|
RISPERIDONE MICROSPHERES ER 12.5 MG IM SRER [168906]
|
Facility
|
OP
|
$368.77
|
|
|
Service Code
|
HCPCS J2794
|
| Hospital Charge Code |
50458030911
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.51 |
| Max. Negotiated Rate |
$295.02 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$202.82
|
| 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 |
$276.58
|
| 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 |
$295.02
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$250.76
|
| Rate for Payer: Elderplan Medicare Advantage |
$12.15
|
| Rate for Payer: EmblemHealth Commercial |
$12.15
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$10.33
|
| Rate for Payer: Fidelis Essential Plan QHP |
$10.81
|
| Rate for Payer: Fidelis Medicare Advantage |
$12.15
|
| Rate for Payer: Fidelis Qualified Health Plan |
$10.81
|
| 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 |
$184.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.15
|
| 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: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$12.18
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$12.91
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$12.91
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$12.91
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$12.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$239.70
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$9.72
|
| Rate for Payer: Wellcare Medicare |
$11.54
|
|
|
RISPERIDONE MICROSPHERES ER 25 MG IM SRER [168907]
|
Facility
|
OP
|
$737.47
|
|
|
Service Code
|
HCPCS J2794
|
| Hospital Charge Code |
50458030611
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.51 |
| Max. Negotiated Rate |
$589.98 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$405.61
|
| 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 |
$553.10
|
| 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 |
$589.98
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$501.48
|
| Rate for Payer: Elderplan Medicare Advantage |
$12.15
|
| Rate for Payer: EmblemHealth Commercial |
$12.15
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$10.33
|
| Rate for Payer: Fidelis Essential Plan QHP |
$10.81
|
| Rate for Payer: Fidelis Medicare Advantage |
$12.15
|
| Rate for Payer: Fidelis Qualified Health Plan |
$10.81
|
| 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 |
$368.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.15
|
| 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: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$12.18
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$12.91
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$12.91
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$12.91
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$12.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$479.36
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$9.72
|
| Rate for Payer: Wellcare Medicare |
$11.54
|
|
|
RISPERIDONE MICROSPHERES ER 37.5 MG IM SRER [168908]
|
Facility
|
OP
|
$1,106.26
|
|
|
Service Code
|
HCPCS J2794
|
| Hospital Charge Code |
50458030711
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.51 |
| Max. Negotiated Rate |
$885.01 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$608.44
|
| 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 |
$829.70
|
| 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 |
$885.01
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$752.26
|
| Rate for Payer: Elderplan Medicare Advantage |
$12.15
|
| Rate for Payer: EmblemHealth Commercial |
$12.15
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$10.33
|
| Rate for Payer: Fidelis Essential Plan QHP |
$10.81
|
| Rate for Payer: Fidelis Medicare Advantage |
$12.15
|
| Rate for Payer: Fidelis Qualified Health Plan |
$10.81
|
| 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 |
$553.13
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.15
|
| 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: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$12.18
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$12.91
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$12.91
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$12.91
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$12.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$719.07
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$9.72
|
| Rate for Payer: Wellcare Medicare |
$11.54
|
|
|
RISPERIDONE MICROSPHERES ER 50 MG IM SRER [168909]
|
Facility
|
OP
|
$1,475.05
|
|
|
Service Code
|
HCPCS J2794
|
| Hospital Charge Code |
50458030811
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.51 |
| Max. Negotiated Rate |
$1,180.04 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$811.28
|
| 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 |
$1,106.29
|
| 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 |
$1,180.04
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,003.03
|
| Rate for Payer: Elderplan Medicare Advantage |
$12.15
|
| Rate for Payer: EmblemHealth Commercial |
$12.15
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$10.33
|
| Rate for Payer: Fidelis Essential Plan QHP |
$10.81
|
| Rate for Payer: Fidelis Medicare Advantage |
$12.15
|
| Rate for Payer: Fidelis Qualified Health Plan |
$10.81
|
| 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 |
$737.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.15
|
| 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: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$12.18
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$12.91
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$12.91
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$12.91
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$12.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$958.78
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$9.72
|
| Rate for Payer: Wellcare Medicare |
$11.54
|
|
|
RITA MEDICAL SYSTEMS LIFEPORT
|
Facility
|
OP
|
$390.00
|
|
| Hospital Charge Code |
40203335
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$136.50 |
| Max. Negotiated Rate |
$312.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$214.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$195.00
|
| Rate for Payer: Aetna Government |
$195.00
|
| Rate for Payer: Brighton Health Commercial |
$292.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$312.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$265.20
|
| Rate for Payer: Group Health Inc Commercial |
$195.00
|
| Rate for Payer: Group Health Inc Medicare |
$136.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$195.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$195.00
|
|
|
RITA MEDICAL SYSTEMS LIFEPORT
|
Facility
|
OP
|
$390.00
|
|
| Hospital Charge Code |
40009317
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$136.50 |
| Max. Negotiated Rate |
$312.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$214.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$195.00
|
| Rate for Payer: Aetna Government |
$195.00
|
| Rate for Payer: Brighton Health Commercial |
$292.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$312.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$265.20
|
| Rate for Payer: Group Health Inc Commercial |
$195.00
|
| Rate for Payer: Group Health Inc Medicare |
$136.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$195.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$195.00
|
|
|
RITONAVIR 100 MG PO TABS [100995]
|
Facility
|
OP
|
$9.26
|
|
|
Service Code
|
NDC 65862068730
|
| Hospital Charge Code |
65862068730
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.24 |
| Max. Negotiated Rate |
$7.41 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.09
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.63
|
| Rate for Payer: Aetna Government |
$4.63
|
| Rate for Payer: Brighton Health Commercial |
$6.94
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7.41
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.30
|
| Rate for Payer: Group Health Inc Commercial |
$4.63
|
| Rate for Payer: Group Health Inc Medicare |
$3.24
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.63
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.63
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6.02
|
|
|
RITONAVIR 100 MG PO TABS [100995]
|
Facility
|
OP
|
$10.29
|
|
|
Service Code
|
NDC 00074234030
|
| Hospital Charge Code |
00074234030
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.60 |
| Max. Negotiated Rate |
$8.23 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.66
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.14
|
| Rate for Payer: Aetna Government |
$5.14
|
| Rate for Payer: Brighton Health Commercial |
$7.72
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.23
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7.00
|
| Rate for Payer: Group Health Inc Commercial |
$5.14
|
| Rate for Payer: Group Health Inc Medicare |
$3.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6.69
|
|
|
RITONAVIR 100MG POWDER
|
Facility
|
OP
|
$39.22
|
|
| Hospital Charge Code |
41650332
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.73 |
| Max. Negotiated Rate |
$31.38 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$21.57
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$19.61
|
| Rate for Payer: Aetna Government |
$19.61
|
| Rate for Payer: Brighton Health Commercial |
$29.42
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$31.38
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$26.67
|
| Rate for Payer: Group Health Inc Commercial |
$19.61
|
| Rate for Payer: Group Health Inc Medicare |
$13.73
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$19.61
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$19.61
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$25.49
|
|
|
RITONAVIR 100MG POWDER
|
Facility
|
OP
|
$39.22
|
|
| Hospital Charge Code |
41640332
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.73 |
| Max. Negotiated Rate |
$31.38 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$21.57
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$19.61
|
| Rate for Payer: Aetna Government |
$19.61
|
| Rate for Payer: Brighton Health Commercial |
$29.42
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$31.38
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$26.67
|
| Rate for Payer: Group Health Inc Commercial |
$19.61
|
| Rate for Payer: Group Health Inc Medicare |
$13.73
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$19.61
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$19.61
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$25.49
|
|
|
RITONAVIR 100 MG TAB
|
Facility
|
OP
|
$16.99
|
|
| Hospital Charge Code |
41655573
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.95 |
| Max. Negotiated Rate |
$13.59 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$9.34
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8.50
|
| Rate for Payer: Aetna Government |
$8.50
|
| Rate for Payer: Brighton Health Commercial |
$12.74
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$13.59
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$11.55
|
| Rate for Payer: Group Health Inc Commercial |
$8.50
|
| Rate for Payer: Group Health Inc Medicare |
$5.95
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$11.04
|
|
|
RITONAVIR 100 MG TAB
|
Facility
|
OP
|
$16.99
|
|
| Hospital Charge Code |
41645573
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.95 |
| Max. Negotiated Rate |
$13.59 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$9.34
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8.50
|
| Rate for Payer: Aetna Government |
$8.50
|
| Rate for Payer: Brighton Health Commercial |
$12.74
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$13.59
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$11.55
|
| Rate for Payer: Group Health Inc Commercial |
$8.50
|
| Rate for Payer: Group Health Inc Medicare |
$5.95
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$11.04
|
|
|
RITONAVIR 80 MG/ML SOLN
|
Facility
|
OP
|
$14.00
|
|
| Hospital Charge Code |
41640928
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.90 |
| Max. Negotiated Rate |
$11.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$7.00
|
| Rate for Payer: Aetna Government |
$7.00
|
| Rate for Payer: Brighton Health Commercial |
$10.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$11.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$9.52
|
| Rate for Payer: Group Health Inc Commercial |
$7.00
|
| Rate for Payer: Group Health Inc Medicare |
$4.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$9.10
|
|
|
RITONAVIR 80 MG/ML SOLN
|
Facility
|
OP
|
$14.00
|
|
| Hospital Charge Code |
41650928
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.90 |
| Max. Negotiated Rate |
$11.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$7.00
|
| Rate for Payer: Aetna Government |
$7.00
|
| Rate for Payer: Brighton Health Commercial |
$10.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$11.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$9.52
|
| Rate for Payer: Group Health Inc Commercial |
$7.00
|
| Rate for Payer: Group Health Inc Medicare |
$4.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$9.10
|
|
|
RITUXIMAB 100 MG/10 ML INJ
|
Facility
|
IP
|
$2,428.00
|
|
|
Service Code
|
HCPCS J9312
|
| Hospital Charge Code |
41652921
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,214.00 |
| Max. Negotiated Rate |
$1,214.00 |
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,214.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,214.00
|
|
|
RITUXIMAB 100 MG/10 ML INJ
|
Facility
|
OP
|
$2,428.00
|
|
|
Service Code
|
HCPCS J9312
|
| Hospital Charge Code |
41642921
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$55.44 |
| Max. Negotiated Rate |
$1,578.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,335.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$79.20
|
| Rate for Payer: Aetna Government |
$79.20
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$55.44
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$55.44
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$55.44
|
| Rate for Payer: Brighton Health Commercial |
$1,456.80
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$79.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,214.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,396.10
|
| Rate for Payer: Elderplan Medicare Advantage |
$79.20
|
| Rate for Payer: EmblemHealth Commercial |
$79.20
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$79.20
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$79.20
|
| Rate for Payer: Fidelis Essential Plan QHP |
$83.16
|
| Rate for Payer: Fidelis Medicare Advantage |
$79.20
|
| Rate for Payer: Fidelis Qualified Health Plan |
$83.16
|
| Rate for Payer: Group Health Inc Commercial |
$79.20
|
| Rate for Payer: Group Health Inc Medicare |
$79.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,214.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,214.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$67.32
|
| Rate for Payer: Healthfirst QHP |
$79.20
|
| Rate for Payer: Humana Medicare |
$80.78
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$79.20
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$83.60
|
| Rate for Payer: SOMOS Essential |
$83.60
|
| Rate for Payer: United Healthcare Commercial |
$81.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$79.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,578.20
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$63.36
|
| Rate for Payer: Wellcare Medicare |
$75.24
|
|
|
RITUXIMAB 100 MG/10 ML INJ
|
Facility
|
IP
|
$2,428.00
|
|
|
Service Code
|
HCPCS J9312
|
| Hospital Charge Code |
41642921
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,214.00 |
| Max. Negotiated Rate |
$1,214.00 |
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,214.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,214.00
|
|
|
RITUXIMAB 100 MG/10 ML INJ
|
Facility
|
OP
|
$2,428.00
|
|
|
Service Code
|
HCPCS J9312
|
| Hospital Charge Code |
41652921
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$55.44 |
| Max. Negotiated Rate |
$1,578.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,335.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$79.20
|
| Rate for Payer: Aetna Government |
$79.20
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$55.44
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$55.44
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$55.44
|
| Rate for Payer: Brighton Health Commercial |
$1,456.80
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$79.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,214.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,396.10
|
| Rate for Payer: Elderplan Medicare Advantage |
$79.20
|
| Rate for Payer: EmblemHealth Commercial |
$79.20
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$79.20
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$79.20
|
| Rate for Payer: Fidelis Essential Plan QHP |
$83.16
|
| Rate for Payer: Fidelis Medicare Advantage |
$79.20
|
| Rate for Payer: Fidelis Qualified Health Plan |
$83.16
|
| Rate for Payer: Group Health Inc Commercial |
$79.20
|
| Rate for Payer: Group Health Inc Medicare |
$79.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,214.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,214.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$67.32
|
| Rate for Payer: Healthfirst QHP |
$79.20
|
| Rate for Payer: Humana Medicare |
$80.78
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$79.20
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$83.60
|
| Rate for Payer: SOMOS Essential |
$83.60
|
| Rate for Payer: United Healthcare Commercial |
$81.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$79.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,578.20
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$63.36
|
| Rate for Payer: Wellcare Medicare |
$75.24
|
|
|
RITUXIMAB 100 MG/10ML IV SOLN [129647]
|
Facility
|
OP
|
$112.74
|
|
|
Service Code
|
HCPCS J9312
|
| Hospital Charge Code |
50242005121
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$56.37 |
| Max. Negotiated Rate |
$80.78 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$62.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$79.20
|
| Rate for Payer: Aetna Government |
$79.20
|
| Rate for Payer: Brighton Health Commercial |
$67.65
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$79.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$56.37
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$64.83
|
| Rate for Payer: Elderplan Medicare Advantage |
$79.20
|
| Rate for Payer: EmblemHealth Commercial |
$56.37
|
| Rate for Payer: Fidelis Medicare Advantage |
$79.20
|
| Rate for Payer: Group Health Inc Commercial |
$79.20
|
| Rate for Payer: Group Health Inc Medicare |
$79.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$56.37
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$56.37
|
| Rate for Payer: Healthfirst Medicare Advantage |
$67.32
|
| Rate for Payer: Healthfirst QHP |
$79.20
|
| Rate for Payer: Humana Medicare |
$80.78
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$79.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$79.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$73.28
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$63.36
|
|
|
RITUXIMAB 100 MG/10ML IV SOLN [129647]
|
Facility
|
IP
|
$112.74
|
|
|
Service Code
|
HCPCS J9312
|
| Hospital Charge Code |
50242005121
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$56.37 |
| Max. Negotiated Rate |
$56.37 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$56.37
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$56.37
|
|
|
RITUXIMAB 500 MG/50 ML INJ
|
Facility
|
IP
|
$2,428.00
|
|
|
Service Code
|
HCPCS J9312
|
| Hospital Charge Code |
41642922
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,214.00 |
| Max. Negotiated Rate |
$1,214.00 |
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,214.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,214.00
|
|
|
RITUXIMAB 500 MG/50 ML INJ
|
Facility
|
OP
|
$2,428.00
|
|
|
Service Code
|
HCPCS J9312
|
| Hospital Charge Code |
41652922
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$55.44 |
| Max. Negotiated Rate |
$1,578.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,335.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$79.20
|
| Rate for Payer: Aetna Government |
$79.20
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$55.44
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$55.44
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$55.44
|
| Rate for Payer: Brighton Health Commercial |
$1,456.80
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$79.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,214.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,396.10
|
| Rate for Payer: Elderplan Medicare Advantage |
$79.20
|
| Rate for Payer: EmblemHealth Commercial |
$79.20
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$79.20
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$79.20
|
| Rate for Payer: Fidelis Essential Plan QHP |
$83.16
|
| Rate for Payer: Fidelis Medicare Advantage |
$79.20
|
| Rate for Payer: Fidelis Qualified Health Plan |
$83.16
|
| Rate for Payer: Group Health Inc Commercial |
$79.20
|
| Rate for Payer: Group Health Inc Medicare |
$79.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,214.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,214.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$67.32
|
| Rate for Payer: Healthfirst QHP |
$79.20
|
| Rate for Payer: Humana Medicare |
$80.78
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$79.20
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$83.60
|
| Rate for Payer: SOMOS Essential |
$83.60
|
| Rate for Payer: United Healthcare Commercial |
$81.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$79.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,578.20
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$63.36
|
| Rate for Payer: Wellcare Medicare |
$75.24
|
|
|
RITUXIMAB 500 MG/50 ML INJ
|
Facility
|
IP
|
$2,428.00
|
|
|
Service Code
|
HCPCS J9312
|
| Hospital Charge Code |
41652922
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,214.00 |
| Max. Negotiated Rate |
$1,214.00 |
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,214.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,214.00
|
|
|
RITUXIMAB 500 MG/50 ML INJ
|
Facility
|
OP
|
$2,428.00
|
|
|
Service Code
|
HCPCS J9312
|
| Hospital Charge Code |
41642922
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$55.44 |
| Max. Negotiated Rate |
$1,578.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,335.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$79.20
|
| Rate for Payer: Aetna Government |
$79.20
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$55.44
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$55.44
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$55.44
|
| Rate for Payer: Brighton Health Commercial |
$1,456.80
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$79.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,214.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,396.10
|
| Rate for Payer: Elderplan Medicare Advantage |
$79.20
|
| Rate for Payer: EmblemHealth Commercial |
$79.20
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$79.20
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$79.20
|
| Rate for Payer: Fidelis Essential Plan QHP |
$83.16
|
| Rate for Payer: Fidelis Medicare Advantage |
$79.20
|
| Rate for Payer: Fidelis Qualified Health Plan |
$83.16
|
| Rate for Payer: Group Health Inc Commercial |
$79.20
|
| Rate for Payer: Group Health Inc Medicare |
$79.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,214.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,214.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$67.32
|
| Rate for Payer: Healthfirst QHP |
$79.20
|
| Rate for Payer: Humana Medicare |
$80.78
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$79.20
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$83.60
|
| Rate for Payer: SOMOS Essential |
$83.60
|
| Rate for Payer: United Healthcare Commercial |
$81.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$79.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,578.20
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$63.36
|
| Rate for Payer: Wellcare Medicare |
$75.24
|
|
|
RITUXIMAB 500 MG/50ML IV SOLN [129648]
|
Facility
|
IP
|
$112.74
|
|
|
Service Code
|
HCPCS J9312
|
| Hospital Charge Code |
50242005306
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$56.37 |
| Max. Negotiated Rate |
$56.37 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$56.37
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$56.37
|
|
