|
ROM HAND MEASUREMENTS REPORT (MOD 59)
|
Facility
|
OP
|
$70.00
|
|
|
Service Code
|
HCPCS 95852 GP,59
|
| Hospital Charge Code |
4650375
|
|
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 W KX)
|
Facility
|
IP
|
$70.00
|
|
|
Service Code
|
HCPCS 95852 GP,59,KX
|
| Hospital Charge Code |
4650427
|
|
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 (MOD 59 W KX)
|
Facility
|
OP
|
$70.00
|
|
|
Service Code
|
HCPCS 95852 GP,59,KX
|
| Hospital Charge Code |
4650427
|
|
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 (W/ KX)
|
Facility
|
OP
|
$70.00
|
|
|
Service Code
|
HCPCS 95852 GP,KX
|
| Hospital Charge Code |
4650320
|
|
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 (W/ KX)
|
Facility
|
IP
|
$70.00
|
|
|
Service Code
|
HCPCS 95852 GP,KX
|
| Hospital Charge Code |
4650320
|
|
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
|
|
|
ROPINEROLE 1 MG TAB
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
NDC 904637461
|
| 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
|
|
|
ROPINEROLE 1 MG TAB
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 904637461
|
| Hospital Charge Code |
4401271
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.93 |
| Max. Negotiated Rate |
$4.94 |
| 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) Medicare |
$2.47
|
| Rate for Payer: Cash Price |
$4.64
|
| 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 |
$2.47
|
| Rate for Payer: Galaxy Health Commercial |
$4.02
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.47
|
| Rate for Payer: Humana Medicare |
$2.47
|
| 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 |
$4.63
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3.48
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2.60
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$0.93
|
| Rate for Payer: United Healthcare Medicare |
$2.47
|
| Rate for Payer: WellCare Medicare |
$3.40
|
|
|
ROPINIROLE HCL 0.25MG TABS 10X10EA
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 904637361
|
| Hospital Charge Code |
4400685
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.93 |
| Max. Negotiated Rate |
$4.94 |
| 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) Medicare |
$2.47
|
| Rate for Payer: Cash Price |
$4.64
|
| 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 |
$2.47
|
| Rate for Payer: Galaxy Health Commercial |
$4.02
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.47
|
| Rate for Payer: Humana Medicare |
$2.47
|
| 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 |
$4.63
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3.48
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2.60
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$0.93
|
| Rate for Payer: United Healthcare Medicare |
$2.47
|
| Rate for Payer: WellCare Medicare |
$3.40
|
|
|
ROPINIROLE HCL 0.25MG TABS 10X10EA
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
NDC 904637361
|
| 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
|
|
|
ROPIVACAINE HCL INJ 1 MG
|
Facility
|
IP
|
$53.56
|
|
|
Service Code
|
HCPCS J2795
|
| Hospital Charge Code |
4400547
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$34.81 |
| Rate for Payer: Aetna of NY Commercial |
$29.46
|
| Rate for Payer: Cash Price |
$40.17
|
| Rate for Payer: Cash Price |
$40.17
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.05
|
| Rate for Payer: EmblemHealth Select Care |
$0.05
|
| 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
|
|
|
ROPIVACAINE HCL INJ 1 MG
|
Facility
|
OP
|
$41.97
|
|
|
Service Code
|
HCPCS J2795
|
| Hospital Charge Code |
4400544
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$33.58 |
| Rate for Payer: Aetna of NY Medicare |
$19.31
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$16.79
|
| Rate for Payer: Cash Price |
$31.48
|
| Rate for Payer: Cash Price |
$31.48
|
| Rate for Payer: CDPHP Medicare |
$15.53
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.05
|
| 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 |
$0.05
|
| Rate for Payer: Fidelis Medicare |
$16.79
|
| Rate for Payer: Galaxy Health Commercial |
$27.28
|
| Rate for Payer: Hamaspik Choice Medicare |
$16.79
|
| Rate for Payer: Humana Medicare |
$16.79
|
| 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 |
$17.63
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$0.12
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$6.30
|
| Rate for Payer: United Healthcare Commercial |
$0.12
|
| Rate for Payer: United Healthcare Medicare |
$16.79
|
| Rate for Payer: WellCare Medicare |
$23.08
|
|
|
ROPIVACAINE HCL INJ 1 MG
|
Facility
|
OP
|
$53.56
|
|
|
Service Code
|
HCPCS J2795
|
| Hospital Charge Code |
4400547
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$42.85 |
| Rate for Payer: Aetna of NY Medicare |
$24.64
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$21.42
|
| Rate for Payer: Cash Price |
$40.17
|
| Rate for Payer: Cash Price |
$40.17
|
| Rate for Payer: CDPHP Medicare |
$19.82
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.05
|
| 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 |
$0.05
|
| Rate for Payer: Fidelis Medicare |
$21.42
|
| Rate for Payer: Galaxy Health Commercial |
$34.81
|
| Rate for Payer: Hamaspik Choice Medicare |
$21.42
|
| Rate for Payer: Humana Medicare |
$21.42
|
| 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 |
$22.50
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$0.12
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$8.03
|
| Rate for Payer: United Healthcare Commercial |
$0.12
|
| Rate for Payer: United Healthcare Medicare |
$21.42
|
| Rate for Payer: WellCare Medicare |
$29.46
|
|
|
ROPIVACAINE HCL INJ 1 MG
|
Facility
|
IP
|
$41.97
|
|
|
Service Code
|
HCPCS J2795
|
| Hospital Charge Code |
4400544
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$27.28 |
| Rate for Payer: Aetna of NY Commercial |
$23.08
|
| Rate for Payer: Cash Price |
$31.48
|
| Rate for Payer: Cash Price |
$31.48
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.05
|
| Rate for Payer: EmblemHealth Select Care |
$0.05
|
| 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
|
OP
|
$18.03
|
|
|
Service Code
|
HCPCS J2795
|
| Hospital Charge Code |
4400545
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$14.42 |
| Rate for Payer: Aetna of NY Medicare |
$8.29
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$7.21
|
| Rate for Payer: Cash Price |
$13.52
|
| Rate for Payer: Cash Price |
$13.52
|
| Rate for Payer: CDPHP Medicare |
$6.67
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.05
|
| 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 |
$0.05
|
| Rate for Payer: Fidelis Medicare |
$7.21
|
| Rate for Payer: Galaxy Health Commercial |
$11.72
|
| Rate for Payer: Hamaspik Choice Medicare |
$7.21
|
| Rate for Payer: Humana Medicare |
$7.21
|
| 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 |
$7.57
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$0.12
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$2.70
|
| Rate for Payer: United Healthcare Commercial |
$0.12
|
| Rate for Payer: United Healthcare Medicare |
$7.21
|
| Rate for Payer: WellCare Medicare |
$9.92
|
|
|
ROPIVACAINE HCL INJ 1 MG
|
Facility
|
IP
|
$18.03
|
|
|
Service Code
|
HCPCS J2795
|
| Hospital Charge Code |
4400545
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$11.72 |
| Rate for Payer: Aetna of NY Commercial |
$9.92
|
| Rate for Payer: Cash Price |
$13.52
|
| Rate for Payer: Cash Price |
$13.52
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.05
|
| Rate for Payer: EmblemHealth Select Care |
$0.05
|
| 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
|
|
|
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 |
$4.60 |
| Max. Negotiated Rate |
$24.51 |
| 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) Medicare |
$12.26
|
| Rate for Payer: Cash Price |
$22.98
|
| 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 |
$12.26
|
| Rate for Payer: Galaxy Health Commercial |
$19.92
|
| Rate for Payer: Hamaspik Choice Medicare |
$12.26
|
| Rate for Payer: Humana Medicare |
$12.26
|
| 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 |
$12.87
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$4.60
|
| Rate for Payer: United Healthcare Medicare |
$12.26
|
| Rate for Payer: WellCare Medicare |
$16.85
|
|
|
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 5 MG TAB 5 mg, 100 eaches
|
Facility
|
OP
|
$6.00
|
|
|
Service Code
|
NDC 904677861
|
| Hospital Charge Code |
4401484
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$4.80 |
| 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) Medicare |
$2.40
|
| Rate for Payer: Cash Price |
$4.50
|
| 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 |
$2.40
|
| Rate for Payer: Galaxy Health Commercial |
$3.90
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.40
|
| Rate for Payer: Humana Medicare |
$2.40
|
| 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 |
$2.52
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$0.90
|
| Rate for Payer: United Healthcare Medicare |
$2.40
|
| Rate for Payer: WellCare Medicare |
$3.30
|
|
|
rosuvastatin CALCIUM 5 MG TAB 5 mg, 100 eaches
|
Facility
|
IP
|
$6.00
|
|
|
Service Code
|
NDC 904677861
|
| 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
|
|
|
ROTH NET 2.5MM DISPOSIBLE
|
Facility
|
IP
|
$354.32
|
|
| Hospital Charge Code |
4471022
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$230.31 |
| Max. Negotiated Rate |
$230.31 |
| Rate for Payer: Cash Price |
$265.74
|
| Rate for Payer: Galaxy Health Commercial |
$230.31
|
|
|
ROTH NET 2.5MM DISPOSIBLE
|
Facility
|
OP
|
$354.32
|
|
| Hospital Charge Code |
4471022
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$53.15 |
| Max. Negotiated Rate |
$283.46 |
| Rate for Payer: Aetna of NY Commercial |
$248.02
|
| Rate for Payer: Aetna of NY Medicare |
$162.99
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$141.73
|
| Rate for Payer: Cash Price |
$265.74
|
| Rate for Payer: CDPHP Medicare |
$131.10
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$283.46
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$283.46
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$283.46
|
| Rate for Payer: EmblemHealth Medicaid |
$283.46
|
| Rate for Payer: EmblemHealth Medicare |
$120.47
|
| Rate for Payer: EmblemHealth Select Care |
$255.11
|
| Rate for Payer: Fidelis Medicare |
$141.73
|
| Rate for Payer: Galaxy Health Commercial |
$230.31
|
| Rate for Payer: Hamaspik Choice Medicare |
$141.73
|
| Rate for Payer: Humana Medicare |
$141.73
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$248.02
|
| Rate for Payer: Local 1199SEIU Medicare |
$162.99
|
| Rate for Payer: MVP Health Care of NY Commercial |
$265.74
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$199.48
|
| Rate for Payer: MVP Health Care of NY Medicare |
$148.81
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$53.15
|
| Rate for Payer: United Healthcare Medicare |
$141.73
|
| Rate for Payer: WellCare Medicare |
$194.88
|
|
|
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
|
|
|
ROZEREM 8 MG TABLET
|
Facility
|
OP
|
$46.00
|
|
|
Service Code
|
NDC 64764080530
|
| Hospital Charge Code |
4401353
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$36.80 |
| 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) Medicare |
$18.40
|
| Rate for Payer: Cash Price |
$34.50
|
| 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 |
$18.40
|
| Rate for Payer: Galaxy Health Commercial |
$29.90
|
| Rate for Payer: Hamaspik Choice Medicare |
$18.40
|
| Rate for Payer: Humana Medicare |
$18.40
|
| 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 |
$19.32
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$6.90
|
| Rate for Payer: United Healthcare Medicare |
$18.40
|
| Rate for Payer: WellCare Medicare |
$25.30
|
|
|
RPLC GTUBE NO REVJ TRC
|
Facility
|
IP
|
$766.00
|
|
|
Service Code
|
HCPCS 43762
|
| Hospital Charge Code |
4853031
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$497.90 |
| Max. Negotiated Rate |
$497.90 |
| Rate for Payer: Cash Price |
$574.50
|
| Rate for Payer: Galaxy Health Commercial |
$497.90
|
|
|
RPLC GTUBE NO REVJ TRC
|
Facility
|
IP
|
$766.00
|
|
|
Service Code
|
HCPCS 43762
|
| Hospital Charge Code |
4602227
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$497.90 |
| Max. Negotiated Rate |
$497.90 |
| Rate for Payer: Cash Price |
$574.50
|
| Rate for Payer: Galaxy Health Commercial |
$497.90
|
|
