|
LNLRATHECAL CATH
|
Facility
|
OP
|
$4,099.40
|
|
| Hospital Charge Code |
4471644
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$614.91 |
| Max. Negotiated Rate |
$3,279.52 |
| Rate for Payer: Aetna of NY Commercial |
$2,869.58
|
| Rate for Payer: Aetna of NY Medicare |
$1,885.72
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1,639.76
|
| Rate for Payer: Cash Price |
$3,074.55
|
| Rate for Payer: CDPHP Medicare |
$1,516.78
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$3,279.52
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$3,279.52
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$3,279.52
|
| Rate for Payer: EmblemHealth Medicaid |
$3,279.52
|
| Rate for Payer: EmblemHealth Medicare |
$1,393.80
|
| Rate for Payer: EmblemHealth Select Care |
$2,951.57
|
| Rate for Payer: Fidelis Medicare |
$1,639.76
|
| Rate for Payer: Galaxy Health Commercial |
$2,664.61
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,639.76
|
| Rate for Payer: Humana Medicare |
$1,639.76
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$2,869.58
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,885.72
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,074.55
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$2,307.96
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1,721.75
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$614.91
|
| Rate for Payer: United Healthcare Medicare |
$1,639.76
|
| Rate for Payer: WellCare Medicare |
$2,254.67
|
|
|
LONG ARM CAST APPLICATION
|
Facility
|
OP
|
$857.00
|
|
|
Service Code
|
HCPCS 29065
|
| Hospital Charge Code |
4850015
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$128.55 |
| Max. Negotiated Rate |
$685.60 |
| Rate for Payer: Aetna of NY Commercial |
$599.90
|
| Rate for Payer: Aetna of NY Medicare |
$394.22
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$342.80
|
| Rate for Payer: Cash Price |
$642.75
|
| Rate for Payer: CDPHP Medicare |
$317.09
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$685.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$685.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$685.60
|
| Rate for Payer: EmblemHealth Medicaid |
$685.60
|
| Rate for Payer: EmblemHealth Medicare |
$291.38
|
| Rate for Payer: EmblemHealth Select Care |
$617.04
|
| Rate for Payer: Fidelis Medicare |
$342.80
|
| Rate for Payer: Galaxy Health Commercial |
$557.05
|
| Rate for Payer: Hamaspik Choice Medicare |
$342.80
|
| Rate for Payer: Humana Medicare |
$342.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$599.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$394.22
|
| Rate for Payer: MVP Health Care of NY Commercial |
$642.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$482.49
|
| Rate for Payer: MVP Health Care of NY Medicare |
$359.94
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$128.55
|
| Rate for Payer: United Healthcare Medicare |
$342.80
|
| Rate for Payer: WellCare Medicare |
$471.35
|
|
|
LONG ARM CAST APPLICATION
|
Facility
|
IP
|
$857.00
|
|
|
Service Code
|
HCPCS 29065
|
| Hospital Charge Code |
4850015
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$557.05 |
| Max. Negotiated Rate |
$557.05 |
| Rate for Payer: Cash Price |
$642.75
|
| Rate for Payer: Galaxy Health Commercial |
$557.05
|
|
|
LONG ARM SPLINTS APPLICATION
|
Facility
|
OP
|
$498.00
|
|
|
Service Code
|
HCPCS 29105
|
| Hospital Charge Code |
4850020
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$74.70 |
| Max. Negotiated Rate |
$398.40 |
| Rate for Payer: Aetna of NY Commercial |
$348.60
|
| Rate for Payer: Aetna of NY Medicare |
$229.08
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$199.20
|
| Rate for Payer: Cash Price |
$373.50
|
| Rate for Payer: CDPHP Medicare |
$184.26
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$398.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$398.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$398.40
|
| Rate for Payer: EmblemHealth Medicaid |
$398.40
|
| Rate for Payer: EmblemHealth Medicare |
$169.32
|
| Rate for Payer: EmblemHealth Select Care |
$358.56
|
| Rate for Payer: Fidelis Medicare |
$199.20
|
| Rate for Payer: Galaxy Health Commercial |
$323.70
|
| Rate for Payer: Hamaspik Choice Medicare |
$199.20
|
| Rate for Payer: Humana Medicare |
$199.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$348.60
|
| Rate for Payer: Local 1199SEIU Medicare |
$229.08
|
| Rate for Payer: MVP Health Care of NY Commercial |
$373.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$280.37
|
| Rate for Payer: MVP Health Care of NY Medicare |
$209.16
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$74.70
|
| Rate for Payer: United Healthcare Medicare |
$199.20
|
| Rate for Payer: WellCare Medicare |
$273.90
|
|
|
LONG ARM SPLINTS APPLICATION
|
Facility
|
IP
|
$498.00
|
|
|
Service Code
|
HCPCS 29105
|
| Hospital Charge Code |
4850020
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$323.70 |
| Max. Negotiated Rate |
$323.70 |
| Rate for Payer: Cash Price |
$373.50
|
| Rate for Payer: Galaxy Health Commercial |
$323.70
|
|
|
LONG LEG CAST APPLICATION
|
Facility
|
OP
|
$857.00
|
|
|
Service Code
|
HCPCS 29345
|
| Hospital Charge Code |
4850018
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$128.55 |
| Max. Negotiated Rate |
$685.60 |
| Rate for Payer: Aetna of NY Commercial |
$599.90
|
| Rate for Payer: Aetna of NY Medicare |
$394.22
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$342.80
|
| Rate for Payer: Cash Price |
$642.75
|
| Rate for Payer: CDPHP Medicare |
$317.09
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$685.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$685.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$685.60
|
| Rate for Payer: EmblemHealth Medicaid |
$685.60
|
| Rate for Payer: EmblemHealth Medicare |
$291.38
|
| Rate for Payer: EmblemHealth Select Care |
$617.04
|
| Rate for Payer: Fidelis Medicare |
$342.80
|
| Rate for Payer: Galaxy Health Commercial |
$557.05
|
| Rate for Payer: Hamaspik Choice Medicare |
$342.80
|
| Rate for Payer: Humana Medicare |
$342.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$599.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$394.22
|
| Rate for Payer: MVP Health Care of NY Commercial |
$642.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$482.49
|
| Rate for Payer: MVP Health Care of NY Medicare |
$359.94
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$128.55
|
| Rate for Payer: United Healthcare Medicare |
$342.80
|
| Rate for Payer: WellCare Medicare |
$471.35
|
|
|
LONG LEG CAST APPLICATION
|
Facility
|
IP
|
$857.00
|
|
|
Service Code
|
HCPCS 29345
|
| Hospital Charge Code |
4850018
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$557.05 |
| Max. Negotiated Rate |
$557.05 |
| Rate for Payer: Cash Price |
$642.75
|
| Rate for Payer: Galaxy Health Commercial |
$557.05
|
|
|
LONG LEG SPLINT APPLICATION
|
Facility
|
IP
|
$498.00
|
|
|
Service Code
|
HCPCS 29505
|
| Hospital Charge Code |
4850023
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$323.70 |
| Max. Negotiated Rate |
$323.70 |
| Rate for Payer: Cash Price |
$373.50
|
| Rate for Payer: Galaxy Health Commercial |
$323.70
|
|
|
LONG LEG SPLINT APPLICATION
|
Facility
|
OP
|
$498.00
|
|
|
Service Code
|
HCPCS 29505
|
| Hospital Charge Code |
4850023
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$74.70 |
| Max. Negotiated Rate |
$398.40 |
| Rate for Payer: Aetna of NY Commercial |
$348.60
|
| Rate for Payer: Aetna of NY Medicare |
$229.08
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$199.20
|
| Rate for Payer: Cash Price |
$373.50
|
| Rate for Payer: CDPHP Medicare |
$184.26
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$398.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$398.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$398.40
|
| Rate for Payer: EmblemHealth Medicaid |
$398.40
|
| Rate for Payer: EmblemHealth Medicare |
$169.32
|
| Rate for Payer: EmblemHealth Select Care |
$358.56
|
| Rate for Payer: Fidelis Medicare |
$199.20
|
| Rate for Payer: Galaxy Health Commercial |
$323.70
|
| Rate for Payer: Hamaspik Choice Medicare |
$199.20
|
| Rate for Payer: Humana Medicare |
$199.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$348.60
|
| Rate for Payer: Local 1199SEIU Medicare |
$229.08
|
| Rate for Payer: MVP Health Care of NY Commercial |
$373.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$280.37
|
| Rate for Payer: MVP Health Care of NY Medicare |
$209.16
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$74.70
|
| Rate for Payer: United Healthcare Medicare |
$199.20
|
| Rate for Payer: WellCare Medicare |
$273.90
|
|
|
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
|
|
|
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 |
$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
|
|
|
LORATADINE 10MG TABS 10X10EA
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 68084024811
|
| Hospital Charge Code |
4400463
|
|
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
|
|
|
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
|
|
|
LORAZEPAM 0.5MG TABS 100 EA
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 904600761
|
| Hospital Charge Code |
4400465
|
|
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
|
|
|
LORAZEPAM 0.5MG TABS 100 EA
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
NDC 904600761
|
| 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 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 |
$1.66 |
| Max. Negotiated Rate |
$8.45 |
| Rate for Payer: Aetna of NY Commercial |
$7.15
|
| Rate for Payer: Cash Price |
$9.75
|
| Rate for Payer: Cash Price |
$9.75
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1.66
|
| Rate for Payer: EmblemHealth Select Care |
$1.66
|
| 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 |
$1.40 |
| Max. Negotiated Rate |
$10.40 |
| Rate for Payer: Aetna of NY Medicare |
$5.98
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$5.20
|
| Rate for Payer: Cash Price |
$9.75
|
| Rate for Payer: Cash Price |
$9.75
|
| Rate for Payer: CDPHP Medicare |
$4.81
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1.66
|
| 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 |
$1.66
|
| Rate for Payer: Fidelis Medicare |
$5.20
|
| Rate for Payer: Galaxy Health Commercial |
$8.45
|
| Rate for Payer: Hamaspik Choice Medicare |
$5.20
|
| Rate for Payer: Humana Medicare |
$5.20
|
| 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 |
$5.46
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1.40
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1.95
|
| Rate for Payer: United Healthcare Commercial |
$1.40
|
| Rate for Payer: United Healthcare Medicare |
$5.20
|
| 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 |
$0.93 |
| Max. Negotiated Rate |
$4.94 |
| 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: Cash Price |
$4.64
|
| Rate for Payer: CDPHP Medicare |
$2.29
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1.66
|
| 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 |
$1.66
|
| 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 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: Oxford Health Plans Freedom/Liberty/Metro |
$1.40
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$0.93
|
| Rate for Payer: United Healthcare Commercial |
$1.40
|
| Rate for Payer: United Healthcare Medicare |
$2.47
|
| 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 |
$1.66 |
| Max. Negotiated Rate |
$4.02 |
| Rate for Payer: Aetna of NY Commercial |
$3.40
|
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1.66
|
| Rate for Payer: EmblemHealth Select Care |
$1.66
|
| 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 |
$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
|
|
|
LOSARTAN 50 MG TABLET, NDC 00904-6390-61
|
Facility
|
IP
|
$6.95
|
|
|
Service Code
|
NDC 904639061
|
| 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
|
|
|
LOSARTAN 50 MG TABLET, NDC 00904-6390-61
|
Facility
|
OP
|
$6.95
|
|
|
Service Code
|
NDC 904639061
|
| Hospital Charge Code |
4409228
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.04 |
| Max. Negotiated Rate |
$5.56 |
| Rate for Payer: Aetna of NY Commercial |
$4.87
|
| Rate for Payer: Aetna of NY Medicare |
$3.20
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2.78
|
| Rate for Payer: Cash Price |
$5.21
|
| 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 |
$2.78
|
| Rate for Payer: Galaxy Health Commercial |
$4.52
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.78
|
| Rate for Payer: Humana Medicare |
$2.78
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$4.87
|
| 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 |
$2.92
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1.04
|
| Rate for Payer: United Healthcare Medicare |
$2.78
|
| 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 |
$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
|
|
