|
BEVACIZUMAB 100 MG/4 ML INJ
|
Facility
OP
|
$199.22
|
|
|
Service Code
|
HCPCS J9035
|
| Hospital Charge Code |
41653654
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$59.26 |
| Max. Negotiated Rate |
$129.49 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$109.57
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$74.07
|
| Rate for Payer: Aetna Government |
$74.07
|
| Rate for Payer: Cash Price |
$74.07
|
| Rate for Payer: Cash Price |
$74.07
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$74.07
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$99.61
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$114.55
|
| Rate for Payer: Elderplan Medicare Advantage |
$74.07
|
| Rate for Payer: EmblemHealth Commercial |
$74.07
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$74.07
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$74.07
|
| Rate for Payer: Fidelis Essential Plan QHP |
$77.78
|
| Rate for Payer: Fidelis Medicare Advantage |
$74.07
|
| Rate for Payer: Fidelis Qualified Health Plan |
$77.78
|
| Rate for Payer: Group Health Inc Commercial |
$74.07
|
| Rate for Payer: Group Health Inc Medicare |
$74.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$99.61
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$99.61
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$73.58
|
| Rate for Payer: Healthfirst Medicare Advantage |
$62.96
|
| Rate for Payer: Healthfirst QHP |
$74.07
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$74.07
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$78.61
|
| Rate for Payer: SOMOS Essential |
$78.61
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$129.49
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$59.26
|
| Rate for Payer: Wellcare Medicare |
$70.37
|
|
|
BEVACIZUMAB 100 MG/4 ML INJ
|
Facility
OP
|
$199.22
|
|
|
Service Code
|
HCPCS J9035
|
| Hospital Charge Code |
41643654
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$59.26 |
| Max. Negotiated Rate |
$129.49 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$109.57
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$74.07
|
| Rate for Payer: Aetna Government |
$74.07
|
| Rate for Payer: Cash Price |
$74.07
|
| Rate for Payer: Cash Price |
$74.07
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$74.07
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$99.61
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$114.55
|
| Rate for Payer: Elderplan Medicare Advantage |
$74.07
|
| Rate for Payer: EmblemHealth Commercial |
$74.07
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$74.07
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$74.07
|
| Rate for Payer: Fidelis Essential Plan QHP |
$77.78
|
| Rate for Payer: Fidelis Medicare Advantage |
$74.07
|
| Rate for Payer: Fidelis Qualified Health Plan |
$77.78
|
| Rate for Payer: Group Health Inc Commercial |
$74.07
|
| Rate for Payer: Group Health Inc Medicare |
$74.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$99.61
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$99.61
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$73.58
|
| Rate for Payer: Healthfirst Medicare Advantage |
$62.96
|
| Rate for Payer: Healthfirst QHP |
$74.07
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$74.07
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$78.61
|
| Rate for Payer: SOMOS Essential |
$78.61
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$129.49
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$59.26
|
| Rate for Payer: Wellcare Medicare |
$70.37
|
|
|
BEVACIZUMAB 400 MG/16 ML INJ
|
Facility
IP
|
$226.00
|
|
|
Service Code
|
HCPCS J9035
|
| Hospital Charge Code |
41643846
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$113.00 |
| Max. Negotiated Rate |
$113.00 |
| Rate for Payer: Cash Price |
$74.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$113.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$113.00
|
|
|
BEVACIZUMAB 400 MG/16 ML INJ
|
Facility
IP
|
$226.00
|
|
|
Service Code
|
HCPCS J9035
|
| Hospital Charge Code |
41653846
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$113.00 |
| Max. Negotiated Rate |
$113.00 |
| Rate for Payer: Cash Price |
$74.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$113.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$113.00
|
|
|
BEVACIZUMAB 400 MG/16 ML INJ
|
Facility
OP
|
$226.00
|
|
|
Service Code
|
HCPCS J9035
|
| Hospital Charge Code |
41653846
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$59.26 |
| Max. Negotiated Rate |
$146.90 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$124.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$74.07
|
| Rate for Payer: Aetna Government |
$74.07
|
| Rate for Payer: Cash Price |
$74.07
|
| Rate for Payer: Cash Price |
$74.07
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$74.07
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$113.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$129.95
|
| Rate for Payer: Elderplan Medicare Advantage |
$74.07
|
| Rate for Payer: EmblemHealth Commercial |
$74.07
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$74.07
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$74.07
|
| Rate for Payer: Fidelis Essential Plan QHP |
$77.78
|
| Rate for Payer: Fidelis Medicare Advantage |
$74.07
|
| Rate for Payer: Fidelis Qualified Health Plan |
$77.78
|
| Rate for Payer: Group Health Inc Commercial |
$74.07
|
| Rate for Payer: Group Health Inc Medicare |
$74.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$113.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$113.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$73.58
|
| Rate for Payer: Healthfirst Medicare Advantage |
$62.96
|
| Rate for Payer: Healthfirst QHP |
$74.07
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$74.07
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$78.61
|
| Rate for Payer: SOMOS Essential |
$78.61
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$146.90
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$59.26
|
| Rate for Payer: Wellcare Medicare |
$70.37
|
|
|
BEVACIZUMAB 400 MG/16 ML INJ
|
Facility
OP
|
$226.00
|
|
|
Service Code
|
HCPCS J9035
|
| Hospital Charge Code |
41643846
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$59.26 |
| Max. Negotiated Rate |
$146.90 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$124.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$74.07
|
| Rate for Payer: Aetna Government |
$74.07
|
| Rate for Payer: Cash Price |
$74.07
|
| Rate for Payer: Cash Price |
$74.07
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$74.07
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$113.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$129.95
|
| Rate for Payer: Elderplan Medicare Advantage |
$74.07
|
| Rate for Payer: EmblemHealth Commercial |
$74.07
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$74.07
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$74.07
|
| Rate for Payer: Fidelis Essential Plan QHP |
$77.78
|
| Rate for Payer: Fidelis Medicare Advantage |
$74.07
|
| Rate for Payer: Fidelis Qualified Health Plan |
$77.78
|
| Rate for Payer: Group Health Inc Commercial |
$74.07
|
| Rate for Payer: Group Health Inc Medicare |
$74.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$113.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$113.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$73.58
|
| Rate for Payer: Healthfirst Medicare Advantage |
$62.96
|
| Rate for Payer: Healthfirst QHP |
$74.07
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$74.07
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$78.61
|
| Rate for Payer: SOMOS Essential |
$78.61
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$146.90
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$59.26
|
| Rate for Payer: Wellcare Medicare |
$70.37
|
|
|
BEVACIZUMAB-AWWB 10MG
|
Facility
OP
|
$68.86
|
|
|
Service Code
|
HCPCS Q5107
|
| Hospital Charge Code |
41656101
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.50 |
| Max. Negotiated Rate |
$44.76 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$37.87
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$25.62
|
| Rate for Payer: Aetna Government |
$25.62
|
| Rate for Payer: Cash Price |
$25.62
|
| Rate for Payer: Cash Price |
$25.62
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$25.62
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$34.43
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$39.59
|
| Rate for Payer: Elderplan Medicare Advantage |
$25.62
|
| Rate for Payer: EmblemHealth Commercial |
$25.62
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$25.62
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$25.62
|
| Rate for Payer: Fidelis Essential Plan QHP |
$26.90
|
| Rate for Payer: Fidelis Medicare Advantage |
$25.62
|
| Rate for Payer: Fidelis Qualified Health Plan |
$26.90
|
| Rate for Payer: Group Health Inc Commercial |
$25.62
|
| Rate for Payer: Group Health Inc Medicare |
$25.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$34.43
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$34.43
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$28.40
|
| Rate for Payer: Healthfirst Medicare Advantage |
$21.78
|
| Rate for Payer: Healthfirst QHP |
$25.62
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$25.62
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$28.36
|
| Rate for Payer: SOMOS Essential |
$28.36
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$44.76
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$20.50
|
| Rate for Payer: Wellcare Medicare |
$24.34
|
|
|
BEVACIZUMAB-AWWB 10MG
|
Facility
IP
|
$68.86
|
|
|
Service Code
|
HCPCS Q5107
|
| Hospital Charge Code |
41646101
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$34.43 |
| Max. Negotiated Rate |
$34.43 |
| Rate for Payer: Cash Price |
$25.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$34.43
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$34.43
|
|
|
BEVACIZUMAB-AWWB 10MG
|
Facility
OP
|
$68.86
|
|
|
Service Code
|
HCPCS Q5107
|
| Hospital Charge Code |
41646101
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.50 |
| Max. Negotiated Rate |
$44.76 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$37.87
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$25.62
|
| Rate for Payer: Aetna Government |
$25.62
|
| Rate for Payer: Cash Price |
$25.62
|
| Rate for Payer: Cash Price |
$25.62
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$25.62
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$34.43
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$39.59
|
| Rate for Payer: Elderplan Medicare Advantage |
$25.62
|
| Rate for Payer: EmblemHealth Commercial |
$25.62
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$25.62
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$25.62
|
| Rate for Payer: Fidelis Essential Plan QHP |
$26.90
|
| Rate for Payer: Fidelis Medicare Advantage |
$25.62
|
| Rate for Payer: Fidelis Qualified Health Plan |
$26.90
|
| Rate for Payer: Group Health Inc Commercial |
$25.62
|
| Rate for Payer: Group Health Inc Medicare |
$25.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$34.43
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$34.43
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$28.40
|
| Rate for Payer: Healthfirst Medicare Advantage |
$21.78
|
| Rate for Payer: Healthfirst QHP |
$25.62
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$25.62
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$28.36
|
| Rate for Payer: SOMOS Essential |
$28.36
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$44.76
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$20.50
|
| Rate for Payer: Wellcare Medicare |
$24.34
|
|
|
BEVACIZUMAB-AWWB 10MG
|
Facility
IP
|
$68.86
|
|
|
Service Code
|
HCPCS Q5107
|
| Hospital Charge Code |
41656101
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$34.43 |
| Max. Negotiated Rate |
$34.43 |
| Rate for Payer: Cash Price |
$25.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$34.43
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$34.43
|
|
|
BEVACIZUMAB-AWWB 25MG
|
Facility
IP
|
$68.86
|
|
|
Service Code
|
HCPCS Q5107
|
| Hospital Charge Code |
41646102
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$34.43 |
| Max. Negotiated Rate |
$34.43 |
| Rate for Payer: Cash Price |
$25.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$34.43
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$34.43
|
|
|
BEVACIZUMAB-AWWB 25MG
|
Facility
OP
|
$68.86
|
|
|
Service Code
|
HCPCS Q5107
|
| Hospital Charge Code |
41656102
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.50 |
| Max. Negotiated Rate |
$44.76 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$37.87
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$25.62
|
| Rate for Payer: Aetna Government |
$25.62
|
| Rate for Payer: Cash Price |
$25.62
|
| Rate for Payer: Cash Price |
$25.62
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$25.62
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$34.43
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$39.59
|
| Rate for Payer: Elderplan Medicare Advantage |
$25.62
|
| Rate for Payer: EmblemHealth Commercial |
$25.62
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$25.62
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$25.62
|
| Rate for Payer: Fidelis Essential Plan QHP |
$26.90
|
| Rate for Payer: Fidelis Medicare Advantage |
$25.62
|
| Rate for Payer: Fidelis Qualified Health Plan |
$26.90
|
| Rate for Payer: Group Health Inc Commercial |
$25.62
|
| Rate for Payer: Group Health Inc Medicare |
$25.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$34.43
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$34.43
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$28.40
|
| Rate for Payer: Healthfirst Medicare Advantage |
$21.78
|
| Rate for Payer: Healthfirst QHP |
$25.62
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$25.62
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$28.36
|
| Rate for Payer: SOMOS Essential |
$28.36
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$44.76
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$20.50
|
| Rate for Payer: Wellcare Medicare |
$24.34
|
|
|
BEVACIZUMAB-AWWB 25MG
|
Facility
OP
|
$68.86
|
|
|
Service Code
|
HCPCS Q5107
|
| Hospital Charge Code |
41646102
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.50 |
| Max. Negotiated Rate |
$44.76 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$37.87
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$25.62
|
| Rate for Payer: Aetna Government |
$25.62
|
| Rate for Payer: Cash Price |
$25.62
|
| Rate for Payer: Cash Price |
$25.62
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$25.62
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$34.43
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$39.59
|
| Rate for Payer: Elderplan Medicare Advantage |
$25.62
|
| Rate for Payer: EmblemHealth Commercial |
$25.62
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$25.62
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$25.62
|
| Rate for Payer: Fidelis Essential Plan QHP |
$26.90
|
| Rate for Payer: Fidelis Medicare Advantage |
$25.62
|
| Rate for Payer: Fidelis Qualified Health Plan |
$26.90
|
| Rate for Payer: Group Health Inc Commercial |
$25.62
|
| Rate for Payer: Group Health Inc Medicare |
$25.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$34.43
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$34.43
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$28.40
|
| Rate for Payer: Healthfirst Medicare Advantage |
$21.78
|
| Rate for Payer: Healthfirst QHP |
$25.62
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$25.62
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$28.36
|
| Rate for Payer: SOMOS Essential |
$28.36
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$44.76
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$20.50
|
| Rate for Payer: Wellcare Medicare |
$24.34
|
|
|
BEVACIZUMAB-AWWB 25MG
|
Facility
IP
|
$68.86
|
|
|
Service Code
|
HCPCS Q5107
|
| Hospital Charge Code |
41656102
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$34.43 |
| Max. Negotiated Rate |
$34.43 |
| Rate for Payer: Cash Price |
$25.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$34.43
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$34.43
|
|
|
BEVACIZUMAB-BVZR 10MG
|
Facility
IP
|
$55.94
|
|
|
Service Code
|
HCPCS Q5118
|
| Hospital Charge Code |
41646100
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$27.97 |
| Max. Negotiated Rate |
$27.97 |
| Rate for Payer: Cash Price |
$21.51
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$27.97
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$27.97
|
|
|
BEVACIZUMAB-BVZR 10MG
|
Facility
IP
|
$55.94
|
|
|
Service Code
|
HCPCS Q5118
|
| Hospital Charge Code |
41656100
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$27.97 |
| Max. Negotiated Rate |
$27.97 |
| Rate for Payer: Cash Price |
$21.51
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$27.97
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$27.97
|
|
|
BEVACIZUMAB-BVZR 10MG
|
Facility
OP
|
$55.94
|
|
|
Service Code
|
HCPCS Q5118
|
| Hospital Charge Code |
41656100
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.21 |
| Max. Negotiated Rate |
$36.36 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$30.77
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$21.51
|
| Rate for Payer: Aetna Government |
$21.51
|
| Rate for Payer: Cash Price |
$21.51
|
| Rate for Payer: Cash Price |
$21.51
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$21.51
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$27.97
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$32.17
|
| Rate for Payer: Elderplan Medicare Advantage |
$21.51
|
| Rate for Payer: EmblemHealth Commercial |
$21.51
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$21.51
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$21.51
|
| Rate for Payer: Fidelis Essential Plan QHP |
$22.59
|
| Rate for Payer: Fidelis Medicare Advantage |
$21.51
|
| Rate for Payer: Fidelis Qualified Health Plan |
$22.59
|
| Rate for Payer: Group Health Inc Commercial |
$21.51
|
| Rate for Payer: Group Health Inc Medicare |
$21.51
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$27.97
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$27.97
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$28.19
|
| Rate for Payer: Healthfirst Medicare Advantage |
$18.28
|
| Rate for Payer: Healthfirst QHP |
$21.51
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$21.51
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$22.00
|
| Rate for Payer: SOMOS Essential |
$22.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$36.36
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$17.21
|
| Rate for Payer: Wellcare Medicare |
$20.44
|
|
|
BEVACIZUMAB-BVZR 10MG
|
Facility
OP
|
$55.94
|
|
|
Service Code
|
HCPCS Q5118
|
| Hospital Charge Code |
41646100
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.21 |
| Max. Negotiated Rate |
$36.36 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$30.77
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$21.51
|
| Rate for Payer: Aetna Government |
$21.51
|
| Rate for Payer: Cash Price |
$21.51
|
| Rate for Payer: Cash Price |
$21.51
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$21.51
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$27.97
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$32.17
|
| Rate for Payer: Elderplan Medicare Advantage |
$21.51
|
| Rate for Payer: EmblemHealth Commercial |
$21.51
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$21.51
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$21.51
|
| Rate for Payer: Fidelis Essential Plan QHP |
$22.59
|
| Rate for Payer: Fidelis Medicare Advantage |
$21.51
|
| Rate for Payer: Fidelis Qualified Health Plan |
$22.59
|
| Rate for Payer: Group Health Inc Commercial |
$21.51
|
| Rate for Payer: Group Health Inc Medicare |
$21.51
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$27.97
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$27.97
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$28.19
|
| Rate for Payer: Healthfirst Medicare Advantage |
$18.28
|
| Rate for Payer: Healthfirst QHP |
$21.51
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$21.51
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$22.00
|
| Rate for Payer: SOMOS Essential |
$22.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$36.36
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$17.21
|
| Rate for Payer: Wellcare Medicare |
$20.44
|
|
|
BEVACIZUMAB-BVZR 25MG
|
Facility
OP
|
$55.94
|
|
|
Service Code
|
HCPCS Q5118
|
| Hospital Charge Code |
41656103
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.21 |
| Max. Negotiated Rate |
$36.36 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$30.77
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$21.51
|
| Rate for Payer: Aetna Government |
$21.51
|
| Rate for Payer: Cash Price |
$21.51
|
| Rate for Payer: Cash Price |
$21.51
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$21.51
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$27.97
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$32.17
|
| Rate for Payer: Elderplan Medicare Advantage |
$21.51
|
| Rate for Payer: EmblemHealth Commercial |
$21.51
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$21.51
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$21.51
|
| Rate for Payer: Fidelis Essential Plan QHP |
$22.59
|
| Rate for Payer: Fidelis Medicare Advantage |
$21.51
|
| Rate for Payer: Fidelis Qualified Health Plan |
$22.59
|
| Rate for Payer: Group Health Inc Commercial |
$21.51
|
| Rate for Payer: Group Health Inc Medicare |
$21.51
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$27.97
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$27.97
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$28.19
|
| Rate for Payer: Healthfirst Medicare Advantage |
$18.28
|
| Rate for Payer: Healthfirst QHP |
$21.51
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$21.51
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$22.00
|
| Rate for Payer: SOMOS Essential |
$22.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$36.36
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$17.21
|
| Rate for Payer: Wellcare Medicare |
$20.44
|
|
|
BEVACIZUMAB-BVZR 25MG
|
Facility
IP
|
$55.94
|
|
|
Service Code
|
HCPCS Q5118
|
| Hospital Charge Code |
41646103
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$27.97 |
| Max. Negotiated Rate |
$27.97 |
| Rate for Payer: Cash Price |
$21.51
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$27.97
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$27.97
|
|
|
BEVACIZUMAB-BVZR 25MG
|
Facility
IP
|
$55.94
|
|
|
Service Code
|
HCPCS Q5118
|
| Hospital Charge Code |
41656103
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$27.97 |
| Max. Negotiated Rate |
$27.97 |
| Rate for Payer: Cash Price |
$21.51
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$27.97
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$27.97
|
|
|
BEVACIZUMAB-BVZR 25MG
|
Facility
OP
|
$55.94
|
|
|
Service Code
|
HCPCS Q5118
|
| Hospital Charge Code |
41646103
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.21 |
| Max. Negotiated Rate |
$36.36 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$30.77
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$21.51
|
| Rate for Payer: Aetna Government |
$21.51
|
| Rate for Payer: Cash Price |
$21.51
|
| Rate for Payer: Cash Price |
$21.51
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$21.51
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$27.97
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$32.17
|
| Rate for Payer: Elderplan Medicare Advantage |
$21.51
|
| Rate for Payer: EmblemHealth Commercial |
$21.51
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$21.51
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$21.51
|
| Rate for Payer: Fidelis Essential Plan QHP |
$22.59
|
| Rate for Payer: Fidelis Medicare Advantage |
$21.51
|
| Rate for Payer: Fidelis Qualified Health Plan |
$22.59
|
| Rate for Payer: Group Health Inc Commercial |
$21.51
|
| Rate for Payer: Group Health Inc Medicare |
$21.51
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$27.97
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$27.97
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$28.19
|
| Rate for Payer: Healthfirst Medicare Advantage |
$18.28
|
| Rate for Payer: Healthfirst QHP |
$21.51
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$21.51
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$22.00
|
| Rate for Payer: SOMOS Essential |
$22.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$36.36
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$17.21
|
| Rate for Payer: Wellcare Medicare |
$20.44
|
|
|
B-HCG QUANTITATIVE
|
Facility
OP
|
$37.63
|
|
|
Service Code
|
HCPCS 84702
|
| Hospital Charge Code |
40602525
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.04 |
| Max. Negotiated Rate |
$23.92 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$20.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$15.05
|
| Rate for Payer: Aetna Government |
$15.05
|
| Rate for Payer: Cash Price |
$15.05
|
| Rate for Payer: Cash Price |
$15.05
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$15.05
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$23.92
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$20.24
|
| Rate for Payer: Elderplan Medicare Advantage |
$15.05
|
| Rate for Payer: EmblemHealth Commercial |
$15.05
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$13.54
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$12.79
|
| Rate for Payer: Fidelis Essential Plan QHP |
$13.39
|
| Rate for Payer: Fidelis Medicare Advantage |
$15.05
|
| Rate for Payer: Fidelis Qualified Health Plan |
$13.39
|
| Rate for Payer: Group Health Inc Commercial |
$15.05
|
| Rate for Payer: Group Health Inc Medicare |
$15.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$18.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$15.05
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$15.05
|
| Rate for Payer: Healthfirst Medicare Advantage |
$15.05
|
| Rate for Payer: Healthfirst QHP |
$15.05
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$15.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$15.05
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$12.04
|
| Rate for Payer: Wellcare Medicare |
$13.54
|
|
|
B,HENSELAE AB (IGG,IGM)
|
Facility
OP
|
$25.45
|
|
|
Service Code
|
HCPCS 86611
|
| Hospital Charge Code |
30303373
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.14 |
| Max. Negotiated Rate |
$16.17 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$14.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$10.18
|
| Rate for Payer: Aetna Government |
$10.18
|
| Rate for Payer: Cash Price |
$10.18
|
| Rate for Payer: Cash Price |
$10.18
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$10.18
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$16.17
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$13.68
|
| Rate for Payer: Elderplan Medicare Advantage |
$10.18
|
| Rate for Payer: EmblemHealth Commercial |
$10.18
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$9.16
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$8.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$9.06
|
| Rate for Payer: Fidelis Medicare Advantage |
$10.18
|
| Rate for Payer: Fidelis Qualified Health Plan |
$9.06
|
| Rate for Payer: Group Health Inc Commercial |
$10.18
|
| Rate for Payer: Group Health Inc Medicare |
$10.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$10.18
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$10.18
|
| Rate for Payer: Healthfirst Medicare Advantage |
$10.18
|
| Rate for Payer: Healthfirst QHP |
$10.18
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$10.18
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$10.18
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$8.14
|
| Rate for Payer: Wellcare Medicare |
$9.16
|
|
|
BICALUTAMIDE 50 MG TAB
|
Facility
OP
|
$2.10
|
|
| Hospital Charge Code |
41652629
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.74 |
| Max. Negotiated Rate |
$1.68 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.16
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.05
|
| Rate for Payer: Aetna Government |
$1.05
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.68
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.43
|
| Rate for Payer: Group Health Inc Commercial |
$1.05
|
| Rate for Payer: Group Health Inc Medicare |
$0.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.36
|
|
