|
LIDOCAINE HCL INJ FOR IV 10 MG
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
HCPCS J2001
|
| Hospital Charge Code |
4400443
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.40 |
| Max. Negotiated Rate |
$4.02 |
| Rate for Payer: Aetna of NY Commercial |
$3.40
|
| Rate for Payer: Cash Price |
$4.64
|
| 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
|
|
|
LIDOCAINE HCL INJ FOR IV 10 MG
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
HCPCS J2001
|
| Hospital Charge Code |
4400444
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.40 |
| Max. Negotiated Rate |
$4.02 |
| Rate for Payer: Aetna of NY Commercial |
$3.40
|
| Rate for Payer: Cash Price |
$4.64
|
| 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
|
|
|
LIDOCAINE HCL INJ FOR IV 10 MG
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 55150016205
|
| Hospital Charge Code |
4400439
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.93 |
| Max. Negotiated Rate |
$4.94 |
| 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) Medicare |
$2.47
|
| Rate for Payer: Cash Price |
$4.64
|
| 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 |
$2.47
|
| Rate for Payer: Galaxy Health Commercial |
$4.02
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.47
|
| Rate for Payer: Humana Medicare |
$2.47
|
| 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 |
$4.63
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3.48
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2.60
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$0.93
|
| Rate for Payer: United Healthcare Medicare |
$2.47
|
| Rate for Payer: WellCare Medicare |
$3.40
|
|
|
LIDOCAINE JELLY 2%, 5 ML SIZE
|
Facility
|
IP
|
$24.21
|
|
|
Service Code
|
NDC 17478071110
|
| Hospital Charge Code |
4400830
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.32 |
| Max. Negotiated Rate |
$15.74 |
| Rate for Payer: Cash Price |
$18.16
|
| Rate for Payer: Galaxy Health Commercial |
$15.74
|
| Rate for Payer: WellCare Medicare |
$13.32
|
|
|
LIDOCAINE JELLY 2%, 5 ML SIZE
|
Facility
|
OP
|
$24.21
|
|
|
Service Code
|
NDC 17478071110
|
| Hospital Charge Code |
4400830
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.63 |
| Max. Negotiated Rate |
$19.37 |
| Rate for Payer: Aetna of NY Commercial |
$16.95
|
| Rate for Payer: Aetna of NY Medicare |
$11.14
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$9.68
|
| Rate for Payer: Cash Price |
$18.16
|
| Rate for Payer: CDPHP Medicare |
$8.96
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$19.37
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$19.37
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$19.37
|
| Rate for Payer: EmblemHealth Medicaid |
$19.37
|
| Rate for Payer: EmblemHealth Medicare |
$8.23
|
| Rate for Payer: EmblemHealth Select Care |
$17.43
|
| Rate for Payer: Fidelis Medicare |
$9.68
|
| Rate for Payer: Galaxy Health Commercial |
$15.74
|
| Rate for Payer: Hamaspik Choice Medicare |
$9.68
|
| Rate for Payer: Humana Medicare |
$9.68
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$16.95
|
| Rate for Payer: Local 1199SEIU Medicare |
$11.14
|
| Rate for Payer: MVP Health Care of NY Commercial |
$18.16
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$13.63
|
| Rate for Payer: MVP Health Care of NY Medicare |
$10.17
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$3.63
|
| Rate for Payer: United Healthcare Medicare |
$9.68
|
| Rate for Payer: WellCare Medicare |
$13.32
|
|
|
LIDOCAINE ORAL SOLUTION 2% VISCOUS 15ML
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
NDC 50383077515
|
| Hospital Charge Code |
4409199
|
|
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
|
|
|
LIDOCAINE ORAL SOLUTION 2% VISCOUS 15ML
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 50383077515
|
| Hospital Charge Code |
4409199
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.93 |
| Max. Negotiated Rate |
$4.94 |
| 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) Medicare |
$2.47
|
| Rate for Payer: Cash Price |
$4.64
|
| 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 |
$2.47
|
| Rate for Payer: Galaxy Health Commercial |
$4.02
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.47
|
| Rate for Payer: Humana Medicare |
$2.47
|
| 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 |
$4.63
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3.48
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2.60
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$0.93
|
| Rate for Payer: United Healthcare Medicare |
$2.47
|
| Rate for Payer: WellCare Medicare |
$3.40
|
|
|
LIDOCAINE/PRILOCAINE 2.5-2.5% CRM 5X5GM
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
NDC 115146853
|
| Hospital Charge Code |
4400450
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.50 |
| Max. Negotiated Rate |
$19.50 |
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Galaxy Health Commercial |
$19.50
|
| Rate for Payer: WellCare Medicare |
$16.50
|
|
|
LIDOCAINE/PRILOCAINE 2.5-2.5% CRM 5X5GM
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
NDC 115146853
|
| Hospital Charge Code |
4400450
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.50 |
| Max. Negotiated Rate |
$24.00 |
| Rate for Payer: Aetna of NY Commercial |
$21.00
|
| Rate for Payer: Aetna of NY Medicare |
$13.80
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$12.00
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: CDPHP Medicare |
$11.10
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$24.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$24.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$24.00
|
| Rate for Payer: EmblemHealth Medicaid |
$24.00
|
| Rate for Payer: EmblemHealth Medicare |
$10.20
|
| Rate for Payer: EmblemHealth Select Care |
$21.60
|
| Rate for Payer: Fidelis Medicare |
$12.00
|
| Rate for Payer: Galaxy Health Commercial |
$19.50
|
| Rate for Payer: Hamaspik Choice Medicare |
$12.00
|
| Rate for Payer: Humana Medicare |
$12.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$21.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$13.80
|
| Rate for Payer: MVP Health Care of NY Commercial |
$22.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$16.89
|
| Rate for Payer: MVP Health Care of NY Medicare |
$12.60
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$4.50
|
| Rate for Payer: United Healthcare Medicare |
$12.00
|
| Rate for Payer: WellCare Medicare |
$16.50
|
|
|
LINEAR ST LEAD 50CM
|
Facility
|
OP
|
$10,613.12
|
|
|
Service Code
|
HCPCS C1778
|
| Hospital Charge Code |
4472055
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,591.97 |
| Max. Negotiated Rate |
$8,490.50 |
| Rate for Payer: Aetna of NY Commercial |
$7,429.18
|
| Rate for Payer: Aetna of NY Medicare |
$4,882.04
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$4,245.25
|
| Rate for Payer: Cash Price |
$7,959.84
|
| Rate for Payer: CDPHP Medicare |
$3,926.85
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$5,306.56
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$8,490.50
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$8,490.50
|
| Rate for Payer: EmblemHealth Medicaid |
$8,490.50
|
| Rate for Payer: EmblemHealth Medicare |
$3,608.46
|
| Rate for Payer: EmblemHealth Select Care |
$5,306.56
|
| Rate for Payer: Fidelis Medicare |
$4,245.25
|
| Rate for Payer: Galaxy Health Commercial |
$6,898.53
|
| Rate for Payer: Hamaspik Choice Medicare |
$4,245.25
|
| Rate for Payer: Humana Medicare |
$4,245.25
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$7,429.18
|
| Rate for Payer: Local 1199SEIU Medicare |
$4,882.04
|
| Rate for Payer: MVP Health Care of NY Commercial |
$6,898.53
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$6,898.53
|
| Rate for Payer: MVP Health Care of NY Medicare |
$4,457.51
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,591.97
|
| Rate for Payer: United Healthcare Medicare |
$4,245.25
|
| Rate for Payer: WellCare Medicare |
$5,837.22
|
|
|
LINEAR ST LEAD 50CM
|
Facility
|
IP
|
$10,613.12
|
|
|
Service Code
|
HCPCS C1778
|
| Hospital Charge Code |
4472056
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,775.90 |
| Max. Negotiated Rate |
$7,429.18 |
| Rate for Payer: Aetna of NY Commercial |
$7,429.18
|
| Rate for Payer: Cash Price |
$7,959.84
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$5,306.56
|
| Rate for Payer: EmblemHealth Select Care |
$5,306.56
|
| Rate for Payer: Galaxy Health Commercial |
$6,898.53
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$7,429.18
|
| Rate for Payer: Multiplan Commercial |
$4,775.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$6,898.53
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$6,898.53
|
| Rate for Payer: WellCare Medicare |
$5,837.22
|
|
|
LINEAR ST LEAD 50CM
|
Facility
|
IP
|
$10,613.12
|
|
|
Service Code
|
HCPCS C1778
|
| Hospital Charge Code |
4472055
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,775.90 |
| Max. Negotiated Rate |
$7,429.18 |
| Rate for Payer: Aetna of NY Commercial |
$7,429.18
|
| Rate for Payer: Cash Price |
$7,959.84
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$5,306.56
|
| Rate for Payer: EmblemHealth Select Care |
$5,306.56
|
| Rate for Payer: Galaxy Health Commercial |
$6,898.53
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$7,429.18
|
| Rate for Payer: Multiplan Commercial |
$4,775.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$6,898.53
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$6,898.53
|
| Rate for Payer: WellCare Medicare |
$5,837.22
|
|
|
LINEAR ST LEAD 50CM
|
Facility
|
OP
|
$10,613.12
|
|
|
Service Code
|
HCPCS C1778
|
| Hospital Charge Code |
4472056
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,591.97 |
| Max. Negotiated Rate |
$8,490.50 |
| Rate for Payer: Aetna of NY Commercial |
$7,429.18
|
| Rate for Payer: Aetna of NY Medicare |
$4,882.04
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$4,245.25
|
| Rate for Payer: Cash Price |
$7,959.84
|
| Rate for Payer: CDPHP Medicare |
$3,926.85
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$5,306.56
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$8,490.50
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$8,490.50
|
| Rate for Payer: EmblemHealth Medicaid |
$8,490.50
|
| Rate for Payer: EmblemHealth Medicare |
$3,608.46
|
| Rate for Payer: EmblemHealth Select Care |
$5,306.56
|
| Rate for Payer: Fidelis Medicare |
$4,245.25
|
| Rate for Payer: Galaxy Health Commercial |
$6,898.53
|
| Rate for Payer: Hamaspik Choice Medicare |
$4,245.25
|
| Rate for Payer: Humana Medicare |
$4,245.25
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$7,429.18
|
| Rate for Payer: Local 1199SEIU Medicare |
$4,882.04
|
| Rate for Payer: MVP Health Care of NY Commercial |
$6,898.53
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$6,898.53
|
| Rate for Payer: MVP Health Care of NY Medicare |
$4,457.51
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,591.97
|
| Rate for Payer: United Healthcare Medicare |
$4,245.25
|
| Rate for Payer: WellCare Medicare |
$5,837.22
|
|
|
LINEAR ST LEAD 70CM
|
Facility
|
IP
|
$10,613.12
|
|
|
Service Code
|
HCPCS C1778
|
| Hospital Charge Code |
4472057
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,775.90 |
| Max. Negotiated Rate |
$7,429.18 |
| Rate for Payer: Aetna of NY Commercial |
$7,429.18
|
| Rate for Payer: Cash Price |
$7,959.84
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$5,306.56
|
| Rate for Payer: EmblemHealth Select Care |
$5,306.56
|
| Rate for Payer: Galaxy Health Commercial |
$6,898.53
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$7,429.18
|
| Rate for Payer: Multiplan Commercial |
$4,775.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$6,898.53
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$6,898.53
|
| Rate for Payer: WellCare Medicare |
$5,837.22
|
|
|
LINEAR ST LEAD 70CM
|
Facility
|
OP
|
$10,613.12
|
|
|
Service Code
|
HCPCS C1778
|
| Hospital Charge Code |
4472057
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,591.97 |
| Max. Negotiated Rate |
$8,490.50 |
| Rate for Payer: Aetna of NY Commercial |
$7,429.18
|
| Rate for Payer: Aetna of NY Medicare |
$4,882.04
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$4,245.25
|
| Rate for Payer: Cash Price |
$7,959.84
|
| Rate for Payer: CDPHP Medicare |
$3,926.85
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$5,306.56
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$8,490.50
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$8,490.50
|
| Rate for Payer: EmblemHealth Medicaid |
$8,490.50
|
| Rate for Payer: EmblemHealth Medicare |
$3,608.46
|
| Rate for Payer: EmblemHealth Select Care |
$5,306.56
|
| Rate for Payer: Fidelis Medicare |
$4,245.25
|
| Rate for Payer: Galaxy Health Commercial |
$6,898.53
|
| Rate for Payer: Hamaspik Choice Medicare |
$4,245.25
|
| Rate for Payer: Humana Medicare |
$4,245.25
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$7,429.18
|
| Rate for Payer: Local 1199SEIU Medicare |
$4,882.04
|
| Rate for Payer: MVP Health Care of NY Commercial |
$6,898.53
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$6,898.53
|
| Rate for Payer: MVP Health Care of NY Medicare |
$4,457.51
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,591.97
|
| Rate for Payer: United Healthcare Medicare |
$4,245.25
|
| Rate for Payer: WellCare Medicare |
$5,837.22
|
|
|
LINEZOLID INJ 200 MG
|
Facility
|
IP
|
$296.64
|
|
|
Service Code
|
HCPCS J2020
|
| Hospital Charge Code |
4450017
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.48 |
| Max. Negotiated Rate |
$192.82 |
| Rate for Payer: Aetna of NY Commercial |
$163.15
|
| Rate for Payer: Cash Price |
$222.48
|
| Rate for Payer: Cash Price |
$222.48
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$2.48
|
| Rate for Payer: EmblemHealth Select Care |
$2.48
|
| Rate for Payer: Galaxy Health Commercial |
$192.82
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$163.15
|
| Rate for Payer: WellCare Medicare |
$163.15
|
|
|
LINEZOLID INJ 200 MG
|
Facility
|
OP
|
$296.64
|
|
|
Service Code
|
HCPCS J2020
|
| Hospital Charge Code |
4450017
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.48 |
| Max. Negotiated Rate |
$237.31 |
| Rate for Payer: Aetna of NY Medicare |
$136.45
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$118.66
|
| Rate for Payer: Cash Price |
$222.48
|
| Rate for Payer: Cash Price |
$222.48
|
| Rate for Payer: CDPHP Medicare |
$109.76
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$2.48
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$237.31
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$237.31
|
| Rate for Payer: EmblemHealth Medicaid |
$237.31
|
| Rate for Payer: EmblemHealth Medicare |
$100.86
|
| Rate for Payer: EmblemHealth Select Care |
$2.48
|
| Rate for Payer: Fidelis Medicare |
$118.66
|
| Rate for Payer: Galaxy Health Commercial |
$192.82
|
| Rate for Payer: Hamaspik Choice Medicare |
$118.66
|
| Rate for Payer: Humana Medicare |
$118.66
|
| Rate for Payer: Local 1199SEIU Medicare |
$136.45
|
| Rate for Payer: MVP Health Care of NY Commercial |
$222.48
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$167.01
|
| Rate for Payer: MVP Health Care of NY Medicare |
$124.59
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$5.73
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$44.50
|
| Rate for Payer: United Healthcare Commercial |
$5.73
|
| Rate for Payer: United Healthcare Medicare |
$118.66
|
| Rate for Payer: WellCare Medicare |
$163.15
|
|
|
LIPASE SERUM
|
Facility
|
IP
|
$95.00
|
|
|
Service Code
|
HCPCS 83690
|
| Hospital Charge Code |
4301045
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$61.75 |
| Max. Negotiated Rate |
$61.75 |
| Rate for Payer: Cash Price |
$71.25
|
| Rate for Payer: Galaxy Health Commercial |
$61.75
|
|
|
LIPASE SERUM
|
Facility
|
OP
|
$95.00
|
|
|
Service Code
|
HCPCS 83690
|
| Hospital Charge Code |
4301045
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.25 |
| Max. Negotiated Rate |
$76.00 |
| Rate for Payer: Aetna of NY Commercial |
$61.75
|
| Rate for Payer: Aetna of NY Medicare |
$43.70
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$38.00
|
| Rate for Payer: Cash Price |
$71.25
|
| Rate for Payer: CDPHP Medicare |
$35.15
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$57.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$76.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$76.00
|
| Rate for Payer: EmblemHealth Medicaid |
$76.00
|
| Rate for Payer: EmblemHealth Medicare |
$32.30
|
| Rate for Payer: EmblemHealth Select Care |
$57.00
|
| Rate for Payer: Fidelis Medicare |
$38.00
|
| Rate for Payer: Galaxy Health Commercial |
$61.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$38.00
|
| Rate for Payer: Humana Medicare |
$38.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$61.75
|
| Rate for Payer: Local 1199SEIU Medicare |
$43.70
|
| Rate for Payer: MVP Health Care of NY Commercial |
$71.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$53.48
|
| Rate for Payer: MVP Health Care of NY Medicare |
$39.90
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$71.25
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$14.25
|
| Rate for Payer: United Healthcare Commercial |
$71.25
|
| Rate for Payer: United Healthcare Medicare |
$38.00
|
| Rate for Payer: WellCare Medicare |
$52.25
|
|
|
LIPID PROFILE
|
Facility
|
IP
|
$52.00
|
|
|
Service Code
|
HCPCS 80061
|
| Hospital Charge Code |
4300530
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$33.80 |
| Max. Negotiated Rate |
$33.80 |
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Galaxy Health Commercial |
$33.80
|
|
|
LIPID PROFILE
|
Facility
|
OP
|
$52.00
|
|
|
Service Code
|
HCPCS 80061
|
| Hospital Charge Code |
4300530
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.80 |
| Max. Negotiated Rate |
$41.60 |
| Rate for Payer: Aetna of NY Commercial |
$33.80
|
| Rate for Payer: Aetna of NY Medicare |
$23.92
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$20.80
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: CDPHP Medicare |
$19.24
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$31.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$41.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$41.60
|
| Rate for Payer: EmblemHealth Medicaid |
$41.60
|
| Rate for Payer: EmblemHealth Medicare |
$17.68
|
| Rate for Payer: EmblemHealth Select Care |
$31.20
|
| Rate for Payer: Fidelis Medicare |
$20.80
|
| Rate for Payer: Galaxy Health Commercial |
$33.80
|
| Rate for Payer: Hamaspik Choice Medicare |
$20.80
|
| Rate for Payer: Humana Medicare |
$20.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$33.80
|
| Rate for Payer: Local 1199SEIU Medicare |
$23.92
|
| Rate for Payer: MVP Health Care of NY Commercial |
$39.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$29.28
|
| Rate for Payer: MVP Health Care of NY Medicare |
$21.84
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$39.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$7.80
|
| Rate for Payer: United Healthcare Commercial |
$39.00
|
| Rate for Payer: United Healthcare Medicare |
$20.80
|
| Rate for Payer: WellCare Medicare |
$28.60
|
|
|
LISINOPRIL 10MG TABS 10X10EA
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
NDC 51079098201
|
| Hospital Charge Code |
4400454
|
|
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
|
|
|
LISINOPRIL 10MG TABS 10X10EA
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 51079098201
|
| Hospital Charge Code |
4400454
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.93 |
| Max. Negotiated Rate |
$4.94 |
| 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) Medicare |
$2.47
|
| Rate for Payer: Cash Price |
$4.64
|
| 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 |
$2.47
|
| Rate for Payer: Galaxy Health Commercial |
$4.02
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.47
|
| Rate for Payer: Humana Medicare |
$2.47
|
| 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 |
$4.63
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3.48
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2.60
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$0.93
|
| Rate for Payer: United Healthcare Medicare |
$2.47
|
| Rate for Payer: WellCare Medicare |
$3.40
|
|
|
LISINOPRIL 20MG TABS 100 EA
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 51079098301
|
| Hospital Charge Code |
4400455
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.93 |
| Max. Negotiated Rate |
$4.94 |
| 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) Medicare |
$2.47
|
| Rate for Payer: Cash Price |
$4.64
|
| 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 |
$2.47
|
| Rate for Payer: Galaxy Health Commercial |
$4.02
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.47
|
| Rate for Payer: Humana Medicare |
$2.47
|
| 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 |
$4.63
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3.48
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2.60
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$0.93
|
| Rate for Payer: United Healthcare Medicare |
$2.47
|
| Rate for Payer: WellCare Medicare |
$3.40
|
|
|
LISINOPRIL 20MG TABS 100 EA
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
NDC 51079098301
|
| Hospital Charge Code |
4400455
|
|
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
|
|
