|
RITUXIMAB 500 MG/50ML IV SOLN
|
Facility
|
OP
|
$112.74
|
|
|
Service Code
|
HCPCS J9312
|
| Hospital Charge Code |
5024205306
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$52.65 |
| Max. Negotiated Rate |
$90.19 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$62.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$75.22
|
| Rate for Payer: Aetna Government |
$75.22
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$52.65
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$52.65
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$52.65
|
| Rate for Payer: Brighton Health Commercial |
$84.56
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$75.22
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$90.19
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$76.66
|
| Rate for Payer: Elderplan Medicare Advantage |
$75.22
|
| Rate for Payer: EmblemHealth Commercial |
$75.22
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$67.70
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$63.94
|
| Rate for Payer: Fidelis Essential Plan QHP |
$66.95
|
| Rate for Payer: Fidelis Medicare Advantage |
$75.22
|
| Rate for Payer: Fidelis Qualified Health Plan |
$66.95
|
| Rate for Payer: Group Health Inc Commercial |
$75.22
|
| Rate for Payer: Group Health Inc Medicare |
$75.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$75.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$75.22
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$75.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$63.94
|
| Rate for Payer: Healthfirst QHP |
$75.22
|
| Rate for Payer: Humana Medicare |
$76.72
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$75.22
|
| Rate for Payer: United Healthcare Medicare Advantage |
$75.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$73.28
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$71.46
|
| Rate for Payer: Wellcare Medicare |
$71.46
|
|
|
RITUXIMAB-ABBS 100 MG/10ML IV SOLN
|
Facility
|
OP
|
$101.47
|
|
|
Service Code
|
HCPCS Q5115
|
| Hospital Charge Code |
6345910310
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$20.57 |
| Max. Negotiated Rate |
$81.17 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$55.81
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$29.38
|
| Rate for Payer: Aetna Government |
$29.38
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$20.57
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$20.57
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$20.57
|
| Rate for Payer: Brighton Health Commercial |
$76.10
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$29.38
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$81.17
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$69.00
|
| Rate for Payer: Elderplan Medicare Advantage |
$29.38
|
| Rate for Payer: EmblemHealth Commercial |
$29.38
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$26.44
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$24.97
|
| Rate for Payer: Fidelis Essential Plan QHP |
$26.15
|
| Rate for Payer: Fidelis Medicare Advantage |
$29.38
|
| Rate for Payer: Fidelis Qualified Health Plan |
$26.15
|
| Rate for Payer: Group Health Inc Commercial |
$29.38
|
| Rate for Payer: Group Health Inc Medicare |
$29.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$29.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$29.38
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$29.38
|
| Rate for Payer: Healthfirst Medicare Advantage |
$24.97
|
| Rate for Payer: Healthfirst QHP |
$29.38
|
| Rate for Payer: Humana Medicare |
$29.97
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$29.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$29.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$65.95
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$27.91
|
| Rate for Payer: Wellcare Medicare |
$27.91
|
|
|
RITUXIMAB-ABBS 100 MG/10ML IV SOLN
|
Facility
|
IP
|
$101.47
|
|
|
Service Code
|
HCPCS Q5115
|
| Hospital Charge Code |
6345910310
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$50.73 |
| Max. Negotiated Rate |
$50.73 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$50.73
|
|
|
RITUXIMAB-ABBS 500 MG/50ML IV SOLN
|
Facility
|
OP
|
$101.47
|
|
|
Service Code
|
HCPCS Q5115
|
| Hospital Charge Code |
6345910450
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$20.57 |
| Max. Negotiated Rate |
$81.17 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$55.81
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$29.38
|
| Rate for Payer: Aetna Government |
$29.38
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$20.57
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$20.57
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$20.57
|
| Rate for Payer: Brighton Health Commercial |
$76.10
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$29.38
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$81.17
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$69.00
|
| Rate for Payer: Elderplan Medicare Advantage |
$29.38
|
| Rate for Payer: EmblemHealth Commercial |
$29.38
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$26.44
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$24.97
|
| Rate for Payer: Fidelis Essential Plan QHP |
$26.15
|
| Rate for Payer: Fidelis Medicare Advantage |
$29.38
|
| Rate for Payer: Fidelis Qualified Health Plan |
$26.15
|
| Rate for Payer: Group Health Inc Commercial |
$29.38
|
| Rate for Payer: Group Health Inc Medicare |
$29.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$29.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$29.38
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$29.38
|
| Rate for Payer: Healthfirst Medicare Advantage |
$24.97
|
| Rate for Payer: Healthfirst QHP |
$29.38
|
| Rate for Payer: Humana Medicare |
$29.97
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$29.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$29.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$65.95
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$27.91
|
| Rate for Payer: Wellcare Medicare |
$27.91
|
|
|
RITUXIMAB-ABBS 500 MG/50ML IV SOLN
|
Facility
|
IP
|
$101.47
|
|
|
Service Code
|
HCPCS Q5115
|
| Hospital Charge Code |
6345910450
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$50.73 |
| Max. Negotiated Rate |
$50.73 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$50.73
|
|
|
RITUXIMAB-ARRX 100 MG/10ML IV SOLN
|
Facility
|
IP
|
$86.02
|
|
|
Service Code
|
HCPCS Q5123
|
| Hospital Charge Code |
5551322401
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$43.01 |
| Max. Negotiated Rate |
$43.01 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$43.01
|
|
|
RITUXIMAB-ARRX 100 MG/10ML IV SOLN
|
Facility
|
OP
|
$86.02
|
|
|
Service Code
|
HCPCS Q5123
|
| Hospital Charge Code |
5551322401
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$18.56 |
| Max. Negotiated Rate |
$68.81 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$47.31
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$26.51
|
| Rate for Payer: Aetna Government |
$26.51
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$18.56
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$18.56
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$18.56
|
| Rate for Payer: Brighton Health Commercial |
$64.51
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$26.51
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$68.81
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$58.49
|
| Rate for Payer: Elderplan Medicare Advantage |
$26.51
|
| Rate for Payer: EmblemHealth Commercial |
$26.51
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$23.86
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$22.53
|
| Rate for Payer: Fidelis Essential Plan QHP |
$23.59
|
| Rate for Payer: Fidelis Medicare Advantage |
$26.51
|
| Rate for Payer: Fidelis Qualified Health Plan |
$23.59
|
| Rate for Payer: Group Health Inc Commercial |
$26.51
|
| Rate for Payer: Group Health Inc Medicare |
$26.51
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$26.51
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$26.51
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$26.51
|
| Rate for Payer: Healthfirst Medicare Advantage |
$22.53
|
| Rate for Payer: Healthfirst QHP |
$26.51
|
| Rate for Payer: Humana Medicare |
$27.04
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$26.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$26.51
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$55.91
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$25.18
|
| Rate for Payer: Wellcare Medicare |
$25.18
|
|
|
RITUXIMAB-ARRX 500 MG/50ML IV SOLN
|
Facility
|
IP
|
$86.02
|
|
|
Service Code
|
HCPCS Q5123
|
| Hospital Charge Code |
5551332601
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$43.01 |
| Max. Negotiated Rate |
$43.01 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$43.01
|
|
|
RITUXIMAB-ARRX 500 MG/50ML IV SOLN
|
Facility
|
OP
|
$86.02
|
|
|
Service Code
|
HCPCS Q5123
|
| Hospital Charge Code |
5551332601
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$18.56 |
| Max. Negotiated Rate |
$68.81 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$47.31
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$26.51
|
| Rate for Payer: Aetna Government |
$26.51
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$18.56
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$18.56
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$18.56
|
| Rate for Payer: Brighton Health Commercial |
$64.51
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$26.51
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$68.81
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$58.49
|
| Rate for Payer: Elderplan Medicare Advantage |
$26.51
|
| Rate for Payer: EmblemHealth Commercial |
$26.51
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$23.86
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$22.53
|
| Rate for Payer: Fidelis Essential Plan QHP |
$23.59
|
| Rate for Payer: Fidelis Medicare Advantage |
$26.51
|
| Rate for Payer: Fidelis Qualified Health Plan |
$23.59
|
| Rate for Payer: Group Health Inc Commercial |
$26.51
|
| Rate for Payer: Group Health Inc Medicare |
$26.51
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$26.51
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$26.51
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$26.51
|
| Rate for Payer: Healthfirst Medicare Advantage |
$22.53
|
| Rate for Payer: Healthfirst QHP |
$26.51
|
| Rate for Payer: Humana Medicare |
$27.04
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$26.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$26.51
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$55.91
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$25.18
|
| Rate for Payer: Wellcare Medicare |
$25.18
|
|
|
RITUXIMAB-PVVR 100 MG/10ML IV SOLN
|
Facility
|
OP
|
$86.02
|
|
|
Service Code
|
HCPCS Q5119
|
| Hospital Charge Code |
0069023801
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$19.50 |
| Max. Negotiated Rate |
$68.81 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$47.31
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$27.85
|
| Rate for Payer: Aetna Government |
$27.85
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$19.50
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$19.50
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$19.50
|
| Rate for Payer: Brighton Health Commercial |
$64.51
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$27.85
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$68.81
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$58.49
|
| Rate for Payer: Elderplan Medicare Advantage |
$27.85
|
| Rate for Payer: EmblemHealth Commercial |
$27.85
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$25.07
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$23.67
|
| Rate for Payer: Fidelis Essential Plan QHP |
$24.79
|
| Rate for Payer: Fidelis Medicare Advantage |
$27.85
|
| Rate for Payer: Fidelis Qualified Health Plan |
$24.79
|
| Rate for Payer: Group Health Inc Commercial |
$27.85
|
| Rate for Payer: Group Health Inc Medicare |
$27.85
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$27.85
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$27.85
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$27.85
|
| Rate for Payer: Healthfirst Medicare Advantage |
$23.67
|
| Rate for Payer: Healthfirst QHP |
$27.85
|
| Rate for Payer: Humana Medicare |
$28.41
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$27.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$27.85
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$55.91
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$26.46
|
| Rate for Payer: Wellcare Medicare |
$26.46
|
|
|
RITUXIMAB-PVVR 100 MG/10ML IV SOLN
|
Facility
|
IP
|
$86.02
|
|
|
Service Code
|
HCPCS Q5119
|
| Hospital Charge Code |
0069023801
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$43.01 |
| Max. Negotiated Rate |
$43.01 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$43.01
|
|
|
RITUXIMAB-PVVR 500 MG/50ML IV SOLN
|
Facility
|
OP
|
$86.02
|
|
|
Service Code
|
HCPCS Q5119
|
| Hospital Charge Code |
0069024901
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$19.50 |
| Max. Negotiated Rate |
$68.81 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$47.31
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$27.85
|
| Rate for Payer: Aetna Government |
$27.85
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$19.50
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$19.50
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$19.50
|
| Rate for Payer: Brighton Health Commercial |
$64.51
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$27.85
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$68.81
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$58.49
|
| Rate for Payer: Elderplan Medicare Advantage |
$27.85
|
| Rate for Payer: EmblemHealth Commercial |
$27.85
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$25.07
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$23.67
|
| Rate for Payer: Fidelis Essential Plan QHP |
$24.79
|
| Rate for Payer: Fidelis Medicare Advantage |
$27.85
|
| Rate for Payer: Fidelis Qualified Health Plan |
$24.79
|
| Rate for Payer: Group Health Inc Commercial |
$27.85
|
| Rate for Payer: Group Health Inc Medicare |
$27.85
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$27.85
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$27.85
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$27.85
|
| Rate for Payer: Healthfirst Medicare Advantage |
$23.67
|
| Rate for Payer: Healthfirst QHP |
$27.85
|
| Rate for Payer: Humana Medicare |
$28.41
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$27.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$27.85
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$55.91
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$26.46
|
| Rate for Payer: Wellcare Medicare |
$26.46
|
|
|
RITUXIMAB-PVVR 500 MG/50ML IV SOLN
|
Facility
|
IP
|
$86.02
|
|
|
Service Code
|
HCPCS Q5119
|
| Hospital Charge Code |
0069024901
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$43.01 |
| Max. Negotiated Rate |
$43.01 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$43.01
|
|
|
RIVAROXABAN 10 MG PO TABS
|
Facility
|
OP
|
$22.78
|
|
|
Service Code
|
NDC 5045858010
|
| Hospital Charge Code |
5045858010
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.97 |
| Max. Negotiated Rate |
$18.23 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$12.53
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$11.39
|
| Rate for Payer: Aetna Government |
$11.39
|
| Rate for Payer: Brighton Health Commercial |
$17.09
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$18.23
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$15.49
|
| Rate for Payer: EmblemHealth Commercial |
$11.39
|
| Rate for Payer: Group Health Inc Commercial |
$11.39
|
| Rate for Payer: Group Health Inc Medicare |
$7.97
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$11.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$14.81
|
|
|
RIVAROXABAN 10 MG PO TABS
|
Facility
|
IP
|
$22.78
|
|
|
Service Code
|
NDC 5045858030
|
| Hospital Charge Code |
5045858030
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.39 |
| Max. Negotiated Rate |
$11.39 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11.39
|
|
|
RIVAROXABAN 10 MG PO TABS
|
Facility
|
IP
|
$22.78
|
|
|
Service Code
|
NDC 5045858010
|
| Hospital Charge Code |
5045858010
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.39 |
| Max. Negotiated Rate |
$11.39 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11.39
|
|
|
RIVAROXABAN 10 MG PO TABS
|
Facility
|
OP
|
$22.78
|
|
|
Service Code
|
NDC 5045858030
|
| Hospital Charge Code |
5045858030
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.97 |
| Max. Negotiated Rate |
$18.23 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$12.53
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$11.39
|
| Rate for Payer: Aetna Government |
$11.39
|
| Rate for Payer: Brighton Health Commercial |
$17.09
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$18.23
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$15.49
|
| Rate for Payer: EmblemHealth Commercial |
$11.39
|
| Rate for Payer: Group Health Inc Commercial |
$11.39
|
| Rate for Payer: Group Health Inc Medicare |
$7.97
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$11.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$14.81
|
|
|
RIVAROXABAN 10 MG PO TABS
|
Facility
|
IP
|
$23.93
|
|
|
Service Code
|
NDC 5045858001
|
| Hospital Charge Code |
5045858001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.96 |
| Max. Negotiated Rate |
$11.96 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11.96
|
|
|
RIVAROXABAN 10 MG PO TABS
|
Facility
|
OP
|
$23.93
|
|
|
Service Code
|
NDC 5045858001
|
| Hospital Charge Code |
5045858001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.38 |
| Max. Negotiated Rate |
$19.14 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$13.16
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$11.96
|
| Rate for Payer: Aetna Government |
$11.96
|
| Rate for Payer: Brighton Health Commercial |
$17.95
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$19.14
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$16.27
|
| Rate for Payer: EmblemHealth Commercial |
$11.96
|
| Rate for Payer: Group Health Inc Commercial |
$11.96
|
| Rate for Payer: Group Health Inc Medicare |
$8.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11.96
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$11.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$15.55
|
|
|
RIVAROXABAN 15 MG PO TABS
|
Facility
|
OP
|
$22.78
|
|
|
Service Code
|
NDC 5045857830
|
| Hospital Charge Code |
5045857830
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.97 |
| Max. Negotiated Rate |
$18.23 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$12.53
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$11.39
|
| Rate for Payer: Aetna Government |
$11.39
|
| Rate for Payer: Brighton Health Commercial |
$17.09
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$18.23
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$15.49
|
| Rate for Payer: EmblemHealth Commercial |
$11.39
|
| Rate for Payer: Group Health Inc Commercial |
$11.39
|
| Rate for Payer: Group Health Inc Medicare |
$7.97
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$11.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$14.81
|
|
|
RIVAROXABAN 15 MG PO TABS
|
Facility
|
OP
|
$22.78
|
|
|
Service Code
|
NDC 5045857810
|
| Hospital Charge Code |
5045857810
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.97 |
| Max. Negotiated Rate |
$18.23 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$12.53
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$11.39
|
| Rate for Payer: Aetna Government |
$11.39
|
| Rate for Payer: Brighton Health Commercial |
$17.09
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$18.23
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$15.49
|
| Rate for Payer: EmblemHealth Commercial |
$11.39
|
| Rate for Payer: Group Health Inc Commercial |
$11.39
|
| Rate for Payer: Group Health Inc Medicare |
$7.97
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$11.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$14.81
|
|
|
RIVAROXABAN 15 MG PO TABS
|
Facility
|
IP
|
$22.78
|
|
|
Service Code
|
NDC 5045857830
|
| Hospital Charge Code |
5045857830
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.39 |
| Max. Negotiated Rate |
$11.39 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11.39
|
|
|
RIVAROXABAN 15 MG PO TABS
|
Facility
|
IP
|
$22.78
|
|
|
Service Code
|
NDC 5045857810
|
| Hospital Charge Code |
5045857810
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.39 |
| Max. Negotiated Rate |
$11.39 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11.39
|
|
|
RIVAROXABAN 15 MG PO TABS
|
Facility
|
OP
|
$22.78
|
|
|
Service Code
|
NDC 5045857801
|
| Hospital Charge Code |
5045857801
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.97 |
| Max. Negotiated Rate |
$18.23 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$12.53
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$11.39
|
| Rate for Payer: Aetna Government |
$11.39
|
| Rate for Payer: Brighton Health Commercial |
$17.09
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$18.23
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$15.49
|
| Rate for Payer: EmblemHealth Commercial |
$11.39
|
| Rate for Payer: Group Health Inc Commercial |
$11.39
|
| Rate for Payer: Group Health Inc Medicare |
$7.97
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$11.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$14.81
|
|
|
RIVAROXABAN 15 MG PO TABS
|
Facility
|
IP
|
$22.78
|
|
|
Service Code
|
NDC 5045857801
|
| Hospital Charge Code |
5045857801
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.39 |
| Max. Negotiated Rate |
$11.39 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11.39
|
|
