|
REPLACEMENT PICC SAME VENOUS ACCESS
|
Facility
|
IP
|
$4,825.00
|
|
|
Service Code
|
HCPCS 36584
|
| Hospital Charge Code |
4850260
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,136.25 |
| Max. Negotiated Rate |
$3,136.25 |
| Rate for Payer: Cash Price |
$3,618.75
|
| Rate for Payer: Galaxy Health Commercial |
$3,136.25
|
|
|
REPLACE NON-TUNNELED CV CATH
|
Facility
|
OP
|
$4,825.00
|
|
|
Service Code
|
HCPCS 36580
|
| Hospital Charge Code |
4450115
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$723.75 |
| Max. Negotiated Rate |
$3,860.00 |
| Rate for Payer: Aetna of NY Commercial |
$3,377.50
|
| Rate for Payer: Aetna of NY Medicare |
$2,219.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1,930.00
|
| Rate for Payer: Cash Price |
$3,618.75
|
| Rate for Payer: CDPHP Medicare |
$1,785.25
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$3,860.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$3,860.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$3,860.00
|
| Rate for Payer: EmblemHealth Medicaid |
$3,860.00
|
| Rate for Payer: EmblemHealth Medicare |
$1,640.50
|
| Rate for Payer: EmblemHealth Select Care |
$3,474.00
|
| Rate for Payer: Fidelis Medicare |
$1,930.00
|
| Rate for Payer: Galaxy Health Commercial |
$3,136.25
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,930.00
|
| Rate for Payer: Humana Medicare |
$1,930.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$3,377.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$2,219.50
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,618.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$2,716.47
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2,026.50
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$723.75
|
| Rate for Payer: United Healthcare Medicare |
$1,930.00
|
| Rate for Payer: WellCare Medicare |
$2,653.75
|
|
|
REPLACE NON-TUNNELED CV CATH
|
Facility
|
IP
|
$4,825.00
|
|
|
Service Code
|
HCPCS 36580
|
| Hospital Charge Code |
4450115
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,136.25 |
| Max. Negotiated Rate |
$3,136.25 |
| Rate for Payer: Cash Price |
$3,618.75
|
| Rate for Payer: Galaxy Health Commercial |
$3,136.25
|
|
|
RESOLUTION CLIP 235CM
|
Facility
|
IP
|
$885.80
|
|
| Hospital Charge Code |
4471975
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$575.77 |
| Max. Negotiated Rate |
$575.77 |
| Rate for Payer: Cash Price |
$664.35
|
| Rate for Payer: Galaxy Health Commercial |
$575.77
|
|
|
RESOLUTION CLIP 235CM
|
Facility
|
OP
|
$885.80
|
|
| Hospital Charge Code |
4471975
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$132.87 |
| Max. Negotiated Rate |
$708.64 |
| Rate for Payer: Aetna of NY Commercial |
$620.06
|
| Rate for Payer: Aetna of NY Medicare |
$407.47
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$354.32
|
| Rate for Payer: Cash Price |
$664.35
|
| Rate for Payer: CDPHP Medicare |
$327.75
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$708.64
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$708.64
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$708.64
|
| Rate for Payer: EmblemHealth Medicaid |
$708.64
|
| Rate for Payer: EmblemHealth Medicare |
$301.17
|
| Rate for Payer: EmblemHealth Select Care |
$637.78
|
| Rate for Payer: Fidelis Medicare |
$354.32
|
| Rate for Payer: Galaxy Health Commercial |
$575.77
|
| Rate for Payer: Hamaspik Choice Medicare |
$354.32
|
| Rate for Payer: Humana Medicare |
$354.32
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$620.06
|
| Rate for Payer: Local 1199SEIU Medicare |
$407.47
|
| Rate for Payer: MVP Health Care of NY Commercial |
$664.35
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$498.71
|
| Rate for Payer: MVP Health Care of NY Medicare |
$372.04
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$132.87
|
| Rate for Payer: United Healthcare Medicare |
$354.32
|
| Rate for Payer: WellCare Medicare |
$487.19
|
|
|
RESOLUTION CLIP 360 ULTRA (M00521400)
|
Facility
|
IP
|
$1,205.00
|
|
| Hospital Charge Code |
4473042
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$542.25 |
| Max. Negotiated Rate |
$843.50 |
| Rate for Payer: Aetna of NY Commercial |
$843.50
|
| Rate for Payer: Cash Price |
$903.75
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$602.50
|
| Rate for Payer: EmblemHealth Select Care |
$602.50
|
| Rate for Payer: Galaxy Health Commercial |
$783.25
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$843.50
|
| Rate for Payer: Multiplan Commercial |
$542.25
|
| Rate for Payer: MVP Health Care of NY Commercial |
$783.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$783.25
|
| Rate for Payer: WellCare Medicare |
$662.75
|
|
|
RESOLUTION CLIP 360 ULTRA (M00521400)
|
Facility
|
OP
|
$1,205.00
|
|
| Hospital Charge Code |
4473042
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$180.75 |
| Max. Negotiated Rate |
$964.00 |
| Rate for Payer: Aetna of NY Commercial |
$843.50
|
| Rate for Payer: Aetna of NY Medicare |
$554.30
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$482.00
|
| Rate for Payer: Cash Price |
$903.75
|
| Rate for Payer: CDPHP Medicare |
$445.85
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$602.50
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$964.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$964.00
|
| Rate for Payer: EmblemHealth Medicaid |
$964.00
|
| Rate for Payer: EmblemHealth Medicare |
$409.70
|
| Rate for Payer: EmblemHealth Select Care |
$602.50
|
| Rate for Payer: Fidelis Medicare |
$482.00
|
| Rate for Payer: Galaxy Health Commercial |
$783.25
|
| Rate for Payer: Hamaspik Choice Medicare |
$482.00
|
| Rate for Payer: Humana Medicare |
$482.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$843.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$554.30
|
| Rate for Payer: MVP Health Care of NY Commercial |
$783.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$783.25
|
| Rate for Payer: MVP Health Care of NY Medicare |
$506.10
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$180.75
|
| Rate for Payer: United Healthcare Medicare |
$482.00
|
| Rate for Payer: WellCare Medicare |
$662.75
|
|
|
RESP FLOW VOLUME LOOP
|
Facility
|
IP
|
$662.00
|
|
|
Service Code
|
HCPCS 94375
|
| Hospital Charge Code |
4530035
|
|
Hospital Revenue Code
|
460
|
| 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
|
|
|
RESP FLOW VOLUME LOOP
|
Facility
|
OP
|
$662.00
|
|
|
Service Code
|
HCPCS 94375
|
| Hospital Charge Code |
4530035
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$99.30 |
| Max. Negotiated Rate |
$529.60 |
| 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) Medicare |
$264.80
|
| Rate for Payer: Cash Price |
$496.50
|
| Rate for Payer: CDPHP Medicare |
$244.94
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$463.40
|
| 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: EmblemHealth Select Care |
$430.30
|
| Rate for Payer: Fidelis Medicare |
$264.80
|
| Rate for Payer: Galaxy Health Commercial |
$430.30
|
| Rate for Payer: Hamaspik Choice Medicare |
$264.80
|
| Rate for Payer: Humana Medicare |
$264.80
|
| 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 |
$278.04
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$99.30
|
| Rate for Payer: United Healthcare Medicare |
$264.80
|
| Rate for Payer: WellCare Medicare |
$364.10
|
|
|
RETICULOCYTE COUNT
|
Facility
|
OP
|
$13.00
|
|
|
Service Code
|
HCPCS 85044
|
| Hospital Charge Code |
4300697
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$1.95 |
| Max. Negotiated Rate |
$10.40 |
| Rate for Payer: Aetna of NY Commercial |
$8.45
|
| Rate for Payer: Aetna of NY Medicare |
$5.98
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$5.20
|
| Rate for Payer: Cash Price |
$9.75
|
| Rate for Payer: CDPHP Medicare |
$4.81
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$7.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$10.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$10.40
|
| Rate for Payer: EmblemHealth Medicaid |
$10.40
|
| Rate for Payer: EmblemHealth Medicare |
$4.42
|
| Rate for Payer: EmblemHealth Select Care |
$7.80
|
| Rate for Payer: Fidelis Medicare |
$5.20
|
| Rate for Payer: Galaxy Health Commercial |
$8.45
|
| Rate for Payer: Hamaspik Choice Medicare |
$5.20
|
| Rate for Payer: Humana Medicare |
$5.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$8.45
|
| Rate for Payer: Local 1199SEIU Medicare |
$5.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$9.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$7.32
|
| Rate for Payer: MVP Health Care of NY Medicare |
$5.46
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$9.75
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1.95
|
| Rate for Payer: United Healthcare Commercial |
$9.75
|
| Rate for Payer: United Healthcare Medicare |
$5.20
|
| Rate for Payer: WellCare Medicare |
$7.15
|
|
|
RETICULOCYTE COUNT
|
Facility
|
IP
|
$13.00
|
|
|
Service Code
|
HCPCS 85044
|
| Hospital Charge Code |
4300697
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$8.45 |
| Max. Negotiated Rate |
$8.45 |
| Rate for Payer: Cash Price |
$9.75
|
| Rate for Payer: Galaxy Health Commercial |
$8.45
|
|
|
RETRIEVAL SYSTEM 10MM ENDSCP
|
Facility
|
OP
|
$206.00
|
|
| Hospital Charge Code |
4471802
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$30.90 |
| Max. Negotiated Rate |
$164.80 |
| Rate for Payer: Aetna of NY Commercial |
$144.20
|
| Rate for Payer: Aetna of NY Medicare |
$94.76
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$82.40
|
| Rate for Payer: Cash Price |
$154.50
|
| Rate for Payer: CDPHP Medicare |
$76.22
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$164.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$164.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$164.80
|
| Rate for Payer: EmblemHealth Medicaid |
$164.80
|
| Rate for Payer: EmblemHealth Medicare |
$70.04
|
| Rate for Payer: EmblemHealth Select Care |
$148.32
|
| Rate for Payer: Fidelis Medicare |
$82.40
|
| Rate for Payer: Galaxy Health Commercial |
$133.90
|
| Rate for Payer: Hamaspik Choice Medicare |
$82.40
|
| Rate for Payer: Humana Medicare |
$82.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$144.20
|
| Rate for Payer: Local 1199SEIU Medicare |
$94.76
|
| Rate for Payer: MVP Health Care of NY Commercial |
$154.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$115.98
|
| Rate for Payer: MVP Health Care of NY Medicare |
$86.52
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$30.90
|
| Rate for Payer: United Healthcare Medicare |
$82.40
|
| Rate for Payer: WellCare Medicare |
$113.30
|
|
|
RETRIEVAL SYSTEM 10MM ENDSCP
|
Facility
|
IP
|
$206.00
|
|
| Hospital Charge Code |
4471802
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$133.90 |
| Max. Negotiated Rate |
$133.90 |
| Rate for Payer: Cash Price |
$154.50
|
| Rate for Payer: Galaxy Health Commercial |
$133.90
|
|
|
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 |
$1,900.00 |
| Max. Negotiated Rate |
$3,241.90 |
| Rate for Payer: Aetna of NY Commercial |
$1,900.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,900.00
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$2,097.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$3,241.90
|
| Rate for Payer: United Healthcare Commercial |
$2,097.00
|
|
|
RHEUMATOID FACTOR QUANTITATIVE
|
Facility
|
OP
|
$21.00
|
|
|
Service Code
|
HCPCS 86431
|
| Hospital Charge Code |
4302015
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.15 |
| Max. Negotiated Rate |
$16.80 |
| 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) Medicare |
$8.40
|
| Rate for Payer: Cash Price |
$15.75
|
| 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 |
$8.40
|
| Rate for Payer: Galaxy Health Commercial |
$13.65
|
| Rate for Payer: Hamaspik Choice Medicare |
$8.40
|
| Rate for Payer: Humana Medicare |
$8.40
|
| 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 |
$8.82
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$15.75
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$3.15
|
| Rate for Payer: United Healthcare Commercial |
$15.75
|
| Rate for Payer: United Healthcare Medicare |
$8.40
|
| 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
|
OP
|
$118.00
|
|
|
Service Code
|
HCPCS 86901
|
| Hospital Charge Code |
4300699
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.70 |
| Max. Negotiated Rate |
$94.40 |
| Rate for Payer: Aetna of NY Commercial |
$76.70
|
| Rate for Payer: Aetna of NY Medicare |
$54.28
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$47.20
|
| Rate for Payer: Cash Price |
$88.50
|
| Rate for Payer: CDPHP Medicare |
$43.66
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$70.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$94.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$94.40
|
| Rate for Payer: EmblemHealth Medicaid |
$94.40
|
| Rate for Payer: EmblemHealth Medicare |
$40.12
|
| Rate for Payer: EmblemHealth Select Care |
$70.80
|
| Rate for Payer: Fidelis Medicare |
$47.20
|
| Rate for Payer: Galaxy Health Commercial |
$76.70
|
| Rate for Payer: Hamaspik Choice Medicare |
$47.20
|
| Rate for Payer: Humana Medicare |
$47.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$76.70
|
| Rate for Payer: Local 1199SEIU Medicare |
$54.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$88.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$66.43
|
| Rate for Payer: MVP Health Care of NY Medicare |
$49.56
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$88.50
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$17.70
|
| Rate for Payer: United Healthcare Commercial |
$88.50
|
| Rate for Payer: United Healthcare Medicare |
$47.20
|
| Rate for Payer: WellCare Medicare |
$64.90
|
|
|
RH TYPE
|
Facility
|
IP
|
$118.00
|
|
|
Service Code
|
HCPCS 86901
|
| Hospital Charge Code |
4300699
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$76.70 |
| Max. Negotiated Rate |
$76.70 |
| Rate for Payer: Cash Price |
$88.50
|
| Rate for Payer: Galaxy Health Commercial |
$76.70
|
|
|
RIFAMPIN 300 MG PO
|
Facility
|
OP
|
$7.50
|
|
|
Service Code
|
NDC 61748001801
|
| Hospital Charge Code |
4409021
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.12 |
| Max. Negotiated Rate |
$6.00 |
| 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) Medicare |
$3.00
|
| Rate for Payer: Cash Price |
$5.62
|
| Rate for Payer: CDPHP Medicare |
$2.77
|
| 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 |
$3.00
|
| Rate for Payer: Galaxy Health Commercial |
$4.88
|
| Rate for Payer: Hamaspik Choice Medicare |
$3.00
|
| Rate for Payer: Humana Medicare |
$3.00
|
| 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 |
$3.15
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1.12
|
| Rate for Payer: United Healthcare Medicare |
$3.00
|
| Rate for Payer: WellCare Medicare |
$4.12
|
|
|
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 |
$5.62
|
| Rate for Payer: Galaxy Health Commercial |
$4.88
|
| 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 |
$82.50 |
| Max. Negotiated Rate |
$440.00 |
| 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) Medicare |
$220.00
|
| Rate for Payer: Cash Price |
$412.50
|
| 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 |
$220.00
|
| Rate for Payer: Galaxy Health Commercial |
$357.50
|
| Rate for Payer: Hamaspik Choice Medicare |
$220.00
|
| Rate for Payer: Humana Medicare |
$220.00
|
| 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 |
$231.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$82.50
|
| Rate for Payer: United Healthcare Medicare |
$220.00
|
| 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 |
$302.50 |
| Max. Negotiated Rate |
$357.50 |
| Rate for Payer: Aetna of NY Commercial |
$302.50
|
| 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 |
$8.92 |
| Max. Negotiated Rate |
$47.58 |
| 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) Medicare |
$23.79
|
| Rate for Payer: Cash Price |
$44.61
|
| 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 |
$23.79
|
| Rate for Payer: Galaxy Health Commercial |
$38.66
|
| Rate for Payer: Hamaspik Choice Medicare |
$23.79
|
| Rate for Payer: Humana Medicare |
$23.79
|
| 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 |
$24.98
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$8.92
|
| Rate for Payer: United Healthcare Medicare |
$23.79
|
| 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
|
OP
|
$10.82
|
|
|
Service Code
|
NDC 51079046001
|
| Hospital Charge Code |
4400683
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.62 |
| Max. Negotiated Rate |
$8.66 |
| 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) Medicare |
$4.33
|
| Rate for Payer: Cash Price |
$8.12
|
| 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 |
$4.33
|
| Rate for Payer: Galaxy Health Commercial |
$7.03
|
| Rate for Payer: Hamaspik Choice Medicare |
$4.33
|
| Rate for Payer: Humana Medicare |
$4.33
|
| 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 |
$4.54
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1.62
|
| Rate for Payer: United Healthcare Medicare |
$4.33
|
| Rate for Payer: WellCare Medicare |
$5.95
|
|
