|
ROSUVASTATIN CALCIUM 20 MG PO TABS
|
Facility
|
OP
|
$7.14
|
|
|
Service Code
|
NDC 6068725611
|
| Hospital Charge Code |
6068725611
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.50 |
| Max. Negotiated Rate |
$5.72 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.93
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.57
|
| Rate for Payer: Aetna Government |
$3.57
|
| Rate for Payer: Brighton Health Commercial |
$5.36
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5.72
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.86
|
| Rate for Payer: EmblemHealth Commercial |
$3.57
|
| Rate for Payer: Group Health Inc Commercial |
$3.57
|
| Rate for Payer: Group Health Inc Medicare |
$2.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.57
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.57
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.64
|
|
|
ROSUVASTATIN CALCIUM 20 MG PO TABS
|
Facility
|
IP
|
$8.95
|
|
|
Service Code
|
NDC 7220500499
|
| Hospital Charge Code |
7220500499
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.47 |
| Max. Negotiated Rate |
$4.47 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.47
|
|
|
ROSUVASTATIN CALCIUM 20 MG PO TABS
|
Facility
|
IP
|
$7.14
|
|
|
Service Code
|
NDC 6068725611
|
| Hospital Charge Code |
6068725611
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.57 |
| Max. Negotiated Rate |
$3.57 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.57
|
|
|
ROSUVASTATIN CALCIUM 20 MG PO TABS
|
Facility
|
IP
|
$8.95
|
|
|
Service Code
|
NDC 4733558481
|
| Hospital Charge Code |
4733558481
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.47 |
| Max. Negotiated Rate |
$4.47 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.47
|
|
|
ROSUVASTATIN CALCIUM 20 MG PO TABS
|
Facility
|
OP
|
$1.48
|
|
|
Service Code
|
NDC 5026871011
|
| Hospital Charge Code |
5026871011
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.52 |
| Max. Negotiated Rate |
$1.18 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.81
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.74
|
| Rate for Payer: Aetna Government |
$0.74
|
| Rate for Payer: Brighton Health Commercial |
$1.11
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.18
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.01
|
| Rate for Payer: EmblemHealth Commercial |
$0.74
|
| Rate for Payer: Group Health Inc Commercial |
$0.74
|
| Rate for Payer: Group Health Inc Medicare |
$0.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.96
|
|
|
ROSUVASTATIN CALCIUM 20 MG PO TABS
|
Facility
|
IP
|
$1.48
|
|
|
Service Code
|
NDC 5026871011
|
| Hospital Charge Code |
5026871011
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.74 |
| Max. Negotiated Rate |
$0.74 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.74
|
|
|
ROSUVASTATIN CALCIUM 20 MG PO TABS
|
Facility
|
OP
|
$8.95
|
|
|
Service Code
|
NDC 6586229590
|
| Hospital Charge Code |
6586229590
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.13 |
| Max. Negotiated Rate |
$7.16 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.92
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.47
|
| Rate for Payer: Aetna Government |
$4.47
|
| Rate for Payer: Brighton Health Commercial |
$6.71
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7.16
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.08
|
| Rate for Payer: EmblemHealth Commercial |
$4.47
|
| Rate for Payer: Group Health Inc Commercial |
$4.47
|
| Rate for Payer: Group Health Inc Medicare |
$3.13
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.47
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.81
|
|
|
ROSUVASTATIN CALCIUM 40 MG PO TABS
|
Facility
|
OP
|
$8.95
|
|
|
Service Code
|
NDC 6846226430
|
| Hospital Charge Code |
6846226430
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.13 |
| Max. Negotiated Rate |
$7.16 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.92
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.47
|
| Rate for Payer: Aetna Government |
$4.47
|
| Rate for Payer: Brighton Health Commercial |
$6.71
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7.16
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.08
|
| Rate for Payer: EmblemHealth Commercial |
$4.47
|
| Rate for Payer: Group Health Inc Commercial |
$4.47
|
| Rate for Payer: Group Health Inc Medicare |
$3.13
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.47
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.81
|
|
|
ROSUVASTATIN CALCIUM 40 MG PO TABS
|
Facility
|
OP
|
$8.95
|
|
|
Service Code
|
NDC 1672928715
|
| Hospital Charge Code |
1672928715
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.13 |
| Max. Negotiated Rate |
$7.16 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.92
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.47
|
| Rate for Payer: Aetna Government |
$4.47
|
| Rate for Payer: Brighton Health Commercial |
$6.71
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7.16
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.08
|
| Rate for Payer: EmblemHealth Commercial |
$4.47
|
| Rate for Payer: Group Health Inc Commercial |
$4.47
|
| Rate for Payer: Group Health Inc Medicare |
$3.13
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.47
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.81
|
|
|
ROSUVASTATIN CALCIUM 40 MG PO TABS
|
Facility
|
IP
|
$8.95
|
|
|
Service Code
|
NDC 6846226430
|
| Hospital Charge Code |
6846226430
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.47 |
| Max. Negotiated Rate |
$4.47 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.47
|
|
|
ROSUVASTATIN CALCIUM 40 MG PO TABS
|
Facility
|
IP
|
$1.59
|
|
|
Service Code
|
NDC 5026871115
|
| Hospital Charge Code |
5026871115
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.79 |
| Max. Negotiated Rate |
$0.79 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.79
|
|
|
ROSUVASTATIN CALCIUM 40 MG PO TABS
|
Facility
|
OP
|
$8.95
|
|
|
Service Code
|
NDC 7220500590
|
| Hospital Charge Code |
7220500590
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.13 |
| Max. Negotiated Rate |
$7.16 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.92
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.47
|
| Rate for Payer: Aetna Government |
$4.47
|
| Rate for Payer: Brighton Health Commercial |
$6.71
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7.16
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.08
|
| Rate for Payer: EmblemHealth Commercial |
$4.47
|
| Rate for Payer: Group Health Inc Commercial |
$4.47
|
| Rate for Payer: Group Health Inc Medicare |
$3.13
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.47
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.81
|
|
|
ROSUVASTATIN CALCIUM 40 MG PO TABS
|
Facility
|
IP
|
$8.95
|
|
|
Service Code
|
NDC 7220500590
|
| Hospital Charge Code |
7220500590
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.47 |
| Max. Negotiated Rate |
$4.47 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.47
|
|
|
ROSUVASTATIN CALCIUM 40 MG PO TABS
|
Facility
|
IP
|
$8.94
|
|
|
Service Code
|
NDC 3172288530
|
| Hospital Charge Code |
3172288530
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.47 |
| Max. Negotiated Rate |
$4.47 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.47
|
|
|
ROSUVASTATIN CALCIUM 40 MG PO TABS
|
Facility
|
OP
|
$8.95
|
|
|
Service Code
|
NDC 5723717190
|
| Hospital Charge Code |
5723717190
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.13 |
| Max. Negotiated Rate |
$7.16 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.92
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.47
|
| Rate for Payer: Aetna Government |
$4.47
|
| Rate for Payer: Brighton Health Commercial |
$6.71
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7.16
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.08
|
| Rate for Payer: EmblemHealth Commercial |
$4.47
|
| Rate for Payer: Group Health Inc Commercial |
$4.47
|
| Rate for Payer: Group Health Inc Medicare |
$3.13
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.47
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.81
|
|
|
ROSUVASTATIN CALCIUM 40 MG PO TABS
|
Facility
|
OP
|
$1.59
|
|
|
Service Code
|
NDC 5026871115
|
| Hospital Charge Code |
5026871115
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.56 |
| Max. Negotiated Rate |
$1.27 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.87
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.79
|
| Rate for Payer: Aetna Government |
$0.79
|
| Rate for Payer: Brighton Health Commercial |
$1.19
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.27
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.08
|
| Rate for Payer: EmblemHealth Commercial |
$0.79
|
| Rate for Payer: Group Health Inc Commercial |
$0.79
|
| Rate for Payer: Group Health Inc Medicare |
$0.56
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.79
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.03
|
|
|
ROSUVASTATIN CALCIUM 40 MG PO TABS
|
Facility
|
IP
|
$8.95
|
|
|
Service Code
|
NDC 5723717105
|
| Hospital Charge Code |
5723717105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.47 |
| Max. Negotiated Rate |
$4.47 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.47
|
|
|
ROSUVASTATIN CALCIUM 40 MG PO TABS
|
Facility
|
IP
|
$8.95
|
|
|
Service Code
|
NDC 5723717190
|
| Hospital Charge Code |
5723717190
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.47 |
| Max. Negotiated Rate |
$4.47 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.47
|
|
|
ROSUVASTATIN CALCIUM 40 MG PO TABS
|
Facility
|
OP
|
$8.95
|
|
|
Service Code
|
NDC 5723717105
|
| Hospital Charge Code |
5723717105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.13 |
| Max. Negotiated Rate |
$7.16 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.92
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.47
|
| Rate for Payer: Aetna Government |
$4.47
|
| Rate for Payer: Brighton Health Commercial |
$6.71
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7.16
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.08
|
| Rate for Payer: EmblemHealth Commercial |
$4.47
|
| Rate for Payer: Group Health Inc Commercial |
$4.47
|
| Rate for Payer: Group Health Inc Medicare |
$3.13
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.47
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.81
|
|
|
ROSUVASTATIN CALCIUM 40 MG PO TABS
|
Facility
|
IP
|
$1.59
|
|
|
Service Code
|
NDC 5026871111
|
| Hospital Charge Code |
5026871111
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.79 |
| Max. Negotiated Rate |
$0.79 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.79
|
|
|
ROSUVASTATIN CALCIUM 40 MG PO TABS
|
Facility
|
IP
|
$8.95
|
|
|
Service Code
|
NDC 1672928715
|
| Hospital Charge Code |
1672928715
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.47 |
| Max. Negotiated Rate |
$4.47 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.47
|
|
|
ROSUVASTATIN CALCIUM 40 MG PO TABS
|
Facility
|
IP
|
$8.95
|
|
|
Service Code
|
NDC 4733558583
|
| Hospital Charge Code |
4733558583
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.47 |
| Max. Negotiated Rate |
$4.47 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.47
|
|
|
ROSUVASTATIN CALCIUM 40 MG PO TABS
|
Facility
|
OP
|
$1.59
|
|
|
Service Code
|
NDC 5026871111
|
| Hospital Charge Code |
5026871111
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.56 |
| Max. Negotiated Rate |
$1.27 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.87
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.79
|
| Rate for Payer: Aetna Government |
$0.79
|
| Rate for Payer: Brighton Health Commercial |
$1.19
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.27
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.08
|
| Rate for Payer: EmblemHealth Commercial |
$0.79
|
| Rate for Payer: Group Health Inc Commercial |
$0.79
|
| Rate for Payer: Group Health Inc Medicare |
$0.56
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.79
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.03
|
|
|
ROSUVASTATIN CALCIUM 40 MG PO TABS
|
Facility
|
OP
|
$8.94
|
|
|
Service Code
|
NDC 3172288530
|
| Hospital Charge Code |
3172288530
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.13 |
| Max. Negotiated Rate |
$7.16 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.92
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.47
|
| Rate for Payer: Aetna Government |
$4.47
|
| Rate for Payer: Brighton Health Commercial |
$6.71
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7.16
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.08
|
| Rate for Payer: EmblemHealth Commercial |
$4.47
|
| Rate for Payer: Group Health Inc Commercial |
$4.47
|
| Rate for Payer: Group Health Inc Medicare |
$3.13
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.47
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.81
|
|
|
ROSUVASTATIN CALCIUM 40 MG PO TABS
|
Facility
|
OP
|
$8.95
|
|
|
Service Code
|
NDC 4733558583
|
| Hospital Charge Code |
4733558583
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.13 |
| Max. Negotiated Rate |
$7.16 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.92
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.47
|
| Rate for Payer: Aetna Government |
$4.47
|
| Rate for Payer: Brighton Health Commercial |
$6.71
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7.16
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.08
|
| Rate for Payer: EmblemHealth Commercial |
$4.47
|
| Rate for Payer: Group Health Inc Commercial |
$4.47
|
| Rate for Payer: Group Health Inc Medicare |
$3.13
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.47
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.81
|
|
