|
RITUXIMAB 500 MG/50ML IV SOLN [129648]
|
Facility
|
OP
|
$112.74
|
|
|
Service Code
|
HCPCS J9312
|
| Hospital Charge Code |
50242005306
|
|
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-ABBS 100 MG/10ML IV SOLN [170115]
|
Facility
|
OP
|
$101.47
|
|
|
Service Code
|
HCPCS Q5115
|
| Hospital Charge Code |
63459010310
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$28.71 |
| Max. Negotiated Rate |
$65.95 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$55.81
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$35.89
|
| Rate for Payer: Aetna Government |
$35.89
|
| Rate for Payer: Brighton Health Commercial |
$60.88
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$35.89
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$50.73
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$58.34
|
| Rate for Payer: Elderplan Medicare Advantage |
$35.89
|
| Rate for Payer: EmblemHealth Commercial |
$50.73
|
| Rate for Payer: Fidelis Medicare Advantage |
$35.89
|
| Rate for Payer: Group Health Inc Commercial |
$35.89
|
| Rate for Payer: Group Health Inc Medicare |
$35.89
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$50.73
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$50.73
|
| Rate for Payer: Healthfirst Medicare Advantage |
$30.51
|
| Rate for Payer: Healthfirst QHP |
$35.89
|
| Rate for Payer: Humana Medicare |
$36.61
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$35.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$65.95
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$28.71
|
|
|
RITUXIMAB-ABBS 100 MG/10ML IV SOLN [170115]
|
Facility
|
IP
|
$101.47
|
|
|
Service Code
|
HCPCS Q5115
|
| Hospital Charge Code |
63459010310
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$50.73 |
| Max. Negotiated Rate |
$50.73 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$50.73
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$50.73
|
|
|
RITUXIMAB-ABBS 500 MG/50ML IV SOLN [170116]
|
Facility
|
IP
|
$101.47
|
|
|
Service Code
|
HCPCS Q5115
|
| Hospital Charge Code |
63459010450
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$50.73 |
| Max. Negotiated Rate |
$50.73 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$50.73
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$50.73
|
|
|
RITUXIMAB-ABBS 500 MG/50ML IV SOLN [170116]
|
Facility
|
OP
|
$101.47
|
|
|
Service Code
|
HCPCS Q5115
|
| Hospital Charge Code |
63459010450
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$28.71 |
| Max. Negotiated Rate |
$65.95 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$55.81
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$35.89
|
| Rate for Payer: Aetna Government |
$35.89
|
| Rate for Payer: Brighton Health Commercial |
$60.88
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$35.89
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$50.73
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$58.34
|
| Rate for Payer: Elderplan Medicare Advantage |
$35.89
|
| Rate for Payer: EmblemHealth Commercial |
$50.73
|
| Rate for Payer: Fidelis Medicare Advantage |
$35.89
|
| Rate for Payer: Group Health Inc Commercial |
$35.89
|
| Rate for Payer: Group Health Inc Medicare |
$35.89
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$50.73
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$50.73
|
| Rate for Payer: Healthfirst Medicare Advantage |
$30.51
|
| Rate for Payer: Healthfirst QHP |
$35.89
|
| Rate for Payer: Humana Medicare |
$36.61
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$35.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$65.95
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$28.71
|
|
|
RITUXIMAB-ABSS
|
Facility
|
OP
|
$55.12
|
|
|
Service Code
|
HCPCS Q5115
|
| Hospital Charge Code |
41640281
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$25.12 |
| Max. Negotiated Rate |
$48.83 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$30.32
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$35.89
|
| Rate for Payer: Aetna Government |
$35.89
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$25.12
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$25.12
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$25.12
|
| Rate for Payer: Brighton Health Commercial |
$33.07
|
| Rate for Payer: Cash Price |
$35.89
|
| Rate for Payer: Cash Price |
$35.89
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$35.89
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$27.56
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$31.69
|
| Rate for Payer: Elderplan Medicare Advantage |
$35.89
|
| Rate for Payer: EmblemHealth Commercial |
$35.89
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$35.89
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$35.89
|
| Rate for Payer: Fidelis Essential Plan QHP |
$37.69
|
| Rate for Payer: Fidelis Medicare Advantage |
$35.89
|
| Rate for Payer: Fidelis Qualified Health Plan |
$37.69
|
| Rate for Payer: Group Health Inc Commercial |
$35.89
|
| Rate for Payer: Group Health Inc Medicare |
$35.89
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$27.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$27.56
|
| Rate for Payer: Healthfirst Medicare Advantage |
$30.51
|
| Rate for Payer: Healthfirst QHP |
$35.89
|
| Rate for Payer: Humana Medicare |
$36.61
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$35.89
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$32.84
|
| Rate for Payer: SOMOS Essential |
$32.84
|
| Rate for Payer: United Healthcare Commercial |
$48.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$35.83
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$28.71
|
| Rate for Payer: Wellcare Medicare |
$34.10
|
|
|
RITUXIMAB-ABSS
|
Facility
|
OP
|
$55.12
|
|
|
Service Code
|
HCPCS Q5115
|
| Hospital Charge Code |
41650281
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$25.12 |
| Max. Negotiated Rate |
$48.83 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$30.32
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$35.89
|
| Rate for Payer: Aetna Government |
$35.89
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$25.12
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$25.12
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$25.12
|
| Rate for Payer: Brighton Health Commercial |
$33.07
|
| Rate for Payer: Cash Price |
$35.89
|
| Rate for Payer: Cash Price |
$35.89
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$35.89
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$27.56
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$31.69
|
| Rate for Payer: Elderplan Medicare Advantage |
$35.89
|
| Rate for Payer: EmblemHealth Commercial |
$35.89
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$35.89
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$35.89
|
| Rate for Payer: Fidelis Essential Plan QHP |
$37.69
|
| Rate for Payer: Fidelis Medicare Advantage |
$35.89
|
| Rate for Payer: Fidelis Qualified Health Plan |
$37.69
|
| Rate for Payer: Group Health Inc Commercial |
$35.89
|
| Rate for Payer: Group Health Inc Medicare |
$35.89
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$27.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$27.56
|
| Rate for Payer: Healthfirst Medicare Advantage |
$30.51
|
| Rate for Payer: Healthfirst QHP |
$35.89
|
| Rate for Payer: Humana Medicare |
$36.61
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$35.89
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$32.84
|
| Rate for Payer: SOMOS Essential |
$32.84
|
| Rate for Payer: United Healthcare Commercial |
$48.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$35.83
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$28.71
|
| Rate for Payer: Wellcare Medicare |
$34.10
|
|
|
RITUXIMAB-ABSS
|
Facility
|
IP
|
$55.12
|
|
|
Service Code
|
HCPCS Q5115
|
| Hospital Charge Code |
41640281
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$27.56 |
| Max. Negotiated Rate |
$27.56 |
| Rate for Payer: Cash Price |
$35.89
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$27.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$27.56
|
|
|
RITUXIMAB-ABSS
|
Facility
|
IP
|
$55.12
|
|
|
Service Code
|
HCPCS Q5115
|
| Hospital Charge Code |
41650281
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$27.56 |
| Max. Negotiated Rate |
$27.56 |
| Rate for Payer: Cash Price |
$35.89
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$27.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$27.56
|
|
|
RITUXIMAB-ARRX 100 MG/10ML IV SOLN [176600]
|
Facility
|
OP
|
$86.02
|
|
|
Service Code
|
HCPCS Q5123
|
| Hospital Charge Code |
55513022401
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$33.14 |
| Max. Negotiated Rate |
$55.91 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$47.31
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$41.42
|
| Rate for Payer: Aetna Government |
$41.42
|
| Rate for Payer: Brighton Health Commercial |
$51.61
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$41.42
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$43.01
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$49.46
|
| Rate for Payer: Elderplan Medicare Advantage |
$41.42
|
| Rate for Payer: EmblemHealth Commercial |
$43.01
|
| Rate for Payer: Fidelis Medicare Advantage |
$41.42
|
| Rate for Payer: Group Health Inc Commercial |
$41.42
|
| Rate for Payer: Group Health Inc Medicare |
$41.42
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$43.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$43.01
|
| Rate for Payer: Healthfirst Medicare Advantage |
$35.21
|
| Rate for Payer: Healthfirst QHP |
$41.42
|
| Rate for Payer: Humana Medicare |
$42.25
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$41.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$41.42
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$55.91
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$33.14
|
|
|
RITUXIMAB-ARRX 100 MG/10ML IV SOLN [176600]
|
Facility
|
IP
|
$86.02
|
|
|
Service Code
|
HCPCS Q5123
|
| Hospital Charge Code |
55513022401
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$43.01 |
| Max. Negotiated Rate |
$43.01 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$43.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$43.01
|
|
|
RITUXIMAB-ARRX 500 MG/50ML IV SOLN [176601]
|
Facility
|
OP
|
$86.02
|
|
|
Service Code
|
HCPCS Q5123
|
| Hospital Charge Code |
55513032601
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$33.14 |
| Max. Negotiated Rate |
$55.91 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$47.31
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$41.42
|
| Rate for Payer: Aetna Government |
$41.42
|
| Rate for Payer: Brighton Health Commercial |
$51.61
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$41.42
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$43.01
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$49.46
|
| Rate for Payer: Elderplan Medicare Advantage |
$41.42
|
| Rate for Payer: EmblemHealth Commercial |
$43.01
|
| Rate for Payer: Fidelis Medicare Advantage |
$41.42
|
| Rate for Payer: Group Health Inc Commercial |
$41.42
|
| Rate for Payer: Group Health Inc Medicare |
$41.42
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$43.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$43.01
|
| Rate for Payer: Healthfirst Medicare Advantage |
$35.21
|
| Rate for Payer: Healthfirst QHP |
$41.42
|
| Rate for Payer: Humana Medicare |
$42.25
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$41.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$41.42
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$55.91
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$33.14
|
|
|
RITUXIMAB-ARRX 500 MG/50ML IV SOLN [176601]
|
Facility
|
IP
|
$86.02
|
|
|
Service Code
|
HCPCS Q5123
|
| Hospital Charge Code |
55513032601
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$43.01 |
| Max. Negotiated Rate |
$43.01 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$43.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$43.01
|
|
|
RITUXIMAB-PVVR 100 MG/10ML IV SOLN [171639]
|
Facility
|
IP
|
$86.02
|
|
|
Service Code
|
HCPCS Q5119
|
| Hospital Charge Code |
00069023801
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$43.01 |
| Max. Negotiated Rate |
$43.01 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$43.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$43.01
|
|
|
RITUXIMAB-PVVR 100 MG/10ML IV SOLN [171639]
|
Facility
|
OP
|
$86.02
|
|
|
Service Code
|
HCPCS Q5119
|
| Hospital Charge Code |
00069023801
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$16.36 |
| Max. Negotiated Rate |
$55.91 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$47.31
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$20.45
|
| Rate for Payer: Aetna Government |
$20.45
|
| Rate for Payer: Brighton Health Commercial |
$51.61
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$20.45
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$43.01
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$49.46
|
| Rate for Payer: Elderplan Medicare Advantage |
$20.45
|
| Rate for Payer: EmblemHealth Commercial |
$43.01
|
| Rate for Payer: Fidelis Medicare Advantage |
$20.45
|
| Rate for Payer: Group Health Inc Commercial |
$20.45
|
| Rate for Payer: Group Health Inc Medicare |
$20.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$43.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$43.01
|
| Rate for Payer: Healthfirst Medicare Advantage |
$17.38
|
| Rate for Payer: Healthfirst QHP |
$20.45
|
| Rate for Payer: Humana Medicare |
$20.86
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$20.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20.45
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$55.91
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$16.36
|
|
|
RITUXIMAB-PVVR 500 MG/50ML IV SOLN [171640]
|
Facility
|
IP
|
$86.02
|
|
|
Service Code
|
HCPCS Q5119
|
| Hospital Charge Code |
00069024901
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$43.01 |
| Max. Negotiated Rate |
$43.01 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$43.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$43.01
|
|
|
RITUXIMAB-PVVR 500 MG/50ML IV SOLN [171640]
|
Facility
|
OP
|
$86.02
|
|
|
Service Code
|
HCPCS Q5119
|
| Hospital Charge Code |
00069024901
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$16.36 |
| Max. Negotiated Rate |
$55.91 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$47.31
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$20.45
|
| Rate for Payer: Aetna Government |
$20.45
|
| Rate for Payer: Brighton Health Commercial |
$51.61
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$20.45
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$43.01
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$49.46
|
| Rate for Payer: Elderplan Medicare Advantage |
$20.45
|
| Rate for Payer: EmblemHealth Commercial |
$43.01
|
| Rate for Payer: Fidelis Medicare Advantage |
$20.45
|
| Rate for Payer: Group Health Inc Commercial |
$20.45
|
| Rate for Payer: Group Health Inc Medicare |
$20.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$43.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$43.01
|
| Rate for Payer: Healthfirst Medicare Advantage |
$17.38
|
| Rate for Payer: Healthfirst QHP |
$20.45
|
| Rate for Payer: Humana Medicare |
$20.86
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$20.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20.45
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$55.91
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$16.36
|
|
|
RIVAROXABAN 10 MG PO TABS [110250]
|
Facility
|
OP
|
$22.78
|
|
|
Service Code
|
NDC 50458058010
|
| Hospital Charge Code |
50458058010
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.97 |
| Max. Negotiated Rate |
$18.23 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$12.53
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$11.39
|
| Rate for Payer: Aetna Government |
$11.39
|
| Rate for Payer: Brighton Health Commercial |
$17.09
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$18.23
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$15.49
|
| Rate for Payer: Group Health Inc Commercial |
$11.39
|
| Rate for Payer: Group Health Inc Medicare |
$7.97
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$11.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$14.81
|
|
|
RIVAROXABAN 10 MG PO TABS [110250]
|
Facility
|
OP
|
$22.78
|
|
|
Service Code
|
NDC 50458058030
|
| Hospital Charge Code |
50458058030
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.97 |
| Max. Negotiated Rate |
$18.23 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$12.53
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$11.39
|
| Rate for Payer: Aetna Government |
$11.39
|
| Rate for Payer: Brighton Health Commercial |
$17.09
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$18.23
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$15.49
|
| Rate for Payer: Group Health Inc Commercial |
$11.39
|
| Rate for Payer: Group Health Inc Medicare |
$7.97
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$11.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$14.81
|
|
|
RIVAROXABAN 15 MG PO TABS [112834]
|
Facility
|
OP
|
$22.78
|
|
|
Service Code
|
NDC 50458057830
|
| Hospital Charge Code |
50458057830
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.97 |
| Max. Negotiated Rate |
$18.23 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$12.53
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$11.39
|
| Rate for Payer: Aetna Government |
$11.39
|
| Rate for Payer: Brighton Health Commercial |
$17.09
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$18.23
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$15.49
|
| Rate for Payer: Group Health Inc Commercial |
$11.39
|
| Rate for Payer: Group Health Inc Medicare |
$7.97
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$11.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$14.81
|
|
|
RIVAROXABAN 15 MG PO TABS [112834]
|
Facility
|
OP
|
$22.78
|
|
|
Service Code
|
NDC 50458057810
|
| Hospital Charge Code |
50458057810
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.97 |
| Max. Negotiated Rate |
$18.23 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$12.53
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$11.39
|
| Rate for Payer: Aetna Government |
$11.39
|
| Rate for Payer: Brighton Health Commercial |
$17.09
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$18.23
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$15.49
|
| Rate for Payer: Group Health Inc Commercial |
$11.39
|
| Rate for Payer: Group Health Inc Medicare |
$7.97
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$11.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$14.81
|
|
|
RIVAROXABAN 15MG TAB
|
Facility
|
OP
|
$10.36
|
|
| Hospital Charge Code |
41657999
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.63 |
| Max. Negotiated Rate |
$8.29 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.18
|
| Rate for Payer: Aetna Government |
$5.18
|
| Rate for Payer: Brighton Health Commercial |
$7.77
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.29
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7.04
|
| Rate for Payer: Group Health Inc Commercial |
$5.18
|
| Rate for Payer: Group Health Inc Medicare |
$3.63
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.18
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6.73
|
|
|
RIVAROXABAN 15MG TAB
|
Facility
|
OP
|
$10.36
|
|
| Hospital Charge Code |
41647999
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.63 |
| Max. Negotiated Rate |
$8.29 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.18
|
| Rate for Payer: Aetna Government |
$5.18
|
| Rate for Payer: Brighton Health Commercial |
$7.77
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.29
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7.04
|
| Rate for Payer: Group Health Inc Commercial |
$5.18
|
| Rate for Payer: Group Health Inc Medicare |
$3.63
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.18
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6.73
|
|
|
RIVAROXABAN 20 MG PO TABS [112835]
|
Facility
|
OP
|
$22.78
|
|
|
Service Code
|
NDC 50458057910
|
| Hospital Charge Code |
50458057910
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.97 |
| Max. Negotiated Rate |
$18.23 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$12.53
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$11.39
|
| Rate for Payer: Aetna Government |
$11.39
|
| Rate for Payer: Brighton Health Commercial |
$17.09
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$18.23
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$15.49
|
| Rate for Payer: Group Health Inc Commercial |
$11.39
|
| Rate for Payer: Group Health Inc Medicare |
$7.97
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$11.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$14.81
|
|
|
RIVAROXABAN 20 MG PO TABS [112835]
|
Facility
|
OP
|
$22.78
|
|
|
Service Code
|
NDC 50458057930
|
| Hospital Charge Code |
50458057930
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.97 |
| Max. Negotiated Rate |
$18.23 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$12.53
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$11.39
|
| Rate for Payer: Aetna Government |
$11.39
|
| Rate for Payer: Brighton Health Commercial |
$17.09
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$18.23
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$15.49
|
| Rate for Payer: Group Health Inc Commercial |
$11.39
|
| Rate for Payer: Group Health Inc Medicare |
$7.97
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$11.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$14.81
|
|
