|
ROPINEROLE 1 MG TAB
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
NDC 00904637461
|
| Hospital Charge Code |
4401271
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.40 |
| Max. Negotiated Rate |
$4.02 |
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: Galaxy Health Commercial |
$4.02
|
| Rate for Payer: WellCare Medicare |
$3.40
|
|
|
ROPINIROLE HCL 0.25MG TABS 10X10EA
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
NDC 00904637361
|
| Hospital Charge Code |
4400685
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.40 |
| Max. Negotiated Rate |
$4.02 |
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: Galaxy Health Commercial |
$4.02
|
| Rate for Payer: WellCare Medicare |
$3.40
|
|
|
ROPINIROLE HCL 0.25MG TABS 10X10EA
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 00904637361
|
| Hospital Charge Code |
4400685
|
|
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
|
|
|
ROPIVACAINE HCL INJ 1 MG
|
Facility
|
OP
|
$53.56
|
|
|
Service Code
|
HCPCS J2795
|
| Hospital Charge Code |
4400547
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$43.12 |
| Rate for Payer: Aetna of NY Commercial |
$29.46
|
| Rate for Payer: Aetna of NY Medicare |
$24.64
|
| 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 |
$19.82
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$26.78
|
| Rate for Payer: Cash Price |
$40.17
|
| Rate for Payer: Cash Price |
$40.17
|
| Rate for Payer: CDPHP Commercial |
$43.12
|
| Rate for Payer: CDPHP Medicare |
$19.82
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.07
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$42.85
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$42.85
|
| Rate for Payer: EmblemHealth Medicaid |
$42.85
|
| Rate for Payer: EmblemHealth Medicare |
$18.21
|
| Rate for Payer: EmblemHealth Select Care |
$0.07
|
| Rate for Payer: Fidelis Medicare |
$20.41
|
| Rate for Payer: Galaxy Health Commercial |
$34.81
|
| Rate for Payer: Hamaspik Choice Medicare |
$19.82
|
| Rate for Payer: Humana Medicare |
$19.82
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$29.46
|
| Rate for Payer: Local 1199SEIU Medicare |
$24.64
|
| Rate for Payer: MVP Health Care of NY Commercial |
$40.17
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$30.15
|
| Rate for Payer: MVP Health Care of NY Medicare |
$20.81
|
| 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 |
$19.82
|
| Rate for Payer: WellCare Medicare |
$29.46
|
|
|
ROPIVACAINE HCL INJ 1 MG
|
Facility
|
OP
|
$18.03
|
|
|
Service Code
|
HCPCS J2795
|
| Hospital Charge Code |
4400545
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$14.51 |
| Rate for Payer: Aetna of NY Commercial |
$9.92
|
| Rate for Payer: Aetna of NY Medicare |
$8.29
|
| 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 |
$6.67
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$9.02
|
| Rate for Payer: Cash Price |
$13.52
|
| Rate for Payer: Cash Price |
$13.52
|
| Rate for Payer: CDPHP Commercial |
$14.51
|
| Rate for Payer: CDPHP Medicare |
$6.67
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.07
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$14.42
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$14.42
|
| Rate for Payer: EmblemHealth Medicaid |
$14.42
|
| Rate for Payer: EmblemHealth Medicare |
$6.13
|
| Rate for Payer: EmblemHealth Select Care |
$0.07
|
| Rate for Payer: Fidelis Medicare |
$6.87
|
| Rate for Payer: Galaxy Health Commercial |
$11.72
|
| Rate for Payer: Hamaspik Choice Medicare |
$6.67
|
| Rate for Payer: Humana Medicare |
$6.67
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$9.92
|
| Rate for Payer: Local 1199SEIU Medicare |
$8.29
|
| Rate for Payer: MVP Health Care of NY Commercial |
$13.52
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$10.15
|
| Rate for Payer: MVP Health Care of NY Medicare |
$7.00
|
| 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 |
$6.67
|
| Rate for Payer: WellCare Medicare |
$9.92
|
|
|
ROPIVACAINE HCL INJ 1 MG
|
Facility
|
IP
|
$41.97
|
|
|
Service Code
|
HCPCS J2795
|
| Hospital Charge Code |
4400544
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$27.28 |
| Rate for Payer: Aetna of NY Commercial |
$23.08
|
| 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: Cash Price |
$31.48
|
| Rate for Payer: Cash Price |
$31.48
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.07
|
| Rate for Payer: EmblemHealth Select Care |
$0.07
|
| Rate for Payer: Galaxy Health Commercial |
$27.28
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$23.08
|
| Rate for Payer: WellCare Medicare |
$23.08
|
|
|
ROPIVACAINE HCL INJ 1 MG
|
Facility
|
IP
|
$18.03
|
|
|
Service Code
|
HCPCS J2795
|
| Hospital Charge Code |
4400545
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$11.72 |
| Rate for Payer: Aetna of NY Commercial |
$9.92
|
| 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: Cash Price |
$13.52
|
| Rate for Payer: Cash Price |
$13.52
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.07
|
| Rate for Payer: EmblemHealth Select Care |
$0.07
|
| Rate for Payer: Galaxy Health Commercial |
$11.72
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$9.92
|
| Rate for Payer: WellCare Medicare |
$9.92
|
|
|
ROPIVACAINE HCL INJ 1 MG
|
Facility
|
OP
|
$41.97
|
|
|
Service Code
|
HCPCS J2795
|
| Hospital Charge Code |
4400544
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$33.79 |
| Rate for Payer: Aetna of NY Commercial |
$23.08
|
| Rate for Payer: Aetna of NY Medicare |
$19.31
|
| 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 |
$15.53
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$20.98
|
| Rate for Payer: Cash Price |
$31.48
|
| Rate for Payer: Cash Price |
$31.48
|
| Rate for Payer: CDPHP Commercial |
$33.79
|
| Rate for Payer: CDPHP Medicare |
$15.53
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.07
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$33.58
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$33.58
|
| Rate for Payer: EmblemHealth Medicaid |
$33.58
|
| Rate for Payer: EmblemHealth Medicare |
$14.27
|
| Rate for Payer: EmblemHealth Select Care |
$0.07
|
| Rate for Payer: Fidelis Medicare |
$15.99
|
| Rate for Payer: Galaxy Health Commercial |
$27.28
|
| Rate for Payer: Hamaspik Choice Medicare |
$15.53
|
| Rate for Payer: Humana Medicare |
$15.53
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$23.08
|
| Rate for Payer: Local 1199SEIU Medicare |
$19.31
|
| Rate for Payer: MVP Health Care of NY Commercial |
$31.48
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$23.63
|
| Rate for Payer: MVP Health Care of NY Medicare |
$16.31
|
| 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 |
$15.53
|
| Rate for Payer: WellCare Medicare |
$23.08
|
|
|
ROPIVACAINE HCL INJ 1 MG
|
Facility
|
IP
|
$53.56
|
|
|
Service Code
|
HCPCS J2795
|
| Hospital Charge Code |
4400547
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$34.81 |
| Rate for Payer: Aetna of NY Commercial |
$29.46
|
| 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: Cash Price |
$40.17
|
| Rate for Payer: Cash Price |
$40.17
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.07
|
| Rate for Payer: EmblemHealth Select Care |
$0.07
|
| Rate for Payer: Galaxy Health Commercial |
$34.81
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$29.46
|
| Rate for Payer: WellCare Medicare |
$29.46
|
|
|
ROSUVASTATIN CALCIUM 10MG TABS 100 EA
|
Facility
|
IP
|
$30.64
|
|
|
Service Code
|
NDC 60687024511
|
| Hospital Charge Code |
4400196
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.85 |
| Max. Negotiated Rate |
$19.92 |
| Rate for Payer: Cash Price |
$22.98
|
| Rate for Payer: Galaxy Health Commercial |
$19.92
|
| Rate for Payer: WellCare Medicare |
$16.85
|
|
|
ROSUVASTATIN CALCIUM 10MG TABS 100 EA
|
Facility
|
OP
|
$30.64
|
|
|
Service Code
|
NDC 60687024511
|
| Hospital Charge Code |
4400196
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.42 |
| Max. Negotiated Rate |
$24.67 |
| Rate for Payer: Aetna of NY Commercial |
$21.45
|
| Rate for Payer: Aetna of NY Medicare |
$14.09
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$22.98
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$22.98
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$11.34
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$15.32
|
| Rate for Payer: Cash Price |
$22.98
|
| Rate for Payer: CDPHP Commercial |
$24.67
|
| Rate for Payer: CDPHP Medicare |
$11.34
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$24.51
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$24.51
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$24.51
|
| Rate for Payer: EmblemHealth Medicaid |
$24.51
|
| Rate for Payer: EmblemHealth Medicare |
$10.42
|
| Rate for Payer: EmblemHealth Select Care |
$22.06
|
| Rate for Payer: Fidelis Medicare |
$11.68
|
| Rate for Payer: Galaxy Health Commercial |
$19.92
|
| Rate for Payer: Hamaspik Choice Medicare |
$11.34
|
| Rate for Payer: Humana Medicare |
$11.34
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$21.45
|
| Rate for Payer: Local 1199SEIU Medicare |
$14.09
|
| Rate for Payer: MVP Health Care of NY Commercial |
$22.98
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$17.25
|
| Rate for Payer: MVP Health Care of NY Medicare |
$11.90
|
| Rate for Payer: United Healthcare Medicare |
$11.34
|
| Rate for Payer: WellCare Medicare |
$16.85
|
|
|
rosuvastatin CALCIUM 5 MG TAB 5 mg, 100 eaches
|
Facility
|
IP
|
$6.00
|
|
|
Service Code
|
NDC 00904677861
|
| Hospital Charge Code |
4401484
|
|
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
|
|
|
rosuvastatin CALCIUM 5 MG TAB 5 mg, 100 eaches
|
Facility
|
OP
|
$6.00
|
|
|
Service Code
|
NDC 00904677861
|
| Hospital Charge Code |
4401484
|
|
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
|
|
|
ROTH NET 2.5MM DISPOSIBLE
|
Facility
|
IP
|
$344.00
|
|
| Hospital Charge Code |
4471022
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$223.60 |
| Max. Negotiated Rate |
$223.60 |
| Rate for Payer: Cash Price |
$258.00
|
| Rate for Payer: Galaxy Health Commercial |
$223.60
|
|
|
ROTH NET 2.5MM DISPOSIBLE
|
Facility
|
OP
|
$344.00
|
|
| Hospital Charge Code |
4471022
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$116.96 |
| Max. Negotiated Rate |
$276.92 |
| Rate for Payer: Aetna of NY Commercial |
$240.80
|
| Rate for Payer: Aetna of NY Medicare |
$158.24
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$258.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$258.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$127.28
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$172.00
|
| Rate for Payer: Cash Price |
$258.00
|
| Rate for Payer: CDPHP Commercial |
$276.92
|
| Rate for Payer: CDPHP Medicare |
$127.28
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$275.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$275.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$275.20
|
| Rate for Payer: EmblemHealth Medicaid |
$275.20
|
| Rate for Payer: EmblemHealth Medicare |
$116.96
|
| Rate for Payer: EmblemHealth Select Care |
$247.68
|
| Rate for Payer: Fidelis Medicare |
$131.10
|
| Rate for Payer: Galaxy Health Commercial |
$223.60
|
| Rate for Payer: Hamaspik Choice Medicare |
$127.28
|
| Rate for Payer: Humana Medicare |
$127.28
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$240.80
|
| Rate for Payer: Local 1199SEIU Medicare |
$158.24
|
| Rate for Payer: MVP Health Care of NY Commercial |
$258.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$193.67
|
| Rate for Payer: MVP Health Care of NY Medicare |
$133.64
|
| Rate for Payer: United Healthcare Medicare |
$127.28
|
| Rate for Payer: WellCare Medicare |
$189.20
|
|
|
ROZEREM 8 MG TABLET
|
Facility
|
OP
|
$46.00
|
|
|
Service Code
|
NDC 64764080530
|
| Hospital Charge Code |
4401353
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.64 |
| Max. Negotiated Rate |
$37.03 |
| Rate for Payer: Aetna of NY Commercial |
$32.20
|
| Rate for Payer: Aetna of NY Medicare |
$21.16
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$34.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$34.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$17.02
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$23.00
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: CDPHP Commercial |
$37.03
|
| Rate for Payer: CDPHP Medicare |
$17.02
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$36.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$36.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$36.80
|
| Rate for Payer: EmblemHealth Medicaid |
$36.80
|
| Rate for Payer: EmblemHealth Medicare |
$15.64
|
| Rate for Payer: EmblemHealth Select Care |
$33.12
|
| Rate for Payer: Fidelis Medicare |
$17.53
|
| Rate for Payer: Galaxy Health Commercial |
$29.90
|
| Rate for Payer: Hamaspik Choice Medicare |
$17.02
|
| Rate for Payer: Humana Medicare |
$17.02
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$32.20
|
| Rate for Payer: Local 1199SEIU Medicare |
$21.16
|
| Rate for Payer: MVP Health Care of NY Commercial |
$34.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$25.90
|
| Rate for Payer: MVP Health Care of NY Medicare |
$17.87
|
| Rate for Payer: United Healthcare Medicare |
$17.02
|
| Rate for Payer: WellCare Medicare |
$25.30
|
|
|
ROZEREM 8 MG TABLET
|
Facility
|
IP
|
$46.00
|
|
|
Service Code
|
NDC 64764080530
|
| Hospital Charge Code |
4401353
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$25.30 |
| Max. Negotiated Rate |
$29.90 |
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Galaxy Health Commercial |
$29.90
|
| Rate for Payer: WellCare Medicare |
$25.30
|
|
|
RPLC GTUBE NO REVJ TRC
|
Facility
|
OP
|
$707.00
|
|
|
Service Code
|
HCPCS 43762
|
| Hospital Charge Code |
4853031
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$235.48 |
| Max. Negotiated Rate |
$2,521.93 |
| Rate for Payer: Aetna of NY Commercial |
$494.90
|
| Rate for Payer: Aetna of NY Medicare |
$325.22
|
| 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 |
$261.59
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$353.50
|
| Rate for Payer: Cash Price |
$530.25
|
| Rate for Payer: Cash Price |
$530.25
|
| Rate for Payer: Cash Price |
$530.25
|
| Rate for Payer: CDPHP Commercial |
$569.14
|
| Rate for Payer: CDPHP Medicare |
$261.59
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$565.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$565.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$565.60
|
| Rate for Payer: EmblemHealth Medicaid |
$565.60
|
| Rate for Payer: EmblemHealth Medicare |
$240.38
|
| Rate for Payer: EmblemHealth Select Care |
$509.04
|
| Rate for Payer: Fidelis Medicare |
$269.44
|
| Rate for Payer: Galaxy Health Commercial |
$459.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$261.59
|
| Rate for Payer: Humana Medicare |
$261.59
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$494.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$325.22
|
| Rate for Payer: MVP Health Care of NY Commercial |
$530.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$398.04
|
| Rate for Payer: MVP Health Care of NY Medicare |
$274.67
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$235.48
|
| Rate for Payer: United Healthcare Medicare |
$261.59
|
| Rate for Payer: WellCare Medicare |
$388.85
|
|
|
RPLC GTUBE NO REVJ TRC
|
Facility
|
OP
|
$707.00
|
|
|
Service Code
|
HCPCS 43762
|
| Hospital Charge Code |
4602227
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$235.48 |
| Max. Negotiated Rate |
$1,189.18 |
| Rate for Payer: Aetna of NY Commercial |
$955.00
|
| Rate for Payer: Aetna of NY Medicare |
$325.22
|
| 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 |
$261.59
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$353.50
|
| Rate for Payer: Cash Price |
$530.25
|
| Rate for Payer: Cash Price |
$530.25
|
| Rate for Payer: Cash Price |
$530.25
|
| Rate for Payer: Cash Price |
$530.25
|
| Rate for Payer: CDPHP Commercial |
$569.14
|
| Rate for Payer: CDPHP Medicare |
$261.59
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,182.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$565.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$565.60
|
| Rate for Payer: EmblemHealth Medicaid |
$565.60
|
| Rate for Payer: EmblemHealth Medicare |
$240.38
|
| 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 |
$269.44
|
| Rate for Payer: Galaxy Health Commercial |
$459.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$261.59
|
| Rate for Payer: Humana Medicare |
$261.59
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$955.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$325.22
|
| 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 |
$274.67
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$980.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$235.48
|
| Rate for Payer: United Healthcare Commercial |
$980.00
|
| Rate for Payer: United Healthcare Medicare |
$261.59
|
| Rate for Payer: WellCare Medicare |
$388.85
|
|
|
RPLC GTUBE NO REVJ TRC
|
Facility
|
IP
|
$707.00
|
|
|
Service Code
|
HCPCS 43762
|
| Hospital Charge Code |
4602227
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$459.55 |
| Max. Negotiated Rate |
$459.55 |
| Rate for Payer: Cash Price |
$530.25
|
| Rate for Payer: Galaxy Health Commercial |
$459.55
|
|
|
RPLC GTUBE NO REVJ TRC
|
Facility
|
IP
|
$707.00
|
|
|
Service Code
|
HCPCS 43762
|
| Hospital Charge Code |
4853031
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$459.55 |
| Max. Negotiated Rate |
$459.55 |
| Rate for Payer: Cash Price |
$530.25
|
| Rate for Payer: Galaxy Health Commercial |
$459.55
|
|
|
RPLC GTUBE REVJ GSTRST TRC
|
Facility
|
OP
|
$707.00
|
|
|
Service Code
|
HCPCS 43763
|
| Hospital Charge Code |
4853032
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$235.48 |
| Max. Negotiated Rate |
$2,521.93 |
| Rate for Payer: Aetna of NY Commercial |
$494.90
|
| Rate for Payer: Aetna of NY Medicare |
$325.22
|
| 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 |
$261.59
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$353.50
|
| Rate for Payer: Cash Price |
$530.25
|
| Rate for Payer: Cash Price |
$530.25
|
| Rate for Payer: Cash Price |
$530.25
|
| Rate for Payer: CDPHP Commercial |
$569.14
|
| Rate for Payer: CDPHP Medicare |
$261.59
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$565.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$565.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$565.60
|
| Rate for Payer: EmblemHealth Medicaid |
$565.60
|
| Rate for Payer: EmblemHealth Medicare |
$240.38
|
| Rate for Payer: EmblemHealth Select Care |
$509.04
|
| Rate for Payer: Fidelis Medicare |
$269.44
|
| Rate for Payer: Galaxy Health Commercial |
$459.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$261.59
|
| Rate for Payer: Humana Medicare |
$261.59
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$494.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$325.22
|
| Rate for Payer: MVP Health Care of NY Commercial |
$530.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$398.04
|
| Rate for Payer: MVP Health Care of NY Medicare |
$274.67
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$235.48
|
| Rate for Payer: United Healthcare Medicare |
$261.59
|
| Rate for Payer: WellCare Medicare |
$388.85
|
|
|
RPLC GTUBE REVJ GSTRST TRC
|
Facility
|
IP
|
$707.00
|
|
|
Service Code
|
HCPCS 43763
|
| Hospital Charge Code |
4853032
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$459.55 |
| Max. Negotiated Rate |
$459.55 |
| Rate for Payer: Cash Price |
$530.25
|
| Rate for Payer: Galaxy Health Commercial |
$459.55
|
|
|
RP LOCLZJ TUM SPECT CT 2AREA 1D IMG/1 AR IMG>2+D
|
Facility
|
OP
|
$4,476.00
|
|
|
Service Code
|
HCPCS 78832
|
| Hospital Charge Code |
4211263
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$262.54 |
| Max. Negotiated Rate |
$3,603.18 |
| Rate for Payer: Aetna of NY Commercial |
$1,036.00
|
| Rate for Payer: Aetna of NY Medicare |
$2,058.96
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$3,357.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$3,357.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1,656.12
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$2,238.00
|
| Rate for Payer: Cash Price |
$3,357.00
|
| Rate for Payer: Cash Price |
$3,357.00
|
| Rate for Payer: Cash Price |
$3,357.00
|
| Rate for Payer: CDPHP Commercial |
$3,603.18
|
| Rate for Payer: CDPHP Medicare |
$1,656.12
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$3,133.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$3,580.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$3,580.80
|
| Rate for Payer: EmblemHealth Medicaid |
$3,580.80
|
| Rate for Payer: EmblemHealth Medicare |
$1,521.84
|
| Rate for Payer: EmblemHealth Select Care |
$2,909.40
|
| Rate for Payer: Fidelis Medicare |
$1,705.80
|
| Rate for Payer: Galaxy Health Commercial |
$2,909.40
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,656.12
|
| Rate for Payer: Humana Medicare |
$1,656.12
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,036.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$2,058.96
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,357.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$2,519.99
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1,738.93
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,500.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$262.54
|
| Rate for Payer: United Healthcare Commercial |
$1,500.00
|
| Rate for Payer: United Healthcare Medicare |
$1,656.12
|
| Rate for Payer: WellCare Medicare |
$2,461.80
|
|
|
RP LOCLZJ TUM SPECT CT 2AREA 1D IMG/1 AR IMG>2+D
|
Facility
|
IP
|
$4,476.00
|
|
|
Service Code
|
HCPCS 78832
|
| Hospital Charge Code |
4211263
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$2,909.40 |
| Max. Negotiated Rate |
$2,909.40 |
| Rate for Payer: Cash Price |
$3,357.00
|
| Rate for Payer: Galaxy Health Commercial |
$2,909.40
|
|
