|
RESOLUTION CLIP 235CM
|
Facility
|
OP
|
$860.00
|
|
| Hospital Charge Code |
4471975
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$292.40 |
| Max. Negotiated Rate |
$692.30 |
| Rate for Payer: Aetna of NY Commercial |
$602.00
|
| Rate for Payer: Aetna of NY Medicare |
$395.60
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$645.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$645.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$318.20
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$430.00
|
| Rate for Payer: Cash Price |
$645.00
|
| Rate for Payer: CDPHP Commercial |
$692.30
|
| Rate for Payer: CDPHP Medicare |
$318.20
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$688.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$688.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$688.00
|
| Rate for Payer: EmblemHealth Medicaid |
$688.00
|
| Rate for Payer: EmblemHealth Medicare |
$292.40
|
| Rate for Payer: EmblemHealth Select Care |
$619.20
|
| Rate for Payer: Fidelis Medicare |
$327.75
|
| Rate for Payer: Galaxy Health Commercial |
$559.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$318.20
|
| Rate for Payer: Humana Medicare |
$318.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$602.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$395.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$645.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$484.18
|
| Rate for Payer: MVP Health Care of NY Medicare |
$334.11
|
| Rate for Payer: United Healthcare Medicare |
$318.20
|
| Rate for Payer: WellCare Medicare |
$473.00
|
|
|
RESP FLOW VOLUME LOOP
|
Facility
|
OP
|
$898.00
|
|
|
Service Code
|
HCPCS 94375
|
| Hospital Charge Code |
4530035
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$15.15 |
| Max. Negotiated Rate |
$722.89 |
| Rate for Payer: Aetna of NY Commercial |
$628.60
|
| Rate for Payer: Aetna of NY Medicare |
$413.08
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$673.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$673.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$332.26
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$449.00
|
| Rate for Payer: Cash Price |
$673.50
|
| Rate for Payer: Cash Price |
$673.50
|
| Rate for Payer: CDPHP Commercial |
$722.89
|
| Rate for Payer: CDPHP Medicare |
$332.26
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$628.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$718.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$718.40
|
| Rate for Payer: EmblemHealth Medicaid |
$718.40
|
| Rate for Payer: EmblemHealth Medicare |
$305.32
|
| Rate for Payer: EmblemHealth Select Care |
$583.70
|
| Rate for Payer: Fidelis Medicare |
$342.23
|
| Rate for Payer: Galaxy Health Commercial |
$583.70
|
| Rate for Payer: Hamaspik Choice Medicare |
$332.26
|
| Rate for Payer: Humana Medicare |
$332.26
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$628.60
|
| Rate for Payer: Local 1199SEIU Medicare |
$413.08
|
| Rate for Payer: MVP Health Care of NY Commercial |
$673.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$505.57
|
| Rate for Payer: MVP Health Care of NY Medicare |
$348.87
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$15.15
|
| Rate for Payer: United Healthcare Medicare |
$332.26
|
| Rate for Payer: WellCare Medicare |
$493.90
|
|
|
RESP FLOW VOLUME LOOP
|
Facility
|
IP
|
$898.00
|
|
|
Service Code
|
HCPCS 94375
|
| Hospital Charge Code |
4530035
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$583.70 |
| Max. Negotiated Rate |
$583.70 |
| Rate for Payer: Cash Price |
$673.50
|
| Rate for Payer: Galaxy Health Commercial |
$583.70
|
|
|
RETICULOCYTE COUNT
|
Facility
|
OP
|
$24.00
|
|
|
Service Code
|
HCPCS 85044
|
| Hospital Charge Code |
4300697
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$1.44 |
| Max. Negotiated Rate |
$19.32 |
| Rate for Payer: Aetna of NY Commercial |
$15.60
|
| Rate for Payer: Aetna of NY Medicare |
$11.04
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$18.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$18.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$8.88
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$12.00
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: CDPHP Commercial |
$19.32
|
| Rate for Payer: CDPHP Medicare |
$8.88
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$14.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$19.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$19.20
|
| Rate for Payer: EmblemHealth Medicaid |
$19.20
|
| Rate for Payer: EmblemHealth Medicare |
$8.16
|
| Rate for Payer: EmblemHealth Select Care |
$14.40
|
| Rate for Payer: Fidelis Medicare |
$9.15
|
| Rate for Payer: Galaxy Health Commercial |
$15.60
|
| Rate for Payer: Hamaspik Choice Medicare |
$8.88
|
| Rate for Payer: Humana Medicare |
$8.88
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$15.60
|
| Rate for Payer: Local 1199SEIU Medicare |
$11.04
|
| Rate for Payer: MVP Health Care of NY Commercial |
$18.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$13.51
|
| Rate for Payer: MVP Health Care of NY Medicare |
$9.32
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$18.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1.44
|
| Rate for Payer: United Healthcare Commercial |
$18.00
|
| Rate for Payer: United Healthcare Medicare |
$8.88
|
| Rate for Payer: WellCare Medicare |
$13.20
|
|
|
RETICULOCYTE COUNT
|
Facility
|
IP
|
$24.00
|
|
|
Service Code
|
HCPCS 85044
|
| Hospital Charge Code |
4300697
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$15.60 |
| Max. Negotiated Rate |
$15.60 |
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Galaxy Health Commercial |
$15.60
|
|
|
RETRIEVAL SYSTEM 10MM ENDSCP
|
Facility
|
OP
|
$200.00
|
|
| Hospital Charge Code |
4471802
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$68.00 |
| Max. Negotiated Rate |
$161.00 |
| Rate for Payer: Aetna of NY Commercial |
$140.00
|
| Rate for Payer: Aetna of NY Medicare |
$92.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$150.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$150.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$74.00
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$100.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: CDPHP Commercial |
$161.00
|
| Rate for Payer: CDPHP Medicare |
$74.00
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$160.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$160.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$160.00
|
| Rate for Payer: EmblemHealth Medicaid |
$160.00
|
| Rate for Payer: EmblemHealth Medicare |
$68.00
|
| Rate for Payer: EmblemHealth Select Care |
$144.00
|
| Rate for Payer: Fidelis Medicare |
$76.22
|
| Rate for Payer: Galaxy Health Commercial |
$130.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$74.00
|
| Rate for Payer: Humana Medicare |
$74.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$140.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$92.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$150.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$112.60
|
| Rate for Payer: MVP Health Care of NY Medicare |
$77.70
|
| Rate for Payer: United Healthcare Medicare |
$74.00
|
| Rate for Payer: WellCare Medicare |
$110.00
|
|
|
RETRIEVAL SYSTEM 10MM ENDSCP
|
Facility
|
IP
|
$200.00
|
|
| Hospital Charge Code |
4471802
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$130.00 |
| Max. Negotiated Rate |
$130.00 |
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Galaxy Health Commercial |
$130.00
|
|
|
REVISION OR REMOVAL OF IMPLANTED SPINAL NEUROSTIMULATOR PULSE GENERATOR OR RECEIVER, WITH DETACHABLE CONNECTION TO ELECTRODE ARRAY
|
Facility
|
OP
|
$3,241.90
|
|
|
Service Code
|
CPT 63688
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$1,307.00 |
| Max. Negotiated Rate |
$3,241.90 |
| Rate for Payer: Aetna of NY Commercial |
$1,857.00
|
| 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: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$1,307.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,857.00
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,775.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$3,241.90
|
| Rate for Payer: United Healthcare Commercial |
$2,036.00
|
|
|
RHEUMATOID FACTOR QUANTITATIVE
|
Facility
|
OP
|
$21.00
|
|
|
Service Code
|
HCPCS 86431
|
| Hospital Charge Code |
4302015
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.25 |
| Max. Negotiated Rate |
$16.90 |
| Rate for Payer: Aetna of NY Commercial |
$13.65
|
| Rate for Payer: Aetna of NY Medicare |
$9.66
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$15.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$15.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$7.77
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$10.50
|
| Rate for Payer: Cash Price |
$15.75
|
| Rate for Payer: Cash Price |
$15.75
|
| Rate for Payer: CDPHP Commercial |
$16.90
|
| Rate for Payer: CDPHP Medicare |
$7.77
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$12.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$16.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$16.80
|
| Rate for Payer: EmblemHealth Medicaid |
$16.80
|
| Rate for Payer: EmblemHealth Medicare |
$7.14
|
| Rate for Payer: EmblemHealth Select Care |
$12.60
|
| Rate for Payer: Fidelis Medicare |
$8.00
|
| Rate for Payer: Galaxy Health Commercial |
$13.65
|
| Rate for Payer: Hamaspik Choice Medicare |
$7.77
|
| Rate for Payer: Humana Medicare |
$7.77
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$13.65
|
| Rate for Payer: Local 1199SEIU Medicare |
$9.66
|
| Rate for Payer: MVP Health Care of NY Commercial |
$15.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$11.82
|
| Rate for Payer: MVP Health Care of NY Medicare |
$8.16
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$15.75
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$5.25
|
| Rate for Payer: United Healthcare Commercial |
$15.75
|
| Rate for Payer: United Healthcare Medicare |
$7.77
|
| Rate for Payer: WellCare Medicare |
$11.55
|
|
|
RHEUMATOID FACTOR QUANTITATIVE
|
Facility
|
IP
|
$21.00
|
|
|
Service Code
|
HCPCS 86431
|
| Hospital Charge Code |
4302015
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.65 |
| Max. Negotiated Rate |
$13.65 |
| Rate for Payer: Cash Price |
$15.75
|
| Rate for Payer: Galaxy Health Commercial |
$13.65
|
|
|
RH TYPE
|
Facility
|
IP
|
$115.00
|
|
|
Service Code
|
HCPCS 86901
|
| Hospital Charge Code |
4300699
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$74.75 |
| Max. Negotiated Rate |
$74.75 |
| Rate for Payer: Cash Price |
$86.25
|
| Rate for Payer: Galaxy Health Commercial |
$74.75
|
|
|
RH TYPE
|
Facility
|
OP
|
$115.00
|
|
|
Service Code
|
HCPCS 86901
|
| Hospital Charge Code |
4300699
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$92.58 |
| Rate for Payer: Aetna of NY Commercial |
$74.75
|
| Rate for Payer: Aetna of NY Medicare |
$52.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$86.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$86.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$42.55
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$57.50
|
| Rate for Payer: Cash Price |
$86.25
|
| Rate for Payer: Cash Price |
$86.25
|
| Rate for Payer: CDPHP Commercial |
$92.58
|
| Rate for Payer: CDPHP Medicare |
$42.55
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$69.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$92.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$92.00
|
| Rate for Payer: EmblemHealth Medicaid |
$92.00
|
| Rate for Payer: EmblemHealth Medicare |
$39.10
|
| Rate for Payer: EmblemHealth Select Care |
$69.00
|
| Rate for Payer: Fidelis Medicare |
$43.83
|
| Rate for Payer: Galaxy Health Commercial |
$74.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$42.55
|
| Rate for Payer: Humana Medicare |
$42.55
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$74.75
|
| Rate for Payer: Local 1199SEIU Medicare |
$52.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$86.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$64.74
|
| Rate for Payer: MVP Health Care of NY Medicare |
$44.68
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$86.25
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$2.99
|
| Rate for Payer: United Healthcare Commercial |
$86.25
|
| Rate for Payer: United Healthcare Medicare |
$42.55
|
| Rate for Payer: WellCare Medicare |
$63.25
|
|
|
RIFAMPIN 300 MG PO
|
Facility
|
IP
|
$7.50
|
|
|
Service Code
|
NDC 61748001801
|
| Hospital Charge Code |
4409021
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.12 |
| Max. Negotiated Rate |
$4.88 |
| Rate for Payer: Cash Price |
$5.63
|
| Rate for Payer: Galaxy Health Commercial |
$4.88
|
| Rate for Payer: WellCare Medicare |
$4.12
|
|
|
RIFAMPIN 300 MG PO
|
Facility
|
OP
|
$7.50
|
|
|
Service Code
|
NDC 61748001801
|
| Hospital Charge Code |
4409021
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.55 |
| Max. Negotiated Rate |
$6.04 |
| Rate for Payer: Aetna of NY Commercial |
$5.25
|
| Rate for Payer: Aetna of NY Medicare |
$3.45
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$5.62
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$5.62
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2.78
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$3.75
|
| Rate for Payer: Cash Price |
$5.63
|
| Rate for Payer: CDPHP Commercial |
$6.04
|
| Rate for Payer: CDPHP Medicare |
$2.78
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$6.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$6.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$6.00
|
| Rate for Payer: EmblemHealth Medicaid |
$6.00
|
| Rate for Payer: EmblemHealth Medicare |
$2.55
|
| Rate for Payer: EmblemHealth Select Care |
$5.40
|
| Rate for Payer: Fidelis Medicare |
$2.86
|
| Rate for Payer: Galaxy Health Commercial |
$4.88
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.78
|
| Rate for Payer: Humana Medicare |
$2.78
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$5.25
|
| Rate for Payer: Local 1199SEIU Medicare |
$3.45
|
| Rate for Payer: MVP Health Care of NY Commercial |
$5.62
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$4.22
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2.91
|
| Rate for Payer: United Healthcare Medicare |
$2.78
|
| Rate for Payer: WellCare Medicare |
$4.12
|
|
|
rifAMPin IV 600 MG VIAL 600 mg, 1 each
|
Facility
|
OP
|
$550.00
|
|
|
Service Code
|
NDC 63323035120
|
| Hospital Charge Code |
4401557
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$187.00 |
| Max. Negotiated Rate |
$442.75 |
| Rate for Payer: Aetna of NY Commercial |
$302.50
|
| Rate for Payer: Aetna of NY Medicare |
$253.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$247.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$247.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$203.50
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$275.00
|
| Rate for Payer: Cash Price |
$412.50
|
| Rate for Payer: CDPHP Commercial |
$442.75
|
| Rate for Payer: CDPHP Medicare |
$203.50
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$440.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$440.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$440.00
|
| Rate for Payer: EmblemHealth Medicaid |
$440.00
|
| Rate for Payer: EmblemHealth Medicare |
$187.00
|
| Rate for Payer: EmblemHealth Select Care |
$396.00
|
| Rate for Payer: Fidelis Medicare |
$209.60
|
| Rate for Payer: Galaxy Health Commercial |
$357.50
|
| Rate for Payer: Hamaspik Choice Medicare |
$203.50
|
| Rate for Payer: Humana Medicare |
$203.50
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$302.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$253.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$412.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$309.65
|
| Rate for Payer: MVP Health Care of NY Medicare |
$213.68
|
| Rate for Payer: United Healthcare Medicare |
$203.50
|
| Rate for Payer: WellCare Medicare |
$302.50
|
|
|
rifAMPin IV 600 MG VIAL 600 mg, 1 each
|
Facility
|
IP
|
$550.00
|
|
|
Service Code
|
NDC 63323035120
|
| Hospital Charge Code |
4401557
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$247.50 |
| Max. Negotiated Rate |
$357.50 |
| Rate for Payer: Aetna of NY Commercial |
$302.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$247.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$247.50
|
| Rate for Payer: Cash Price |
$412.50
|
| Rate for Payer: Galaxy Health Commercial |
$357.50
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$302.50
|
| Rate for Payer: WellCare Medicare |
$302.50
|
|
|
RIFAXIMIN 200MG TABS 30 EA
|
Facility
|
OP
|
$59.48
|
|
|
Service Code
|
NDC 65649030103
|
| Hospital Charge Code |
4400813
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$20.22 |
| Max. Negotiated Rate |
$47.88 |
| Rate for Payer: Aetna of NY Commercial |
$41.64
|
| Rate for Payer: Aetna of NY Medicare |
$27.36
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$44.61
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$44.61
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$22.01
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$29.74
|
| Rate for Payer: Cash Price |
$44.61
|
| Rate for Payer: CDPHP Commercial |
$47.88
|
| Rate for Payer: CDPHP Medicare |
$22.01
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$47.58
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$47.58
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$47.58
|
| Rate for Payer: EmblemHealth Medicaid |
$47.58
|
| Rate for Payer: EmblemHealth Medicare |
$20.22
|
| Rate for Payer: EmblemHealth Select Care |
$42.83
|
| Rate for Payer: Fidelis Medicare |
$22.67
|
| Rate for Payer: Galaxy Health Commercial |
$38.66
|
| Rate for Payer: Hamaspik Choice Medicare |
$22.01
|
| Rate for Payer: Humana Medicare |
$22.01
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$41.64
|
| Rate for Payer: Local 1199SEIU Medicare |
$27.36
|
| Rate for Payer: MVP Health Care of NY Commercial |
$44.61
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$33.49
|
| Rate for Payer: MVP Health Care of NY Medicare |
$23.11
|
| Rate for Payer: United Healthcare Medicare |
$22.01
|
| Rate for Payer: WellCare Medicare |
$32.71
|
|
|
RIFAXIMIN 200MG TABS 30 EA
|
Facility
|
IP
|
$59.48
|
|
|
Service Code
|
NDC 65649030103
|
| Hospital Charge Code |
4400813
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$32.71 |
| Max. Negotiated Rate |
$38.66 |
| Rate for Payer: Cash Price |
$44.61
|
| Rate for Payer: Galaxy Health Commercial |
$38.66
|
| Rate for Payer: WellCare Medicare |
$32.71
|
|
|
RISPERIDONE 0.25MG TABS 100 EA
|
Facility
|
IP
|
$10.82
|
|
|
Service Code
|
NDC 51079046001
|
| Hospital Charge Code |
4400683
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.95 |
| Max. Negotiated Rate |
$7.03 |
| Rate for Payer: Cash Price |
$8.12
|
| Rate for Payer: Galaxy Health Commercial |
$7.03
|
| Rate for Payer: WellCare Medicare |
$5.95
|
|
|
RISPERIDONE 0.25MG TABS 100 EA
|
Facility
|
OP
|
$10.82
|
|
|
Service Code
|
NDC 51079046001
|
| Hospital Charge Code |
4400683
|
|
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
|
|
|
RISPERIDONE 1 MG TAB
|
Facility
|
OP
|
$7.21
|
|
|
Service Code
|
NDC 00904635961
|
| Hospital Charge Code |
4409022
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.45 |
| Max. Negotiated Rate |
$5.80 |
| Rate for Payer: Aetna of NY Commercial |
$5.05
|
| Rate for Payer: Aetna of NY Medicare |
$3.32
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$5.41
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$5.41
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2.67
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$3.60
|
| Rate for Payer: Cash Price |
$5.41
|
| Rate for Payer: CDPHP Commercial |
$5.80
|
| Rate for Payer: CDPHP Medicare |
$2.67
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$5.77
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$5.77
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$5.77
|
| Rate for Payer: EmblemHealth Medicaid |
$5.77
|
| Rate for Payer: EmblemHealth Medicare |
$2.45
|
| Rate for Payer: EmblemHealth Select Care |
$5.19
|
| Rate for Payer: Fidelis Medicare |
$2.75
|
| Rate for Payer: Galaxy Health Commercial |
$4.69
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.67
|
| Rate for Payer: Humana Medicare |
$2.67
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$5.05
|
| Rate for Payer: Local 1199SEIU Medicare |
$3.32
|
| Rate for Payer: MVP Health Care of NY Commercial |
$5.41
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$4.06
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2.80
|
| Rate for Payer: United Healthcare Medicare |
$2.67
|
| Rate for Payer: WellCare Medicare |
$3.97
|
|
|
RISPERIDONE 1 MG TAB
|
Facility
|
IP
|
$7.21
|
|
|
Service Code
|
NDC 00904635961
|
| Hospital Charge Code |
4409022
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.97 |
| Max. Negotiated Rate |
$4.69 |
| Rate for Payer: Cash Price |
$5.41
|
| Rate for Payer: Galaxy Health Commercial |
$4.69
|
| Rate for Payer: WellCare Medicare |
$3.97
|
|
|
R LARGE WRIST W/ABDUCTED THUMB
|
Facility
|
IP
|
$57.00
|
|
| Hospital Charge Code |
4471577
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$37.05 |
| Max. Negotiated Rate |
$37.05 |
| Rate for Payer: Cash Price |
$42.75
|
| Rate for Payer: Galaxy Health Commercial |
$37.05
|
|
|
R LARGE WRIST W/ABDUCTED THUMB
|
Facility
|
OP
|
$57.00
|
|
| Hospital Charge Code |
4471577
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$19.38 |
| Max. Negotiated Rate |
$45.88 |
| Rate for Payer: Aetna of NY Commercial |
$39.90
|
| Rate for Payer: Aetna of NY Medicare |
$26.22
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$42.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$42.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$21.09
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$28.50
|
| Rate for Payer: Cash Price |
$42.75
|
| Rate for Payer: CDPHP Commercial |
$45.88
|
| Rate for Payer: CDPHP Medicare |
$21.09
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$45.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$45.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$45.60
|
| Rate for Payer: EmblemHealth Medicaid |
$45.60
|
| Rate for Payer: EmblemHealth Medicare |
$19.38
|
| Rate for Payer: EmblemHealth Select Care |
$41.04
|
| Rate for Payer: Fidelis Medicare |
$21.72
|
| Rate for Payer: Galaxy Health Commercial |
$37.05
|
| Rate for Payer: Hamaspik Choice Medicare |
$21.09
|
| Rate for Payer: Humana Medicare |
$21.09
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$39.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$26.22
|
| Rate for Payer: MVP Health Care of NY Commercial |
$42.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$32.09
|
| Rate for Payer: MVP Health Care of NY Medicare |
$22.14
|
| Rate for Payer: United Healthcare Medicare |
$21.09
|
| Rate for Payer: WellCare Medicare |
$31.35
|
|
|
RM & BED - DETOX
|
Facility
|
IP
|
$1,051.00
|
|
| Hospital Charge Code |
1000004
|
|
Hospital Revenue Code
|
116
|
| Min. Negotiated Rate |
$550.00 |
| Max. Negotiated Rate |
$2,328.56 |
| Rate for Payer: Aetna of NY Commercial |
$1,273.00
|
| Rate for Payer: Aetna of NY Medicare |
$2,328.56
|
| Rate for Payer: Cash Price |
$788.25
|
| Rate for Payer: Cash Price |
$788.25
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$550.00
|
| Rate for Payer: Galaxy Health Commercial |
$683.15
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,273.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$2,328.56
|
|
