|
RAD. REDUCING GLOVES SIZE 7.5
|
Facility
|
OP
|
$151.00
|
|
| Hospital Charge Code |
4471683
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$51.34 |
| Max. Negotiated Rate |
$121.56 |
| Rate for Payer: Aetna of NY Commercial |
$105.70
|
| Rate for Payer: Aetna of NY Medicare |
$69.46
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$113.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$113.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$55.87
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$75.50
|
| Rate for Payer: Cash Price |
$113.25
|
| Rate for Payer: CDPHP Commercial |
$121.56
|
| Rate for Payer: CDPHP Medicare |
$55.87
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$120.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$120.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$120.80
|
| Rate for Payer: EmblemHealth Medicaid |
$120.80
|
| Rate for Payer: EmblemHealth Medicare |
$51.34
|
| Rate for Payer: EmblemHealth Select Care |
$108.72
|
| Rate for Payer: Fidelis Medicare |
$57.55
|
| Rate for Payer: Galaxy Health Commercial |
$98.15
|
| Rate for Payer: Hamaspik Choice Medicare |
$55.87
|
| Rate for Payer: Humana Medicare |
$55.87
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$105.70
|
| Rate for Payer: Local 1199SEIU Medicare |
$69.46
|
| Rate for Payer: MVP Health Care of NY Commercial |
$113.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$85.01
|
| Rate for Payer: MVP Health Care of NY Medicare |
$58.66
|
| Rate for Payer: United Healthcare Medicare |
$55.87
|
| Rate for Payer: WellCare Medicare |
$83.05
|
|
|
RALOXIFENE HCL 60MG TABS 30 EA
|
Facility
|
IP
|
$24.46
|
|
|
Service Code
|
NDC 60687026621
|
| Hospital Charge Code |
4400282
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.45 |
| Max. Negotiated Rate |
$15.90 |
| Rate for Payer: Cash Price |
$18.35
|
| Rate for Payer: Galaxy Health Commercial |
$15.90
|
| Rate for Payer: WellCare Medicare |
$13.45
|
|
|
RALOXIFENE HCL 60MG TABS 30 EA
|
Facility
|
OP
|
$24.46
|
|
|
Service Code
|
NDC 60687026621
|
| Hospital Charge Code |
4400282
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.32 |
| Max. Negotiated Rate |
$19.69 |
| Rate for Payer: Aetna of NY Commercial |
$17.12
|
| Rate for Payer: Aetna of NY Medicare |
$11.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$18.34
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$18.34
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$9.05
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$12.23
|
| Rate for Payer: Cash Price |
$18.35
|
| Rate for Payer: CDPHP Commercial |
$19.69
|
| Rate for Payer: CDPHP Medicare |
$9.05
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$19.57
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$19.57
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$19.57
|
| Rate for Payer: EmblemHealth Medicaid |
$19.57
|
| Rate for Payer: EmblemHealth Medicare |
$8.32
|
| Rate for Payer: EmblemHealth Select Care |
$17.61
|
| Rate for Payer: Fidelis Medicare |
$9.32
|
| Rate for Payer: Galaxy Health Commercial |
$15.90
|
| Rate for Payer: Hamaspik Choice Medicare |
$9.05
|
| Rate for Payer: Humana Medicare |
$9.05
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$17.12
|
| Rate for Payer: Local 1199SEIU Medicare |
$11.25
|
| Rate for Payer: MVP Health Care of NY Commercial |
$18.34
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$13.77
|
| Rate for Payer: MVP Health Care of NY Medicare |
$9.50
|
| Rate for Payer: United Healthcare Medicare |
$9.05
|
| Rate for Payer: WellCare Medicare |
$13.45
|
|
|
RANOLAZINE 500MG TABS 60 EA
|
Facility
|
IP
|
$20.60
|
|
|
Service Code
|
NDC 61958100301
|
| Hospital Charge Code |
4400676
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.33 |
| Max. Negotiated Rate |
$13.39 |
| Rate for Payer: Cash Price |
$15.45
|
| Rate for Payer: Galaxy Health Commercial |
$13.39
|
| Rate for Payer: WellCare Medicare |
$11.33
|
|
|
RANOLAZINE 500MG TABS 60 EA
|
Facility
|
OP
|
$20.60
|
|
|
Service Code
|
NDC 61958100301
|
| Hospital Charge Code |
4400676
|
|
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
|
|
|
RANOLAZINE ER 500 MG TABLET 500 mg, 60 eaches
|
Facility
|
OP
|
$6.00
|
|
|
Service Code
|
NDC 68462031960
|
| Hospital Charge Code |
4401475
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.04 |
| Max. Negotiated Rate |
$4.83 |
| Rate for Payer: Aetna of NY Commercial |
$4.20
|
| Rate for Payer: Aetna of NY Medicare |
$2.76
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$4.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$4.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2.22
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$3.00
|
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: CDPHP Commercial |
$4.83
|
| Rate for Payer: CDPHP Medicare |
$2.22
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$4.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$4.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$4.80
|
| Rate for Payer: EmblemHealth Medicaid |
$4.80
|
| Rate for Payer: EmblemHealth Medicare |
$2.04
|
| Rate for Payer: EmblemHealth Select Care |
$4.32
|
| Rate for Payer: Fidelis Medicare |
$2.29
|
| Rate for Payer: Galaxy Health Commercial |
$3.90
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.22
|
| Rate for Payer: Humana Medicare |
$2.22
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$4.20
|
| Rate for Payer: Local 1199SEIU Medicare |
$2.76
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3.38
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2.33
|
| Rate for Payer: United Healthcare Medicare |
$2.22
|
| Rate for Payer: WellCare Medicare |
$3.30
|
|
|
RANOLAZINE ER 500 MG TABLET 500 mg, 60 eaches
|
Facility
|
IP
|
$6.00
|
|
|
Service Code
|
NDC 68462031960
|
| Hospital Charge Code |
4401475
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.30 |
| Max. Negotiated Rate |
$3.90 |
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: Galaxy Health Commercial |
$3.90
|
| Rate for Payer: WellCare Medicare |
$3.30
|
|
|
RAPID FIRE LIGATOR
|
Facility
|
IP
|
$265.00
|
|
| Hospital Charge Code |
4471003
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$172.25 |
| Max. Negotiated Rate |
$172.25 |
| Rate for Payer: Cash Price |
$198.75
|
| Rate for Payer: Galaxy Health Commercial |
$172.25
|
|
|
RAPID FIRE LIGATOR
|
Facility
|
OP
|
$265.00
|
|
| Hospital Charge Code |
4471003
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$90.10 |
| Max. Negotiated Rate |
$213.32 |
| Rate for Payer: Aetna of NY Commercial |
$185.50
|
| Rate for Payer: Aetna of NY Medicare |
$121.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$198.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$198.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$98.05
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$132.50
|
| Rate for Payer: Cash Price |
$198.75
|
| Rate for Payer: CDPHP Commercial |
$213.32
|
| Rate for Payer: CDPHP Medicare |
$98.05
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$212.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$212.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$212.00
|
| Rate for Payer: EmblemHealth Medicaid |
$212.00
|
| Rate for Payer: EmblemHealth Medicare |
$90.10
|
| Rate for Payer: EmblemHealth Select Care |
$190.80
|
| Rate for Payer: Fidelis Medicare |
$100.99
|
| Rate for Payer: Galaxy Health Commercial |
$172.25
|
| Rate for Payer: Hamaspik Choice Medicare |
$98.05
|
| Rate for Payer: Humana Medicare |
$98.05
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$185.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$121.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$198.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$149.20
|
| Rate for Payer: MVP Health Care of NY Medicare |
$102.95
|
| Rate for Payer: United Healthcare Medicare |
$98.05
|
| Rate for Payer: WellCare Medicare |
$145.75
|
|
|
RASAGILINE MESYLATE 1 MG TAB 1 mg, 30 eaches
|
Facility
|
IP
|
$75.00
|
|
|
Service Code
|
NDC 67877026030
|
| Hospital Charge Code |
4401568
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$41.25 |
| Max. Negotiated Rate |
$48.75 |
| Rate for Payer: Cash Price |
$56.25
|
| Rate for Payer: Galaxy Health Commercial |
$48.75
|
| Rate for Payer: WellCare Medicare |
$41.25
|
|
|
RASAGILINE MESYLATE 1 MG TAB 1 mg, 30 eaches
|
Facility
|
OP
|
$75.00
|
|
|
Service Code
|
NDC 67877026030
|
| Hospital Charge Code |
4401568
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$25.50 |
| Max. Negotiated Rate |
$60.38 |
| Rate for Payer: Aetna of NY Commercial |
$52.50
|
| Rate for Payer: Aetna of NY Medicare |
$34.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$56.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$56.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$27.75
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$37.50
|
| Rate for Payer: Cash Price |
$56.25
|
| Rate for Payer: CDPHP Commercial |
$60.38
|
| Rate for Payer: CDPHP Medicare |
$27.75
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$60.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$60.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$60.00
|
| Rate for Payer: EmblemHealth Medicaid |
$60.00
|
| Rate for Payer: EmblemHealth Medicare |
$25.50
|
| Rate for Payer: EmblemHealth Select Care |
$54.00
|
| Rate for Payer: Fidelis Medicare |
$28.58
|
| Rate for Payer: Galaxy Health Commercial |
$48.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$27.75
|
| Rate for Payer: Humana Medicare |
$27.75
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$52.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$34.50
|
| Rate for Payer: MVP Health Care of NY Commercial |
$56.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$42.22
|
| Rate for Payer: MVP Health Care of NY Medicare |
$29.14
|
| Rate for Payer: United Healthcare Medicare |
$27.75
|
| Rate for Payer: WellCare Medicare |
$41.25
|
|
|
RDCTJ TORSION TSTIS W/WO FIXJ CLAT TESTIS
|
Facility
|
IP
|
$9,975.00
|
|
|
Service Code
|
HCPCS 54600
|
| Hospital Charge Code |
4002052
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$6,483.75 |
| Max. Negotiated Rate |
$6,483.75 |
| Rate for Payer: Cash Price |
$7,481.25
|
| Rate for Payer: Galaxy Health Commercial |
$6,483.75
|
|
|
RDCTJ TORSION TSTIS W/WO FIXJ CLAT TESTIS
|
Facility
|
OP
|
$9,975.00
|
|
|
Service Code
|
HCPCS 54600
|
| Hospital Charge Code |
4002052
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$1,266.00 |
| Max. Negotiated Rate |
$8,029.88 |
| Rate for Payer: Aetna of NY Commercial |
$1,857.00
|
| Rate for Payer: Aetna of NY Medicare |
$4,588.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$2,017.33
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$2,521.93
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$3,690.75
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$1,266.00
|
| Rate for Payer: Cash Price |
$7,481.25
|
| Rate for Payer: Cash Price |
$7,481.25
|
| Rate for Payer: Cash Price |
$7,481.25
|
| Rate for Payer: CDPHP Commercial |
$8,029.88
|
| Rate for Payer: CDPHP Medicare |
$3,690.75
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$7,980.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$7,980.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$7,980.00
|
| Rate for Payer: EmblemHealth Medicaid |
$7,980.00
|
| Rate for Payer: EmblemHealth Medicare |
$3,391.50
|
| Rate for Payer: EmblemHealth Select Care |
$7,182.00
|
| Rate for Payer: Fidelis Medicare |
$3,801.47
|
| Rate for Payer: Galaxy Health Commercial |
$6,483.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$3,690.75
|
| Rate for Payer: Humana Medicare |
$3,690.75
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,857.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$4,588.50
|
| Rate for Payer: Multiplan Commercial |
$7,980.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$7,481.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$5,615.92
|
| Rate for Payer: MVP Health Care of NY Medicare |
$3,875.29
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,775.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$3,321.58
|
| Rate for Payer: United Healthcare Commercial |
$2,036.00
|
| Rate for Payer: United Healthcare Medicare |
$3,690.75
|
| Rate for Payer: WellCare Medicare |
$5,486.25
|
|
|
RECOVER ROOM LEVEL3 10+ HOURS
|
Facility
|
OP
|
$2,556.00
|
|
| Hospital Charge Code |
4000216
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$869.04 |
| Max. Negotiated Rate |
$2,057.58 |
| Rate for Payer: Aetna of NY Commercial |
$1,789.20
|
| Rate for Payer: Aetna of NY Medicare |
$1,175.76
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1,917.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,917.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$945.72
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$1,278.00
|
| Rate for Payer: Cash Price |
$1,917.00
|
| Rate for Payer: CDPHP Commercial |
$2,057.58
|
| Rate for Payer: CDPHP Medicare |
$945.72
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2,044.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$2,044.80
|
| Rate for Payer: EmblemHealth Medicaid |
$2,044.80
|
| Rate for Payer: EmblemHealth Medicare |
$869.04
|
| Rate for Payer: Fidelis Medicare |
$974.09
|
| Rate for Payer: Galaxy Health Commercial |
$1,661.40
|
| Rate for Payer: Hamaspik Choice Medicare |
$945.72
|
| Rate for Payer: Humana Medicare |
$945.72
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,789.20
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,175.76
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,917.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1,439.03
|
| Rate for Payer: MVP Health Care of NY Medicare |
$993.01
|
| Rate for Payer: United Healthcare Medicare |
$945.72
|
| Rate for Payer: WellCare Medicare |
$1,405.80
|
|
|
RECOVER ROOM LEVEL3 10+ HOURS
|
Facility
|
IP
|
$2,556.00
|
|
| Hospital Charge Code |
4000216
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$1,661.40 |
| Max. Negotiated Rate |
$1,661.40 |
| Rate for Payer: Cash Price |
$1,917.00
|
| Rate for Payer: Galaxy Health Commercial |
$1,661.40
|
|
|
RECOVERY ROOM - 121-150 MINS
|
Facility
|
OP
|
$1,021.00
|
|
| Hospital Charge Code |
4007614
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$347.14 |
| Max. Negotiated Rate |
$821.90 |
| Rate for Payer: Aetna of NY Commercial |
$714.70
|
| Rate for Payer: Aetna of NY Medicare |
$469.66
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$765.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$765.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$377.77
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$510.50
|
| Rate for Payer: Cash Price |
$765.75
|
| Rate for Payer: CDPHP Commercial |
$821.90
|
| Rate for Payer: CDPHP Medicare |
$377.77
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$816.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$816.80
|
| Rate for Payer: EmblemHealth Medicaid |
$816.80
|
| Rate for Payer: EmblemHealth Medicare |
$347.14
|
| Rate for Payer: Fidelis Medicare |
$389.10
|
| Rate for Payer: Galaxy Health Commercial |
$663.65
|
| Rate for Payer: Hamaspik Choice Medicare |
$377.77
|
| Rate for Payer: Humana Medicare |
$377.77
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$714.70
|
| Rate for Payer: Local 1199SEIU Medicare |
$469.66
|
| Rate for Payer: MVP Health Care of NY Commercial |
$765.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$574.82
|
| Rate for Payer: MVP Health Care of NY Medicare |
$396.66
|
| Rate for Payer: United Healthcare Medicare |
$377.77
|
| Rate for Payer: WellCare Medicare |
$561.55
|
|
|
RECOVERY ROOM - 121-150 MINS
|
Facility
|
IP
|
$1,021.00
|
|
| Hospital Charge Code |
4007614
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$663.65 |
| Max. Negotiated Rate |
$663.65 |
| Rate for Payer: Cash Price |
$765.75
|
| Rate for Payer: Galaxy Health Commercial |
$663.65
|
|
|
RECOVERY ROOM - 151-180 MINS
|
Facility
|
OP
|
$1,201.00
|
|
| Hospital Charge Code |
4007615
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$408.34 |
| Max. Negotiated Rate |
$966.80 |
| Rate for Payer: Aetna of NY Commercial |
$840.70
|
| Rate for Payer: Aetna of NY Medicare |
$552.46
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$900.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$900.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$444.37
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$600.50
|
| Rate for Payer: Cash Price |
$900.75
|
| Rate for Payer: CDPHP Commercial |
$966.80
|
| Rate for Payer: CDPHP Medicare |
$444.37
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$960.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$960.80
|
| Rate for Payer: EmblemHealth Medicaid |
$960.80
|
| Rate for Payer: EmblemHealth Medicare |
$408.34
|
| Rate for Payer: Fidelis Medicare |
$457.70
|
| Rate for Payer: Galaxy Health Commercial |
$780.65
|
| Rate for Payer: Hamaspik Choice Medicare |
$444.37
|
| Rate for Payer: Humana Medicare |
$444.37
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$840.70
|
| Rate for Payer: Local 1199SEIU Medicare |
$552.46
|
| Rate for Payer: MVP Health Care of NY Commercial |
$900.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$676.16
|
| Rate for Payer: MVP Health Care of NY Medicare |
$466.59
|
| Rate for Payer: United Healthcare Medicare |
$444.37
|
| Rate for Payer: WellCare Medicare |
$660.55
|
|
|
RECOVERY ROOM - 151-180 MINS
|
Facility
|
IP
|
$1,201.00
|
|
| Hospital Charge Code |
4007615
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$780.65 |
| Max. Negotiated Rate |
$780.65 |
| Rate for Payer: Cash Price |
$900.75
|
| Rate for Payer: Galaxy Health Commercial |
$780.65
|
|
|
RECOVERY ROOM - 31-60 MINS
|
Facility
|
IP
|
$486.00
|
|
| Hospital Charge Code |
4007611
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$315.90 |
| Max. Negotiated Rate |
$315.90 |
| Rate for Payer: Cash Price |
$364.50
|
| Rate for Payer: Galaxy Health Commercial |
$315.90
|
|
|
RECOVERY ROOM - 31-60 MINS
|
Facility
|
OP
|
$486.00
|
|
| Hospital Charge Code |
4007611
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$165.24 |
| Max. Negotiated Rate |
$391.23 |
| Rate for Payer: Aetna of NY Commercial |
$340.20
|
| Rate for Payer: Aetna of NY Medicare |
$223.56
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$364.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$364.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$179.82
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$243.00
|
| Rate for Payer: Cash Price |
$364.50
|
| Rate for Payer: CDPHP Commercial |
$391.23
|
| Rate for Payer: CDPHP Medicare |
$179.82
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$388.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$388.80
|
| Rate for Payer: EmblemHealth Medicaid |
$388.80
|
| Rate for Payer: EmblemHealth Medicare |
$165.24
|
| Rate for Payer: Fidelis Medicare |
$185.21
|
| Rate for Payer: Galaxy Health Commercial |
$315.90
|
| Rate for Payer: Hamaspik Choice Medicare |
$179.82
|
| Rate for Payer: Humana Medicare |
$179.82
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$340.20
|
| Rate for Payer: Local 1199SEIU Medicare |
$223.56
|
| Rate for Payer: MVP Health Care of NY Commercial |
$364.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$273.62
|
| Rate for Payer: MVP Health Care of NY Medicare |
$188.81
|
| Rate for Payer: United Healthcare Medicare |
$179.82
|
| Rate for Payer: WellCare Medicare |
$267.30
|
|
|
RECOVERY ROOM - 61-90 MINS
|
Facility
|
OP
|
$662.00
|
|
| Hospital Charge Code |
4007612
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$225.08 |
| Max. Negotiated Rate |
$532.91 |
| Rate for Payer: Aetna of NY Commercial |
$463.40
|
| Rate for Payer: Aetna of NY Medicare |
$304.52
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$496.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$496.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$244.94
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$331.00
|
| Rate for Payer: Cash Price |
$496.50
|
| Rate for Payer: CDPHP Commercial |
$532.91
|
| Rate for Payer: CDPHP Medicare |
$244.94
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$529.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$529.60
|
| Rate for Payer: EmblemHealth Medicaid |
$529.60
|
| Rate for Payer: EmblemHealth Medicare |
$225.08
|
| Rate for Payer: Fidelis Medicare |
$252.29
|
| Rate for Payer: Galaxy Health Commercial |
$430.30
|
| Rate for Payer: Hamaspik Choice Medicare |
$244.94
|
| Rate for Payer: Humana Medicare |
$244.94
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$463.40
|
| Rate for Payer: Local 1199SEIU Medicare |
$304.52
|
| Rate for Payer: MVP Health Care of NY Commercial |
$496.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$372.71
|
| Rate for Payer: MVP Health Care of NY Medicare |
$257.19
|
| Rate for Payer: United Healthcare Medicare |
$244.94
|
| Rate for Payer: WellCare Medicare |
$364.10
|
|
|
RECOVERY ROOM - 61-90 MINS
|
Facility
|
IP
|
$662.00
|
|
| Hospital Charge Code |
4007612
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$430.30 |
| Max. Negotiated Rate |
$430.30 |
| Rate for Payer: Cash Price |
$496.50
|
| Rate for Payer: Galaxy Health Commercial |
$430.30
|
|
|
RECOVERY ROOM - 91-120 MINS
|
Facility
|
IP
|
$842.00
|
|
| Hospital Charge Code |
4007613
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$547.30 |
| Max. Negotiated Rate |
$547.30 |
| Rate for Payer: Cash Price |
$631.50
|
| Rate for Payer: Galaxy Health Commercial |
$547.30
|
|
|
RECOVERY ROOM - 91-120 MINS
|
Facility
|
OP
|
$842.00
|
|
| Hospital Charge Code |
4007613
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$286.28 |
| Max. Negotiated Rate |
$677.81 |
| Rate for Payer: Aetna of NY Commercial |
$589.40
|
| Rate for Payer: Aetna of NY Medicare |
$387.32
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$631.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$631.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$311.54
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$421.00
|
| Rate for Payer: Cash Price |
$631.50
|
| Rate for Payer: CDPHP Commercial |
$677.81
|
| Rate for Payer: CDPHP Medicare |
$311.54
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$673.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$673.60
|
| Rate for Payer: EmblemHealth Medicaid |
$673.60
|
| Rate for Payer: EmblemHealth Medicare |
$286.28
|
| Rate for Payer: Fidelis Medicare |
$320.89
|
| Rate for Payer: Galaxy Health Commercial |
$547.30
|
| Rate for Payer: Hamaspik Choice Medicare |
$311.54
|
| Rate for Payer: Humana Medicare |
$311.54
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$589.40
|
| Rate for Payer: Local 1199SEIU Medicare |
$387.32
|
| Rate for Payer: MVP Health Care of NY Commercial |
$631.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$474.05
|
| Rate for Payer: MVP Health Care of NY Medicare |
$327.12
|
| Rate for Payer: United Healthcare Medicare |
$311.54
|
| Rate for Payer: WellCare Medicare |
$463.10
|
|
