.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$14.68
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$11.02
|
| Rate for Payer: MVP Health Care of NY Medicare |
$8.22
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$3.94
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$2.94
|
| Rate for Payer: United Healthcare Commercial |
$3.94
|
| Rate for Payer: United Healthcare Medicare |
$7.83
|
| Rate for Payer: WellCare Medicare |
$10.76
|
|
|
LACTATED RINGER'S INJ 1000ML
|
Facility
|
OP
|
$17.51
|
|
| Hospital Charge Code |
4471941
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.63 |
| Max. Negotiated Rate |
$14.01 |
| Rate for Payer: Aetna of NY Commercial |
$12.26
|
| Rate for Payer: Aetna of NY Medicare |
$8.05
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$7.00
|
| Rate for Payer: Cash Price |
$13.13
|
| Rate for Payer: CDPHP Medicare |
$6.48
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$14.01
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$14.01
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$14.01
|
| Rate for Payer: EmblemHealth Medicaid |
$14.01
|
| Rate for Payer: EmblemHealth Medicare |
$5.95
|
| Rate for Payer: EmblemHealth Select Care |
$12.61
|
| Rate for Payer: Fidelis Medicare |
$7.00
|
| Rate for Payer: Galaxy Health Commercial |
$11.38
|
| Rate for Payer: Hamaspik Choice Medicare |
$7.00
|
| Rate for Payer: Humana Medicare |
$7.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$12.26
|
| Rate for Payer: Local 1199SEIU Medicare |
$8.05
|
| Rate for Payer: MVP Health Care of NY Commercial |
$13.13
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$9.86
|
| Rate for Payer: MVP Health Care of NY Medicare |
$7.35
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$2.63
|
| Rate for Payer: United Healthcare Medicare |
$7.00
|
| Rate for Payer: WellCare Medicare |
$9.63
|
|
|
LACTATED RINGER'S INJ 1000ML
|
Facility
|
IP
|
$17.51
|
|
| Hospital Charge Code |
4471941
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$11.38 |
| Max. Negotiated Rate |
$11.38 |
| Rate for Payer: Cash Price |
$13.13
|
| Rate for Payer: Galaxy Health Commercial |
$11.38
|
|
|
LACTIC ACID
|
Facility
|
IP
|
$82.00
|
|
|
Service Code
|
HCPCS 83605
|
| Hospital Charge Code |
4300507
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$53.30 |
| Max. Negotiated Rate |
$53.30 |
| Rate for Payer: Cash Price |
$61.50
|
| Rate for Payer: Galaxy Health Commercial |
$53.30
|
|
|
LACTIC ACID
|
Facility
|
OP
|
$82.00
|
|
|
Service Code
|
HCPCS 83605
|
| Hospital Charge Code |
4300507
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.30 |
| Max. Negotiated Rate |
$65.60 |
| Rate for Payer: Aetna of NY Commercial |
$53.30
|
| Rate for Payer: Aetna of NY Medicare |
$37.72
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$32.80
|
| Rate for Payer: Cash Price |
$61.50
|
| Rate for Payer: CDPHP Medicare |
$30.34
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$49.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$65.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$65.60
|
| Rate for Payer: EmblemHealth Medicaid |
$65.60
|
| Rate for Payer: EmblemHealth Medicare |
$27.88
|
| Rate for Payer: EmblemHealth Select Care |
$49.20
|
| Rate for Payer: Fidelis Medicare |
$32.80
|
| Rate for Payer: Galaxy Health Commercial |
$53.30
|
| Rate for Payer: Hamaspik Choice Medicare |
$32.80
|
| Rate for Payer: Humana Medicare |
$32.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$53.30
|
| Rate for Payer: Local 1199SEIU Medicare |
$37.72
|
| Rate for Payer: MVP Health Care of NY Commercial |
$61.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$46.17
|
| Rate for Payer: MVP Health Care of NY Medicare |
$34.44
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$61.50
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$12.30
|
| Rate for Payer: United Healthcare Commercial |
$61.50
|
| Rate for Payer: United Healthcare Medicare |
$32.80
|
| Rate for Payer: WellCare Medicare |
$45.10
|
|
|
LACTULOSE 10GM/15ML SOLN 40X30ML
|
Facility
|
IP
|
$9.50
|
|
|
Service Code
|
NDC 121115430
|
| Hospital Charge Code |
4400413
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$6.17 |
| Rate for Payer: Cash Price |
$7.12
|
| Rate for Payer: Galaxy Health Commercial |
$6.17
|
| Rate for Payer: WellCare Medicare |
$5.22
|
|
|
LACTULOSE 10GM/15ML SOLN 40X30ML
|
Facility
|
OP
|
$9.50
|
|
|
Service Code
|
NDC 121115430
|
| Hospital Charge Code |
4400413
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.43 |
| Max. Negotiated Rate |
$7.60 |
| Rate for Payer: Aetna of NY Commercial |
$6.65
|
| Rate for Payer: Aetna of NY Medicare |
$4.37
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$3.80
|
| Rate for Payer: Cash Price |
$7.12
|
| Rate for Payer: CDPHP Medicare |
$3.52
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$7.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$7.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$7.60
|
| Rate for Payer: EmblemHealth Medicaid |
$7.60
|
| Rate for Payer: EmblemHealth Medicare |
$3.23
|
| Rate for Payer: EmblemHealth Select Care |
$6.84
|
| Rate for Payer: Fidelis Medicare |
$3.80
|
| Rate for Payer: Galaxy Health Commercial |
$6.17
|
| Rate for Payer: Hamaspik Choice Medicare |
$3.80
|
| Rate for Payer: Humana Medicare |
$3.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$6.65
|
| Rate for Payer: Local 1199SEIU Medicare |
$4.37
|
| Rate for Payer: MVP Health Care of NY Commercial |
$7.12
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$5.35
|
| Rate for Payer: MVP Health Care of NY Medicare |
$3.99
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1.43
|
| Rate for Payer: United Healthcare Medicare |
$3.80
|
| Rate for Payer: WellCare Medicare |
$5.22
|
|
|
LAMOTRIGINE
|
Facility
|
OP
|
$75.00
|
|
|
Service Code
|
HCPCS 82542
|
| Hospital Charge Code |
4300510
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.25 |
| Max. Negotiated Rate |
$60.00 |
| Rate for Payer: Aetna of NY Commercial |
$48.75
|
| Rate for Payer: Aetna of NY Medicare |
$34.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$30.00
|
| Rate for Payer: Cash Price |
$56.25
|
| Rate for Payer: CDPHP Medicare |
$27.75
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$45.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$60.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$60.00
|
| Rate for Payer: EmblemHealth Medicaid |
$60.00
|
| Rate for Payer: EmblemHealth Medicare |
$25.50
|
| Rate for Payer: EmblemHealth Select Care |
$45.00
|
| Rate for Payer: Fidelis Medicare |
$30.00
|
| Rate for Payer: Galaxy Health Commercial |
$48.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$30.00
|
| Rate for Payer: Humana Medicare |
$30.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$48.75
|
| Rate for Payer: Local 1199SEIU Medicare |
$34.50
|
| Rate for Payer: MVP Health Care of NY Commercial |
$56.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$42.23
|
| Rate for Payer: MVP Health Care of NY Medicare |
$31.50
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$56.25
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$11.25
|
| Rate for Payer: United Healthcare Commercial |
$56.25
|
| Rate for Payer: United Healthcare Medicare |
$30.00
|
| Rate for Payer: WellCare Medicare |
$41.25
|
|
|
LAMOTRIGINE
|
Facility
|
IP
|
$75.00
|
|
|
Service Code
|
HCPCS 82542
|
| Hospital Charge Code |
4300510
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$48.75 |
| Max. Negotiated Rate |
$48.75 |
| Rate for Payer: Cash Price |
$56.25
|
| Rate for Payer: Galaxy Health Commercial |
$48.75
|
|
|
LAMOTRIGINE 100 MG TABLET
|
Facility
|
OP
|
$14.68
|
|
|
Service Code
|
NDC 51079049920
|
| Hospital Charge Code |
4409104
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.20 |
| Max. Negotiated Rate |
$11.74 |
| Rate for Payer: Aetna of NY Commercial |
$10.28
|
| Rate for Payer: Aetna of NY Medicare |
$6.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$5.87
|
| Rate for Payer: Cash Price |
$11.01
|
| Rate for Payer: CDPHP Medicare |
$5.43
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$11.74
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$11.74
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$11.74
|
| Rate for Payer: EmblemHealth Medicaid |
$11.74
|
| Rate for Payer: EmblemHealth Medicare |
$4.99
|
| Rate for Payer: EmblemHealth Select Care |
$10.57
|
| Rate for Payer: Fidelis Medicare |
$5.87
|
| Rate for Payer: Galaxy Health Commercial |
$9.54
|
| Rate for Payer: Hamaspik Choice Medicare |
$5.87
|
| Rate for Payer: Humana Medicare |
$5.87
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$10.28
|
| Rate for Payer: Local 1199SEIU Medicare |
$6.75
|
| Rate for Payer: MVP Health Care of NY Commercial |
$11.01
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$8.26
|
| Rate for Payer: MVP Health Care of NY Medicare |
$6.17
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$2.20
|
| Rate for Payer: United Healthcare Medicare |
$5.87
|
| Rate for Payer: WellCare Medicare |
$8.07
|
|
|
LAMOTRIGINE 100 MG TABLET
|
Facility
|
IP
|
$14.68
|
|
|
Service Code
|
NDC 51079049920
|
| Hospital Charge Code |
4409104
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.07 |
| Max. Negotiated Rate |
$9.54 |
| Rate for Payer: Cash Price |
$11.01
|
| Rate for Payer: Galaxy Health Commercial |
$9.54
|
| Rate for Payer: WellCare Medicare |
$8.07
|
|
|
LAMOTRIGINE 25 MG
|
Facility
|
OP
|
$12.88
|
|
|
Service Code
|
NDC 51079049820
|
| Hospital Charge Code |
4409062
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.93 |
| Max. Negotiated Rate |
$10.30 |
| Rate for Payer: Aetna of NY Commercial |
$9.02
|
| Rate for Payer: Aetna of NY Medicare |
$5.92
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$5.15
|
| Rate for Payer: Cash Price |
$9.66
|
| Rate for Payer: CDPHP Medicare |
$4.77
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$10.30
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$10.30
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$10.30
|
| Rate for Payer: EmblemHealth Medicaid |
$10.30
|
| Rate for Payer: EmblemHealth Medicare |
$4.38
|
| Rate for Payer: EmblemHealth Select Care |
$9.27
|
| Rate for Payer: Fidelis Medicare |
$5.15
|
| Rate for Payer: Galaxy Health Commercial |
$8.37
|
| Rate for Payer: Hamaspik Choice Medicare |
$5.15
|
| Rate for Payer: Humana Medicare |
$5.15
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$9.02
|
| Rate for Payer: Local 1199SEIU Medicare |
$5.92
|
| Rate for Payer: MVP Health Care of NY Commercial |
$9.66
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$7.25
|
| Rate for Payer: MVP Health Care of NY Medicare |
$5.41
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1.93
|
| Rate for Payer: United Healthcare Medicare |
$5.15
|
| Rate for Payer: WellCare Medicare |
$7.08
|
|
|
LAMOTRIGINE 25 MG
|
Facility
|
IP
|
$12.88
|
|
|
Service Code
|
NDC 51079049820
|
| Hospital Charge Code |
4409062
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.08 |
| Max. Negotiated Rate |
$8.37 |
| Rate for Payer: Cash Price |
$9.66
|
| Rate for Payer: Galaxy Health Commercial |
$8.37
|
| Rate for Payer: WellCare Medicare |
$7.08
|
|
|
Lantus 100 UNIT/ML VIAL 100 unit, 10 mL
|
Facility
|
IP
|
$4.34
|
|
|
Service Code
|
HCPCS J1815
|
| Hospital Charge Code |
4401516
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.39 |
| Max. Negotiated Rate |
$2.82 |
| Rate for Payer: Aetna of NY Commercial |
$2.39
|
| Rate for Payer: Cash Price |
$3.26
|
| Rate for Payer: Galaxy Health Commercial |
$2.82
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$2.39
|
| Rate for Payer: WellCare Medicare |
$2.39
|
|
|
Lantus 100 UNIT/ML VIAL 100 unit, 10 mL
|
Facility
|
OP
|
$4.34
|
|
|
Service Code
|
HCPCS J1815
|
| Hospital Charge Code |
4401516
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.65 |
| Max. Negotiated Rate |
$3.47 |
| Rate for Payer: Aetna of NY Medicare |
$2.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1.74
|
| Rate for Payer: Cash Price |
$3.26
|
| Rate for Payer: Cash Price |
$3.26
|
| Rate for Payer: CDPHP Medicare |
$1.61
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$3.47
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$3.47
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$3.47
|
| Rate for Payer: EmblemHealth Medicaid |
$3.47
|
| Rate for Payer: EmblemHealth Medicare |
$1.48
|
| Rate for Payer: EmblemHealth Select Care |
$3.12
|
| Rate for Payer: Fidelis Medicare |
$1.74
|
| Rate for Payer: Galaxy Health Commercial |
$2.82
|
| Rate for Payer: Hamaspik Choice Medicare |
$1.74
|
| Rate for Payer: Humana Medicare |
$1.74
|
| Rate for Payer: Local 1199SEIU Medicare |
$2.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$2.44
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1.82
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$2.24
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$0.65
|
| Rate for Payer: United Healthcare Commercial |
$2.24
|
| Rate for Payer: United Healthcare Medicare |
$1.74
|
| Rate for Payer: WellCare Medicare |
$2.39
|
|
|
LAPAROSCOPY PACK
|
Facility
|
IP
|
$164.80
|
|
| Hospital Charge Code |
4479181
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$107.12 |
| Max. Negotiated Rate |
$107.12 |
| Rate for Payer: Cash Price |
$123.60
|
| Rate for Payer: Galaxy Health Commercial |
$107.12
|
|
|
LAPAROSCOPY PACK
|
Facility
|
OP
|
$164.80
|
|
| Hospital Charge Code |
4479181
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$24.72 |
| Max. Negotiated Rate |
$131.84 |
| Rate for Payer: Aetna of NY Commercial |
$115.36
|
| Rate for Payer: Aetna of NY Medicare |
$75.81
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$65.92
|
| Rate for Payer: Cash Price |
$123.60
|
| Rate for Payer: CDPHP Medicare |
$60.98
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$131.84
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$131.84
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$131.84
|
| Rate for Payer: EmblemHealth Medicaid |
$131.84
|
| Rate for Payer: EmblemHealth Medicare |
$56.03
|
| Rate for Payer: EmblemHealth Select Care |
$118.66
|
| Rate for Payer: Fidelis Medicare |
$65.92
|
| Rate for Payer: Galaxy Health Commercial |
$107.12
|
| Rate for Payer: Hamaspik Choice Medicare |
$65.92
|
| Rate for Payer: Humana Medicare |
$65.92
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.36
|
| Rate for Payer: Local 1199SEIU Medicare |
$75.81
|
| Rate for Payer: MVP Health Care of NY Commercial |
$123.60
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$92.78
|
| Rate for Payer: MVP Health Care of NY Medicare |
$69.22
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$24.72
|
| Rate for Payer: United Healthcare Medicare |
$65.92
|
| Rate for Payer: WellCare Medicare |
$90.64
|
|
|
LAP CHOLE PACK
|
Facility
|
OP
|
$929.06
|
|
| Hospital Charge Code |
4479180
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$139.36 |
| Max. Negotiated Rate |
$743.25 |
| Rate for Payer: Aetna of NY Commercial |
$650.34
|
| Rate for Payer: Aetna of NY Medicare |
$427.37
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$371.62
|
| Rate for Payer: Cash Price |
$696.80
|
| Rate for Payer: CDPHP Medicare |
$343.75
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$743.25
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$743.25
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$743.25
|
| Rate for Payer: EmblemHealth Medicaid |
$743.25
|
| Rate for Payer: EmblemHealth Medicare |
$315.88
|
| Rate for Payer: EmblemHealth Select Care |
$668.92
|
| Rate for Payer: Fidelis Medicare |
$371.62
|
| Rate for Payer: Galaxy Health Commercial |
$603.89
|
| Rate for Payer: Hamaspik Choice Medicare |
$371.62
|
| Rate for Payer: Humana Medicare |
$371.62
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$650.34
|
| Rate for Payer: Local 1199SEIU Medicare |
$427.37
|
| Rate for Payer: MVP Health Care of NY Commercial |
$696.79
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$523.06
|
| Rate for Payer: MVP Health Care of NY Medicare |
$390.21
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$139.36
|
| Rate for Payer: United Healthcare Medicare |
$371.62
|
| Rate for Payer: WellCare Medicare |
$510.98
|
|
|
LAP CHOLE PACK
|
Facility
|
IP
|
$929.06
|
|
| Hospital Charge Code |
4479180
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$603.89 |
| Max. Negotiated Rate |
$603.89 |
| Rate for Payer: Cash Price |
$696.80
|
| Rate for Payer: Galaxy Health Commercial |
$603.89
|
|
