|
LOVENOX INJ 10 MG
|
Facility
|
OP
|
$2.79
|
|
|
Service Code
|
HCPCS J1650
|
| Hospital Charge Code |
4451240
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.42 |
| Max. Negotiated Rate |
$2.23 |
| Rate for Payer: Aetna of NY Medicare |
$1.28
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1.12
|
| Rate for Payer: Cash Price |
$2.09
|
| Rate for Payer: Cash Price |
$2.09
|
| Rate for Payer: CDPHP Medicare |
$1.03
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.54
|
| 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 |
$0.54
|
| Rate for Payer: Fidelis Medicare |
$1.12
|
| Rate for Payer: Galaxy Health Commercial |
$1.81
|
| Rate for Payer: Hamaspik Choice Medicare |
$1.12
|
| Rate for Payer: Humana Medicare |
$1.12
|
| 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 |
$1.17
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1.12
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$0.42
|
| Rate for Payer: United Healthcare Commercial |
$1.12
|
| Rate for Payer: United Healthcare Medicare |
$1.12
|
| Rate for Payer: WellCare Medicare |
$1.53
|
|
|
LOVENOX INJ 10 MG
|
Facility
|
OP
|
$2.79
|
|
|
Service Code
|
HCPCS J1650
|
| Hospital Charge Code |
4401240
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.42 |
| Max. Negotiated Rate |
$2.23 |
| Rate for Payer: Aetna of NY Medicare |
$1.28
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1.12
|
| Rate for Payer: Cash Price |
$2.09
|
| Rate for Payer: Cash Price |
$2.09
|
| Rate for Payer: CDPHP Medicare |
$1.03
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.54
|
| 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 |
$0.54
|
| Rate for Payer: Fidelis Medicare |
$1.12
|
| Rate for Payer: Galaxy Health Commercial |
$1.81
|
| Rate for Payer: Hamaspik Choice Medicare |
$1.12
|
| Rate for Payer: Humana Medicare |
$1.12
|
| 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 |
$1.17
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1.12
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$0.42
|
| Rate for Payer: United Healthcare Commercial |
$1.12
|
| Rate for Payer: United Healthcare Medicare |
$1.12
|
| 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 |
$0.54 |
| Max. Negotiated Rate |
$1.81 |
| Rate for Payer: Aetna of NY Commercial |
$1.53
|
| Rate for Payer: Cash Price |
$2.09
|
| Rate for Payer: Cash Price |
$2.09
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.54
|
| Rate for Payer: EmblemHealth Select Care |
$0.54
|
| 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 |
4401243
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.42 |
| Max. Negotiated Rate |
$2.23 |
| Rate for Payer: Aetna of NY Medicare |
$1.28
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1.12
|
| Rate for Payer: Cash Price |
$2.09
|
| Rate for Payer: Cash Price |
$2.09
|
| Rate for Payer: CDPHP Medicare |
$1.03
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.54
|
| 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 |
$0.54
|
| Rate for Payer: Fidelis Medicare |
$1.12
|
| Rate for Payer: Galaxy Health Commercial |
$1.81
|
| Rate for Payer: Hamaspik Choice Medicare |
$1.12
|
| Rate for Payer: Humana Medicare |
$1.12
|
| 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 |
$1.17
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1.12
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$0.42
|
| Rate for Payer: United Healthcare Commercial |
$1.12
|
| Rate for Payer: United Healthcare Medicare |
$1.12
|
| Rate for Payer: WellCare Medicare |
$1.53
|
|
|
LOVENOX INJ 10 MG
|
Facility
|
IP
|
$2.79
|
|
|
Service Code
|
HCPCS J1650
|
| Hospital Charge Code |
4401242
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.54 |
| Max. Negotiated Rate |
$1.81 |
| Rate for Payer: Aetna of NY Commercial |
$1.53
|
| Rate for Payer: Cash Price |
$2.09
|
| Rate for Payer: Cash Price |
$2.09
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.54
|
| Rate for Payer: EmblemHealth Select Care |
$0.54
|
| 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 |
4451240
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.54 |
| Max. Negotiated Rate |
$1.81 |
| Rate for Payer: Aetna of NY Commercial |
$1.53
|
| Rate for Payer: Cash Price |
$2.09
|
| Rate for Payer: Cash Price |
$2.09
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.54
|
| Rate for Payer: EmblemHealth Select Care |
$0.54
|
| 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 |
4401240
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.54 |
| Max. Negotiated Rate |
$1.81 |
| Rate for Payer: Aetna of NY Commercial |
$1.53
|
| Rate for Payer: Cash Price |
$2.09
|
| Rate for Payer: Cash Price |
$2.09
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.54
|
| Rate for Payer: EmblemHealth Select Care |
$0.54
|
| 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 |
4401242
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.42 |
| Max. Negotiated Rate |
$2.23 |
| Rate for Payer: Aetna of NY Medicare |
$1.28
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1.12
|
| Rate for Payer: Cash Price |
$2.09
|
| Rate for Payer: Cash Price |
$2.09
|
| Rate for Payer: CDPHP Medicare |
$1.03
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.54
|
| 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 |
$0.54
|
| Rate for Payer: Fidelis Medicare |
$1.12
|
| Rate for Payer: Galaxy Health Commercial |
$1.81
|
| Rate for Payer: Hamaspik Choice Medicare |
$1.12
|
| Rate for Payer: Humana Medicare |
$1.12
|
| 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 |
$1.17
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1.12
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$0.42
|
| Rate for Payer: United Healthcare Commercial |
$1.12
|
| Rate for Payer: United Healthcare Medicare |
$1.12
|
| Rate for Payer: WellCare Medicare |
$1.53
|
|
|
LOW-LEVEL LASER TRMT 15 MIN
|
Facility
|
OP
|
$75.19
|
|
|
Service Code
|
HCPCS S8948 GP
|
| Hospital Charge Code |
4650071
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$11.28 |
| Max. Negotiated Rate |
$187.00 |
| Rate for Payer: Aetna of NY Commercial |
$115.00
|
| Rate for Payer: Aetna of NY Medicare |
$34.59
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$30.08
|
| Rate for Payer: Cash Price |
$56.39
|
| Rate for Payer: Cash Price |
$56.39
|
| Rate for Payer: Cash Price |
$56.39
|
| Rate for Payer: CDPHP Medicare |
$27.82
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$60.15
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$60.15
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$60.15
|
| Rate for Payer: EmblemHealth Medicaid |
$60.15
|
| Rate for Payer: EmblemHealth Medicare |
$25.56
|
| Rate for Payer: EmblemHealth Select Care |
$54.14
|
| Rate for Payer: Fidelis Medicare |
$30.08
|
| Rate for Payer: Galaxy Health Commercial |
$48.87
|
| Rate for Payer: Hamaspik Choice Medicare |
$30.08
|
| Rate for Payer: Humana Medicare |
$30.08
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$34.59
|
| Rate for Payer: MVP Health Care of NY Commercial |
$187.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$141.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$31.58
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$11.28
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$30.08
|
| Rate for Payer: WellCare Medicare |
$41.35
|
|
|
LOW-LEVEL LASER TRMT 15 MIN
|
Facility
|
IP
|
$75.19
|
|
|
Service Code
|
HCPCS S8948 GP
|
| Hospital Charge Code |
4650071
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$48.87 |
| Max. Negotiated Rate |
$48.87 |
| Rate for Payer: Cash Price |
$56.39
|
| Rate for Payer: Galaxy Health Commercial |
$48.87
|
|
|
LPT REG GREAT TOE
|
Facility
|
IP
|
$6,418.96
|
|
| Hospital Charge Code |
4471388
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4,172.32 |
| Max. Negotiated Rate |
$4,172.32 |
| Rate for Payer: Cash Price |
$4,814.22
|
| Rate for Payer: Galaxy Health Commercial |
$4,172.32
|
|
|
LPT REG GREAT TOE
|
Facility
|
OP
|
$6,418.96
|
|
| Hospital Charge Code |
4471388
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$962.84 |
| Max. Negotiated Rate |
$5,135.17 |
| Rate for Payer: Aetna of NY Commercial |
$4,493.27
|
| Rate for Payer: Aetna of NY Medicare |
$2,952.72
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2,567.58
|
| Rate for Payer: Cash Price |
$4,814.22
|
| Rate for Payer: CDPHP Medicare |
$2,375.02
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$5,135.17
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$5,135.17
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$5,135.17
|
| Rate for Payer: EmblemHealth Medicaid |
$5,135.17
|
| Rate for Payer: EmblemHealth Medicare |
$2,182.45
|
| Rate for Payer: EmblemHealth Select Care |
$4,621.65
|
| Rate for Payer: Fidelis Medicare |
$2,567.58
|
| Rate for Payer: Galaxy Health Commercial |
$4,172.32
|
| Rate for Payer: Hamaspik Choice Medicare |
$2,567.58
|
| Rate for Payer: Humana Medicare |
$2,567.58
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$4,493.27
|
| Rate for Payer: Local 1199SEIU Medicare |
$2,952.72
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4,814.22
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3,613.87
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2,695.96
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$962.84
|
| Rate for Payer: United Healthcare Medicare |
$2,567.58
|
| Rate for Payer: WellCare Medicare |
$3,530.43
|
|
|
L SMALL WRIST W/ABDUCTED THUMB
|
Facility
|
IP
|
$58.71
|
|
| Hospital Charge Code |
4471580
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$38.16 |
| Max. Negotiated Rate |
$38.16 |
| Rate for Payer: Cash Price |
$44.03
|
| Rate for Payer: Galaxy Health Commercial |
$38.16
|
|
|
L SMALL WRIST W/ABDUCTED THUMB
|
Facility
|
OP
|
$58.71
|
|
| Hospital Charge Code |
4471580
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.81 |
| Max. Negotiated Rate |
$46.97 |
| Rate for Payer: Aetna of NY Commercial |
$41.10
|
| Rate for Payer: Aetna of NY Medicare |
$27.01
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$23.48
|
| Rate for Payer: Cash Price |
$44.03
|
| Rate for Payer: CDPHP Medicare |
$21.72
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$46.97
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$46.97
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$46.97
|
| Rate for Payer: EmblemHealth Medicaid |
$46.97
|
| Rate for Payer: EmblemHealth Medicare |
$19.96
|
| Rate for Payer: EmblemHealth Select Care |
$42.27
|
| Rate for Payer: Fidelis Medicare |
$23.48
|
| Rate for Payer: Galaxy Health Commercial |
$38.16
|
| Rate for Payer: Hamaspik Choice Medicare |
$23.48
|
| Rate for Payer: Humana Medicare |
$23.48
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$41.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$27.01
|
| Rate for Payer: MVP Health Care of NY Commercial |
$44.03
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$33.05
|
| Rate for Payer: MVP Health Care of NY Medicare |
$24.66
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$8.81
|
| Rate for Payer: United Healthcare Medicare |
$23.48
|
| Rate for Payer: WellCare Medicare |
$32.29
|
|
|
LUBIPROSTONE 8 MCG CAPSULE 8 mcg, 60 eaches
|
Facility
|
OP
|
$22.00
|
|
|
Service Code
|
NDC 254302802
|
| Hospital Charge Code |
4401474
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.30 |
| Max. Negotiated Rate |
$17.60 |
| 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) Medicare |
$8.80
|
| Rate for Payer: Cash Price |
$16.50
|
| 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 |
$8.80
|
| Rate for Payer: Galaxy Health Commercial |
$14.30
|
| Rate for Payer: Hamaspik Choice Medicare |
$8.80
|
| Rate for Payer: Humana Medicare |
$8.80
|
| 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 |
$9.24
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$3.30
|
| Rate for Payer: United Healthcare Medicare |
$8.80
|
| Rate for Payer: WellCare Medicare |
$12.10
|
|
|
LUBIPROSTONE 8 MCG CAPSULE 8 mcg, 60 eaches
|
Facility
|
IP
|
$22.00
|
|
|
Service Code
|
NDC 254302802
|
| 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
|
|
|
LUMBAR COOLED INTRODUCER LUI-17-100
|
Facility
|
IP
|
$419.21
|
|
| Hospital Charge Code |
4479243
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$272.49 |
| Max. Negotiated Rate |
$272.49 |
| Rate for Payer: Cash Price |
$314.41
|
| Rate for Payer: Galaxy Health Commercial |
$272.49
|
|
|
LUMBAR COOLED INTRODUCER LUI-17-100
|
Facility
|
OP
|
$419.21
|
|
| Hospital Charge Code |
4479243
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$62.88 |
| Max. Negotiated Rate |
$335.37 |
| Rate for Payer: Aetna of NY Commercial |
$293.45
|
| Rate for Payer: Aetna of NY Medicare |
$192.84
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$167.68
|
| Rate for Payer: Cash Price |
$314.41
|
| Rate for Payer: CDPHP Medicare |
$155.11
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$335.37
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$335.37
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$335.37
|
| Rate for Payer: EmblemHealth Medicaid |
$335.37
|
| Rate for Payer: EmblemHealth Medicare |
$142.53
|
| Rate for Payer: EmblemHealth Select Care |
$301.83
|
| Rate for Payer: Fidelis Medicare |
$167.68
|
| Rate for Payer: Galaxy Health Commercial |
$272.49
|
| Rate for Payer: Hamaspik Choice Medicare |
$167.68
|
| Rate for Payer: Humana Medicare |
$167.68
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$293.45
|
| Rate for Payer: Local 1199SEIU Medicare |
$192.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$314.41
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$236.02
|
| Rate for Payer: MVP Health Care of NY Medicare |
$176.07
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$62.88
|
| Rate for Payer: United Healthcare Medicare |
$167.68
|
| Rate for Payer: WellCare Medicare |
$230.57
|
|
|
LUMBAR KIT (CERVICOOL)GENIC LUK-17-100-4
|
Facility
|
IP
|
$3,131.20
|
|
| Hospital Charge Code |
4479191
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2,035.28 |
| Max. Negotiated Rate |
$2,035.28 |
| Rate for Payer: Cash Price |
$2,348.40
|
| Rate for Payer: Galaxy Health Commercial |
$2,035.28
|
|
|
LUMBAR KIT (CERVICOOL)GENIC LUK-17-100-4
|
Facility
|
OP
|
$3,131.20
|
|
| Hospital Charge Code |
4479191
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$469.68 |
| Max. Negotiated Rate |
$2,504.96 |
| Rate for Payer: Aetna of NY Commercial |
$2,191.84
|
| Rate for Payer: Aetna of NY Medicare |
$1,440.35
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1,252.48
|
| Rate for Payer: Cash Price |
$2,348.40
|
| Rate for Payer: CDPHP Medicare |
$1,158.54
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$2,504.96
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2,504.96
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$2,504.96
|
| Rate for Payer: EmblemHealth Medicaid |
$2,504.96
|
| Rate for Payer: EmblemHealth Medicare |
$1,064.61
|
| Rate for Payer: EmblemHealth Select Care |
$2,254.46
|
| Rate for Payer: Fidelis Medicare |
$1,252.48
|
| Rate for Payer: Galaxy Health Commercial |
$2,035.28
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,252.48
|
| Rate for Payer: Humana Medicare |
$1,252.48
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$2,191.84
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,440.35
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,348.40
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1,762.87
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1,315.10
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$469.68
|
| Rate for Payer: United Healthcare Medicare |
$1,252.48
|
| Rate for Payer: WellCare Medicare |
$1,722.16
|
|
|
LUMBAR PROBE LUP-17-150-4
|
Facility
|
OP
|
$2,190.81
|
|
| Hospital Charge Code |
4479263
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$328.62 |
| Max. Negotiated Rate |
$1,752.65 |
| Rate for Payer: Aetna of NY Commercial |
$1,533.57
|
| Rate for Payer: Aetna of NY Medicare |
$1,007.77
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$876.32
|
| Rate for Payer: Cash Price |
$1,643.11
|
| Rate for Payer: CDPHP Medicare |
$810.60
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,752.65
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,752.65
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,752.65
|
| Rate for Payer: EmblemHealth Medicaid |
$1,752.65
|
| Rate for Payer: EmblemHealth Medicare |
$744.88
|
| Rate for Payer: EmblemHealth Select Care |
$1,577.38
|
| Rate for Payer: Fidelis Medicare |
$876.32
|
| Rate for Payer: Galaxy Health Commercial |
$1,424.03
|
| Rate for Payer: Hamaspik Choice Medicare |
$876.32
|
| Rate for Payer: Humana Medicare |
$876.32
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,533.57
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,007.77
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,643.11
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1,233.43
|
| Rate for Payer: MVP Health Care of NY Medicare |
$920.14
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$328.62
|
| Rate for Payer: United Healthcare Medicare |
$876.32
|
| Rate for Payer: WellCare Medicare |
$1,204.95
|
|
|
LUMBAR PROBE LUP-17-150-4
|
Facility
|
IP
|
$2,190.81
|
|
| Hospital Charge Code |
4479263
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,424.03 |
| Max. Negotiated Rate |
$1,424.03 |
| Rate for Payer: Cash Price |
$1,643.11
|
| Rate for Payer: Galaxy Health Commercial |
$1,424.03
|
|
|
LUMBAR PUNCTURE TRAY 20GX3 1
|
Facility
|
OP
|
$58.71
|
|
| Hospital Charge Code |
4471853
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.81 |
| Max. Negotiated Rate |
$46.97 |
| Rate for Payer: Aetna of NY Commercial |
$41.10
|
| Rate for Payer: Aetna of NY Medicare |
$27.01
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$23.48
|
| Rate for Payer: Cash Price |
$44.03
|
| Rate for Payer: CDPHP Medicare |
$21.72
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$46.97
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$46.97
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$46.97
|
| Rate for Payer: EmblemHealth Medicaid |
$46.97
|
| Rate for Payer: EmblemHealth Medicare |
$19.96
|
| Rate for Payer: EmblemHealth Select Care |
$42.27
|
| Rate for Payer: Fidelis Medicare |
$23.48
|
| Rate for Payer: Galaxy Health Commercial |
$38.16
|
| Rate for Payer: Hamaspik Choice Medicare |
$23.48
|
| Rate for Payer: Humana Medicare |
$23.48
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$41.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$27.01
|
| Rate for Payer: MVP Health Care of NY Commercial |
$44.03
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$33.05
|
| Rate for Payer: MVP Health Care of NY Medicare |
$24.66
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$8.81
|
| Rate for Payer: United Healthcare Medicare |
$23.48
|
| Rate for Payer: WellCare Medicare |
$32.29
|
|
|
LUMBAR PUNCTURE TRAY 20GX3 1
|
Facility
|
IP
|
$58.71
|
|
| Hospital Charge Code |
4471853
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$38.16 |
| Max. Negotiated Rate |
$38.16 |
| Rate for Payer: Cash Price |
$44.03
|
| Rate for Payer: Galaxy Health Commercial |
$38.16
|
|
|
LUMBAR PUNCTURE TRAY ADULT 2
|
Facility
|
OP
|
$37.08
|
|
| Hospital Charge Code |
4471222
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.56 |
| Max. Negotiated Rate |
$29.66 |
| Rate for Payer: Aetna of NY Commercial |
$25.96
|
| Rate for Payer: Aetna of NY Medicare |
$17.06
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$14.83
|
| Rate for Payer: Cash Price |
$27.81
|
| Rate for Payer: CDPHP Medicare |
$13.72
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$29.66
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$29.66
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$29.66
|
| Rate for Payer: EmblemHealth Medicaid |
$29.66
|
| Rate for Payer: EmblemHealth Medicare |
$12.61
|
| Rate for Payer: EmblemHealth Select Care |
$26.70
|
| Rate for Payer: Fidelis Medicare |
$14.83
|
| Rate for Payer: Galaxy Health Commercial |
$24.10
|
| Rate for Payer: Hamaspik Choice Medicare |
$14.83
|
| Rate for Payer: Humana Medicare |
$14.83
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$25.96
|
| Rate for Payer: Local 1199SEIU Medicare |
$17.06
|
| Rate for Payer: MVP Health Care of NY Commercial |
$27.81
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$20.88
|
| Rate for Payer: MVP Health Care of NY Medicare |
$15.57
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$5.56
|
| Rate for Payer: United Healthcare Medicare |
$14.83
|
| Rate for Payer: WellCare Medicare |
$20.39
|
|
