|
ATAZANAVIR SULFATE 300 MG PO CAPS [77648]
|
Facility
|
OP
|
$55.08
|
|
|
Service Code
|
NDC 69238113803
|
| Hospital Charge Code |
69238113803
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$19.28 |
| Max. Negotiated Rate |
$44.06 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$30.29
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$27.54
|
| Rate for Payer: Aetna Government |
$27.54
|
| Rate for Payer: Brighton Health Commercial |
$41.31
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$44.06
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$37.45
|
| Rate for Payer: Group Health Inc Commercial |
$27.54
|
| Rate for Payer: Group Health Inc Medicare |
$19.28
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$27.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$27.54
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$35.80
|
|
|
ATAZANAVIR SULFATE 300 MG PO CAPS [77648]
|
Facility
|
OP
|
$55.08
|
|
|
Service Code
|
NDC 65862071330
|
| Hospital Charge Code |
65862071330
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$19.28 |
| Max. Negotiated Rate |
$44.06 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$30.29
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$27.54
|
| Rate for Payer: Aetna Government |
$27.54
|
| Rate for Payer: Brighton Health Commercial |
$41.31
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$44.06
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$37.45
|
| Rate for Payer: Group Health Inc Commercial |
$27.54
|
| Rate for Payer: Group Health Inc Medicare |
$19.28
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$27.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$27.54
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$35.80
|
|
|
ATENOLOL 25 MG PO TABS [717]
|
Facility
|
OP
|
$0.24
|
|
|
Service Code
|
NDC 00904718761
|
| Hospital Charge Code |
00904718761
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.19 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.13
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.12
|
| Rate for Payer: Aetna Government |
$0.12
|
| Rate for Payer: Brighton Health Commercial |
$0.18
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.19
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.16
|
| Rate for Payer: Group Health Inc Commercial |
$0.12
|
| Rate for Payer: Group Health Inc Medicare |
$0.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.15
|
|
|
ATENOLOL 25 MG PO TABS [717]
|
Facility
|
OP
|
$0.82
|
|
|
Service Code
|
NDC 00093078701
|
| Hospital Charge Code |
00093078701
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$0.65 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.41
|
| Rate for Payer: Aetna Government |
$0.41
|
| Rate for Payer: Brighton Health Commercial |
$0.61
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.65
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.56
|
| Rate for Payer: Group Health Inc Commercial |
$0.41
|
| Rate for Payer: Group Health Inc Medicare |
$0.29
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.41
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.41
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.53
|
|
|
ATENOLOL 25 MG TAB
|
Facility
|
OP
|
$1.00
|
|
| Hospital Charge Code |
41650832
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$0.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.50
|
| Rate for Payer: Aetna Government |
$0.50
|
| Rate for Payer: Brighton Health Commercial |
$0.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.68
|
| Rate for Payer: Group Health Inc Commercial |
$0.50
|
| Rate for Payer: Group Health Inc Medicare |
$0.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.65
|
|
|
ATENOLOL 25 MG TAB
|
Facility
|
OP
|
$1.00
|
|
| Hospital Charge Code |
41640832
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$0.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.50
|
| Rate for Payer: Aetna Government |
$0.50
|
| Rate for Payer: Brighton Health Commercial |
$0.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.68
|
| Rate for Payer: Group Health Inc Commercial |
$0.50
|
| Rate for Payer: Group Health Inc Medicare |
$0.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.65
|
|
|
ATENOLOL 50 MG PO TABS [718]
|
Facility
|
OP
|
$0.89
|
|
|
Service Code
|
NDC 51079068420
|
| Hospital Charge Code |
51079068420
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.31 |
| Max. Negotiated Rate |
$0.71 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.49
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.45
|
| Rate for Payer: Aetna Government |
$0.45
|
| Rate for Payer: Brighton Health Commercial |
$0.67
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.71
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.61
|
| Rate for Payer: Group Health Inc Commercial |
$0.45
|
| Rate for Payer: Group Health Inc Medicare |
$0.31
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.45
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.45
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.58
|
|
|
ATENOLOL 50 MG PO TABS [718]
|
Facility
|
OP
|
$0.83
|
|
|
Service Code
|
NDC 00093075201
|
| Hospital Charge Code |
00093075201
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$0.67 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.46
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.42
|
| Rate for Payer: Aetna Government |
$0.42
|
| Rate for Payer: Brighton Health Commercial |
$0.63
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.67
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.57
|
| Rate for Payer: Group Health Inc Commercial |
$0.42
|
| Rate for Payer: Group Health Inc Medicare |
$0.29
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.42
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.54
|
|
|
ATENOLOL 50 MG PO TABS [718]
|
Facility
|
OP
|
$0.83
|
|
|
Service Code
|
NDC 65862016901
|
| Hospital Charge Code |
65862016901
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$0.67 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.46
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.42
|
| Rate for Payer: Aetna Government |
$0.42
|
| Rate for Payer: Brighton Health Commercial |
$0.63
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.67
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.57
|
| Rate for Payer: Group Health Inc Commercial |
$0.42
|
| Rate for Payer: Group Health Inc Medicare |
$0.29
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.42
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.54
|
|
|
ATENOLOL 50 MG TAB
|
Facility
|
OP
|
$1.00
|
|
| Hospital Charge Code |
41640644
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$0.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.50
|
| Rate for Payer: Aetna Government |
$0.50
|
| Rate for Payer: Brighton Health Commercial |
$0.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.68
|
| Rate for Payer: Group Health Inc Commercial |
$0.50
|
| Rate for Payer: Group Health Inc Medicare |
$0.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.65
|
|
|
ATENOLOL 50 MG TAB
|
Facility
|
OP
|
$1.00
|
|
| Hospital Charge Code |
41650644
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$0.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.50
|
| Rate for Payer: Aetna Government |
$0.50
|
| Rate for Payer: Brighton Health Commercial |
$0.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.68
|
| Rate for Payer: Group Health Inc Commercial |
$0.50
|
| Rate for Payer: Group Health Inc Medicare |
$0.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.65
|
|
|
ATEZOLIZUMAB 1200 MG/20ML IV SOLN [132613]
|
Facility
|
IP
|
$636.36
|
|
|
Service Code
|
HCPCS J9022
|
| Hospital Charge Code |
50242091701
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$318.18 |
| Max. Negotiated Rate |
$318.18 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$318.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$318.18
|
|
|
ATEZOLIZUMAB 1200 MG/20ML IV SOLN [132613]
|
Facility
|
OP
|
$636.36
|
|
|
Service Code
|
HCPCS J9022
|
| Hospital Charge Code |
50242091701
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$68.01 |
| Max. Negotiated Rate |
$413.63 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$350.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$85.01
|
| Rate for Payer: Aetna Government |
$85.01
|
| Rate for Payer: Brighton Health Commercial |
$381.81
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$85.01
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$318.18
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$365.90
|
| Rate for Payer: Elderplan Medicare Advantage |
$85.01
|
| Rate for Payer: EmblemHealth Commercial |
$318.18
|
| Rate for Payer: Fidelis Medicare Advantage |
$85.01
|
| Rate for Payer: Group Health Inc Commercial |
$85.01
|
| Rate for Payer: Group Health Inc Medicare |
$85.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$318.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$318.18
|
| Rate for Payer: Healthfirst Medicare Advantage |
$72.26
|
| Rate for Payer: Healthfirst QHP |
$85.01
|
| Rate for Payer: Humana Medicare |
$86.71
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$85.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$85.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$413.63
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$68.01
|
|
|
ATEZOLIZUMAB 1200 MG INJECTION
|
Facility
|
IP
|
$179.58
|
|
|
Service Code
|
HCPCS J9022
|
| Hospital Charge Code |
41649596
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$89.79 |
| Max. Negotiated Rate |
$89.79 |
| Rate for Payer: Cash Price |
$85.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$89.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$89.79
|
|
|
ATEZOLIZUMAB 1200 MG INJECTION
|
Facility
|
OP
|
$179.58
|
|
|
Service Code
|
HCPCS J9022
|
| Hospital Charge Code |
41649596
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$59.51 |
| Max. Negotiated Rate |
$116.73 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$98.77
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$85.01
|
| Rate for Payer: Aetna Government |
$85.01
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$59.51
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$59.51
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$59.51
|
| Rate for Payer: Brighton Health Commercial |
$107.75
|
| Rate for Payer: Cash Price |
$85.01
|
| Rate for Payer: Cash Price |
$85.01
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$85.01
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$89.79
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$103.26
|
| Rate for Payer: Elderplan Medicare Advantage |
$85.01
|
| Rate for Payer: EmblemHealth Commercial |
$85.01
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$85.01
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$85.01
|
| Rate for Payer: Fidelis Essential Plan QHP |
$89.26
|
| Rate for Payer: Fidelis Medicare Advantage |
$85.01
|
| Rate for Payer: Fidelis Qualified Health Plan |
$89.26
|
| Rate for Payer: Group Health Inc Commercial |
$85.01
|
| Rate for Payer: Group Health Inc Medicare |
$85.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$89.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$89.79
|
| Rate for Payer: Healthfirst Medicare Advantage |
$72.26
|
| Rate for Payer: Healthfirst QHP |
$85.01
|
| Rate for Payer: Humana Medicare |
$86.71
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$85.01
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$88.97
|
| Rate for Payer: SOMOS Essential |
$88.97
|
| Rate for Payer: United Healthcare Commercial |
$80.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$85.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$116.73
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$68.01
|
| Rate for Payer: Wellcare Medicare |
$80.76
|
|
|
ATEZOLIZUMAB 1200MG INJECTION
|
Facility
|
IP
|
$179.58
|
|
|
Service Code
|
HCPCS J9022
|
| Hospital Charge Code |
41659596
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$89.79 |
| Max. Negotiated Rate |
$89.79 |
| Rate for Payer: Cash Price |
$85.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$89.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$89.79
|
|
|
ATEZOLIZUMAB 1200MG INJECTION
|
Facility
|
OP
|
$179.58
|
|
|
Service Code
|
HCPCS J9022
|
| Hospital Charge Code |
41659596
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$59.51 |
| Max. Negotiated Rate |
$116.73 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$98.77
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$85.01
|
| Rate for Payer: Aetna Government |
$85.01
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$59.51
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$59.51
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$59.51
|
| Rate for Payer: Brighton Health Commercial |
$107.75
|
| Rate for Payer: Cash Price |
$85.01
|
| Rate for Payer: Cash Price |
$85.01
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$85.01
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$89.79
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$103.26
|
| Rate for Payer: Elderplan Medicare Advantage |
$85.01
|
| Rate for Payer: EmblemHealth Commercial |
$85.01
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$85.01
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$85.01
|
| Rate for Payer: Fidelis Essential Plan QHP |
$89.26
|
| Rate for Payer: Fidelis Medicare Advantage |
$85.01
|
| Rate for Payer: Fidelis Qualified Health Plan |
$89.26
|
| Rate for Payer: Group Health Inc Commercial |
$85.01
|
| Rate for Payer: Group Health Inc Medicare |
$85.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$89.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$89.79
|
| Rate for Payer: Healthfirst Medicare Advantage |
$72.26
|
| Rate for Payer: Healthfirst QHP |
$85.01
|
| Rate for Payer: Humana Medicare |
$86.71
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$85.01
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$88.97
|
| Rate for Payer: SOMOS Essential |
$88.97
|
| Rate for Payer: United Healthcare Commercial |
$80.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$85.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$116.73
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$68.01
|
| Rate for Payer: Wellcare Medicare |
$80.76
|
|
|
ATEZOLIZUMAB 840 MG/14ML IV SOLN [166705]
|
Facility
|
IP
|
$636.36
|
|
|
Service Code
|
HCPCS J9022
|
| Hospital Charge Code |
50242091801
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$318.18 |
| Max. Negotiated Rate |
$318.18 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$318.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$318.18
|
|
|
ATEZOLIZUMAB 840 MG/14ML IV SOLN [166705]
|
Facility
|
OP
|
$636.36
|
|
|
Service Code
|
HCPCS J9022
|
| Hospital Charge Code |
50242091801
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$68.01 |
| Max. Negotiated Rate |
$413.63 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$350.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$85.01
|
| Rate for Payer: Aetna Government |
$85.01
|
| Rate for Payer: Brighton Health Commercial |
$381.81
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$85.01
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$318.18
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$365.90
|
| Rate for Payer: Elderplan Medicare Advantage |
$85.01
|
| Rate for Payer: EmblemHealth Commercial |
$318.18
|
| Rate for Payer: Fidelis Medicare Advantage |
$85.01
|
| Rate for Payer: Group Health Inc Commercial |
$85.01
|
| Rate for Payer: Group Health Inc Medicare |
$85.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$318.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$318.18
|
| Rate for Payer: Healthfirst Medicare Advantage |
$72.26
|
| Rate for Payer: Healthfirst QHP |
$85.01
|
| Rate for Payer: Humana Medicare |
$86.71
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$85.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$85.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$413.63
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$68.01
|
|
|
ATEZOLIZUMAB 840MG INJ
|
Facility
|
IP
|
$187.80
|
|
|
Service Code
|
HCPCS J9022
|
| Hospital Charge Code |
41647858
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$93.90 |
| Max. Negotiated Rate |
$93.90 |
| Rate for Payer: Cash Price |
$85.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$93.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$93.90
|
|
|
ATEZOLIZUMAB 840MG INJ
|
Facility
|
OP
|
$187.80
|
|
|
Service Code
|
HCPCS J9022
|
| Hospital Charge Code |
41657858
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$59.51 |
| Max. Negotiated Rate |
$122.07 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$103.29
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$85.01
|
| Rate for Payer: Aetna Government |
$85.01
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$59.51
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$59.51
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$59.51
|
| Rate for Payer: Brighton Health Commercial |
$112.68
|
| Rate for Payer: Cash Price |
$85.01
|
| Rate for Payer: Cash Price |
$85.01
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$85.01
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$93.90
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$107.98
|
| Rate for Payer: Elderplan Medicare Advantage |
$85.01
|
| Rate for Payer: EmblemHealth Commercial |
$85.01
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$85.01
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$85.01
|
| Rate for Payer: Fidelis Essential Plan QHP |
$89.26
|
| Rate for Payer: Fidelis Medicare Advantage |
$85.01
|
| Rate for Payer: Fidelis Qualified Health Plan |
$89.26
|
| Rate for Payer: Group Health Inc Commercial |
$85.01
|
| Rate for Payer: Group Health Inc Medicare |
$85.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$93.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$93.90
|
| Rate for Payer: Healthfirst Medicare Advantage |
$72.26
|
| Rate for Payer: Healthfirst QHP |
$85.01
|
| Rate for Payer: Humana Medicare |
$86.71
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$85.01
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$88.97
|
| Rate for Payer: SOMOS Essential |
$88.97
|
| Rate for Payer: United Healthcare Commercial |
$80.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$85.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$122.07
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$68.01
|
| Rate for Payer: Wellcare Medicare |
$80.76
|
|
|
ATEZOLIZUMAB 840MG INJ
|
Facility
|
OP
|
$187.80
|
|
|
Service Code
|
HCPCS J9022
|
| Hospital Charge Code |
41647858
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$59.51 |
| Max. Negotiated Rate |
$122.07 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$103.29
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$85.01
|
| Rate for Payer: Aetna Government |
$85.01
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$59.51
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$59.51
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$59.51
|
| Rate for Payer: Brighton Health Commercial |
$112.68
|
| Rate for Payer: Cash Price |
$85.01
|
| Rate for Payer: Cash Price |
$85.01
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$85.01
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$93.90
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$107.98
|
| Rate for Payer: Elderplan Medicare Advantage |
$85.01
|
| Rate for Payer: EmblemHealth Commercial |
$85.01
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$85.01
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$85.01
|
| Rate for Payer: Fidelis Essential Plan QHP |
$89.26
|
| Rate for Payer: Fidelis Medicare Advantage |
$85.01
|
| Rate for Payer: Fidelis Qualified Health Plan |
$89.26
|
| Rate for Payer: Group Health Inc Commercial |
$85.01
|
| Rate for Payer: Group Health Inc Medicare |
$85.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$93.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$93.90
|
| Rate for Payer: Healthfirst Medicare Advantage |
$72.26
|
| Rate for Payer: Healthfirst QHP |
$85.01
|
| Rate for Payer: Humana Medicare |
$86.71
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$85.01
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$88.97
|
| Rate for Payer: SOMOS Essential |
$88.97
|
| Rate for Payer: United Healthcare Commercial |
$80.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$85.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$122.07
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$68.01
|
| Rate for Payer: Wellcare Medicare |
$80.76
|
|
|
ATEZOLIZUMAB 840MG INJ
|
Facility
|
IP
|
$187.80
|
|
|
Service Code
|
HCPCS J9022
|
| Hospital Charge Code |
41657858
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$93.90 |
| Max. Negotiated Rate |
$93.90 |
| Rate for Payer: Cash Price |
$85.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$93.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$93.90
|
|
|
ATHEROSCLEROSIS WITH MCC
|
Facility
|
IP
|
$31,452.53
|
|
|
Service Code
|
MSDRG 302
|
| Min. Negotiated Rate |
$9,613.43 |
| Max. Negotiated Rate |
$31,452.53 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$16,530.62
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$22,874.57
|
| Rate for Payer: Aetna Government |
$22,874.57
|
| Rate for Payer: Brighton Health Commercial |
$16,255.95
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$23,332.06
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$19,360.28
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$15,976.93
|
| Rate for Payer: Elderplan Medicare Advantage |
$21,730.84
|
| Rate for Payer: EmblemHealth Commercial |
$9,613.43
|
| Rate for Payer: Fidelis Medicare Advantage |
$22,874.57
|
| Rate for Payer: Group Health Inc Commercial |
$22,874.57
|
| Rate for Payer: Group Health Inc Medicare |
$22,874.57
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$22,874.57
|
| Rate for Payer: Healthfirst Medicare Advantage |
$10,636.68
|
| Rate for Payer: Humana Medicare |
$31,452.53
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$22,874.57
|
| Rate for Payer: United Healthcare Commercial |
$22,295.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$22,874.57
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$22,874.57
|
| Rate for Payer: Wellcare Medicare |
$21,730.84
|
|
|
ATHEROSCLEROSIS WITHOUT MCC
|
Facility
|
IP
|
$22,624.21
|
|
|
Service Code
|
MSDRG 303
|
| Min. Negotiated Rate |
$5,643.21 |
| Max. Negotiated Rate |
$22,624.21 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$9,703.68
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$16,453.97
|
| Rate for Payer: Aetna Government |
$16,453.97
|
| Rate for Payer: Brighton Health Commercial |
$9,542.45
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$16,783.05
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$11,364.73
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$9,378.66
|
| Rate for Payer: Elderplan Medicare Advantage |
$15,631.27
|
| Rate for Payer: EmblemHealth Commercial |
$5,643.21
|
| Rate for Payer: Fidelis Medicare Advantage |
$16,453.97
|
| Rate for Payer: Group Health Inc Commercial |
$16,453.97
|
| Rate for Payer: Group Health Inc Medicare |
$16,453.97
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16,453.97
|
| Rate for Payer: Healthfirst Medicare Advantage |
$7,651.10
|
| Rate for Payer: Humana Medicare |
$22,624.21
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$16,453.97
|
| Rate for Payer: United Healthcare Commercial |
$13,087.63
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16,453.97
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$16,453.97
|
| Rate for Payer: Wellcare Medicare |
$15,631.27
|
|
