|
RANITIDINE 50 MG IVPB PREMIX
|
Facility
|
IP
|
$2.41
|
|
|
Service Code
|
HCPCS J2780
|
| Hospital Charge Code |
41640128
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.21 |
| Max. Negotiated Rate |
$1.21 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.21
|
|
|
RANITIDINE 50 MG IVPB PREMIX
|
Facility
|
OP
|
$2.41
|
|
|
Service Code
|
HCPCS J2780
|
| Hospital Charge Code |
41640128
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.84 |
| Max. Negotiated Rate |
$5.33 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.33
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.33
|
| Rate for Payer: Aetna Government |
$5.33
|
| Rate for Payer: Brighton Health Commercial |
$1.45
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.21
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.39
|
| Rate for Payer: Group Health Inc Commercial |
$1.21
|
| Rate for Payer: Group Health Inc Medicare |
$0.84
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.21
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.57
|
|
|
RANITIDINE 50 MG IVPB PREMIX
|
Facility
|
OP
|
$2.41
|
|
|
Service Code
|
HCPCS J2780
|
| Hospital Charge Code |
41650128
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.84 |
| Max. Negotiated Rate |
$5.33 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.33
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.33
|
| Rate for Payer: Aetna Government |
$5.33
|
| Rate for Payer: Brighton Health Commercial |
$1.45
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.21
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.39
|
| Rate for Payer: Group Health Inc Commercial |
$1.21
|
| Rate for Payer: Group Health Inc Medicare |
$0.84
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.21
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.57
|
|
|
RANOLAZINE 500 MG EXTENDED RELEASE TAB
|
Facility
|
OP
|
$7.46
|
|
| Hospital Charge Code |
41645472
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.61 |
| Max. Negotiated Rate |
$5.97 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.73
|
| Rate for Payer: Aetna Government |
$3.73
|
| Rate for Payer: Brighton Health Commercial |
$5.59
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5.97
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.07
|
| Rate for Payer: Group Health Inc Commercial |
$3.73
|
| Rate for Payer: Group Health Inc Medicare |
$2.61
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.73
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.73
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.85
|
|
|
RANOLAZINE 500 MG EXTENDED RELEASE TAB
|
Facility
|
OP
|
$7.46
|
|
| Hospital Charge Code |
41655472
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.61 |
| Max. Negotiated Rate |
$5.97 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.73
|
| Rate for Payer: Aetna Government |
$3.73
|
| Rate for Payer: Brighton Health Commercial |
$5.59
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5.97
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.07
|
| Rate for Payer: Group Health Inc Commercial |
$3.73
|
| Rate for Payer: Group Health Inc Medicare |
$2.61
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.73
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.73
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.85
|
|
|
RANOLAZINE ER 500 MG PO TB12 [70434]
|
Facility
|
OP
|
$6.43
|
|
|
Service Code
|
NDC 67877052560
|
| Hospital Charge Code |
67877052560
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.25 |
| Max. Negotiated Rate |
$5.14 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.54
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.21
|
| Rate for Payer: Aetna Government |
$3.21
|
| Rate for Payer: Brighton Health Commercial |
$4.82
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5.14
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.37
|
| Rate for Payer: Group Health Inc Commercial |
$3.21
|
| Rate for Payer: Group Health Inc Medicare |
$2.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.21
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.18
|
|
|
RANOLAZINE ER 500 MG PO TB12 [70434]
|
Facility
|
OP
|
$6.42
|
|
|
Service Code
|
NDC 70756070360
|
| Hospital Charge Code |
70756070360
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.25 |
| Max. Negotiated Rate |
$5.14 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.53
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.21
|
| Rate for Payer: Aetna Government |
$3.21
|
| Rate for Payer: Brighton Health Commercial |
$4.82
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5.14
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.37
|
| Rate for Payer: Group Health Inc Commercial |
$3.21
|
| Rate for Payer: Group Health Inc Medicare |
$2.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.21
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.17
|
|
|
RANOLAZINE ER 500 MG PO TB12 [70434]
|
Facility
|
OP
|
$7.11
|
|
|
Service Code
|
NDC 45963041806
|
| Hospital Charge Code |
45963041806
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.49 |
| Max. Negotiated Rate |
$5.69 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.91
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.56
|
| Rate for Payer: Aetna Government |
$3.56
|
| Rate for Payer: Brighton Health Commercial |
$5.33
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5.69
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.84
|
| Rate for Payer: Group Health Inc Commercial |
$3.56
|
| Rate for Payer: Group Health Inc Medicare |
$2.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.56
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.62
|
|
|
RANOLAZINE ER 500 MG PO TB12 [70434]
|
Facility
|
OP
|
$6.42
|
|
|
Service Code
|
NDC 50228042360
|
| Hospital Charge Code |
50228042360
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.25 |
| Max. Negotiated Rate |
$5.14 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.53
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.21
|
| Rate for Payer: Aetna Government |
$3.21
|
| Rate for Payer: Brighton Health Commercial |
$4.82
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5.14
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.37
|
| Rate for Payer: Group Health Inc Commercial |
$3.21
|
| Rate for Payer: Group Health Inc Medicare |
$2.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.21
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.17
|
|
|
RAPID STREP
|
Facility
|
IP
|
$42.03
|
|
|
Service Code
|
HCPCS 87430
|
| Hospital Charge Code |
30303115
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$16.81
|
|
|
RAPID STREP
|
Facility
|
OP
|
$42.03
|
|
|
Service Code
|
HCPCS 87430
|
| Hospital Charge Code |
30303115
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.77 |
| Max. Negotiated Rate |
$31.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$23.12
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$16.81
|
| Rate for Payer: Aetna Government |
$16.81
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$11.77
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$11.77
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$11.77
|
| Rate for Payer: Brighton Health Commercial |
$31.52
|
| Rate for Payer: Cash Price |
$16.81
|
| Rate for Payer: Cash Price |
$16.81
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$16.81
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$19.06
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$16.13
|
| Rate for Payer: Elderplan Medicare Advantage |
$16.81
|
| Rate for Payer: EmblemHealth Commercial |
$16.81
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$14.29
|
| Rate for Payer: Fidelis Essential Plan QHP |
$14.96
|
| Rate for Payer: Fidelis Medicare Advantage |
$16.81
|
| Rate for Payer: Fidelis Qualified Health Plan |
$14.96
|
| Rate for Payer: Group Health Inc Commercial |
$16.81
|
| Rate for Payer: Group Health Inc Medicare |
$16.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$21.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.81
|
| Rate for Payer: Healthfirst Medicare Advantage |
$16.81
|
| Rate for Payer: Healthfirst QHP |
$16.81
|
| Rate for Payer: Humana Medicare |
$17.15
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$16.81
|
| Rate for Payer: United Healthcare Commercial |
$15.19
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.81
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$16.81
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$13.45
|
| Rate for Payer: Wellcare Medicare |
$15.13
|
|
|
RAPID STREP
|
Facility
|
OP
|
$41.33
|
|
|
Service Code
|
HCPCS 87880
|
| Hospital Charge Code |
40614300
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.57 |
| Max. Negotiated Rate |
$31.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$22.73
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$16.53
|
| Rate for Payer: Aetna Government |
$16.53
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$11.57
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$11.57
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$11.57
|
| Rate for Payer: Brighton Health Commercial |
$31.00
|
| Rate for Payer: Cash Price |
$16.53
|
| Rate for Payer: Cash Price |
$16.53
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$16.53
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$19.06
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$16.13
|
| Rate for Payer: Elderplan Medicare Advantage |
$16.53
|
| Rate for Payer: EmblemHealth Commercial |
$16.53
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$14.05
|
| Rate for Payer: Fidelis Essential Plan QHP |
$14.71
|
| Rate for Payer: Fidelis Medicare Advantage |
$16.53
|
| Rate for Payer: Fidelis Qualified Health Plan |
$14.71
|
| Rate for Payer: Group Health Inc Commercial |
$16.53
|
| Rate for Payer: Group Health Inc Medicare |
$16.53
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$20.66
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.53
|
| Rate for Payer: Healthfirst Medicare Advantage |
$16.53
|
| Rate for Payer: Healthfirst QHP |
$16.53
|
| Rate for Payer: Humana Medicare |
$16.86
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$16.53
|
| Rate for Payer: United Healthcare Commercial |
$15.19
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.53
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$16.53
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$13.22
|
| Rate for Payer: Wellcare Medicare |
$14.88
|
|
|
RAPID STREP
|
Facility
|
IP
|
$41.33
|
|
|
Service Code
|
HCPCS 87880
|
| Hospital Charge Code |
40614300
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$16.53
|
|
|
RASAGILINE MESYLATE 1 MG PO TABS [76481]
|
Facility
|
OP
|
$25.00
|
|
|
Service Code
|
NDC 00093306156
|
| Hospital Charge Code |
00093306156
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.75 |
| Max. Negotiated Rate |
$20.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$13.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12.50
|
| Rate for Payer: Aetna Government |
$12.50
|
| Rate for Payer: Brighton Health Commercial |
$18.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$20.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$17.00
|
| Rate for Payer: Group Health Inc Commercial |
$12.50
|
| Rate for Payer: Group Health Inc Medicare |
$8.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$16.25
|
|
|
RASAGILINE MESYLATE 1 MG PO TABS [76481]
|
Facility
|
OP
|
$24.98
|
|
|
Service Code
|
NDC 67877026030
|
| Hospital Charge Code |
67877026030
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.74 |
| Max. Negotiated Rate |
$19.99 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$13.74
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12.49
|
| Rate for Payer: Aetna Government |
$12.49
|
| Rate for Payer: Brighton Health Commercial |
$18.74
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$19.99
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$16.99
|
| Rate for Payer: Group Health Inc Commercial |
$12.49
|
| Rate for Payer: Group Health Inc Medicare |
$8.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.49
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$16.24
|
|
|
RASAGILINE MESYLATE 1MG TABLET
|
Facility
|
OP
|
$62.45
|
|
| Hospital Charge Code |
41640304
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$21.86 |
| Max. Negotiated Rate |
$49.96 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$34.35
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$31.23
|
| Rate for Payer: Aetna Government |
$31.23
|
| Rate for Payer: Brighton Health Commercial |
$46.84
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$49.96
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$42.47
|
| Rate for Payer: Group Health Inc Commercial |
$31.23
|
| Rate for Payer: Group Health Inc Medicare |
$21.86
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$31.23
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$31.23
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$40.59
|
|
|
RASAGILINE MESYLATE 1MG TABLET
|
Facility
|
OP
|
$62.45
|
|
| Hospital Charge Code |
41650304
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$21.86 |
| Max. Negotiated Rate |
$49.96 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$34.35
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$31.23
|
| Rate for Payer: Aetna Government |
$31.23
|
| Rate for Payer: Brighton Health Commercial |
$46.84
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$49.96
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$42.47
|
| Rate for Payer: Group Health Inc Commercial |
$31.23
|
| Rate for Payer: Group Health Inc Medicare |
$21.86
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$31.23
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$31.23
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$40.59
|
|
|
RASBURICASE 1.5MG/1ML
|
Facility
|
IP
|
$958.03
|
|
|
Service Code
|
HCPCS J2783
|
| Hospital Charge Code |
41640291
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$479.01 |
| Max. Negotiated Rate |
$479.01 |
| Rate for Payer: Cash Price |
$367.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$479.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$479.01
|
|
|
RASBURICASE 1.5MG/1ML
|
Facility
|
OP
|
$958.03
|
|
|
Service Code
|
HCPCS J2783
|
| Hospital Charge Code |
41640291
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$257.09 |
| Max. Negotiated Rate |
$622.72 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$526.92
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$367.27
|
| Rate for Payer: Aetna Government |
$367.27
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$257.09
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$257.09
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$257.09
|
| Rate for Payer: Brighton Health Commercial |
$574.82
|
| Rate for Payer: Cash Price |
$367.27
|
| Rate for Payer: Cash Price |
$367.27
|
| Rate for Payer: Cash Price |
$367.27
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$367.27
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$479.01
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$550.87
|
| Rate for Payer: Elderplan Medicare Advantage |
$367.27
|
| Rate for Payer: EmblemHealth Commercial |
$367.27
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$367.27
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$367.27
|
| Rate for Payer: Fidelis Essential Plan QHP |
$385.63
|
| Rate for Payer: Fidelis Medicare Advantage |
$367.27
|
| Rate for Payer: Fidelis Qualified Health Plan |
$385.63
|
| Rate for Payer: Group Health Inc Commercial |
$367.27
|
| Rate for Payer: Group Health Inc Medicare |
$367.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$479.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$479.01
|
| Rate for Payer: Healthfirst Medicare Advantage |
$312.18
|
| Rate for Payer: Healthfirst QHP |
$367.27
|
| Rate for Payer: Humana Medicare |
$374.61
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$367.27
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$389.53
|
| Rate for Payer: SOMOS Essential |
$389.53
|
| Rate for Payer: United Healthcare Commercial |
$340.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$367.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$622.72
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$293.81
|
| Rate for Payer: Wellcare Medicare |
$348.90
|
|
|
RASBURICASE 1.5MG/1ML
|
Facility
|
OP
|
$958.03
|
|
|
Service Code
|
HCPCS J2783
|
| Hospital Charge Code |
41650291
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$257.09 |
| Max. Negotiated Rate |
$622.72 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$526.92
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$367.27
|
| Rate for Payer: Aetna Government |
$367.27
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$257.09
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$257.09
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$257.09
|
| Rate for Payer: Brighton Health Commercial |
$574.82
|
| Rate for Payer: Cash Price |
$367.27
|
| Rate for Payer: Cash Price |
$367.27
|
| Rate for Payer: Cash Price |
$367.27
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$367.27
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$479.01
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$550.87
|
| Rate for Payer: Elderplan Medicare Advantage |
$367.27
|
| Rate for Payer: EmblemHealth Commercial |
$367.27
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$367.27
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$367.27
|
| Rate for Payer: Fidelis Essential Plan QHP |
$385.63
|
| Rate for Payer: Fidelis Medicare Advantage |
$367.27
|
| Rate for Payer: Fidelis Qualified Health Plan |
$385.63
|
| Rate for Payer: Group Health Inc Commercial |
$367.27
|
| Rate for Payer: Group Health Inc Medicare |
$367.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$479.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$479.01
|
| Rate for Payer: Healthfirst Medicare Advantage |
$312.18
|
| Rate for Payer: Healthfirst QHP |
$367.27
|
| Rate for Payer: Humana Medicare |
$374.61
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$367.27
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$389.53
|
| Rate for Payer: SOMOS Essential |
$389.53
|
| Rate for Payer: United Healthcare Commercial |
$340.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$367.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$622.72
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$293.81
|
| Rate for Payer: Wellcare Medicare |
$348.90
|
|
|
RASBURICASE 1.5MG/1ML
|
Facility
|
IP
|
$958.03
|
|
|
Service Code
|
HCPCS J2783
|
| Hospital Charge Code |
41650291
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$479.01 |
| Max. Negotiated Rate |
$479.01 |
| Rate for Payer: Cash Price |
$367.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$479.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$479.01
|
|
|
RASBURICASE 1.5 MG IV SOLR [33591]
|
Facility
|
OP
|
$1,289.42
|
|
|
Service Code
|
HCPCS J2783
|
| Hospital Charge Code |
00024515010
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$293.81 |
| Max. Negotiated Rate |
$838.12 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$709.18
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$367.27
|
| Rate for Payer: Aetna Government |
$367.27
|
| Rate for Payer: Brighton Health Commercial |
$773.65
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$367.27
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$644.71
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$741.42
|
| Rate for Payer: Elderplan Medicare Advantage |
$367.27
|
| Rate for Payer: EmblemHealth Commercial |
$644.71
|
| Rate for Payer: Fidelis Medicare Advantage |
$367.27
|
| Rate for Payer: Group Health Inc Commercial |
$367.27
|
| Rate for Payer: Group Health Inc Medicare |
$367.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$644.71
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$644.71
|
| Rate for Payer: Healthfirst Medicare Advantage |
$312.18
|
| Rate for Payer: Healthfirst QHP |
$367.27
|
| Rate for Payer: Humana Medicare |
$374.61
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$367.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$367.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$838.12
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$293.81
|
|
|
RASBURICASE 1.5 MG IV SOLR [33591]
|
Facility
|
IP
|
$1,289.42
|
|
|
Service Code
|
HCPCS J2783
|
| Hospital Charge Code |
00024515010
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$644.71 |
| Max. Negotiated Rate |
$644.71 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$644.71
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$644.71
|
|
|
RASBURICASE 1.5 MG/ML IV (WET SOLR VIAL) [43033591]
|
Facility
|
IP
|
$1,289.42
|
|
|
Service Code
|
HCPCS J2783
|
| Hospital Charge Code |
00024515010
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$644.71 |
| Max. Negotiated Rate |
$644.71 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$644.71
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$644.71
|
|
|
RASBURICASE 1.5 MG/ML IV (WET SOLR VIAL) [43033591]
|
Facility
|
OP
|
$1,289.42
|
|
|
Service Code
|
HCPCS J2783
|
| Hospital Charge Code |
00024515010
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$293.81 |
| Max. Negotiated Rate |
$838.12 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$709.18
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$367.27
|
| Rate for Payer: Aetna Government |
$367.27
|
| Rate for Payer: Brighton Health Commercial |
$773.65
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$367.27
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$644.71
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$741.42
|
| Rate for Payer: Elderplan Medicare Advantage |
$367.27
|
| Rate for Payer: EmblemHealth Commercial |
$644.71
|
| Rate for Payer: Fidelis Medicare Advantage |
$367.27
|
| Rate for Payer: Group Health Inc Commercial |
$367.27
|
| Rate for Payer: Group Health Inc Medicare |
$367.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$644.71
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$644.71
|
| Rate for Payer: Healthfirst Medicare Advantage |
$312.18
|
| Rate for Payer: Healthfirst QHP |
$367.27
|
| Rate for Payer: Humana Medicare |
$374.61
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$367.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$367.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$838.12
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$293.81
|
|
