|
RISPERIDONE 2 MG TAB
|
Facility
|
OP
|
$1.00
|
|
| Hospital Charge Code |
41650306
|
|
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
|
|
|
RISPERIDONE 3 MG PO TABS [18312]
|
Facility
|
OP
|
$11.54
|
|
|
Service Code
|
NDC 50458033001
|
| Hospital Charge Code |
50458033001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.04 |
| Max. Negotiated Rate |
$9.23 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.35
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.77
|
| Rate for Payer: Aetna Government |
$5.77
|
| Rate for Payer: Brighton Health Commercial |
$8.66
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$9.23
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7.85
|
| Rate for Payer: Group Health Inc Commercial |
$5.77
|
| Rate for Payer: Group Health Inc Medicare |
$4.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.77
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.77
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$7.50
|
|
|
RISPERIDONE 3 MG PO TABS [18312]
|
Facility
|
OP
|
$8.30
|
|
|
Service Code
|
NDC 00904636161
|
| Hospital Charge Code |
00904636161
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.91 |
| Max. Negotiated Rate |
$6.64 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.57
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.15
|
| Rate for Payer: Aetna Government |
$4.15
|
| Rate for Payer: Brighton Health Commercial |
$6.23
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.64
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.65
|
| Rate for Payer: Group Health Inc Commercial |
$4.15
|
| Rate for Payer: Group Health Inc Medicare |
$2.91
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.15
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.40
|
|
|
RISPERIDONE 3 MG PO TABS [18312]
|
Facility
|
OP
|
$8.93
|
|
|
Service Code
|
NDC 13668003960
|
| Hospital Charge Code |
13668003960
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.13 |
| Max. Negotiated Rate |
$7.15 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.91
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.47
|
| Rate for Payer: Aetna Government |
$4.47
|
| Rate for Payer: Brighton Health Commercial |
$6.70
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7.15
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.07
|
| 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
|
|
|
RISPERIDONE 3 MG PO TABS [18312]
|
Facility
|
OP
|
$8.93
|
|
|
Service Code
|
NDC 43547034306
|
| Hospital Charge Code |
43547034306
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.13 |
| Max. Negotiated Rate |
$7.15 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.91
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.47
|
| Rate for Payer: Aetna Government |
$4.47
|
| Rate for Payer: Brighton Health Commercial |
$6.70
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7.15
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.07
|
| 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
|
|
|
RISPERIDONE 3 MG PO TABS [18312]
|
Facility
|
OP
|
$8.93
|
|
|
Service Code
|
NDC 43547034350
|
| Hospital Charge Code |
43547034350
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.13 |
| Max. Negotiated Rate |
$7.15 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.91
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.47
|
| Rate for Payer: Aetna Government |
$4.47
|
| Rate for Payer: Brighton Health Commercial |
$6.70
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7.15
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.07
|
| 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
|
|
|
RISPERIDONE 3 MG TAB
|
Facility
|
OP
|
$16.00
|
|
| Hospital Charge Code |
41640542
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.60 |
| Max. Negotiated Rate |
$12.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$8.80
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8.00
|
| Rate for Payer: Aetna Government |
$8.00
|
| Rate for Payer: Brighton Health Commercial |
$12.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$12.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$10.88
|
| Rate for Payer: Group Health Inc Commercial |
$8.00
|
| Rate for Payer: Group Health Inc Medicare |
$5.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$10.40
|
|
|
RISPERIDONE 3 MG TAB
|
Facility
|
OP
|
$16.00
|
|
| Hospital Charge Code |
41650542
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.60 |
| Max. Negotiated Rate |
$12.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$8.80
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8.00
|
| Rate for Payer: Aetna Government |
$8.00
|
| Rate for Payer: Brighton Health Commercial |
$12.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$12.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$10.88
|
| Rate for Payer: Group Health Inc Commercial |
$8.00
|
| Rate for Payer: Group Health Inc Medicare |
$5.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$10.40
|
|
|
RISPERIDONE 4 MG PO TABS [18310]
|
Facility
|
OP
|
$10.83
|
|
|
Service Code
|
NDC 00904636261
|
| Hospital Charge Code |
00904636261
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.79 |
| Max. Negotiated Rate |
$8.66 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.96
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.41
|
| Rate for Payer: Aetna Government |
$5.41
|
| Rate for Payer: Brighton Health Commercial |
$8.12
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.66
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7.36
|
| Rate for Payer: Group Health Inc Commercial |
$5.41
|
| Rate for Payer: Group Health Inc Medicare |
$3.79
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.41
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.41
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$7.04
|
|
|
RISPERIDONE 4 MG PO TABS [18310]
|
Facility
|
OP
|
$12.00
|
|
|
Service Code
|
NDC 68382011714
|
| Hospital Charge Code |
68382011714
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.20 |
| Max. Negotiated Rate |
$9.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.00
|
| Rate for Payer: Aetna Government |
$6.00
|
| Rate for Payer: Brighton Health Commercial |
$9.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$9.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$8.16
|
| Rate for Payer: Group Health Inc Commercial |
$6.00
|
| Rate for Payer: Group Health Inc Medicare |
$4.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$7.80
|
|
|
RISPERIDONE 4 MG PO TABS [18310]
|
Facility
|
OP
|
$12.00
|
|
|
Service Code
|
NDC 43547034406
|
| Hospital Charge Code |
43547034406
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.20 |
| Max. Negotiated Rate |
$9.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.00
|
| Rate for Payer: Aetna Government |
$6.00
|
| Rate for Payer: Brighton Health Commercial |
$9.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$9.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$8.16
|
| Rate for Payer: Group Health Inc Commercial |
$6.00
|
| Rate for Payer: Group Health Inc Medicare |
$4.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$7.80
|
|
|
RISPERIDONE 4 MG TAB
|
Facility
|
OP
|
$1.03
|
|
| Hospital Charge Code |
41645583
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$0.82 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.57
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.52
|
| Rate for Payer: Aetna Government |
$0.52
|
| Rate for Payer: Brighton Health Commercial |
$0.77
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.82
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.70
|
| Rate for Payer: Group Health Inc Commercial |
$0.52
|
| Rate for Payer: Group Health Inc Medicare |
$0.36
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.67
|
|
|
RISPERIDONE 4 MG TAB
|
Facility
|
OP
|
$1.03
|
|
| Hospital Charge Code |
41655583
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$0.82 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.57
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.52
|
| Rate for Payer: Aetna Government |
$0.52
|
| Rate for Payer: Brighton Health Commercial |
$0.77
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.82
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.70
|
| Rate for Payer: Group Health Inc Commercial |
$0.52
|
| Rate for Payer: Group Health Inc Medicare |
$0.36
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.67
|
|
|
RISPERIDONE CONSTA 25 MG INJ
|
Facility
|
OP
|
$7.63
|
|
|
Service Code
|
HCPCS J2794
|
| Hospital Charge Code |
41643130
|
|
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
|
|
|
RISPERIDONE CONSTA 25 MG INJ
|
Facility
|
IP
|
$7.63
|
|
|
Service Code
|
HCPCS J2794
|
| Hospital Charge Code |
41653130
|
|
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
|
|
|
RISPERIDONE CONSTA 25 MG INJ
|
Facility
|
IP
|
$7.63
|
|
|
Service Code
|
HCPCS J2794
|
| Hospital Charge Code |
41643130
|
|
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
|
|
|
RISPERIDONE CONSTA 25 MG INJ
|
Facility
|
OP
|
$7.63
|
|
|
Service Code
|
HCPCS J2794
|
| Hospital Charge Code |
41653130
|
|
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
|
|
|
RISPERIDONE CONSTA 37.5 MG INJ
|
Facility
|
OP
|
$7.63
|
|
|
Service Code
|
HCPCS J2794
|
| Hospital Charge Code |
41643131
|
|
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
|
|
|
RISPERIDONE CONSTA 37.5 MG INJ
|
Facility
|
IP
|
$7.63
|
|
|
Service Code
|
HCPCS J2794
|
| Hospital Charge Code |
41653131
|
|
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
|
|
|
RISPERIDONE CONSTA 37.5 MG INJ
|
Facility
|
IP
|
$7.63
|
|
|
Service Code
|
HCPCS J2794
|
| Hospital Charge Code |
41643131
|
|
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
|
|
|
RISPERIDONE CONSTA 37.5 MG INJ
|
Facility
|
OP
|
$7.63
|
|
|
Service Code
|
HCPCS J2794
|
| Hospital Charge Code |
41653131
|
|
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
|
|
|
RISPERIDONE CONSTA 50 MG INJ
|
Facility
|
IP
|
$7.63
|
|
|
Service Code
|
HCPCS J2794
|
| Hospital Charge Code |
41643132
|
|
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
|
|
|
RISPERIDONE CONSTA 50 MG INJ
|
Facility
|
OP
|
$7.63
|
|
|
Service Code
|
HCPCS J2794
|
| Hospital Charge Code |
41653132
|
|
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
|
|
|
RISPERIDONE CONSTA 50 MG INJ
|
Facility
|
OP
|
$7.63
|
|
|
Service Code
|
HCPCS J2794
|
| Hospital Charge Code |
41643132
|
|
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
|
|
|
RISPERIDONE CONSTA 50 MG INJ
|
Facility
|
IP
|
$7.63
|
|
|
Service Code
|
HCPCS J2794
|
| Hospital Charge Code |
41653132
|
|
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
|
|
