|
RING,SEAL SKIN BARRIER STND
|
Facility
|
OP
|
$2.21
|
|
| Hospital Charge Code |
64901343
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.77 |
| Max. Negotiated Rate |
$1.77 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.22
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.10
|
| Rate for Payer: Aetna Government |
$1.10
|
| Rate for Payer: Brighton Health Commercial |
$1.66
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.77
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.50
|
| Rate for Payer: Group Health Inc Commercial |
$1.10
|
| Rate for Payer: Group Health Inc Medicare |
$0.77
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.10
|
|
|
RING SEGMENT 155MM
|
Facility
|
IP
|
$2,658.78
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64907406
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,329.39 |
| Max. Negotiated Rate |
$1,329.39 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,329.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,329.39
|
|
|
RING SEGMENT 155MM
|
Facility
|
OP
|
$2,658.78
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64907406
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$2,791.72 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,462.33
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Brighton Health Commercial |
$1,595.27
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,329.39
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,528.80
|
| Rate for Payer: EmblemHealth Commercial |
$1,329.39
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,791.72
|
| Rate for Payer: Group Health Inc Commercial |
$1,329.39
|
| Rate for Payer: Group Health Inc Medicare |
$930.57
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,329.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,329.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,728.21
|
|
|
RINGS SLIM SPINAL ES2
|
Facility
|
OP
|
$1,194.55
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64905053
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$1,254.28 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$657.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Brighton Health Commercial |
$716.73
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$597.28
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$686.87
|
| Rate for Payer: EmblemHealth Commercial |
$597.28
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,254.28
|
| Rate for Payer: Group Health Inc Commercial |
$597.28
|
| Rate for Payer: Group Health Inc Medicare |
$418.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$597.28
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$597.28
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$776.46
|
|
|
RINGS SLIM SPINAL ES2
|
Facility
|
IP
|
$1,194.55
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64905053
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$597.28 |
| Max. Negotiated Rate |
$597.28 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$597.28
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$597.28
|
|
|
RING TENSION CAPSULAR
|
Facility
|
OP
|
$199.00
|
|
| Hospital Charge Code |
64906254
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$69.65 |
| Max. Negotiated Rate |
$159.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$109.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$99.50
|
| Rate for Payer: Aetna Government |
$99.50
|
| Rate for Payer: Brighton Health Commercial |
$149.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$159.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$135.32
|
| Rate for Payer: Group Health Inc Commercial |
$99.50
|
| Rate for Payer: Group Health Inc Medicare |
$69.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$99.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$99.50
|
|
|
RINSE CARTRIDGE
|
Facility
|
OP
|
$53.05
|
|
| Hospital Charge Code |
64902718
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$18.57 |
| Max. Negotiated Rate |
$42.44 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$29.18
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$26.52
|
| Rate for Payer: Aetna Government |
$26.52
|
| Rate for Payer: Brighton Health Commercial |
$39.79
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$42.44
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$36.07
|
| Rate for Payer: Group Health Inc Commercial |
$26.52
|
| Rate for Payer: Group Health Inc Medicare |
$18.57
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$26.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$26.52
|
|
|
RISPERDAL 12.5MG SUST INJ - .5MG
|
Facility
|
IP
|
$7.63
|
|
|
Service Code
|
HCPCS J2794
|
| Hospital Charge Code |
41648025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.82 |
| Max. Negotiated Rate |
$3.82 |
| Rate for Payer: Cash Price |
$12.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.82
|
|
|
RISPERDAL 12.5MG SUST INJ - .5MG
|
Facility
|
IP
|
$7.63
|
|
|
Service Code
|
HCPCS J2794
|
| Hospital Charge Code |
41658025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.82 |
| Max. Negotiated Rate |
$3.82 |
| Rate for Payer: Cash Price |
$12.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.82
|
|
|
RISPERDAL 12.5MG SUST INJ - .5MG
|
Facility
|
OP
|
$7.63
|
|
|
Service Code
|
HCPCS J2794
|
| Hospital Charge Code |
41648025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.82 |
| Max. Negotiated Rate |
$12.91 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.20
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12.15
|
| Rate for Payer: Aetna Government |
$12.15
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$8.51
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$8.51
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$8.51
|
| Rate for Payer: Brighton Health Commercial |
$4.58
|
| Rate for Payer: Cash Price |
$12.15
|
| Rate for Payer: Cash Price |
$12.15
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$12.15
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.82
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.39
|
| Rate for Payer: Elderplan Medicare Advantage |
$12.15
|
| Rate for Payer: EmblemHealth Commercial |
$12.15
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$12.15
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$12.15
|
| Rate for Payer: Fidelis Essential Plan QHP |
$12.76
|
| Rate for Payer: Fidelis Medicare Advantage |
$12.15
|
| Rate for Payer: Fidelis Qualified Health Plan |
$12.76
|
| Rate for Payer: Group Health Inc Commercial |
$12.15
|
| Rate for Payer: Group Health Inc Medicare |
$12.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.82
|
| Rate for Payer: Healthfirst Medicare Advantage |
$10.33
|
| Rate for Payer: Healthfirst QHP |
$12.15
|
| Rate for Payer: Humana Medicare |
$12.39
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$12.15
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$12.91
|
| Rate for Payer: SOMOS Essential |
$12.91
|
| Rate for Payer: United Healthcare Commercial |
$11.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.96
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$9.72
|
| Rate for Payer: Wellcare Medicare |
$11.54
|
|
|
RISPERDAL 12.5MG SUST INJ - .5MG
|
Facility
|
OP
|
$7.63
|
|
|
Service Code
|
HCPCS J2794
|
| Hospital Charge Code |
41658025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.82 |
| Max. Negotiated Rate |
$12.91 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.20
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12.15
|
| Rate for Payer: Aetna Government |
$12.15
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$8.51
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$8.51
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$8.51
|
| Rate for Payer: Brighton Health Commercial |
$4.58
|
| Rate for Payer: Cash Price |
$12.15
|
| Rate for Payer: Cash Price |
$12.15
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$12.15
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.82
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.39
|
| Rate for Payer: Elderplan Medicare Advantage |
$12.15
|
| Rate for Payer: EmblemHealth Commercial |
$12.15
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$12.15
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$12.15
|
| Rate for Payer: Fidelis Essential Plan QHP |
$12.76
|
| Rate for Payer: Fidelis Medicare Advantage |
$12.15
|
| Rate for Payer: Fidelis Qualified Health Plan |
$12.76
|
| Rate for Payer: Group Health Inc Commercial |
$12.15
|
| Rate for Payer: Group Health Inc Medicare |
$12.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.82
|
| Rate for Payer: Healthfirst Medicare Advantage |
$10.33
|
| Rate for Payer: Healthfirst QHP |
$12.15
|
| Rate for Payer: Humana Medicare |
$12.39
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$12.15
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$12.91
|
| Rate for Payer: SOMOS Essential |
$12.91
|
| Rate for Payer: United Healthcare Commercial |
$11.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.96
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$9.72
|
| Rate for Payer: Wellcare Medicare |
$11.54
|
|
|
RISPERDAL 25MG SUST INJ - .5MG
|
Facility
|
IP
|
$8.03
|
|
|
Service Code
|
HCPCS J2794
|
| Hospital Charge Code |
41648024
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.02 |
| Max. Negotiated Rate |
$4.02 |
| Rate for Payer: Cash Price |
$12.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.02
|
|
|
RISPERDAL 25MG SUST INJ - .5MG
|
Facility
|
OP
|
$8.03
|
|
|
Service Code
|
HCPCS J2794
|
| Hospital Charge Code |
41648024
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.02 |
| Max. Negotiated Rate |
$12.91 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.42
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12.15
|
| Rate for Payer: Aetna Government |
$12.15
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$8.51
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$8.51
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$8.51
|
| Rate for Payer: Brighton Health Commercial |
$4.82
|
| Rate for Payer: Cash Price |
$12.15
|
| Rate for Payer: Cash Price |
$12.15
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$12.15
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.02
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.62
|
| Rate for Payer: Elderplan Medicare Advantage |
$12.15
|
| Rate for Payer: EmblemHealth Commercial |
$12.15
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$12.15
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$12.15
|
| Rate for Payer: Fidelis Essential Plan QHP |
$12.76
|
| Rate for Payer: Fidelis Medicare Advantage |
$12.15
|
| Rate for Payer: Fidelis Qualified Health Plan |
$12.76
|
| Rate for Payer: Group Health Inc Commercial |
$12.15
|
| Rate for Payer: Group Health Inc Medicare |
$12.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.02
|
| Rate for Payer: Healthfirst Medicare Advantage |
$10.33
|
| Rate for Payer: Healthfirst QHP |
$12.15
|
| Rate for Payer: Humana Medicare |
$12.39
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$12.15
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$12.91
|
| Rate for Payer: SOMOS Essential |
$12.91
|
| Rate for Payer: United Healthcare Commercial |
$11.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.22
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$9.72
|
| Rate for Payer: Wellcare Medicare |
$11.54
|
|
|
RISPERDAL 25MG SUST INJ - .5MG
|
Facility
|
OP
|
$8.03
|
|
|
Service Code
|
HCPCS J2794
|
| Hospital Charge Code |
41658024
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.02 |
| Max. Negotiated Rate |
$12.91 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.42
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12.15
|
| Rate for Payer: Aetna Government |
$12.15
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$8.51
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$8.51
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$8.51
|
| Rate for Payer: Brighton Health Commercial |
$4.82
|
| Rate for Payer: Cash Price |
$12.15
|
| Rate for Payer: Cash Price |
$12.15
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$12.15
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.02
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.62
|
| Rate for Payer: Elderplan Medicare Advantage |
$12.15
|
| Rate for Payer: EmblemHealth Commercial |
$12.15
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$12.15
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$12.15
|
| Rate for Payer: Fidelis Essential Plan QHP |
$12.76
|
| Rate for Payer: Fidelis Medicare Advantage |
$12.15
|
| Rate for Payer: Fidelis Qualified Health Plan |
$12.76
|
| Rate for Payer: Group Health Inc Commercial |
$12.15
|
| Rate for Payer: Group Health Inc Medicare |
$12.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.02
|
| Rate for Payer: Healthfirst Medicare Advantage |
$10.33
|
| Rate for Payer: Healthfirst QHP |
$12.15
|
| Rate for Payer: Humana Medicare |
$12.39
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$12.15
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$12.91
|
| Rate for Payer: SOMOS Essential |
$12.91
|
| Rate for Payer: United Healthcare Commercial |
$11.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.22
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$9.72
|
| Rate for Payer: Wellcare Medicare |
$11.54
|
|
|
RISPERDAL 25MG SUST INJ - .5MG
|
Facility
|
IP
|
$8.03
|
|
|
Service Code
|
HCPCS J2794
|
| Hospital Charge Code |
41658024
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.02 |
| Max. Negotiated Rate |
$4.02 |
| Rate for Payer: Cash Price |
$12.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.02
|
|
|
RISPERDAL 50MG SUST INJ - .5MG
|
Facility
|
IP
|
$8.03
|
|
|
Service Code
|
HCPCS J2794
|
| Hospital Charge Code |
41658023
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.02 |
| Max. Negotiated Rate |
$4.02 |
| Rate for Payer: Cash Price |
$12.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.02
|
|
|
RISPERDAL 50MG SUST INJ - .5MG
|
Facility
|
OP
|
$8.03
|
|
|
Service Code
|
HCPCS J2794
|
| Hospital Charge Code |
41648023
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.02 |
| Max. Negotiated Rate |
$12.91 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.42
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12.15
|
| Rate for Payer: Aetna Government |
$12.15
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$8.51
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$8.51
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$8.51
|
| Rate for Payer: Brighton Health Commercial |
$4.82
|
| Rate for Payer: Cash Price |
$12.15
|
| Rate for Payer: Cash Price |
$12.15
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$12.15
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.02
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.62
|
| Rate for Payer: Elderplan Medicare Advantage |
$12.15
|
| Rate for Payer: EmblemHealth Commercial |
$12.15
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$12.15
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$12.15
|
| Rate for Payer: Fidelis Essential Plan QHP |
$12.76
|
| Rate for Payer: Fidelis Medicare Advantage |
$12.15
|
| Rate for Payer: Fidelis Qualified Health Plan |
$12.76
|
| Rate for Payer: Group Health Inc Commercial |
$12.15
|
| Rate for Payer: Group Health Inc Medicare |
$12.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.02
|
| Rate for Payer: Healthfirst Medicare Advantage |
$10.33
|
| Rate for Payer: Healthfirst QHP |
$12.15
|
| Rate for Payer: Humana Medicare |
$12.39
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$12.15
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$12.91
|
| Rate for Payer: SOMOS Essential |
$12.91
|
| Rate for Payer: United Healthcare Commercial |
$11.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.22
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$9.72
|
| Rate for Payer: Wellcare Medicare |
$11.54
|
|
|
RISPERDAL 50MG SUST INJ - .5MG
|
Facility
|
IP
|
$8.03
|
|
|
Service Code
|
HCPCS J2794
|
| Hospital Charge Code |
41648023
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.02 |
| Max. Negotiated Rate |
$4.02 |
| Rate for Payer: Cash Price |
$12.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.02
|
|
|
RISPERDAL 50MG SUST INJ - .5MG
|
Facility
|
OP
|
$8.03
|
|
|
Service Code
|
HCPCS J2794
|
| Hospital Charge Code |
41658023
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.02 |
| Max. Negotiated Rate |
$12.91 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.42
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12.15
|
| Rate for Payer: Aetna Government |
$12.15
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$8.51
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$8.51
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$8.51
|
| Rate for Payer: Brighton Health Commercial |
$4.82
|
| Rate for Payer: Cash Price |
$12.15
|
| Rate for Payer: Cash Price |
$12.15
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$12.15
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.02
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.62
|
| Rate for Payer: Elderplan Medicare Advantage |
$12.15
|
| Rate for Payer: EmblemHealth Commercial |
$12.15
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$12.15
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$12.15
|
| Rate for Payer: Fidelis Essential Plan QHP |
$12.76
|
| Rate for Payer: Fidelis Medicare Advantage |
$12.15
|
| Rate for Payer: Fidelis Qualified Health Plan |
$12.76
|
| Rate for Payer: Group Health Inc Commercial |
$12.15
|
| Rate for Payer: Group Health Inc Medicare |
$12.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.02
|
| Rate for Payer: Healthfirst Medicare Advantage |
$10.33
|
| Rate for Payer: Healthfirst QHP |
$12.15
|
| Rate for Payer: Humana Medicare |
$12.39
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$12.15
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$12.91
|
| Rate for Payer: SOMOS Essential |
$12.91
|
| Rate for Payer: United Healthcare Commercial |
$11.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.22
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$9.72
|
| Rate for Payer: Wellcare Medicare |
$11.54
|
|
|
RISPERDONE 37.5MG SUST INJ -.5MG
|
Facility
|
IP
|
$8.03
|
|
|
Service Code
|
HCPCS J2794
|
| Hospital Charge Code |
41658022
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.02 |
| Max. Negotiated Rate |
$4.02 |
| Rate for Payer: Cash Price |
$12.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.02
|
|
|
RISPERDONE 37.5MG SUST INJ -.5MG
|
Facility
|
OP
|
$8.03
|
|
|
Service Code
|
HCPCS J2794
|
| Hospital Charge Code |
41658022
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.02 |
| Max. Negotiated Rate |
$12.91 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.42
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12.15
|
| Rate for Payer: Aetna Government |
$12.15
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$8.51
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$8.51
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$8.51
|
| Rate for Payer: Brighton Health Commercial |
$4.82
|
| Rate for Payer: Cash Price |
$12.15
|
| Rate for Payer: Cash Price |
$12.15
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$12.15
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.02
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.62
|
| Rate for Payer: Elderplan Medicare Advantage |
$12.15
|
| Rate for Payer: EmblemHealth Commercial |
$12.15
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$12.15
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$12.15
|
| Rate for Payer: Fidelis Essential Plan QHP |
$12.76
|
| Rate for Payer: Fidelis Medicare Advantage |
$12.15
|
| Rate for Payer: Fidelis Qualified Health Plan |
$12.76
|
| Rate for Payer: Group Health Inc Commercial |
$12.15
|
| Rate for Payer: Group Health Inc Medicare |
$12.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.02
|
| Rate for Payer: Healthfirst Medicare Advantage |
$10.33
|
| Rate for Payer: Healthfirst QHP |
$12.15
|
| Rate for Payer: Humana Medicare |
$12.39
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$12.15
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$12.91
|
| Rate for Payer: SOMOS Essential |
$12.91
|
| Rate for Payer: United Healthcare Commercial |
$11.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.22
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$9.72
|
| Rate for Payer: Wellcare Medicare |
$11.54
|
|
|
RISPERDONE 37.5MG SUST INJ-.5MG
|
Facility
|
OP
|
$8.03
|
|
|
Service Code
|
HCPCS J2794
|
| Hospital Charge Code |
41648022
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.02 |
| Max. Negotiated Rate |
$12.91 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.42
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12.15
|
| Rate for Payer: Aetna Government |
$12.15
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$8.51
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$8.51
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$8.51
|
| Rate for Payer: Brighton Health Commercial |
$4.82
|
| Rate for Payer: Cash Price |
$12.15
|
| Rate for Payer: Cash Price |
$12.15
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$12.15
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.02
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.62
|
| Rate for Payer: Elderplan Medicare Advantage |
$12.15
|
| Rate for Payer: EmblemHealth Commercial |
$12.15
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$12.15
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$12.15
|
| Rate for Payer: Fidelis Essential Plan QHP |
$12.76
|
| Rate for Payer: Fidelis Medicare Advantage |
$12.15
|
| Rate for Payer: Fidelis Qualified Health Plan |
$12.76
|
| Rate for Payer: Group Health Inc Commercial |
$12.15
|
| Rate for Payer: Group Health Inc Medicare |
$12.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.02
|
| Rate for Payer: Healthfirst Medicare Advantage |
$10.33
|
| Rate for Payer: Healthfirst QHP |
$12.15
|
| Rate for Payer: Humana Medicare |
$12.39
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$12.15
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$12.91
|
| Rate for Payer: SOMOS Essential |
$12.91
|
| Rate for Payer: United Healthcare Commercial |
$11.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.22
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$9.72
|
| Rate for Payer: Wellcare Medicare |
$11.54
|
|
|
RISPERDONE 37.5MG SUST INJ-.5MG
|
Facility
|
IP
|
$8.03
|
|
|
Service Code
|
HCPCS J2794
|
| Hospital Charge Code |
41648022
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.02 |
| Max. Negotiated Rate |
$4.02 |
| Rate for Payer: Cash Price |
$12.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.02
|
|
|
RISPERIDONE 0.25 MG PO TABS [25519]
|
Facility
|
OP
|
$3.90
|
|
|
Service Code
|
NDC 68382011214
|
| Hospital Charge Code |
68382011214
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.37 |
| Max. Negotiated Rate |
$3.12 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.15
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.95
|
| Rate for Payer: Aetna Government |
$1.95
|
| Rate for Payer: Brighton Health Commercial |
$2.93
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.12
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.65
|
| Rate for Payer: Group Health Inc Commercial |
$1.95
|
| Rate for Payer: Group Health Inc Medicare |
$1.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.95
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.54
|
|
|
RISPERIDONE 0.25 MG PO TABS [25519]
|
Facility
|
OP
|
$3.58
|
|
|
Service Code
|
NDC 00904635761
|
| Hospital Charge Code |
00904635761
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.25 |
| Max. Negotiated Rate |
$2.86 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.97
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.79
|
| Rate for Payer: Aetna Government |
$1.79
|
| Rate for Payer: Brighton Health Commercial |
$2.69
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.86
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.44
|
| Rate for Payer: Group Health Inc Commercial |
$1.79
|
| Rate for Payer: Group Health Inc Medicare |
$1.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.79
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.33
|
|
