|
RHOGAM BLOOD TYPING
|
Facility
|
OP
|
$858.38
|
|
|
Service Code
|
HCPCS 86901
|
| Hospital Charge Code |
40701095
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.78 |
| Max. Negotiated Rate |
$643.78 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$472.11
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$46.38
|
| Rate for Payer: Aetna Government |
$46.38
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$32.47
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$32.47
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$32.47
|
| Rate for Payer: Brighton Health Commercial |
$643.78
|
| Rate for Payer: Cash Price |
$46.38
|
| Rate for Payer: Cash Price |
$46.38
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$46.38
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.74
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.02
|
| Rate for Payer: Elderplan Medicare Advantage |
$46.38
|
| Rate for Payer: EmblemHealth Commercial |
$46.38
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$39.42
|
| Rate for Payer: Fidelis Essential Plan QHP |
$41.28
|
| Rate for Payer: Fidelis Medicare Advantage |
$46.38
|
| Rate for Payer: Fidelis Qualified Health Plan |
$41.28
|
| Rate for Payer: Group Health Inc Commercial |
$46.38
|
| Rate for Payer: Group Health Inc Medicare |
$46.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$429.19
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$46.38
|
| Rate for Payer: Healthfirst Medicare Advantage |
$46.38
|
| Rate for Payer: Healthfirst QHP |
$46.38
|
| Rate for Payer: Humana Medicare |
$47.31
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$46.38
|
| Rate for Payer: United Healthcare Commercial |
$3.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$46.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$46.38
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$37.10
|
| Rate for Payer: Wellcare Medicare |
$41.74
|
|
|
RHOGAM CHARGE
|
Facility
|
OP
|
$858.38
|
|
|
Service Code
|
HCPCS 86901
|
| Hospital Charge Code |
40701188
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.78 |
| Max. Negotiated Rate |
$643.78 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$472.11
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$46.38
|
| Rate for Payer: Aetna Government |
$46.38
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$32.47
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$32.47
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$32.47
|
| Rate for Payer: Brighton Health Commercial |
$643.78
|
| Rate for Payer: Cash Price |
$46.38
|
| Rate for Payer: Cash Price |
$46.38
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$46.38
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.74
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.02
|
| Rate for Payer: Elderplan Medicare Advantage |
$46.38
|
| Rate for Payer: EmblemHealth Commercial |
$46.38
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$39.42
|
| Rate for Payer: Fidelis Essential Plan QHP |
$41.28
|
| Rate for Payer: Fidelis Medicare Advantage |
$46.38
|
| Rate for Payer: Fidelis Qualified Health Plan |
$41.28
|
| Rate for Payer: Group Health Inc Commercial |
$46.38
|
| Rate for Payer: Group Health Inc Medicare |
$46.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$429.19
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$46.38
|
| Rate for Payer: Healthfirst Medicare Advantage |
$46.38
|
| Rate for Payer: Healthfirst QHP |
$46.38
|
| Rate for Payer: Humana Medicare |
$47.31
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$46.38
|
| Rate for Payer: United Healthcare Commercial |
$3.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$46.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$46.38
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$37.10
|
| Rate for Payer: Wellcare Medicare |
$41.74
|
|
|
RHOGAM CHARGE
|
Facility
|
IP
|
$858.38
|
|
|
Service Code
|
HCPCS 86901
|
| Hospital Charge Code |
40701188
|
|
Hospital Revenue Code
|
302
|
| Rate for Payer: Cash Price |
$46.38
|
|
|
RHOGAM ULTR FILT PLUS W/SAF SYR
|
Facility
|
OP
|
$207.50
|
|
| Hospital Charge Code |
64902900
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$72.62 |
| Max. Negotiated Rate |
$166.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$114.12
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$103.75
|
| Rate for Payer: Aetna Government |
$103.75
|
| Rate for Payer: Brighton Health Commercial |
$155.62
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$166.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$141.10
|
| Rate for Payer: Group Health Inc Commercial |
$103.75
|
| Rate for Payer: Group Health Inc Medicare |
$72.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$103.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$103.75
|
|
|
RHYTHM ECG- REPORT ONLY
|
Facility
|
OP
|
$49.80
|
|
|
Service Code
|
HCPCS 93042
|
| Hospital Charge Code |
40801001
|
|
Hospital Revenue Code
|
985
|
| Min. Negotiated Rate |
$6.05 |
| Max. Negotiated Rate |
$39.84 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$27.39
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.05
|
| Rate for Payer: Aetna Government |
$6.05
|
| Rate for Payer: Brighton Health Commercial |
$37.35
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$39.84
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$33.86
|
| Rate for Payer: Group Health Inc Commercial |
$24.90
|
| Rate for Payer: Group Health Inc Medicare |
$17.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$24.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$24.90
|
|
|
RHYTHM ECG- REPORT ONLY
|
Facility
|
IP
|
$166.60
|
|
|
Service Code
|
HCPCS 93041
|
| Hospital Charge Code |
30103246
|
|
Hospital Revenue Code
|
730
|
| Rate for Payer: Cash Price |
$70.74
|
|
|
RHYTHM ECG- REPORT ONLY
|
Facility
|
OP
|
$166.60
|
|
|
Service Code
|
HCPCS 93041
|
| Hospital Charge Code |
30103246
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$49.52 |
| Max. Negotiated Rate |
$133.28 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$91.63
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$70.74
|
| Rate for Payer: Aetna Government |
$70.74
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$49.52
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$49.52
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$49.52
|
| Rate for Payer: Brighton Health Commercial |
$124.95
|
| Rate for Payer: Cash Price |
$70.74
|
| Rate for Payer: Cash Price |
$70.74
|
| Rate for Payer: Cash Price |
$70.74
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$70.74
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$133.28
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$113.29
|
| Rate for Payer: Elderplan Medicare Advantage |
$70.74
|
| Rate for Payer: EmblemHealth Commercial |
$70.74
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$60.13
|
| Rate for Payer: Fidelis Essential Plan QHP |
$62.96
|
| Rate for Payer: Fidelis Medicare Advantage |
$70.74
|
| Rate for Payer: Fidelis Qualified Health Plan |
$62.96
|
| Rate for Payer: Group Health Inc Commercial |
$70.74
|
| Rate for Payer: Group Health Inc Medicare |
$70.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$83.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$70.74
|
| Rate for Payer: Healthfirst Medicare Advantage |
$60.13
|
| Rate for Payer: Healthfirst QHP |
$70.74
|
| Rate for Payer: Humana Medicare |
$72.15
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$70.74
|
| Rate for Payer: United Healthcare Commercial |
$101.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$70.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$70.74
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$56.59
|
| Rate for Payer: Wellcare Medicare |
$67.20
|
|
|
RHYTHM ECG-TRACING
|
Facility
|
OP
|
$166.60
|
|
|
Service Code
|
HCPCS 93041
|
| Hospital Charge Code |
40804111
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$49.52 |
| Max. Negotiated Rate |
$133.28 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$91.63
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$70.74
|
| Rate for Payer: Aetna Government |
$70.74
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$49.52
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$49.52
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$49.52
|
| Rate for Payer: Brighton Health Commercial |
$124.95
|
| Rate for Payer: Cash Price |
$70.74
|
| Rate for Payer: Cash Price |
$70.74
|
| Rate for Payer: Cash Price |
$70.74
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$70.74
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$133.28
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$113.29
|
| Rate for Payer: Elderplan Medicare Advantage |
$70.74
|
| Rate for Payer: EmblemHealth Commercial |
$70.74
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$60.13
|
| Rate for Payer: Fidelis Essential Plan QHP |
$62.96
|
| Rate for Payer: Fidelis Medicare Advantage |
$70.74
|
| Rate for Payer: Fidelis Qualified Health Plan |
$62.96
|
| Rate for Payer: Group Health Inc Commercial |
$70.74
|
| Rate for Payer: Group Health Inc Medicare |
$70.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$83.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$70.74
|
| Rate for Payer: Healthfirst Medicare Advantage |
$60.13
|
| Rate for Payer: Healthfirst QHP |
$70.74
|
| Rate for Payer: Humana Medicare |
$72.15
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$70.74
|
| Rate for Payer: United Healthcare Commercial |
$101.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$70.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$70.74
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$56.59
|
| Rate for Payer: Wellcare Medicare |
$67.20
|
|
|
RHYTHM ECG-TRACING
|
Facility
|
IP
|
$166.60
|
|
|
Service Code
|
HCPCS 93041
|
| Hospital Charge Code |
40804111
|
|
Hospital Revenue Code
|
730
|
| Rate for Payer: Cash Price |
$70.74
|
|
|
RHYTHM ECG W/REPORT
|
Facility
|
OP
|
$47.74
|
|
|
Service Code
|
HCPCS 93040
|
| Hospital Charge Code |
30300149
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$11.29 |
| Max. Negotiated Rate |
$101.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$26.26
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$11.29
|
| Rate for Payer: Aetna Government |
$11.29
|
| Rate for Payer: Brighton Health Commercial |
$35.80
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$38.19
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$32.46
|
| Rate for Payer: Group Health Inc Commercial |
$23.87
|
| Rate for Payer: Group Health Inc Medicare |
$16.71
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$23.87
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$23.87
|
| Rate for Payer: United Healthcare Commercial |
$101.00
|
|
|
RIBAVIRIN 200 MG CAP
|
Facility
|
OP
|
$18.24
|
|
| Hospital Charge Code |
41652057
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.38 |
| Max. Negotiated Rate |
$14.59 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$10.03
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$9.12
|
| Rate for Payer: Aetna Government |
$9.12
|
| Rate for Payer: Brighton Health Commercial |
$13.68
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$14.59
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$12.40
|
| Rate for Payer: Group Health Inc Commercial |
$9.12
|
| Rate for Payer: Group Health Inc Medicare |
$6.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$11.86
|
|
|
RIBAVIRIN 200 MG CAP
|
Facility
|
OP
|
$18.24
|
|
| Hospital Charge Code |
41642057
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.38 |
| Max. Negotiated Rate |
$14.59 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$10.03
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$9.12
|
| Rate for Payer: Aetna Government |
$9.12
|
| Rate for Payer: Brighton Health Commercial |
$13.68
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$14.59
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$12.40
|
| Rate for Payer: Group Health Inc Commercial |
$9.12
|
| Rate for Payer: Group Health Inc Medicare |
$6.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$11.86
|
|
|
RIBAVIRIN 200 MG PO TABS [11287]
|
Facility
|
OP
|
$8.27
|
|
|
Service Code
|
NDC 65862020768
|
| Hospital Charge Code |
65862020768
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.90 |
| Max. Negotiated Rate |
$6.62 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.14
|
| Rate for Payer: Aetna Government |
$4.14
|
| Rate for Payer: Brighton Health Commercial |
$6.21
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.62
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.63
|
| Rate for Payer: Group Health Inc Commercial |
$4.14
|
| Rate for Payer: Group Health Inc Medicare |
$2.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.38
|
|
|
RICHARDS HIP SYSTEM
|
Facility
|
OP
|
$5,654.41
|
|
| Hospital Charge Code |
40207031
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,979.04 |
| Max. Negotiated Rate |
$4,523.53 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3,109.93
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,827.20
|
| Rate for Payer: Aetna Government |
$2,827.20
|
| Rate for Payer: Brighton Health Commercial |
$4,240.81
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4,523.53
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3,845.00
|
| Rate for Payer: Group Health Inc Commercial |
$2,827.20
|
| Rate for Payer: Group Health Inc Medicare |
$1,979.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,827.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,827.20
|
|
|
RICHARDS UNIVERSAL ARM SPLINT
|
Facility
|
OP
|
$29.06
|
|
| Hospital Charge Code |
40200025
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$10.17 |
| Max. Negotiated Rate |
$23.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$15.98
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$14.53
|
| Rate for Payer: Aetna Government |
$14.53
|
| Rate for Payer: Brighton Health Commercial |
$21.80
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$23.25
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$19.76
|
| Rate for Payer: Group Health Inc Commercial |
$14.53
|
| Rate for Payer: Group Health Inc Medicare |
$10.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.53
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.53
|
|
|
RICHARD WOLF BIPOLAR GENERATOR
|
Facility
|
OP
|
$5,216.00
|
|
| Hospital Charge Code |
40202368
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$1,825.60 |
| Max. Negotiated Rate |
$4,172.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,868.80
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,608.00
|
| Rate for Payer: Aetna Government |
$2,608.00
|
| Rate for Payer: Brighton Health Commercial |
$3,912.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4,172.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3,546.88
|
| Rate for Payer: Group Health Inc Commercial |
$2,608.00
|
| Rate for Payer: Group Health Inc Medicare |
$1,825.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,608.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,608.00
|
|
|
RICKETTSIA AB PANEL
|
Facility
|
IP
|
$30.13
|
|
|
Service Code
|
HCPCS 86255
|
| Hospital Charge Code |
40728125
|
|
Hospital Revenue Code
|
302
|
| Rate for Payer: Cash Price |
$12.05
|
|
|
RICKETTSIA AB PANEL
|
Facility
|
OP
|
$30.13
|
|
|
Service Code
|
HCPCS 86255
|
| Hospital Charge Code |
40728125
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.44 |
| Max. Negotiated Rate |
$22.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$16.57
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12.05
|
| Rate for Payer: Aetna Government |
$12.05
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$8.44
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$8.44
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$8.44
|
| Rate for Payer: Brighton Health Commercial |
$22.60
|
| Rate for Payer: Cash Price |
$12.05
|
| Rate for Payer: Cash Price |
$12.05
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$12.05
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$19.15
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$16.20
|
| Rate for Payer: Elderplan Medicare Advantage |
$12.05
|
| Rate for Payer: EmblemHealth Commercial |
$12.05
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$10.24
|
| Rate for Payer: Fidelis Essential Plan QHP |
$10.72
|
| Rate for Payer: Fidelis Medicare Advantage |
$12.05
|
| Rate for Payer: Fidelis Qualified Health Plan |
$10.72
|
| Rate for Payer: Group Health Inc Commercial |
$12.05
|
| Rate for Payer: Group Health Inc Medicare |
$12.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.05
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12.05
|
| Rate for Payer: Healthfirst QHP |
$12.05
|
| Rate for Payer: Humana Medicare |
$12.29
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$12.05
|
| Rate for Payer: United Healthcare Commercial |
$15.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12.05
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$9.64
|
| Rate for Payer: Wellcare Medicare |
$10.84
|
|
|
RIFABUTIN 150 MG CAP
|
Facility
|
OP
|
$24.00
|
|
| Hospital Charge Code |
41650204
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.40 |
| Max. Negotiated Rate |
$19.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$13.20
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12.00
|
| Rate for Payer: Aetna Government |
$12.00
|
| Rate for Payer: Brighton Health Commercial |
$18.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$19.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$16.32
|
| Rate for Payer: Group Health Inc Commercial |
$12.00
|
| Rate for Payer: Group Health Inc Medicare |
$8.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$15.60
|
|
|
RIFABUTIN 150 MG CAP
|
Facility
|
OP
|
$24.00
|
|
| Hospital Charge Code |
41640204
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.40 |
| Max. Negotiated Rate |
$19.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$13.20
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12.00
|
| Rate for Payer: Aetna Government |
$12.00
|
| Rate for Payer: Brighton Health Commercial |
$18.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$19.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$16.32
|
| Rate for Payer: Group Health Inc Commercial |
$12.00
|
| Rate for Payer: Group Health Inc Medicare |
$8.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$15.60
|
|
|
RIFABUTIN 150 MG PO CAPS [11290]
|
Facility
|
OP
|
$17.49
|
|
|
Service Code
|
NDC 59762135001
|
| Hospital Charge Code |
59762135001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.12 |
| Max. Negotiated Rate |
$14.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$9.62
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8.75
|
| Rate for Payer: Aetna Government |
$8.75
|
| Rate for Payer: Brighton Health Commercial |
$13.12
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$14.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$11.90
|
| Rate for Payer: Group Health Inc Commercial |
$8.75
|
| Rate for Payer: Group Health Inc Medicare |
$6.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.75
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$11.37
|
|
|
RIFABUTIN 150 MG PO CAPS [11290]
|
Facility
|
OP
|
$23.35
|
|
|
Service Code
|
NDC 00013530117
|
| Hospital Charge Code |
00013530117
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.17 |
| Max. Negotiated Rate |
$18.68 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$12.84
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$11.67
|
| Rate for Payer: Aetna Government |
$11.67
|
| Rate for Payer: Brighton Health Commercial |
$17.51
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$18.68
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$15.87
|
| Rate for Payer: Group Health Inc Commercial |
$11.67
|
| Rate for Payer: Group Health Inc Medicare |
$8.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11.67
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$11.67
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$15.17
|
|
|
RIFABUTIN 20 MG/ML LIQUID
|
Facility
|
OP
|
$21.00
|
|
| Hospital Charge Code |
41653121
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.35 |
| Max. Negotiated Rate |
$16.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$11.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$10.50
|
| Rate for Payer: Aetna Government |
$10.50
|
| Rate for Payer: Brighton Health Commercial |
$15.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$16.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$14.28
|
| Rate for Payer: Group Health Inc Commercial |
$10.50
|
| Rate for Payer: Group Health Inc Medicare |
$7.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$10.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$13.65
|
|
|
RIFABUTIN 20 MG/ML LIQUID
|
Facility
|
OP
|
$21.00
|
|
| Hospital Charge Code |
41643121
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.35 |
| Max. Negotiated Rate |
$16.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$11.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$10.50
|
| Rate for Payer: Aetna Government |
$10.50
|
| Rate for Payer: Brighton Health Commercial |
$15.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$16.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$14.28
|
| Rate for Payer: Group Health Inc Commercial |
$10.50
|
| Rate for Payer: Group Health Inc Medicare |
$7.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$10.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$13.65
|
|
|
RIFAMPIN 10 MG/ML SUSP
|
Facility
|
OP
|
$1.00
|
|
| Hospital Charge Code |
41654749
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$0.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.50
|
| Rate for Payer: Aetna Government |
$0.50
|
| Rate for Payer: Brighton Health Commercial |
$0.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.68
|
| Rate for Payer: Group Health Inc Commercial |
$0.50
|
| Rate for Payer: Group Health Inc Medicare |
$0.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.65
|
|
