|
LASER VAPORIZATION OF PROSTATE FOR URINE FLOW
|
Facility
OP
|
$14,806.00
|
|
|
Service Code
|
HCPCS 52648
|
| Hospital Charge Code |
4002031
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$1,353.00 |
| Max. Negotiated Rate |
$11,918.83 |
| Rate for Payer: Aetna of NY Commercial |
$1,857.00
|
| Rate for Payer: Aetna of NY Medicare |
$6,810.76
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$2,320.09
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$2,899.59
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$5,478.22
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$1,353.00
|
| Rate for Payer: Cash Price |
$11,104.50
|
| Rate for Payer: Cash Price |
$11,104.50
|
| Rate for Payer: Cash Price |
$11,104.50
|
| Rate for Payer: CDPHP Commercial |
$11,918.83
|
| Rate for Payer: CDPHP Medicare |
$5,478.22
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$11,844.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$11,844.80
|
| Rate for Payer: EmblemHealth Medicaid |
$11,844.80
|
| Rate for Payer: EmblemHealth Medicare |
$5,034.04
|
| Rate for Payer: Fidelis Medicare |
$5,642.57
|
| Rate for Payer: Galaxy Health Commercial |
$9,623.90
|
| Rate for Payer: Hamaspik Choice Medicare |
$5,478.22
|
| Rate for Payer: Humana Medicare |
$5,478.22
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,857.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$6,810.76
|
| Rate for Payer: Multiplan Commercial |
$11,844.80
|
| Rate for Payer: MVP Health Care of NY Commercial |
$11,104.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$8,335.78
|
| Rate for Payer: MVP Health Care of NY Medicare |
$5,752.13
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,775.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$4,930.08
|
| Rate for Payer: United Healthcare Commercial |
$2,036.00
|
| Rate for Payer: United Healthcare Medicare |
$5,478.22
|
| Rate for Payer: WellCare Medicare |
$8,143.30
|
|
|
LATANOPROST 0.00005 DROP 3X2.5ML
|
Facility
OP
|
$293.55
|
|
| Hospital Charge Code |
4400812
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$99.81 |
| Max. Negotiated Rate |
$236.31 |
| Rate for Payer: Aetna of NY Commercial |
$205.48
|
| Rate for Payer: Aetna of NY Medicare |
$135.03
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$220.16
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$220.16
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$108.61
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$146.78
|
| Rate for Payer: Cash Price |
$220.16
|
| Rate for Payer: CDPHP Commercial |
$236.31
|
| Rate for Payer: CDPHP Medicare |
$108.61
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$234.84
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$234.84
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$234.84
|
| Rate for Payer: EmblemHealth Medicaid |
$234.84
|
| Rate for Payer: EmblemHealth Medicare |
$99.81
|
| Rate for Payer: EmblemHealth Select Care |
$211.36
|
| Rate for Payer: Fidelis Medicare |
$111.87
|
| Rate for Payer: Galaxy Health Commercial |
$190.81
|
| Rate for Payer: Hamaspik Choice Medicare |
$108.61
|
| Rate for Payer: Humana Medicare |
$108.61
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$205.48
|
| Rate for Payer: Local 1199SEIU Medicare |
$135.03
|
| Rate for Payer: MVP Health Care of NY Commercial |
$220.16
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$165.27
|
| Rate for Payer: MVP Health Care of NY Medicare |
$114.04
|
| Rate for Payer: United Healthcare Medicare |
$108.61
|
| Rate for Payer: WellCare Medicare |
$161.45
|
|
|
LAYER CLOSURE-12.6 TO 20CM
|
Facility
OP
|
$1,797.00
|
|
|
Service Code
|
HCPCS 12045
|
| Hospital Charge Code |
4600119
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$250.00 |
| Max. Negotiated Rate |
$1,446.58 |
| Rate for Payer: Aetna of NY Commercial |
$955.00
|
| Rate for Payer: Aetna of NY Medicare |
$826.62
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$950.93
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,189.18
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$664.89
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$898.50
|
| Rate for Payer: Cash Price |
$1,347.75
|
| Rate for Payer: Cash Price |
$1,347.75
|
| Rate for Payer: Cash Price |
$1,347.75
|
| Rate for Payer: Cash Price |
$1,347.75
|
| Rate for Payer: CDPHP Commercial |
$1,446.58
|
| Rate for Payer: CDPHP Medicare |
$664.89
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,182.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,437.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,437.60
|
| Rate for Payer: EmblemHealth Medicaid |
$1,437.60
|
| Rate for Payer: EmblemHealth Medicare |
$610.98
|
| Rate for Payer: EmblemHealth Select Care |
$1,064.00
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$250.00
|
| Rate for Payer: Fidelis Medicare |
$684.84
|
| Rate for Payer: Galaxy Health Commercial |
$1,168.05
|
| Rate for Payer: Hamaspik Choice Medicare |
$664.89
|
| Rate for Payer: Humana Medicare |
$664.89
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$955.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$826.62
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,174.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$881.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$698.13
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$980.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$598.40
|
| Rate for Payer: United Healthcare Commercial |
$980.00
|
| Rate for Payer: United Healthcare Medicare |
$664.89
|
| Rate for Payer: WellCare Medicare |
$988.35
|
|
|
LAYER CLOSURE-20.1 TO 30.0CM
|
Facility
OP
|
$1,141.00
|
|
|
Service Code
|
HCPCS 12056
|
| Hospital Charge Code |
4600124
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$250.00 |
| Max. Negotiated Rate |
$1,189.18 |
| Rate for Payer: Aetna of NY Commercial |
$955.00
|
| Rate for Payer: Aetna of NY Medicare |
$524.86
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$950.93
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,189.18
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$422.17
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$570.50
|
| Rate for Payer: Cash Price |
$855.75
|
| Rate for Payer: Cash Price |
$855.75
|
| Rate for Payer: Cash Price |
$855.75
|
| Rate for Payer: Cash Price |
$855.75
|
| Rate for Payer: CDPHP Commercial |
$918.50
|
| Rate for Payer: CDPHP Medicare |
$422.17
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,182.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$912.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$912.80
|
| Rate for Payer: EmblemHealth Medicaid |
$912.80
|
| Rate for Payer: EmblemHealth Medicare |
$387.94
|
| Rate for Payer: EmblemHealth Select Care |
$1,064.00
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$250.00
|
| Rate for Payer: Fidelis Medicare |
$434.84
|
| Rate for Payer: Galaxy Health Commercial |
$741.65
|
| Rate for Payer: Hamaspik Choice Medicare |
$422.17
|
| Rate for Payer: Humana Medicare |
$422.17
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$955.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$524.86
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,174.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$881.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$443.28
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$980.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$379.92
|
| Rate for Payer: United Healthcare Commercial |
$980.00
|
| Rate for Payer: United Healthcare Medicare |
$422.17
|
| Rate for Payer: WellCare Medicare |
$627.55
|
|
|
LAYER CLOSURE-2.5 CM OR LESS
|
Facility
OP
|
$1,141.00
|
|
|
Service Code
|
HCPCS 12031
|
| Hospital Charge Code |
4600120
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$250.00 |
| Max. Negotiated Rate |
$1,189.18 |
| Rate for Payer: Aetna of NY Commercial |
$955.00
|
| Rate for Payer: Aetna of NY Medicare |
$524.86
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$950.93
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,189.18
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$422.17
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$570.50
|
| Rate for Payer: Cash Price |
$855.75
|
| Rate for Payer: Cash Price |
$855.75
|
| Rate for Payer: Cash Price |
$855.75
|
| Rate for Payer: Cash Price |
$855.75
|
| Rate for Payer: CDPHP Commercial |
$918.50
|
| Rate for Payer: CDPHP Medicare |
$422.17
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,182.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$912.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$912.80
|
| Rate for Payer: EmblemHealth Medicaid |
$912.80
|
| Rate for Payer: EmblemHealth Medicare |
$387.94
|
| Rate for Payer: EmblemHealth Select Care |
$1,064.00
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$250.00
|
| Rate for Payer: Fidelis Medicare |
$434.84
|
| Rate for Payer: Galaxy Health Commercial |
$741.65
|
| Rate for Payer: Hamaspik Choice Medicare |
$422.17
|
| Rate for Payer: Humana Medicare |
$422.17
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$955.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$524.86
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,174.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$881.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$443.28
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$980.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$379.92
|
| Rate for Payer: United Healthcare Commercial |
$980.00
|
| Rate for Payer: United Healthcare Medicare |
$422.17
|
| Rate for Payer: WellCare Medicare |
$627.55
|
|
|
LAYER CLOSURE-2.5CM OR LESS
|
Facility
OP
|
$1,141.00
|
|
|
Service Code
|
HCPCS 12041
|
| Hospital Charge Code |
4600131
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$250.00 |
| Max. Negotiated Rate |
$1,189.18 |
| Rate for Payer: Aetna of NY Commercial |
$955.00
|
| Rate for Payer: Aetna of NY Medicare |
$524.86
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$950.93
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,189.18
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$422.17
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$570.50
|
| Rate for Payer: Cash Price |
$855.75
|
| Rate for Payer: Cash Price |
$855.75
|
| Rate for Payer: Cash Price |
$855.75
|
| Rate for Payer: Cash Price |
$855.75
|
| Rate for Payer: CDPHP Commercial |
$918.50
|
| Rate for Payer: CDPHP Medicare |
$422.17
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,182.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$912.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$912.80
|
| Rate for Payer: EmblemHealth Medicaid |
$912.80
|
| Rate for Payer: EmblemHealth Medicare |
$387.94
|
| Rate for Payer: EmblemHealth Select Care |
$1,064.00
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$250.00
|
| Rate for Payer: Fidelis Medicare |
$434.84
|
| Rate for Payer: Galaxy Health Commercial |
$741.65
|
| Rate for Payer: Hamaspik Choice Medicare |
$422.17
|
| Rate for Payer: Humana Medicare |
$422.17
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$955.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$524.86
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,174.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$881.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$443.28
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$980.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$379.92
|
| Rate for Payer: United Healthcare Commercial |
$980.00
|
| Rate for Payer: United Healthcare Medicare |
$422.17
|
| Rate for Payer: WellCare Medicare |
$627.55
|
|
|
LAYER CLOSURE-2.6 TO 5.0CM
|
Facility
OP
|
$1,141.00
|
|
|
Service Code
|
HCPCS 12052
|
| Hospital Charge Code |
4600121
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$250.00 |
| Max. Negotiated Rate |
$1,189.18 |
| Rate for Payer: Aetna of NY Commercial |
$955.00
|
| Rate for Payer: Aetna of NY Medicare |
$524.86
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$950.93
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,189.18
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$422.17
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$570.50
|
| Rate for Payer: Cash Price |
$855.75
|
| Rate for Payer: Cash Price |
$855.75
|
| Rate for Payer: Cash Price |
$855.75
|
| Rate for Payer: Cash Price |
$855.75
|
| Rate for Payer: CDPHP Commercial |
$918.50
|
| Rate for Payer: CDPHP Medicare |
$422.17
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,182.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$912.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$912.80
|
| Rate for Payer: EmblemHealth Medicaid |
$912.80
|
| Rate for Payer: EmblemHealth Medicare |
$387.94
|
| Rate for Payer: EmblemHealth Select Care |
$1,064.00
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$250.00
|
| Rate for Payer: Fidelis Medicare |
$434.84
|
| Rate for Payer: Galaxy Health Commercial |
$741.65
|
| Rate for Payer: Hamaspik Choice Medicare |
$422.17
|
| Rate for Payer: Humana Medicare |
$422.17
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$955.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$524.86
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,174.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$881.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$443.28
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$980.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$379.92
|
| Rate for Payer: United Healthcare Commercial |
$980.00
|
| Rate for Payer: United Healthcare Medicare |
$422.17
|
| Rate for Payer: WellCare Medicare |
$627.55
|
|
|
LAYER CLOSURE-2.6 TO 7.5CM
|
Facility
OP
|
$1,141.00
|
|
|
Service Code
|
HCPCS 12032
|
| Hospital Charge Code |
4600122
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$250.00 |
| Max. Negotiated Rate |
$1,189.18 |
| Rate for Payer: Aetna of NY Commercial |
$955.00
|
| Rate for Payer: Aetna of NY Medicare |
$524.86
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$950.93
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,189.18
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$422.17
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$570.50
|
| Rate for Payer: Cash Price |
$855.75
|
| Rate for Payer: Cash Price |
$855.75
|
| Rate for Payer: Cash Price |
$855.75
|
| Rate for Payer: Cash Price |
$855.75
|
| Rate for Payer: CDPHP Commercial |
$918.50
|
| Rate for Payer: CDPHP Medicare |
$422.17
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,182.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$912.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$912.80
|
| Rate for Payer: EmblemHealth Medicaid |
$912.80
|
| Rate for Payer: EmblemHealth Medicare |
$387.94
|
| Rate for Payer: EmblemHealth Select Care |
$1,064.00
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$250.00
|
| Rate for Payer: Fidelis Medicare |
$434.84
|
| Rate for Payer: Galaxy Health Commercial |
$741.65
|
| Rate for Payer: Hamaspik Choice Medicare |
$422.17
|
| Rate for Payer: Humana Medicare |
$422.17
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$955.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$524.86
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,174.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$881.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$443.28
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$980.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$379.92
|
| Rate for Payer: United Healthcare Commercial |
$980.00
|
| Rate for Payer: United Healthcare Medicare |
$422.17
|
| Rate for Payer: WellCare Medicare |
$627.55
|
|
|
LAYER CLOSURE-7.6 TO 12.5CM
|
Facility
OP
|
$1,141.00
|
|
|
Service Code
|
HCPCS 12034
|
| Hospital Charge Code |
4600128
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$250.00 |
| Max. Negotiated Rate |
$1,189.18 |
| Rate for Payer: Aetna of NY Commercial |
$955.00
|
| Rate for Payer: Aetna of NY Medicare |
$524.86
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$950.93
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,189.18
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$422.17
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$570.50
|
| Rate for Payer: Cash Price |
$855.75
|
| Rate for Payer: Cash Price |
$855.75
|
| Rate for Payer: Cash Price |
$855.75
|
| Rate for Payer: Cash Price |
$855.75
|
| Rate for Payer: CDPHP Commercial |
$918.50
|
| Rate for Payer: CDPHP Medicare |
$422.17
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,182.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$912.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$912.80
|
| Rate for Payer: EmblemHealth Medicaid |
$912.80
|
| Rate for Payer: EmblemHealth Medicare |
$387.94
|
| Rate for Payer: EmblemHealth Select Care |
$1,064.00
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$250.00
|
| Rate for Payer: Fidelis Medicare |
$434.84
|
| Rate for Payer: Galaxy Health Commercial |
$741.65
|
| Rate for Payer: Hamaspik Choice Medicare |
$422.17
|
| Rate for Payer: Humana Medicare |
$422.17
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$955.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$524.86
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,174.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$881.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$443.28
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$980.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$379.92
|
| Rate for Payer: United Healthcare Commercial |
$980.00
|
| Rate for Payer: United Healthcare Medicare |
$422.17
|
| Rate for Payer: WellCare Medicare |
$627.55
|
|
|
LDH
|
Facility
OP
|
$34.00
|
|
|
Service Code
|
HCPCS 83615
|
| Hospital Charge Code |
4300514
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.08 |
| Max. Negotiated Rate |
$27.37 |
| Rate for Payer: Aetna of NY Commercial |
$22.10
|
| Rate for Payer: Aetna of NY Medicare |
$15.64
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$25.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$25.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$12.58
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$17.00
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: CDPHP Commercial |
$27.37
|
| Rate for Payer: CDPHP Medicare |
$12.58
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$27.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$27.20
|
| Rate for Payer: EmblemHealth Medicaid |
$27.20
|
| Rate for Payer: EmblemHealth Medicare |
$11.56
|
| Rate for Payer: Fidelis Medicare |
$12.96
|
| Rate for Payer: Galaxy Health Commercial |
$22.10
|
| Rate for Payer: Hamaspik Choice Medicare |
$12.58
|
| Rate for Payer: Humana Medicare |
$12.58
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$22.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$15.64
|
| Rate for Payer: MVP Health Care of NY Commercial |
$25.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$19.14
|
| Rate for Payer: MVP Health Care of NY Medicare |
$13.21
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$25.50
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$5.08
|
| Rate for Payer: United Healthcare Commercial |
$25.50
|
| Rate for Payer: United Healthcare Medicare |
$12.58
|
| Rate for Payer: WellCare Medicare |
$18.70
|
|
|
LEAD KITS
|
Facility
OP
|
$8,947.00
|
|
|
Service Code
|
HCPCS C1778
|
| Hospital Charge Code |
4471319
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,041.98 |
| Max. Negotiated Rate |
$7,202.34 |
| Rate for Payer: Aetna of NY Commercial |
$6,262.90
|
| Rate for Payer: Aetna of NY Medicare |
$4,115.62
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$4,026.15
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$4,026.15
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$3,310.39
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$4,473.50
|
| Rate for Payer: Cash Price |
$6,710.25
|
| Rate for Payer: CDPHP Commercial |
$7,202.34
|
| Rate for Payer: CDPHP Medicare |
$3,310.39
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$4,473.50
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$7,157.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$7,157.60
|
| Rate for Payer: EmblemHealth Medicaid |
$7,157.60
|
| Rate for Payer: EmblemHealth Medicare |
$3,041.98
|
| Rate for Payer: EmblemHealth Select Care |
$4,473.50
|
| Rate for Payer: Fidelis Medicare |
$3,409.70
|
| Rate for Payer: Galaxy Health Commercial |
$5,815.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$3,310.39
|
| Rate for Payer: Humana Medicare |
$3,310.39
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$6,262.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$4,115.62
|
| Rate for Payer: MVP Health Care of NY Commercial |
$5,815.55
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$5,815.55
|
| Rate for Payer: MVP Health Care of NY Medicare |
$3,475.91
|
| Rate for Payer: United Healthcare Medicare |
$3,310.39
|
| Rate for Payer: WellCare Medicare |
$4,920.85
|
|
|
LEFLUNOMIDE 10 MG TABLET 10 mg, 30 eaches
|
Facility
OP
|
$50.00
|
|
| Hospital Charge Code |
4401393
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.00 |
| Max. Negotiated Rate |
$40.25 |
| Rate for Payer: Aetna of NY Commercial |
$35.00
|
| Rate for Payer: Aetna of NY Medicare |
$23.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$37.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$37.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$18.50
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$25.00
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: CDPHP Commercial |
$40.25
|
| Rate for Payer: CDPHP Medicare |
$18.50
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$40.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$40.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$40.00
|
| Rate for Payer: EmblemHealth Medicaid |
$40.00
|
| Rate for Payer: EmblemHealth Medicare |
$17.00
|
| Rate for Payer: EmblemHealth Select Care |
$36.00
|
| Rate for Payer: Fidelis Medicare |
$19.06
|
| Rate for Payer: Galaxy Health Commercial |
$32.50
|
| Rate for Payer: Hamaspik Choice Medicare |
$18.50
|
| Rate for Payer: Humana Medicare |
$18.50
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$35.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$23.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$37.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$28.15
|
| Rate for Payer: MVP Health Care of NY Medicare |
$19.42
|
| Rate for Payer: United Healthcare Medicare |
$18.50
|
| Rate for Payer: WellCare Medicare |
$27.50
|
|
|
LEFLUNOMIDE 20 MG (GENERIC ARAVA ) TABL
|
Facility
OP
|
$50.73
|
|
| Hospital Charge Code |
4409204
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.25 |
| Max. Negotiated Rate |
$40.84 |
| Rate for Payer: Aetna of NY Commercial |
$35.51
|
| Rate for Payer: Aetna of NY Medicare |
$23.34
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$38.05
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$38.05
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$18.77
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$25.36
|
| Rate for Payer: Cash Price |
$38.05
|
| Rate for Payer: CDPHP Commercial |
$40.84
|
| Rate for Payer: CDPHP Medicare |
$18.77
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$40.58
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$40.58
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$40.58
|
| Rate for Payer: EmblemHealth Medicaid |
$40.58
|
| Rate for Payer: EmblemHealth Medicare |
$17.25
|
| Rate for Payer: EmblemHealth Select Care |
$36.53
|
| Rate for Payer: Fidelis Medicare |
$19.33
|
| Rate for Payer: Galaxy Health Commercial |
$32.97
|
| Rate for Payer: Hamaspik Choice Medicare |
$18.77
|
| Rate for Payer: Humana Medicare |
$18.77
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$35.51
|
| Rate for Payer: Local 1199SEIU Medicare |
$23.34
|
| Rate for Payer: MVP Health Care of NY Commercial |
$38.05
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$28.56
|
| Rate for Payer: MVP Health Care of NY Medicare |
$19.71
|
| Rate for Payer: United Healthcare Medicare |
$18.77
|
| Rate for Payer: WellCare Medicare |
$27.90
|
|
|
LEGIONELLA P AG BY DFA
|
Facility
OP
|
$122.00
|
|
|
Service Code
|
HCPCS 87278
|
| Hospital Charge Code |
4301257
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$15.60 |
| Max. Negotiated Rate |
$98.21 |
| Rate for Payer: Aetna of NY Commercial |
$79.30
|
| Rate for Payer: Aetna of NY Medicare |
$56.12
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$91.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$91.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$45.14
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$61.00
|
| Rate for Payer: Cash Price |
$91.50
|
| Rate for Payer: Cash Price |
$91.50
|
| Rate for Payer: CDPHP Commercial |
$98.21
|
| Rate for Payer: CDPHP Medicare |
$45.14
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$97.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$97.60
|
| Rate for Payer: EmblemHealth Medicaid |
$97.60
|
| Rate for Payer: EmblemHealth Medicare |
$41.48
|
| Rate for Payer: Fidelis Medicare |
$46.49
|
| Rate for Payer: Galaxy Health Commercial |
$79.30
|
| Rate for Payer: Hamaspik Choice Medicare |
$45.14
|
| Rate for Payer: Humana Medicare |
$45.14
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$79.30
|
| Rate for Payer: Local 1199SEIU Medicare |
$56.12
|
| Rate for Payer: MVP Health Care of NY Commercial |
$91.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$68.69
|
| Rate for Payer: MVP Health Care of NY Medicare |
$47.40
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$91.50
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$15.60
|
| Rate for Payer: United Healthcare Commercial |
$91.50
|
| Rate for Payer: United Healthcare Medicare |
$45.14
|
| Rate for Payer: WellCare Medicare |
$67.10
|
|
|
LETROZOLE 2.5MG TABS 30 EA
|
Facility
OP
|
$55.88
|
|
| Hospital Charge Code |
4400423
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$19.00 |
| Max. Negotiated Rate |
$44.98 |
| Rate for Payer: Aetna of NY Commercial |
$39.12
|
| Rate for Payer: Aetna of NY Medicare |
$25.70
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$41.91
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$41.91
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$20.68
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$27.94
|
| Rate for Payer: Cash Price |
$41.91
|
| Rate for Payer: CDPHP Commercial |
$44.98
|
| Rate for Payer: CDPHP Medicare |
$20.68
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$44.70
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$44.70
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$44.70
|
| Rate for Payer: EmblemHealth Medicaid |
$44.70
|
| Rate for Payer: EmblemHealth Medicare |
$19.00
|
| Rate for Payer: EmblemHealth Select Care |
$40.23
|
| Rate for Payer: Fidelis Medicare |
$21.30
|
| Rate for Payer: Galaxy Health Commercial |
$36.32
|
| Rate for Payer: Hamaspik Choice Medicare |
$20.68
|
| Rate for Payer: Humana Medicare |
$20.68
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$39.12
|
| Rate for Payer: Local 1199SEIU Medicare |
$25.70
|
| Rate for Payer: MVP Health Care of NY Commercial |
$41.91
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$31.46
|
| Rate for Payer: MVP Health Care of NY Medicare |
$21.71
|
| Rate for Payer: United Healthcare Medicare |
$20.68
|
| Rate for Payer: WellCare Medicare |
$30.73
|
|
|
LEUKOCYTE ASSMT FECAL QUAL/SEMIQUANTITATIVE
|
Facility
OP
|
$15.00
|
|
|
Service Code
|
HCPCS 89055
|
| Hospital Charge Code |
4302016
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.43 |
| Max. Negotiated Rate |
$12.08 |
| Rate for Payer: Aetna of NY Commercial |
$9.75
|
| Rate for Payer: Aetna of NY Medicare |
$6.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$11.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$11.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$5.55
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$7.50
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: CDPHP Commercial |
$12.08
|
| Rate for Payer: CDPHP Medicare |
$5.55
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$12.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$12.00
|
| Rate for Payer: EmblemHealth Medicaid |
$12.00
|
| Rate for Payer: EmblemHealth Medicare |
$5.10
|
| Rate for Payer: Fidelis Medicare |
$5.72
|
| Rate for Payer: Galaxy Health Commercial |
$9.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$5.55
|
| Rate for Payer: Humana Medicare |
$5.55
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$9.75
|
| Rate for Payer: Local 1199SEIU Medicare |
$6.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$11.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$8.44
|
| Rate for Payer: MVP Health Care of NY Medicare |
$5.83
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$11.25
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$3.43
|
| Rate for Payer: United Healthcare Commercial |
$11.25
|
| Rate for Payer: United Healthcare Medicare |
$5.55
|
| Rate for Payer: WellCare Medicare |
$8.25
|
|
|
LEUKO REDUCED PLATELETS EA UNIT
|
Facility
OP
|
$393.00
|
|
|
Service Code
|
HCPCS P9031
|
| Hospital Charge Code |
4302357
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$130.88 |
| Max. Negotiated Rate |
$316.36 |
| Rate for Payer: Aetna of NY Commercial |
$275.10
|
| Rate for Payer: Aetna of NY Medicare |
$180.78
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$294.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$294.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$145.41
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$196.50
|
| Rate for Payer: Cash Price |
$294.75
|
| Rate for Payer: Cash Price |
$294.75
|
| Rate for Payer: CDPHP Commercial |
$316.36
|
| Rate for Payer: CDPHP Medicare |
$145.41
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$196.50
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$314.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$314.40
|
| Rate for Payer: EmblemHealth Medicaid |
$314.40
|
| Rate for Payer: EmblemHealth Medicare |
$133.62
|
| Rate for Payer: EmblemHealth Select Care |
$196.50
|
| Rate for Payer: Fidelis Medicare |
$149.77
|
| Rate for Payer: Galaxy Health Commercial |
$255.45
|
| Rate for Payer: Hamaspik Choice Medicare |
$145.41
|
| Rate for Payer: Humana Medicare |
$145.41
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$275.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$180.78
|
| Rate for Payer: MVP Health Care of NY Commercial |
$294.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$221.26
|
| Rate for Payer: MVP Health Care of NY Medicare |
$152.68
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$294.75
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$130.88
|
| Rate for Payer: United Healthcare Commercial |
$294.75
|
| Rate for Payer: United Healthcare Medicare |
$145.41
|
| Rate for Payer: WellCare Medicare |
$216.15
|
|
|
LEUKOREDUCED RBC
|
Facility
OP
|
$543.00
|
|
|
Service Code
|
HCPCS P9016
|
| Hospital Charge Code |
4300526
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$180.82 |
| Max. Negotiated Rate |
$437.12 |
| Rate for Payer: Aetna of NY Commercial |
$380.10
|
| Rate for Payer: Aetna of NY Medicare |
$249.78
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$407.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$407.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$200.91
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$271.50
|
| Rate for Payer: Cash Price |
$407.25
|
| Rate for Payer: Cash Price |
$407.25
|
| Rate for Payer: CDPHP Commercial |
$437.12
|
| Rate for Payer: CDPHP Medicare |
$200.91
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$271.50
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$434.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$434.40
|
| Rate for Payer: EmblemHealth Medicaid |
$434.40
|
| Rate for Payer: EmblemHealth Medicare |
$184.62
|
| Rate for Payer: EmblemHealth Select Care |
$271.50
|
| Rate for Payer: Fidelis Medicare |
$206.94
|
| Rate for Payer: Galaxy Health Commercial |
$352.95
|
| Rate for Payer: Hamaspik Choice Medicare |
$200.91
|
| Rate for Payer: Humana Medicare |
$200.91
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$380.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$249.78
|
| Rate for Payer: MVP Health Care of NY Commercial |
$407.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$305.71
|
| Rate for Payer: MVP Health Care of NY Medicare |
$210.96
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$407.25
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$180.82
|
| Rate for Payer: United Healthcare Commercial |
$407.25
|
| Rate for Payer: United Healthcare Medicare |
$200.91
|
| Rate for Payer: WellCare Medicare |
$298.65
|
|
|
LEUKOTAPE 1.5" X 15 YDS
|
Facility
OP
|
$41.00
|
|
| Hospital Charge Code |
4471451
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$13.94 |
| Max. Negotiated Rate |
$33.00 |
| Rate for Payer: Aetna of NY Commercial |
$28.70
|
| Rate for Payer: Aetna of NY Medicare |
$18.86
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$30.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$30.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$15.17
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$20.50
|
| Rate for Payer: Cash Price |
$30.75
|
| Rate for Payer: CDPHP Commercial |
$33.00
|
| Rate for Payer: CDPHP Medicare |
$15.17
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$32.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$32.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$32.80
|
| Rate for Payer: EmblemHealth Medicaid |
$32.80
|
| Rate for Payer: EmblemHealth Medicare |
$13.94
|
| Rate for Payer: EmblemHealth Select Care |
$29.52
|
| Rate for Payer: Fidelis Medicare |
$15.63
|
| Rate for Payer: Galaxy Health Commercial |
$26.65
|
| Rate for Payer: Hamaspik Choice Medicare |
$15.17
|
| Rate for Payer: Humana Medicare |
$15.17
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$28.70
|
| Rate for Payer: Local 1199SEIU Medicare |
$18.86
|
| Rate for Payer: MVP Health Care of NY Commercial |
$30.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$23.08
|
| Rate for Payer: MVP Health Care of NY Medicare |
$15.93
|
| Rate for Payer: United Healthcare Medicare |
$15.17
|
| Rate for Payer: WellCare Medicare |
$22.55
|
|
|
LEVALBUTEROL HCL 0.63MG/3ML AMIH 24X3ML
|
Facility
OP
|
$6.18
|
|
| Hospital Charge Code |
4400815
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.10 |
| Max. Negotiated Rate |
$4.97 |
| 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) Blue Access/Small Group |
$4.64
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$4.64
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2.29
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$3.09
|
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: CDPHP Commercial |
$4.97
|
| 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 |
$2.36
|
| Rate for Payer: Galaxy Health Commercial |
$4.02
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.29
|
| Rate for Payer: Humana Medicare |
$2.29
|
| 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 |
$4.64
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3.48
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2.40
|
| Rate for Payer: United Healthcare Medicare |
$2.29
|
| Rate for Payer: WellCare Medicare |
$3.40
|
|
|
LEVALBUTEROL HCL 1.25MG/3ML AMIH 24X3ML
|
Facility
OP
|
$20.60
|
|
| Hospital Charge Code |
4400816
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.00 |
| Max. Negotiated Rate |
$16.58 |
| 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) Blue Access/Small Group |
$15.45
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$15.45
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$7.62
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$10.30
|
| Rate for Payer: Cash Price |
$15.45
|
| Rate for Payer: CDPHP Commercial |
$16.58
|
| 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 |
$7.85
|
| Rate for Payer: Galaxy Health Commercial |
$13.39
|
| Rate for Payer: Hamaspik Choice Medicare |
$7.62
|
| Rate for Payer: Humana Medicare |
$7.62
|
| 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 |
$8.00
|
| Rate for Payer: United Healthcare Medicare |
$7.62
|
| Rate for Payer: WellCare Medicare |
$11.33
|
|
|
LEVETIRACETAM 100MG/ML SOLN 500 ML
|
Facility
OP
|
$6.18
|
|
| Hospital Charge Code |
4400428
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.10 |
| Max. Negotiated Rate |
$4.97 |
| 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) Blue Access/Small Group |
$4.64
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$4.64
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2.29
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$3.09
|
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: CDPHP Commercial |
$4.97
|
| 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 |
$2.36
|
| Rate for Payer: Galaxy Health Commercial |
$4.02
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.29
|
| Rate for Payer: Humana Medicare |
$2.29
|
| 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 |
$4.64
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3.48
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2.40
|
| Rate for Payer: United Healthcare Medicare |
$2.29
|
| Rate for Payer: WellCare Medicare |
$3.40
|
|
|
LEVETIRACETAM 250MG TABS 10X10EA
|
Facility
OP
|
$8.76
|
|
| Hospital Charge Code |
4400429
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.98 |
| Max. Negotiated Rate |
$7.05 |
| Rate for Payer: Aetna of NY Commercial |
$6.13
|
| Rate for Payer: Aetna of NY Medicare |
$4.03
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$6.57
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$6.57
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$3.24
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$4.38
|
| Rate for Payer: Cash Price |
$6.57
|
| Rate for Payer: CDPHP Commercial |
$7.05
|
| Rate for Payer: CDPHP Medicare |
$3.24
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$7.01
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$7.01
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$7.01
|
| Rate for Payer: EmblemHealth Medicaid |
$7.01
|
| Rate for Payer: EmblemHealth Medicare |
$2.98
|
| Rate for Payer: EmblemHealth Select Care |
$6.31
|
| Rate for Payer: Fidelis Medicare |
$3.34
|
| Rate for Payer: Galaxy Health Commercial |
$5.69
|
| Rate for Payer: Hamaspik Choice Medicare |
$3.24
|
| Rate for Payer: Humana Medicare |
$3.24
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$6.13
|
| Rate for Payer: Local 1199SEIU Medicare |
$4.03
|
| Rate for Payer: MVP Health Care of NY Commercial |
$6.57
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$4.93
|
| Rate for Payer: MVP Health Care of NY Medicare |
$3.40
|
| Rate for Payer: United Healthcare Medicare |
$3.24
|
| Rate for Payer: WellCare Medicare |
$4.82
|
|
|
LEVETIRACETAM 500MG TABS 10X10EA
|
Facility
OP
|
$10.82
|
|
| Hospital Charge Code |
4400430
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.68 |
| Max. Negotiated Rate |
$8.71 |
| Rate for Payer: Aetna of NY Commercial |
$7.57
|
| Rate for Payer: Aetna of NY Medicare |
$4.98
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$8.12
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$8.12
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$4.00
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$5.41
|
| Rate for Payer: Cash Price |
$8.12
|
| Rate for Payer: CDPHP Commercial |
$8.71
|
| Rate for Payer: CDPHP Medicare |
$4.00
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$8.66
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$8.66
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$8.66
|
| Rate for Payer: EmblemHealth Medicaid |
$8.66
|
| Rate for Payer: EmblemHealth Medicare |
$3.68
|
| Rate for Payer: EmblemHealth Select Care |
$7.79
|
| Rate for Payer: Fidelis Medicare |
$4.12
|
| Rate for Payer: Galaxy Health Commercial |
$7.03
|
| Rate for Payer: Hamaspik Choice Medicare |
$4.00
|
| Rate for Payer: Humana Medicare |
$4.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$7.57
|
| Rate for Payer: Local 1199SEIU Medicare |
$4.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$8.12
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$6.09
|
| Rate for Payer: MVP Health Care of NY Medicare |
$4.20
|
| Rate for Payer: United Healthcare Medicare |
$4.00
|
| Rate for Payer: WellCare Medicare |
$5.95
|
|
|
LEVETIRACETAM INJECTION 10 MG
|
Facility
OP
|
$0.48
|
|
|
Service Code
|
HCPCS J1953
|
| Hospital Charge Code |
4400431
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.39 |
| Rate for Payer: Aetna of NY Commercial |
$0.26
|
| Rate for Payer: Aetna of NY Medicare |
$0.22
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$0.07
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$0.07
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$0.18
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$0.24
|
| Rate for Payer: Cash Price |
$0.36
|
| Rate for Payer: Cash Price |
$0.36
|
| Rate for Payer: CDPHP Commercial |
$0.39
|
| Rate for Payer: CDPHP Medicare |
$0.18
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.07
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$0.38
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$0.38
|
| Rate for Payer: EmblemHealth Medicaid |
$0.38
|
| Rate for Payer: EmblemHealth Medicare |
$0.16
|
| Rate for Payer: EmblemHealth Select Care |
$0.07
|
| Rate for Payer: Fidelis Medicare |
$0.18
|
| Rate for Payer: Galaxy Health Commercial |
$0.31
|
| Rate for Payer: Hamaspik Choice Medicare |
$0.18
|
| Rate for Payer: Humana Medicare |
$0.18
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$0.26
|
| Rate for Payer: Local 1199SEIU Medicare |
$0.22
|
| Rate for Payer: MVP Health Care of NY Commercial |
$0.36
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$0.27
|
| Rate for Payer: MVP Health Care of NY Medicare |
$0.19
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$0.12
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$0.07
|
| Rate for Payer: United Healthcare Commercial |
$0.12
|
| Rate for Payer: United Healthcare Medicare |
$0.18
|
| Rate for Payer: WellCare Medicare |
$0.26
|
|
