|
NITROPRUSSIDE SODIUM 25 MG/ML IV SOLN [18908]
|
Facility
|
OP
|
$14.70
|
|
|
Service Code
|
NDC 70121118901
|
| Hospital Charge Code |
70121118901
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5.14 |
| Max. Negotiated Rate |
$15.44 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$8.08
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$7.35
|
| Rate for Payer: Aetna Government |
$7.35
|
| Rate for Payer: Brighton Health Commercial |
$8.82
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7.35
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$8.45
|
| Rate for Payer: EmblemHealth Commercial |
$7.35
|
| Rate for Payer: Fidelis Medicare Advantage |
$15.44
|
| Rate for Payer: Group Health Inc Commercial |
$7.35
|
| Rate for Payer: Group Health Inc Medicare |
$5.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.35
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$9.56
|
|
|
NITROPRUSSIDE SODIUM 25 MG/ML IV SOLN [18908]
|
Facility
|
IP
|
$12.50
|
|
|
Service Code
|
NDC 70436002880
|
| Hospital Charge Code |
70436002880
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.25 |
| Max. Negotiated Rate |
$6.25 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.25
|
|
|
NITROPRUSSIDE SODIUM 25 MG/ML IV SOLN [18908]
|
Facility
|
OP
|
$12.50
|
|
|
Service Code
|
NDC 70436002880
|
| Hospital Charge Code |
70436002880
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4.38 |
| Max. Negotiated Rate |
$13.12 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.88
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.25
|
| Rate for Payer: Aetna Government |
$6.25
|
| Rate for Payer: Brighton Health Commercial |
$7.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.25
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7.19
|
| Rate for Payer: EmblemHealth Commercial |
$6.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$13.12
|
| Rate for Payer: Group Health Inc Commercial |
$6.25
|
| Rate for Payer: Group Health Inc Medicare |
$4.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8.12
|
|
|
NITROPRUSSIDE SODIUM 25 MG/ML IV SOLN [18908]
|
Facility
|
OP
|
$161.82
|
|
|
Service Code
|
NDC 67457083902
|
| Hospital Charge Code |
67457083902
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$56.64 |
| Max. Negotiated Rate |
$169.91 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$89.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$80.91
|
| Rate for Payer: Aetna Government |
$80.91
|
| Rate for Payer: Brighton Health Commercial |
$97.09
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$80.91
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$93.05
|
| Rate for Payer: EmblemHealth Commercial |
$80.91
|
| Rate for Payer: Fidelis Medicare Advantage |
$169.91
|
| Rate for Payer: Group Health Inc Commercial |
$80.91
|
| Rate for Payer: Group Health Inc Medicare |
$56.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$80.91
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$80.91
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$105.18
|
|
|
NITROPRUSSIDE SODIUM 25 MG/ML IV SOLN [18908]
|
Facility
|
IP
|
$14.70
|
|
|
Service Code
|
NDC 70121118901
|
| Hospital Charge Code |
70121118901
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7.35 |
| Max. Negotiated Rate |
$7.35 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.35
|
|
|
NITROPRUSSIDE SODIUM 25 MG/ML IV SOLN [18908]
|
Facility
|
IP
|
$12.50
|
|
|
Service Code
|
NDC 70069026101
|
| Hospital Charge Code |
70069026101
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.25 |
| Max. Negotiated Rate |
$6.25 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.25
|
|
|
NITROPRUSSIDE SODIUM 25 MG/ML IV SOLN [18908]
|
Facility
|
OP
|
$12.50
|
|
|
Service Code
|
NDC 70069026101
|
| Hospital Charge Code |
70069026101
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4.38 |
| Max. Negotiated Rate |
$13.12 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.88
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.25
|
| Rate for Payer: Aetna Government |
$6.25
|
| Rate for Payer: Brighton Health Commercial |
$7.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.25
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7.19
|
| Rate for Payer: EmblemHealth Commercial |
$6.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$13.12
|
| Rate for Payer: Group Health Inc Commercial |
$6.25
|
| Rate for Payer: Group Health Inc Medicare |
$4.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8.12
|
|
|
NI UROPCH V2 UCLR 57MM 2-1/4 FLG
|
Facility
|
OP
|
$13.28
|
|
|
Service Code
|
HCPCS A4432
|
| Hospital Charge Code |
40005166
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.18 |
| Max. Negotiated Rate |
$10.62 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.18
|
| Rate for Payer: Aetna Government |
$2.18
|
| Rate for Payer: Brighton Health Commercial |
$9.96
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$10.62
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$9.03
|
| Rate for Payer: Group Health Inc Commercial |
$6.64
|
| Rate for Payer: Group Health Inc Medicare |
$4.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.64
|
|
|
NIVOLUMAB 100MG/10ML INJ
|
Facility
|
IP
|
$67.53
|
|
|
Service Code
|
HCPCS J9299
|
| Hospital Charge Code |
41657860
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$33.76 |
| Max. Negotiated Rate |
$33.76 |
| Rate for Payer: Cash Price |
$31.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$33.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$33.76
|
|
|
NIVOLUMAB 100MG/10ML INJ
|
Facility
|
OP
|
$67.53
|
|
|
Service Code
|
HCPCS J9299
|
| Hospital Charge Code |
41657860
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.76 |
| Max. Negotiated Rate |
$43.89 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$37.14
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$31.09
|
| Rate for Payer: Aetna Government |
$31.09
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$21.76
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$21.76
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$21.76
|
| Rate for Payer: Brighton Health Commercial |
$40.52
|
| Rate for Payer: Cash Price |
$31.09
|
| Rate for Payer: Cash Price |
$31.09
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$31.09
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$33.76
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$38.83
|
| Rate for Payer: Elderplan Medicare Advantage |
$31.09
|
| Rate for Payer: EmblemHealth Commercial |
$31.09
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$31.09
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$31.09
|
| Rate for Payer: Fidelis Essential Plan QHP |
$32.64
|
| Rate for Payer: Fidelis Medicare Advantage |
$31.09
|
| Rate for Payer: Fidelis Qualified Health Plan |
$32.64
|
| Rate for Payer: Group Health Inc Commercial |
$31.09
|
| Rate for Payer: Group Health Inc Medicare |
$31.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$33.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$33.76
|
| Rate for Payer: Healthfirst Medicare Advantage |
$26.43
|
| Rate for Payer: Healthfirst QHP |
$31.09
|
| Rate for Payer: Humana Medicare |
$31.71
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$31.09
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$32.96
|
| Rate for Payer: SOMOS Essential |
$32.96
|
| Rate for Payer: United Healthcare Commercial |
$30.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$31.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$43.89
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$24.87
|
| Rate for Payer: Wellcare Medicare |
$29.53
|
|
|
NIVOLUMAB 100MG/10ML INJ
|
Facility
|
OP
|
$67.53
|
|
|
Service Code
|
HCPCS J9299
|
| Hospital Charge Code |
41647860
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.76 |
| Max. Negotiated Rate |
$43.89 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$37.14
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$31.09
|
| Rate for Payer: Aetna Government |
$31.09
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$21.76
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$21.76
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$21.76
|
| Rate for Payer: Brighton Health Commercial |
$40.52
|
| Rate for Payer: Cash Price |
$31.09
|
| Rate for Payer: Cash Price |
$31.09
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$31.09
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$33.76
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$38.83
|
| Rate for Payer: Elderplan Medicare Advantage |
$31.09
|
| Rate for Payer: EmblemHealth Commercial |
$31.09
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$31.09
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$31.09
|
| Rate for Payer: Fidelis Essential Plan QHP |
$32.64
|
| Rate for Payer: Fidelis Medicare Advantage |
$31.09
|
| Rate for Payer: Fidelis Qualified Health Plan |
$32.64
|
| Rate for Payer: Group Health Inc Commercial |
$31.09
|
| Rate for Payer: Group Health Inc Medicare |
$31.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$33.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$33.76
|
| Rate for Payer: Healthfirst Medicare Advantage |
$26.43
|
| Rate for Payer: Healthfirst QHP |
$31.09
|
| Rate for Payer: Humana Medicare |
$31.71
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$31.09
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$32.96
|
| Rate for Payer: SOMOS Essential |
$32.96
|
| Rate for Payer: United Healthcare Commercial |
$30.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$31.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$43.89
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$24.87
|
| Rate for Payer: Wellcare Medicare |
$29.53
|
|
|
NIVOLUMAB 100MG/10ML INJ
|
Facility
|
IP
|
$67.53
|
|
|
Service Code
|
HCPCS J9299
|
| Hospital Charge Code |
41647860
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$33.76 |
| Max. Negotiated Rate |
$33.76 |
| Rate for Payer: Cash Price |
$31.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$33.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$33.76
|
|
|
NIVOLUMAB 100 MG/10ML IV SOLN [127844]
|
Facility
|
OP
|
$374.25
|
|
|
Service Code
|
HCPCS J9299
|
| Hospital Charge Code |
00003377412
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$24.87 |
| Max. Negotiated Rate |
$243.26 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$205.84
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$31.09
|
| Rate for Payer: Aetna Government |
$31.09
|
| Rate for Payer: Brighton Health Commercial |
$224.55
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$31.09
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$187.12
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$215.19
|
| Rate for Payer: Elderplan Medicare Advantage |
$31.09
|
| Rate for Payer: EmblemHealth Commercial |
$187.12
|
| Rate for Payer: Fidelis Medicare Advantage |
$31.09
|
| Rate for Payer: Group Health Inc Commercial |
$31.09
|
| Rate for Payer: Group Health Inc Medicare |
$31.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$187.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$187.12
|
| Rate for Payer: Healthfirst Medicare Advantage |
$26.43
|
| Rate for Payer: Healthfirst QHP |
$31.09
|
| Rate for Payer: Humana Medicare |
$31.71
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$31.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$31.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$243.26
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$24.87
|
|
|
NIVOLUMAB 100 MG/10ML IV SOLN [127844]
|
Facility
|
IP
|
$374.25
|
|
|
Service Code
|
HCPCS J9299
|
| Hospital Charge Code |
00003377412
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$187.12 |
| Max. Negotiated Rate |
$187.12 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$187.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$187.12
|
|
|
NIVOLUMAB 240MG/14ML INJ
|
Facility
|
IP
|
$35.27
|
|
|
Service Code
|
HCPCS J9299
|
| Hospital Charge Code |
41657859
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.64 |
| Max. Negotiated Rate |
$17.64 |
| Rate for Payer: Cash Price |
$31.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$17.64
|
|
|
NIVOLUMAB 240MG/14ML INJ
|
Facility
|
OP
|
$35.27
|
|
|
Service Code
|
HCPCS J9299
|
| Hospital Charge Code |
41657859
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.64 |
| Max. Negotiated Rate |
$32.96 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$19.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$31.09
|
| Rate for Payer: Aetna Government |
$31.09
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$21.76
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$21.76
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$21.76
|
| Rate for Payer: Brighton Health Commercial |
$21.16
|
| Rate for Payer: Cash Price |
$31.09
|
| Rate for Payer: Cash Price |
$31.09
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$31.09
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$17.64
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$20.28
|
| Rate for Payer: Elderplan Medicare Advantage |
$31.09
|
| Rate for Payer: EmblemHealth Commercial |
$31.09
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$31.09
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$31.09
|
| Rate for Payer: Fidelis Essential Plan QHP |
$32.64
|
| Rate for Payer: Fidelis Medicare Advantage |
$31.09
|
| Rate for Payer: Fidelis Qualified Health Plan |
$32.64
|
| Rate for Payer: Group Health Inc Commercial |
$31.09
|
| Rate for Payer: Group Health Inc Medicare |
$31.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$17.64
|
| Rate for Payer: Healthfirst Medicare Advantage |
$26.43
|
| Rate for Payer: Healthfirst QHP |
$31.09
|
| Rate for Payer: Humana Medicare |
$31.71
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$31.09
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$32.96
|
| Rate for Payer: SOMOS Essential |
$32.96
|
| Rate for Payer: United Healthcare Commercial |
$30.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$31.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$22.93
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$24.87
|
| Rate for Payer: Wellcare Medicare |
$29.53
|
|
|
NIVOLUMAB 240MG/14ML INJ
|
Facility
|
IP
|
$35.27
|
|
|
Service Code
|
HCPCS J9299
|
| Hospital Charge Code |
41647859
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.64 |
| Max. Negotiated Rate |
$17.64 |
| Rate for Payer: Cash Price |
$31.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$17.64
|
|
|
NIVOLUMAB 240MG/14ML INJ
|
Facility
|
OP
|
$35.27
|
|
|
Service Code
|
HCPCS J9299
|
| Hospital Charge Code |
41647859
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.64 |
| Max. Negotiated Rate |
$32.96 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$19.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$31.09
|
| Rate for Payer: Aetna Government |
$31.09
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$21.76
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$21.76
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$21.76
|
| Rate for Payer: Brighton Health Commercial |
$21.16
|
| Rate for Payer: Cash Price |
$31.09
|
| Rate for Payer: Cash Price |
$31.09
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$31.09
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$17.64
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$20.28
|
| Rate for Payer: Elderplan Medicare Advantage |
$31.09
|
| Rate for Payer: EmblemHealth Commercial |
$31.09
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$31.09
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$31.09
|
| Rate for Payer: Fidelis Essential Plan QHP |
$32.64
|
| Rate for Payer: Fidelis Medicare Advantage |
$31.09
|
| Rate for Payer: Fidelis Qualified Health Plan |
$32.64
|
| Rate for Payer: Group Health Inc Commercial |
$31.09
|
| Rate for Payer: Group Health Inc Medicare |
$31.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$17.64
|
| Rate for Payer: Healthfirst Medicare Advantage |
$26.43
|
| Rate for Payer: Healthfirst QHP |
$31.09
|
| Rate for Payer: Humana Medicare |
$31.71
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$31.09
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$32.96
|
| Rate for Payer: SOMOS Essential |
$32.96
|
| Rate for Payer: United Healthcare Commercial |
$30.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$31.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$22.93
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$24.87
|
| Rate for Payer: Wellcare Medicare |
$29.53
|
|
|
NIVOLUMAB 240 MG/24ML IV SOLN [151108]
|
Facility
|
OP
|
$374.25
|
|
|
Service Code
|
HCPCS J9299
|
| Hospital Charge Code |
00003373413
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$24.87 |
| Max. Negotiated Rate |
$243.26 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$205.84
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$31.09
|
| Rate for Payer: Aetna Government |
$31.09
|
| Rate for Payer: Brighton Health Commercial |
$224.55
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$31.09
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$187.12
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$215.19
|
| Rate for Payer: Elderplan Medicare Advantage |
$31.09
|
| Rate for Payer: EmblemHealth Commercial |
$187.12
|
| Rate for Payer: Fidelis Medicare Advantage |
$31.09
|
| Rate for Payer: Group Health Inc Commercial |
$31.09
|
| Rate for Payer: Group Health Inc Medicare |
$31.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$187.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$187.12
|
| Rate for Payer: Healthfirst Medicare Advantage |
$26.43
|
| Rate for Payer: Healthfirst QHP |
$31.09
|
| Rate for Payer: Humana Medicare |
$31.71
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$31.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$31.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$243.26
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$24.87
|
|
|
NIVOLUMAB 240 MG/24ML IV SOLN [151108]
|
Facility
|
IP
|
$374.25
|
|
|
Service Code
|
HCPCS J9299
|
| Hospital Charge Code |
00003373413
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$187.12 |
| Max. Negotiated Rate |
$187.12 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$187.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$187.12
|
|
|
NIVOLUMAB 240MG INJ
|
Facility
|
IP
|
$67.53
|
|
|
Service Code
|
HCPCS J9299
|
| Hospital Charge Code |
41656865
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$33.76 |
| Max. Negotiated Rate |
$33.76 |
| Rate for Payer: Cash Price |
$31.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$33.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$33.76
|
|
|
NIVOLUMAB 240MG INJ
|
Facility
|
OP
|
$67.53
|
|
|
Service Code
|
HCPCS J9299
|
| Hospital Charge Code |
41656865
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.76 |
| Max. Negotiated Rate |
$43.89 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$37.14
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$31.09
|
| Rate for Payer: Aetna Government |
$31.09
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$21.76
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$21.76
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$21.76
|
| Rate for Payer: Brighton Health Commercial |
$40.52
|
| Rate for Payer: Cash Price |
$31.09
|
| Rate for Payer: Cash Price |
$31.09
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$31.09
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$33.76
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$38.83
|
| Rate for Payer: Elderplan Medicare Advantage |
$31.09
|
| Rate for Payer: EmblemHealth Commercial |
$31.09
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$31.09
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$31.09
|
| Rate for Payer: Fidelis Essential Plan QHP |
$32.64
|
| Rate for Payer: Fidelis Medicare Advantage |
$31.09
|
| Rate for Payer: Fidelis Qualified Health Plan |
$32.64
|
| Rate for Payer: Group Health Inc Commercial |
$31.09
|
| Rate for Payer: Group Health Inc Medicare |
$31.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$33.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$33.76
|
| Rate for Payer: Healthfirst Medicare Advantage |
$26.43
|
| Rate for Payer: Healthfirst QHP |
$31.09
|
| Rate for Payer: Humana Medicare |
$31.71
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$31.09
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$32.96
|
| Rate for Payer: SOMOS Essential |
$32.96
|
| Rate for Payer: United Healthcare Commercial |
$30.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$31.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$43.89
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$24.87
|
| Rate for Payer: Wellcare Medicare |
$29.53
|
|
|
NIVOLUMAB 240MG INJ
|
Facility
|
IP
|
$67.53
|
|
|
Service Code
|
HCPCS J9299
|
| Hospital Charge Code |
41646865
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$33.76 |
| Max. Negotiated Rate |
$33.76 |
| Rate for Payer: Cash Price |
$31.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$33.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$33.76
|
|
|
NIVOLUMAB 240MG INJ
|
Facility
|
OP
|
$67.53
|
|
|
Service Code
|
HCPCS J9299
|
| Hospital Charge Code |
41646865
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.76 |
| Max. Negotiated Rate |
$43.89 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$37.14
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$31.09
|
| Rate for Payer: Aetna Government |
$31.09
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$21.76
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$21.76
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$21.76
|
| Rate for Payer: Brighton Health Commercial |
$40.52
|
| Rate for Payer: Cash Price |
$31.09
|
| Rate for Payer: Cash Price |
$31.09
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$31.09
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$33.76
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$38.83
|
| Rate for Payer: Elderplan Medicare Advantage |
$31.09
|
| Rate for Payer: EmblemHealth Commercial |
$31.09
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$31.09
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$31.09
|
| Rate for Payer: Fidelis Essential Plan QHP |
$32.64
|
| Rate for Payer: Fidelis Medicare Advantage |
$31.09
|
| Rate for Payer: Fidelis Qualified Health Plan |
$32.64
|
| Rate for Payer: Group Health Inc Commercial |
$31.09
|
| Rate for Payer: Group Health Inc Medicare |
$31.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$33.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$33.76
|
| Rate for Payer: Healthfirst Medicare Advantage |
$26.43
|
| Rate for Payer: Healthfirst QHP |
$31.09
|
| Rate for Payer: Humana Medicare |
$31.71
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$31.09
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$32.96
|
| Rate for Payer: SOMOS Essential |
$32.96
|
| Rate for Payer: United Healthcare Commercial |
$30.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$31.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$43.89
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$24.87
|
| Rate for Payer: Wellcare Medicare |
$29.53
|
|
|
NJX AA&/STRD PLTR COM DG NRV
|
Facility
|
OP
|
$792.83
|
|
|
Service Code
|
HCPCS 64455
|
| Hospital Charge Code |
30306506
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$222.00 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$342.51
|
| Rate for Payer: Aetna Government |
$342.51
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$239.76
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$239.76
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$239.76
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$342.51
|
| Rate for Payer: Cash Price |
$342.51
|
| Rate for Payer: Cash Price |
$342.51
|
| Rate for Payer: Cash Price |
$342.51
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$342.51
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$342.51
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$291.13
|
| Rate for Payer: Fidelis Essential Plan QHP |
$304.83
|
| Rate for Payer: Fidelis Medicare Advantage |
$342.51
|
| Rate for Payer: Fidelis Qualified Health Plan |
$304.83
|
| Rate for Payer: Group Health Inc Commercial |
$250.00
|
| Rate for Payer: Group Health Inc Medicare |
$250.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$396.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$342.51
|
| Rate for Payer: Healthfirst Medicare Advantage |
$291.13
|
| Rate for Payer: Healthfirst QHP |
$342.51
|
| Rate for Payer: Humana Medicare |
$349.36
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$342.51
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$342.51
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$342.51
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$342.51
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$274.01
|
| Rate for Payer: Wellcare Medicare |
$325.38
|
|
