|
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 1 MG TAB
|
Facility
|
IP
|
$7.21
|
|
|
Service Code
|
NDC 904635961
|
| 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
|
|
|
RISPERIDONE 1 MG TAB
|
Facility
|
OP
|
$7.21
|
|
|
Service Code
|
NDC 904635961
|
| Hospital Charge Code |
4409022
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.08 |
| Max. Negotiated Rate |
$5.77 |
| 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) Medicare |
$2.88
|
| Rate for Payer: Cash Price |
$5.41
|
| 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 |
$2.88
|
| Rate for Payer: Galaxy Health Commercial |
$4.69
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.88
|
| Rate for Payer: Humana Medicare |
$2.88
|
| 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 |
$3.03
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1.08
|
| Rate for Payer: United Healthcare Medicare |
$2.88
|
| Rate for Payer: WellCare Medicare |
$3.97
|
|
|
R LARGE WRIST W/ABDUCTED THUMB
|
Facility
|
OP
|
$58.71
|
|
| Hospital Charge Code |
4471577
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.81 |
| Max. Negotiated Rate |
$46.97 |
| Rate for Payer: Aetna of NY Commercial |
$41.10
|
| Rate for Payer: Aetna of NY Medicare |
$27.01
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$23.48
|
| Rate for Payer: Cash Price |
$44.03
|
| Rate for Payer: CDPHP Medicare |
$21.72
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$46.97
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$46.97
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$46.97
|
| Rate for Payer: EmblemHealth Medicaid |
$46.97
|
| Rate for Payer: EmblemHealth Medicare |
$19.96
|
| Rate for Payer: EmblemHealth Select Care |
$42.27
|
| Rate for Payer: Fidelis Medicare |
$23.48
|
| Rate for Payer: Galaxy Health Commercial |
$38.16
|
| Rate for Payer: Hamaspik Choice Medicare |
$23.48
|
| Rate for Payer: Humana Medicare |
$23.48
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$41.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$27.01
|
| Rate for Payer: MVP Health Care of NY Commercial |
$44.03
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$33.05
|
| Rate for Payer: MVP Health Care of NY Medicare |
$24.66
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$8.81
|
| Rate for Payer: United Healthcare Medicare |
$23.48
|
| Rate for Payer: WellCare Medicare |
$32.29
|
|
|
R LARGE WRIST W/ABDUCTED THUMB
|
Facility
|
IP
|
$58.71
|
|
| Hospital Charge Code |
4471577
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$38.16 |
| Max. Negotiated Rate |
$38.16 |
| Rate for Payer: Cash Price |
$44.03
|
| Rate for Payer: Galaxy Health Commercial |
$38.16
|
|
|
RM & BED - DETOX
|
Facility
|
IP
|
$1,126.00
|
|
| Hospital Charge Code |
1000004
|
|
Hospital Revenue Code
|
116
|
| Min. Negotiated Rate |
$731.90 |
| Max. Negotiated Rate |
$4,871.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,248.00
|
| Rate for Payer: Aetna of NY Medicare |
$2,328.56
|
| Rate for Payer: Cash Price |
$844.50
|
| Rate for Payer: Cash Price |
$844.50
|
| Rate for Payer: Cash Price |
$844.50
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$4,871.00
|
| Rate for Payer: EmblemHealth Medicare |
$1,951.00
|
| Rate for Payer: EmblemHealth Select Care |
$4,383.00
|
| Rate for Payer: Galaxy Health Commercial |
$731.90
|
| Rate for Payer: Galaxy Health Workers Comp |
$2,874.10
|
| Rate for Payer: Hamaspik Choice Medicare |
$2,414.28
|
| Rate for Payer: Humana Medicare |
$2,414.28
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,248.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$2,328.56
|
| Rate for Payer: Multiplan Commercial |
$3,750.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4,370.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3,277.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2,534.99
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,770.58
|
|
|
RM & BED-SEMI PRIVATE
|
Facility
|
IP
|
$1,126.00
|
|
| Hospital Charge Code |
1000001
|
|
Hospital Revenue Code
|
120
|
| Min. Negotiated Rate |
$731.90 |
| Max. Negotiated Rate |
$4,871.00 |
| Rate for Payer: Aetna of NY Commercial |
$4,200.00
|
| Rate for Payer: Aetna of NY Medicare |
$2,328.56
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2,414.28
|
| Rate for Payer: Cash Price |
$844.50
|
| Rate for Payer: Cash Price |
$844.50
|
| Rate for Payer: Cash Price |
$844.50
|
| Rate for Payer: CDPHP Medicare |
$2,414.28
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$4,871.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2,361.42
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,967.85
|
| Rate for Payer: EmblemHealth Medicaid |
$1,967.85
|
| Rate for Payer: EmblemHealth Medicare |
$1,951.00
|
| Rate for Payer: EmblemHealth Select Care |
$4,383.00
|
| Rate for Payer: Fidelis Medicare |
$1,825.00
|
| Rate for Payer: Galaxy Health Commercial |
$731.90
|
| Rate for Payer: Galaxy Health Workers Comp |
$2,874.10
|
| Rate for Payer: Hamaspik Choice Medicaid |
$1,967.85
|
| Rate for Payer: Hamaspik Choice Medicare |
$2,414.28
|
| Rate for Payer: Humana Medicare |
$2,414.28
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$4,200.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$2,328.56
|
| Rate for Payer: Multiplan Commercial |
$3,750.00
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$1,967.85
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4,370.00
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$4,230.88
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$4,230.88
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3,277.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2,534.99
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$4,248.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,770.58
|
| Rate for Payer: United Healthcare Commercial |
$4,248.00
|
| Rate for Payer: United Healthcare Medicare |
$2,414.28
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$1,967.85
|
| Rate for Payer: WellCare Medicare |
$2,414.28
|
|
|
RM & BED-SWING
|
Facility
|
IP
|
$1,109.00
|
|
| Hospital Charge Code |
1050001
|
|
Hospital Revenue Code
|
120
|
| Min. Negotiated Rate |
$720.85 |
| Max. Negotiated Rate |
$4,248.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,076.00
|
| Rate for Payer: Aetna of NY Medicare |
$2,328.56
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1,959.59
|
| Rate for Payer: Cash Price |
$831.75
|
| Rate for Payer: Cash Price |
$831.75
|
| Rate for Payer: Cash Price |
$831.75
|
| Rate for Payer: CDPHP Medicare |
$1,498.74
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,914.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2,361.42
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,967.85
|
| Rate for Payer: EmblemHealth Medicaid |
$1,967.85
|
| Rate for Payer: EmblemHealth Medicare |
$1,563.00
|
| Rate for Payer: EmblemHealth Select Care |
$1,722.00
|
| Rate for Payer: Fidelis Medicare |
$1,825.00
|
| Rate for Payer: Galaxy Health Commercial |
$720.85
|
| Rate for Payer: Galaxy Health Workers Comp |
$2,874.10
|
| Rate for Payer: Hamaspik Choice Medicaid |
$1,967.85
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,959.59
|
| Rate for Payer: Humana Medicare |
$1,959.59
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,076.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$2,328.56
|
| Rate for Payer: Multiplan Commercial |
$3,750.00
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$1,967.85
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,561.00
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$4,230.88
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$4,230.88
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1,170.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2,057.57
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$4,248.00
|
| Rate for Payer: United Healthcare Commercial |
$4,248.00
|
| Rate for Payer: United Healthcare Medicare |
$1,959.59
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$1,967.85
|
| Rate for Payer: WellCare Medicare |
$1,959.59
|
|
|
R MED WRIST W/ABDUCTED THUMB
|
Facility
|
IP
|
$58.71
|
|
| Hospital Charge Code |
4471576
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$38.16 |
| Max. Negotiated Rate |
$38.16 |
| Rate for Payer: Cash Price |
$44.03
|
| Rate for Payer: Galaxy Health Commercial |
$38.16
|
|
|
R MED WRIST W/ABDUCTED THUMB
|
Facility
|
OP
|
$58.71
|
|
| Hospital Charge Code |
4471576
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.81 |
| Max. Negotiated Rate |
$46.97 |
| Rate for Payer: Aetna of NY Commercial |
$41.10
|
| Rate for Payer: Aetna of NY Medicare |
$27.01
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$23.48
|
| Rate for Payer: Cash Price |
$44.03
|
| Rate for Payer: CDPHP Medicare |
$21.72
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$46.97
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$46.97
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$46.97
|
| Rate for Payer: EmblemHealth Medicaid |
$46.97
|
| Rate for Payer: EmblemHealth Medicare |
$19.96
|
| Rate for Payer: EmblemHealth Select Care |
$42.27
|
| Rate for Payer: Fidelis Medicare |
$23.48
|
| Rate for Payer: Galaxy Health Commercial |
$38.16
|
| Rate for Payer: Hamaspik Choice Medicare |
$23.48
|
| Rate for Payer: Humana Medicare |
$23.48
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$41.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$27.01
|
| Rate for Payer: MVP Health Care of NY Commercial |
$44.03
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$33.05
|
| Rate for Payer: MVP Health Care of NY Medicare |
$24.66
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$8.81
|
| Rate for Payer: United Healthcare Medicare |
$23.48
|
| Rate for Payer: WellCare Medicare |
$32.29
|
|
|
RMVL FECAL IMPACTION/FB SPX UNDER ANES
|
Facility
|
IP
|
$3,668.00
|
|
|
Service Code
|
HCPCS 45915
|
| Hospital Charge Code |
4601197
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,384.20 |
| Max. Negotiated Rate |
$2,384.20 |
| Rate for Payer: Cash Price |
$2,751.00
|
| Rate for Payer: Galaxy Health Commercial |
$2,384.20
|
|
|
RMVL FECAL IMPACTION/FB SPX UNDER ANES
|
Facility
|
OP
|
$3,668.00
|
|
|
Service Code
|
HCPCS 45915
|
| Hospital Charge Code |
4601197
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$550.20 |
| Max. Negotiated Rate |
$2,934.40 |
| Rate for Payer: Aetna of NY Commercial |
$1,000.00
|
| Rate for Payer: Aetna of NY Medicare |
$1,687.28
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1,467.20
|
| Rate for Payer: Cash Price |
$2,751.00
|
| Rate for Payer: Cash Price |
$2,751.00
|
| Rate for Payer: Cash Price |
$2,751.00
|
| Rate for Payer: CDPHP Medicare |
$1,357.16
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,206.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2,934.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$2,934.40
|
| Rate for Payer: EmblemHealth Medicaid |
$2,934.40
|
| Rate for Payer: EmblemHealth Medicare |
$1,247.12
|
| Rate for Payer: EmblemHealth Select Care |
$1,085.00
|
| Rate for Payer: Fidelis Medicare |
$1,467.20
|
| Rate for Payer: Galaxy Health Commercial |
$2,384.20
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,467.20
|
| Rate for Payer: Humana Medicare |
$1,467.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,000.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,687.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,234.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$925.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1,540.56
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,009.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$550.20
|
| Rate for Payer: United Healthcare Commercial |
$1,009.00
|
| Rate for Payer: United Healthcare Medicare |
$1,467.20
|
| Rate for Payer: WellCare Medicare |
$2,017.40
|
|
|
RMVL IMPACTED EARWAX USING IRRI/LAVAGE,U
|
Facility
|
IP
|
$181.00
|
|
|
Service Code
|
HCPCS 69209
|
| Hospital Charge Code |
4602748
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$117.65 |
| Max. Negotiated Rate |
$117.65 |
| Rate for Payer: Cash Price |
$135.75
|
| Rate for Payer: Galaxy Health Commercial |
$117.65
|
|
|
RMVL IMPACTED EARWAX USING IRRI/LAVAGE,U
|
Facility
|
OP
|
$181.00
|
|
|
Service Code
|
HCPCS 69209
|
| Hospital Charge Code |
4602748
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$27.15 |
| Max. Negotiated Rate |
$1,234.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,000.00
|
| Rate for Payer: Aetna of NY Medicare |
$83.26
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$72.40
|
| Rate for Payer: Cash Price |
$135.75
|
| Rate for Payer: Cash Price |
$135.75
|
| Rate for Payer: Cash Price |
$135.75
|
| Rate for Payer: CDPHP Medicare |
$66.97
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,206.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$144.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$144.80
|
| Rate for Payer: EmblemHealth Medicaid |
$144.80
|
| Rate for Payer: EmblemHealth Medicare |
$61.54
|
| Rate for Payer: EmblemHealth Select Care |
$1,085.00
|
| Rate for Payer: Fidelis Medicare |
$72.40
|
| Rate for Payer: Galaxy Health Commercial |
$117.65
|
| Rate for Payer: Hamaspik Choice Medicare |
$72.40
|
| Rate for Payer: Humana Medicare |
$72.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,000.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$83.26
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,234.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$925.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$76.02
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,009.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$27.15
|
| Rate for Payer: United Healthcare Commercial |
$1,009.00
|
| Rate for Payer: United Healthcare Medicare |
$72.40
|
| Rate for Payer: WellCare Medicare |
$99.55
|
|
|
RMVL INFLATABLE PENILE PROSTH W/O RPLCMT PROSTH
|
Facility
|
OP
|
$10,804.00
|
|
|
Service Code
|
HCPCS 54406
|
| Hospital Charge Code |
4002068
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$1,620.60 |
| Max. Negotiated Rate |
$8,643.20 |
| Rate for Payer: Aetna of NY Commercial |
$1,900.00
|
| Rate for Payer: Aetna of NY Medicare |
$4,969.84
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$4,321.60
|
| Rate for Payer: Cash Price |
$8,103.00
|
| Rate for Payer: Cash Price |
$8,103.00
|
| Rate for Payer: CDPHP Medicare |
$3,997.48
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$8,643.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$8,643.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$8,643.20
|
| Rate for Payer: EmblemHealth Medicaid |
$8,643.20
|
| Rate for Payer: EmblemHealth Medicare |
$3,673.36
|
| Rate for Payer: EmblemHealth Select Care |
$7,778.88
|
| Rate for Payer: Fidelis Medicare |
$4,321.60
|
| Rate for Payer: Galaxy Health Commercial |
$7,022.60
|
| Rate for Payer: Hamaspik Choice Medicare |
$4,321.60
|
| Rate for Payer: Humana Medicare |
$4,321.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,900.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$4,969.84
|
| Rate for Payer: Multiplan Commercial |
$8,643.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$8,103.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$6,082.65
|
| Rate for Payer: MVP Health Care of NY Medicare |
$4,537.68
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$2,097.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,620.60
|
| Rate for Payer: United Healthcare Commercial |
$2,097.00
|
| Rate for Payer: United Healthcare Medicare |
$4,321.60
|
| Rate for Payer: WellCare Medicare |
$5,942.20
|
|
|
RMVL INFLATABLE PENILE PROSTH W/O RPLCMT PROSTH
|
Facility
|
IP
|
$10,804.00
|
|
|
Service Code
|
HCPCS 54406
|
| Hospital Charge Code |
4002068
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$7,022.60 |
| Max. Negotiated Rate |
$7,022.60 |
| Rate for Payer: Cash Price |
$8,103.00
|
| Rate for Payer: Galaxy Health Commercial |
$7,022.60
|
|
|
RMVL & RPLCMT INFLATABLE PENILE PROSTH SAME SESS
|
Facility
|
OP
|
$63,525.00
|
|
|
Service Code
|
HCPCS 54410
|
| Hospital Charge Code |
4002069
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$1,900.00 |
| Max. Negotiated Rate |
$50,820.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,900.00
|
| Rate for Payer: Aetna of NY Medicare |
$29,221.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$25,410.00
|
| Rate for Payer: Cash Price |
$47,643.75
|
| Rate for Payer: Cash Price |
$47,643.75
|
| Rate for Payer: CDPHP Medicare |
$23,504.25
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$50,820.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$50,820.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$50,820.00
|
| Rate for Payer: EmblemHealth Medicaid |
$50,820.00
|
| Rate for Payer: EmblemHealth Medicare |
$21,598.50
|
| Rate for Payer: EmblemHealth Select Care |
$45,738.00
|
| Rate for Payer: Fidelis Medicare |
$25,410.00
|
| Rate for Payer: Galaxy Health Commercial |
$41,291.25
|
| Rate for Payer: Hamaspik Choice Medicare |
$25,410.00
|
| Rate for Payer: Humana Medicare |
$25,410.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,900.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$29,221.50
|
| Rate for Payer: Multiplan Commercial |
$50,820.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$47,643.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$35,764.57
|
| Rate for Payer: MVP Health Care of NY Medicare |
$26,680.50
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$2,373.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$9,528.75
|
| Rate for Payer: United Healthcare Commercial |
$2,373.00
|
| Rate for Payer: United Healthcare Medicare |
$25,410.00
|
| Rate for Payer: WellCare Medicare |
$34,938.75
|
|
|
RMVL & RPLCMT INFLATABLE PENILE PROSTH SAME SESS
|
Facility
|
IP
|
$63,525.00
|
|
|
Service Code
|
HCPCS 54410
|
| Hospital Charge Code |
4002069
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$41,291.25 |
| Max. Negotiated Rate |
$41,291.25 |
| Rate for Payer: Cash Price |
$47,643.75
|
| Rate for Payer: Galaxy Health Commercial |
$41,291.25
|
|
|
RMVL & RPLCMT NFLTL URETHRAL/BLADDER NECK SPHINC
|
Facility
|
OP
|
$63,525.00
|
|
|
Service Code
|
HCPCS 53447
|
| Hospital Charge Code |
4002072
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$1,900.00 |
| Max. Negotiated Rate |
$50,820.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,900.00
|
| Rate for Payer: Aetna of NY Medicare |
$29,221.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$25,410.00
|
| Rate for Payer: Cash Price |
$47,643.75
|
| Rate for Payer: Cash Price |
$47,643.75
|
| Rate for Payer: CDPHP Medicare |
$23,504.25
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$50,820.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$50,820.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$50,820.00
|
| Rate for Payer: EmblemHealth Medicaid |
$50,820.00
|
| Rate for Payer: EmblemHealth Medicare |
$21,598.50
|
| Rate for Payer: EmblemHealth Select Care |
$45,738.00
|
| Rate for Payer: Fidelis Medicare |
$25,410.00
|
| Rate for Payer: Galaxy Health Commercial |
$41,291.25
|
| Rate for Payer: Hamaspik Choice Medicare |
$25,410.00
|
| Rate for Payer: Humana Medicare |
$25,410.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,900.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$29,221.50
|
| Rate for Payer: Multiplan Commercial |
$50,820.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$47,643.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$35,764.57
|
| Rate for Payer: MVP Health Care of NY Medicare |
$26,680.50
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$2,373.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$9,528.75
|
| Rate for Payer: United Healthcare Commercial |
$2,373.00
|
| Rate for Payer: United Healthcare Medicare |
$25,410.00
|
| Rate for Payer: WellCare Medicare |
$34,938.75
|
|
|
RMVL & RPLCMT NFLTL URETHRAL/BLADDER NECK SPHINC
|
Facility
|
IP
|
$63,525.00
|
|
|
Service Code
|
HCPCS 53447
|
| Hospital Charge Code |
4002072
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$41,291.25 |
| Max. Negotiated Rate |
$41,291.25 |
| Rate for Payer: Cash Price |
$47,643.75
|
| Rate for Payer: Galaxy Health Commercial |
$41,291.25
|
|
|
ROCURONIUM BROMIDE 10MG/ML MDV 10X10ML
|
Facility
|
OP
|
$29.83
|
|
|
Service Code
|
NDC 409955810
|
| Hospital Charge Code |
4400684
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.47 |
| Max. Negotiated Rate |
$23.86 |
| Rate for Payer: Aetna of NY Commercial |
$20.88
|
| Rate for Payer: Aetna of NY Medicare |
$13.72
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$11.93
|
| Rate for Payer: Cash Price |
$22.37
|
| Rate for Payer: CDPHP Medicare |
$11.04
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$23.86
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$23.86
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$23.86
|
| Rate for Payer: EmblemHealth Medicaid |
$23.86
|
| Rate for Payer: EmblemHealth Medicare |
$10.14
|
| Rate for Payer: EmblemHealth Select Care |
$21.48
|
| Rate for Payer: Fidelis Medicare |
$11.93
|
| Rate for Payer: Galaxy Health Commercial |
$19.39
|
| Rate for Payer: Hamaspik Choice Medicare |
$11.93
|
| Rate for Payer: Humana Medicare |
$11.93
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$20.88
|
| Rate for Payer: Local 1199SEIU Medicare |
$13.72
|
| Rate for Payer: MVP Health Care of NY Commercial |
$22.37
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$16.79
|
| Rate for Payer: MVP Health Care of NY Medicare |
$12.53
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$4.47
|
| Rate for Payer: United Healthcare Medicare |
$11.93
|
| Rate for Payer: WellCare Medicare |
$16.41
|
|
|
ROCURONIUM BROMIDE 10MG/ML MDV 10X10ML
|
Facility
|
IP
|
$29.83
|
|
|
Service Code
|
NDC 409955810
|
| Hospital Charge Code |
4400684
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.41 |
| Max. Negotiated Rate |
$19.39 |
| Rate for Payer: Cash Price |
$22.37
|
| Rate for Payer: Galaxy Health Commercial |
$19.39
|
| Rate for Payer: WellCare Medicare |
$16.41
|
|
|
ROM HAND MEASUREMENTS REPORT
|
Facility
|
IP
|
$70.00
|
|
|
Service Code
|
HCPCS 95852 GP
|
| Hospital Charge Code |
4650034
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$45.50 |
| Max. Negotiated Rate |
$45.50 |
| Rate for Payer: Cash Price |
$52.50
|
| Rate for Payer: Galaxy Health Commercial |
$45.50
|
|
|
ROM HAND MEASUREMENTS REPORT
|
Facility
|
OP
|
$70.00
|
|
|
Service Code
|
HCPCS 95852 GP
|
| Hospital Charge Code |
4650034
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$10.50 |
| Max. Negotiated Rate |
$187.00 |
| Rate for Payer: Aetna of NY Commercial |
$115.00
|
| Rate for Payer: Aetna of NY Medicare |
$32.20
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$28.00
|
| Rate for Payer: Cash Price |
$52.50
|
| Rate for Payer: Cash Price |
$52.50
|
| Rate for Payer: Cash Price |
$52.50
|
| Rate for Payer: CDPHP Medicare |
$25.90
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$56.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$56.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$56.00
|
| Rate for Payer: EmblemHealth Medicaid |
$56.00
|
| Rate for Payer: EmblemHealth Medicare |
$23.80
|
| Rate for Payer: EmblemHealth Select Care |
$50.40
|
| Rate for Payer: Fidelis Medicare |
$28.00
|
| Rate for Payer: Galaxy Health Commercial |
$45.50
|
| Rate for Payer: Hamaspik Choice Medicare |
$28.00
|
| Rate for Payer: Humana Medicare |
$28.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$115.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$32.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$187.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$141.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$29.40
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$161.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$10.50
|
| Rate for Payer: United Healthcare Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicare |
$28.00
|
| Rate for Payer: WellCare Medicare |
$38.50
|
|
|
ROM HAND MEASUREMENTS REPORT (MOD 59)
|
Facility
|
IP
|
$70.00
|
|
|
Service Code
|
HCPCS 95852 GP,59
|
| Hospital Charge Code |
4650375
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$45.50 |
| Max. Negotiated Rate |
$45.50 |
| Rate for Payer: Cash Price |
$52.50
|
| Rate for Payer: Galaxy Health Commercial |
$45.50
|
|
