|
RIVAROXABAN 20MG TAB
|
Facility
|
OP
|
$10.18
|
|
| Hospital Charge Code |
41658125
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.56 |
| Max. Negotiated Rate |
$8.14 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.09
|
| Rate for Payer: Aetna Government |
$5.09
|
| Rate for Payer: Brighton Health Commercial |
$7.64
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.14
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.92
|
| Rate for Payer: Group Health Inc Commercial |
$5.09
|
| Rate for Payer: Group Health Inc Medicare |
$3.56
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6.62
|
|
|
RIVAROXABAN 20MG TAB
|
Facility
|
OP
|
$10.18
|
|
| Hospital Charge Code |
41648125
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.56 |
| Max. Negotiated Rate |
$8.14 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.09
|
| Rate for Payer: Aetna Government |
$5.09
|
| Rate for Payer: Brighton Health Commercial |
$7.64
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.14
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.92
|
| Rate for Payer: Group Health Inc Commercial |
$5.09
|
| Rate for Payer: Group Health Inc Medicare |
$3.56
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6.62
|
|
|
RIVAROXABAN TABLET 10 MG
|
Facility
|
OP
|
$12.00
|
|
| Hospital Charge Code |
41646009
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.20 |
| Max. Negotiated Rate |
$9.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.00
|
| Rate for Payer: Aetna Government |
$6.00
|
| Rate for Payer: Brighton Health Commercial |
$9.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$9.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$8.16
|
| Rate for Payer: Group Health Inc Commercial |
$6.00
|
| Rate for Payer: Group Health Inc Medicare |
$4.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$7.80
|
|
|
RIVAROXABAN TABLET 10 MG
|
Facility
|
OP
|
$12.00
|
|
| Hospital Charge Code |
41656009
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.20 |
| Max. Negotiated Rate |
$9.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.00
|
| Rate for Payer: Aetna Government |
$6.00
|
| Rate for Payer: Brighton Health Commercial |
$9.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$9.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$8.16
|
| Rate for Payer: Group Health Inc Commercial |
$6.00
|
| Rate for Payer: Group Health Inc Medicare |
$4.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$7.80
|
|
|
RIVASTIGMINE 13.3 MG/24HR TD PT24 [117356]
|
Facility
|
OP
|
$16.90
|
|
|
Service Code
|
NDC 00781731331
|
| Hospital Charge Code |
00781731331
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.91 |
| Max. Negotiated Rate |
$13.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$9.29
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8.45
|
| Rate for Payer: Aetna Government |
$8.45
|
| Rate for Payer: Brighton Health Commercial |
$12.67
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$13.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$11.49
|
| Rate for Payer: Group Health Inc Commercial |
$8.45
|
| Rate for Payer: Group Health Inc Medicare |
$5.91
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.45
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.45
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$10.98
|
|
|
RIVASTIGMINE 13.3 MG/24HR TD PT24 [117356]
|
Facility
|
OP
|
$16.90
|
|
|
Service Code
|
NDC 00781731358
|
| Hospital Charge Code |
00781731358
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.91 |
| Max. Negotiated Rate |
$13.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$9.29
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8.45
|
| Rate for Payer: Aetna Government |
$8.45
|
| Rate for Payer: Brighton Health Commercial |
$12.67
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$13.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$11.49
|
| Rate for Payer: Group Health Inc Commercial |
$8.45
|
| Rate for Payer: Group Health Inc Medicare |
$5.91
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.45
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.45
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$10.98
|
|
|
RKY(IGG/M)
|
Facility
|
OP
|
$48.38
|
|
|
Service Code
|
HCPCS 86757
|
| Hospital Charge Code |
40729376
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.54 |
| Max. Negotiated Rate |
$36.28 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$26.61
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$19.35
|
| Rate for Payer: Aetna Government |
$19.35
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$13.54
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$13.54
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$13.54
|
| Rate for Payer: Brighton Health Commercial |
$36.28
|
| Rate for Payer: Cash Price |
$19.35
|
| Rate for Payer: Cash Price |
$19.35
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$19.35
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$30.76
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$26.03
|
| Rate for Payer: Elderplan Medicare Advantage |
$19.35
|
| Rate for Payer: EmblemHealth Commercial |
$19.35
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$16.45
|
| Rate for Payer: Fidelis Essential Plan QHP |
$17.22
|
| Rate for Payer: Fidelis Medicare Advantage |
$19.35
|
| Rate for Payer: Fidelis Qualified Health Plan |
$17.22
|
| Rate for Payer: Group Health Inc Commercial |
$19.35
|
| Rate for Payer: Group Health Inc Medicare |
$19.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$24.19
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$19.35
|
| Rate for Payer: Healthfirst Medicare Advantage |
$19.35
|
| Rate for Payer: Healthfirst QHP |
$19.35
|
| Rate for Payer: Humana Medicare |
$19.74
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$19.35
|
| Rate for Payer: United Healthcare Commercial |
$24.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.35
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$19.35
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$15.48
|
| Rate for Payer: Wellcare Medicare |
$17.42
|
|
|
RKY(IGG/M)
|
Facility
|
IP
|
$48.38
|
|
|
Service Code
|
HCPCS 86757
|
| Hospital Charge Code |
40729376
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$19.35
|
|
|
RMVL INTACT BREAST IMPLANT
|
Facility
|
OP
|
$9,175.75
|
|
|
Service Code
|
HCPCS 19328
|
| Hospital Charge Code |
40014306
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,412.00 |
| Max. Negotiated Rate |
$6,881.81 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4,407.98
|
| Rate for Payer: Aetna Government |
$4,407.98
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$3,085.59
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$3,085.59
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$3,085.59
|
| Rate for Payer: Brighton Health Commercial |
$6,881.81
|
| Rate for Payer: Cash Price |
$4,407.98
|
| Rate for Payer: Cash Price |
$4,407.98
|
| Rate for Payer: Cash Price |
$4,407.98
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$4,407.98
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$4,407.98
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,746.78
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,923.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$4,407.98
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,923.10
|
| Rate for Payer: Group Health Inc Commercial |
$4,407.98
|
| Rate for Payer: Group Health Inc Medicare |
$4,407.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,587.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,407.98
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,746.78
|
| Rate for Payer: Healthfirst QHP |
$4,407.98
|
| Rate for Payer: Humana Medicare |
$4,496.14
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4,407.98
|
| Rate for Payer: United Healthcare Commercial |
$1,835.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4,407.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4,407.98
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3,526.38
|
| Rate for Payer: Wellcare Medicare |
$4,187.58
|
|
|
RMVL INTACT BREAST IMPLANT
|
Facility
|
IP
|
$9,175.75
|
|
|
Service Code
|
HCPCS 19328
|
| Hospital Charge Code |
40014306
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$4,407.98
|
|
|
RMVL SUBQ CAR RHYTHM MNTR
|
Facility
|
IP
|
$1,847.58
|
|
|
Service Code
|
HCPCS 33286
|
| Hospital Charge Code |
66523705
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$813.63
|
|
|
RMVL SUBQ CAR RHYTHM MNTR
|
Facility
|
OP
|
$1,847.58
|
|
|
Service Code
|
HCPCS 33286
|
| Hospital Charge Code |
66523705
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$569.54 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$813.63
|
| Rate for Payer: Aetna Government |
$813.63
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$569.54
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$569.54
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$569.54
|
| Rate for Payer: Brighton Health Commercial |
$1,385.68
|
| Rate for Payer: Cash Price |
$813.63
|
| Rate for Payer: Cash Price |
$813.63
|
| Rate for Payer: Cash Price |
$813.63
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$813.63
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$813.63
|
| Rate for Payer: EmblemHealth Commercial |
$813.63
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$691.59
|
| Rate for Payer: Fidelis Essential Plan QHP |
$724.13
|
| Rate for Payer: Fidelis Medicare Advantage |
$813.63
|
| Rate for Payer: Fidelis Qualified Health Plan |
$724.13
|
| Rate for Payer: Group Health Inc Commercial |
$813.63
|
| Rate for Payer: Group Health Inc Medicare |
$813.63
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$923.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$813.63
|
| Rate for Payer: Healthfirst Medicare Advantage |
$691.59
|
| Rate for Payer: Healthfirst QHP |
$813.63
|
| Rate for Payer: Humana Medicare |
$829.90
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$813.63
|
| Rate for Payer: United Healthcare Commercial |
$1,188.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$813.63
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$813.63
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$650.90
|
| Rate for Payer: Wellcare Medicare |
$772.95
|
|
|
RMVL SUBQ CAR RHYTHM-MNTR
|
Facility
|
OP
|
$1,847.58
|
|
|
Service Code
|
HCPCS 33286
|
| Hospital Charge Code |
66573707
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$569.54 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$813.63
|
| Rate for Payer: Aetna Government |
$813.63
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$569.54
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$569.54
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$569.54
|
| Rate for Payer: Brighton Health Commercial |
$1,385.68
|
| Rate for Payer: Cash Price |
$813.63
|
| Rate for Payer: Cash Price |
$813.63
|
| Rate for Payer: Cash Price |
$813.63
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$813.63
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$813.63
|
| Rate for Payer: EmblemHealth Commercial |
$813.63
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$691.59
|
| Rate for Payer: Fidelis Essential Plan QHP |
$724.13
|
| Rate for Payer: Fidelis Medicare Advantage |
$813.63
|
| Rate for Payer: Fidelis Qualified Health Plan |
$724.13
|
| Rate for Payer: Group Health Inc Commercial |
$813.63
|
| Rate for Payer: Group Health Inc Medicare |
$813.63
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$923.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$813.63
|
| Rate for Payer: Healthfirst Medicare Advantage |
$691.59
|
| Rate for Payer: Healthfirst QHP |
$813.63
|
| Rate for Payer: Humana Medicare |
$829.90
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$813.63
|
| Rate for Payer: United Healthcare Commercial |
$1,188.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$813.63
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$813.63
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$650.90
|
| Rate for Payer: Wellcare Medicare |
$772.95
|
|
|
RMVL SUBQ CAR RHYTHM-MNTR
|
Facility
|
IP
|
$1,847.58
|
|
|
Service Code
|
HCPCS 33286
|
| Hospital Charge Code |
66573707
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$813.63
|
|
|
RMVL TIS XPNDR WO INSJ IMPLT
|
Facility
|
IP
|
$7,023.35
|
|
|
Service Code
|
HCPCS 11971
|
| Hospital Charge Code |
40014307
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$3,285.96
|
|
|
RMVL TIS XPNDR WO INSJ IMPLT
|
Facility
|
OP
|
$7,023.35
|
|
|
Service Code
|
HCPCS 11971
|
| Hospital Charge Code |
40014307
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,412.00 |
| Max. Negotiated Rate |
$5,267.51 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,285.96
|
| Rate for Payer: Aetna Government |
$3,285.96
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2,300.17
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2,300.17
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2,300.17
|
| Rate for Payer: Brighton Health Commercial |
$5,267.51
|
| Rate for Payer: Cash Price |
$3,285.96
|
| Rate for Payer: Cash Price |
$3,285.96
|
| Rate for Payer: Cash Price |
$3,285.96
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,285.96
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$3,285.96
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,793.07
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,924.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,285.96
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,924.50
|
| Rate for Payer: Group Health Inc Commercial |
$3,285.96
|
| Rate for Payer: Group Health Inc Medicare |
$3,285.96
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,511.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,285.96
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,793.07
|
| Rate for Payer: Healthfirst QHP |
$3,285.96
|
| Rate for Payer: Humana Medicare |
$3,351.68
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,285.96
|
| Rate for Payer: United Healthcare Commercial |
$1,468.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,285.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,285.96
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,628.77
|
| Rate for Payer: Wellcare Medicare |
$3,121.66
|
|
|
RNA PCR(NONGRAPH)RFX/PSGT+IN
|
Facility
|
IP
|
$212.75
|
|
|
Service Code
|
HCPCS 87536
|
| Hospital Charge Code |
40729398
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$85.10
|
|
|
RNA PCR(NONGRAPH)RFX/PSGT+IN
|
Facility
|
OP
|
$212.75
|
|
|
Service Code
|
HCPCS 87536
|
| Hospital Charge Code |
40729398
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$59.57 |
| Max. Negotiated Rate |
$159.56 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$117.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$85.10
|
| Rate for Payer: Aetna Government |
$85.10
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$59.57
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$59.57
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$59.57
|
| Rate for Payer: Brighton Health Commercial |
$159.56
|
| Rate for Payer: Cash Price |
$85.10
|
| Rate for Payer: Cash Price |
$85.10
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$85.10
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$135.26
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$114.46
|
| Rate for Payer: Elderplan Medicare Advantage |
$85.10
|
| Rate for Payer: EmblemHealth Commercial |
$85.10
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$72.34
|
| Rate for Payer: Fidelis Essential Plan QHP |
$75.74
|
| Rate for Payer: Fidelis Medicare Advantage |
$85.10
|
| Rate for Payer: Fidelis Qualified Health Plan |
$75.74
|
| Rate for Payer: Group Health Inc Commercial |
$85.10
|
| Rate for Payer: Group Health Inc Medicare |
$85.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$106.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$85.10
|
| Rate for Payer: Healthfirst Medicare Advantage |
$85.10
|
| Rate for Payer: Healthfirst QHP |
$85.10
|
| Rate for Payer: Humana Medicare |
$86.80
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$85.10
|
| Rate for Payer: United Healthcare Commercial |
$107.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$85.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$85.10
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$68.08
|
| Rate for Payer: Wellcare Medicare |
$76.59
|
|
|
RNA, PCR (NONGRAPH) RFX/PS INT
|
Facility
|
IP
|
$212.75
|
|
|
Service Code
|
HCPCS 87536
|
| Hospital Charge Code |
40729396
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$85.10
|
|
|
RNA, PCR (NONGRAPH) RFX/PS INT
|
Facility
|
OP
|
$212.75
|
|
|
Service Code
|
HCPCS 87536
|
| Hospital Charge Code |
40729396
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$59.57 |
| Max. Negotiated Rate |
$159.56 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$117.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$85.10
|
| Rate for Payer: Aetna Government |
$85.10
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$59.57
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$59.57
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$59.57
|
| Rate for Payer: Brighton Health Commercial |
$159.56
|
| Rate for Payer: Cash Price |
$85.10
|
| Rate for Payer: Cash Price |
$85.10
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$85.10
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$135.26
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$114.46
|
| Rate for Payer: Elderplan Medicare Advantage |
$85.10
|
| Rate for Payer: EmblemHealth Commercial |
$85.10
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$72.34
|
| Rate for Payer: Fidelis Essential Plan QHP |
$75.74
|
| Rate for Payer: Fidelis Medicare Advantage |
$85.10
|
| Rate for Payer: Fidelis Qualified Health Plan |
$75.74
|
| Rate for Payer: Group Health Inc Commercial |
$85.10
|
| Rate for Payer: Group Health Inc Medicare |
$85.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$106.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$85.10
|
| Rate for Payer: Healthfirst Medicare Advantage |
$85.10
|
| Rate for Payer: Healthfirst QHP |
$85.10
|
| Rate for Payer: Humana Medicare |
$86.80
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$85.10
|
| Rate for Payer: United Healthcare Commercial |
$107.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$85.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$85.10
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$68.08
|
| Rate for Payer: Wellcare Medicare |
$76.59
|
|
|
RNA, REAL TIME PCR (NON-GRAPH)
|
Facility
|
OP
|
$212.75
|
|
|
Service Code
|
HCPCS 87536
|
| Hospital Charge Code |
40729397
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$59.57 |
| Max. Negotiated Rate |
$159.56 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$117.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$85.10
|
| Rate for Payer: Aetna Government |
$85.10
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$59.57
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$59.57
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$59.57
|
| Rate for Payer: Brighton Health Commercial |
$159.56
|
| Rate for Payer: Cash Price |
$85.10
|
| Rate for Payer: Cash Price |
$85.10
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$85.10
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$135.26
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$114.46
|
| Rate for Payer: Elderplan Medicare Advantage |
$85.10
|
| Rate for Payer: EmblemHealth Commercial |
$85.10
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$72.34
|
| Rate for Payer: Fidelis Essential Plan QHP |
$75.74
|
| Rate for Payer: Fidelis Medicare Advantage |
$85.10
|
| Rate for Payer: Fidelis Qualified Health Plan |
$75.74
|
| Rate for Payer: Group Health Inc Commercial |
$85.10
|
| Rate for Payer: Group Health Inc Medicare |
$85.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$106.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$85.10
|
| Rate for Payer: Healthfirst Medicare Advantage |
$85.10
|
| Rate for Payer: Healthfirst QHP |
$85.10
|
| Rate for Payer: Humana Medicare |
$86.80
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$85.10
|
| Rate for Payer: United Healthcare Commercial |
$107.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$85.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$85.10
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$68.08
|
| Rate for Payer: Wellcare Medicare |
$76.59
|
|
|
RNA, REAL TIME PCR (NON-GRAPH)
|
Facility
|
IP
|
$212.75
|
|
|
Service Code
|
HCPCS 87536
|
| Hospital Charge Code |
40729397
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$85.10
|
|
|
ROCKY MTN SPOTTED FEVER IGM
|
Facility
|
IP
|
$48.38
|
|
|
Service Code
|
HCPCS 86757
|
| Hospital Charge Code |
40729719
|
|
Hospital Revenue Code
|
302
|
| Rate for Payer: Cash Price |
$19.35
|
|
|
ROCKY MTN SPOTTED FEVER IGM
|
Facility
|
OP
|
$48.38
|
|
|
Service Code
|
HCPCS 86757
|
| Hospital Charge Code |
40729719
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.54 |
| Max. Negotiated Rate |
$36.28 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$26.61
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$19.35
|
| Rate for Payer: Aetna Government |
$19.35
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$13.54
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$13.54
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$13.54
|
| Rate for Payer: Brighton Health Commercial |
$36.28
|
| Rate for Payer: Cash Price |
$19.35
|
| Rate for Payer: Cash Price |
$19.35
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$19.35
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$30.76
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$26.03
|
| Rate for Payer: Elderplan Medicare Advantage |
$19.35
|
| Rate for Payer: EmblemHealth Commercial |
$19.35
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$16.45
|
| Rate for Payer: Fidelis Essential Plan QHP |
$17.22
|
| Rate for Payer: Fidelis Medicare Advantage |
$19.35
|
| Rate for Payer: Fidelis Qualified Health Plan |
$17.22
|
| Rate for Payer: Group Health Inc Commercial |
$19.35
|
| Rate for Payer: Group Health Inc Medicare |
$19.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$24.19
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$19.35
|
| Rate for Payer: Healthfirst Medicare Advantage |
$19.35
|
| Rate for Payer: Healthfirst QHP |
$19.35
|
| Rate for Payer: Humana Medicare |
$19.74
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$19.35
|
| Rate for Payer: United Healthcare Commercial |
$24.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.35
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$19.35
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$15.48
|
| Rate for Payer: Wellcare Medicare |
$17.42
|
|
|
ROCKY MTN SPOTTED FEV, IGG, QN
|
Facility
|
IP
|
$48.38
|
|
|
Service Code
|
HCPCS 86757
|
| Hospital Charge Code |
40729835
|
|
Hospital Revenue Code
|
302
|
| Rate for Payer: Cash Price |
$19.35
|
|
