|
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 |
41656101
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.93 |
| 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: Affinity Essential Plan 1&2 |
$17.93
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$17.93
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$17.93
|
| Rate for Payer: Brighton Health Commercial |
$41.32
|
| 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 Medicare Advantage |
$21.78
|
| Rate for Payer: Healthfirst QHP |
$25.62
|
| Rate for Payer: Humana Medicare |
$26.13
|
| 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: United Healthcare Commercial |
$31.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$25.62
|
| 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
|
OP
|
$68.86
|
|
|
Service Code
|
HCPCS Q5107
|
| Hospital Charge Code |
41646101
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.93 |
| 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: Affinity Essential Plan 1&2 |
$17.93
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$17.93
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$17.93
|
| Rate for Payer: Brighton Health Commercial |
$41.32
|
| 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 Medicare Advantage |
$21.78
|
| Rate for Payer: Healthfirst QHP |
$25.62
|
| Rate for Payer: Humana Medicare |
$26.13
|
| 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: United Healthcare Commercial |
$31.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$25.62
|
| 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
|
OP
|
$68.86
|
|
|
Service Code
|
HCPCS Q5107
|
| Hospital Charge Code |
41646102
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.93 |
| 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: Affinity Essential Plan 1&2 |
$17.93
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$17.93
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$17.93
|
| Rate for Payer: Brighton Health Commercial |
$41.32
|
| 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 Medicare Advantage |
$21.78
|
| Rate for Payer: Healthfirst QHP |
$25.62
|
| Rate for Payer: Humana Medicare |
$26.13
|
| 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: United Healthcare Commercial |
$31.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$25.62
|
| 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 |
41656102
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.93 |
| 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: Affinity Essential Plan 1&2 |
$17.93
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$17.93
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$17.93
|
| Rate for Payer: Brighton Health Commercial |
$41.32
|
| 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 Medicare Advantage |
$21.78
|
| Rate for Payer: Healthfirst QHP |
$25.62
|
| Rate for Payer: Humana Medicare |
$26.13
|
| 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: United Healthcare Commercial |
$31.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$25.62
|
| 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-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 400 MG/16ML IV SOLN [168889]
|
Facility
|
OP
|
$209.32
|
|
|
Service Code
|
HCPCS Q5107
|
| Hospital Charge Code |
55513020701
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$20.50 |
| Max. Negotiated Rate |
$136.06 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$115.12
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$25.62
|
| Rate for Payer: Aetna Government |
$25.62
|
| Rate for Payer: Brighton Health Commercial |
$125.59
|
| 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 |
$104.66
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$120.36
|
| Rate for Payer: Elderplan Medicare Advantage |
$25.62
|
| Rate for Payer: EmblemHealth Commercial |
$104.66
|
| Rate for Payer: Fidelis Medicare Advantage |
$25.62
|
| 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 |
$104.66
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$104.66
|
| Rate for Payer: Healthfirst Medicare Advantage |
$21.78
|
| Rate for Payer: Healthfirst QHP |
$25.62
|
| Rate for Payer: Humana Medicare |
$26.13
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$25.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$25.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$136.06
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$20.50
|
|
|
BEVACIZUMAB-AWWB 400 MG/16ML IV SOLN [168889]
|
Facility
|
IP
|
$209.32
|
|
|
Service Code
|
HCPCS Q5107
|
| Hospital Charge Code |
55513020701
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$104.66 |
| Max. Negotiated Rate |
$104.66 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$104.66
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$104.66
|
|
|
BEVACIZUMAB-BVZR 100 MG/4ML IV SOLN [171636]
|
Facility
|
OP
|
$184.02
|
|
|
Service Code
|
HCPCS Q5118
|
| Hospital Charge Code |
00069031501
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$17.21 |
| Max. Negotiated Rate |
$119.61 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$101.21
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$21.51
|
| Rate for Payer: Aetna Government |
$21.51
|
| Rate for Payer: Brighton Health Commercial |
$110.41
|
| 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 |
$92.01
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$105.81
|
| Rate for Payer: Elderplan Medicare Advantage |
$21.51
|
| Rate for Payer: EmblemHealth Commercial |
$92.01
|
| Rate for Payer: Fidelis Medicare Advantage |
$21.51
|
| 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 |
$92.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$92.01
|
| Rate for Payer: Healthfirst Medicare Advantage |
$18.28
|
| Rate for Payer: Healthfirst QHP |
$21.51
|
| Rate for Payer: Humana Medicare |
$21.94
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$21.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21.51
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$119.61
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$17.21
|
|
|
BEVACIZUMAB-BVZR 100 MG/4ML IV SOLN [171636]
|
Facility
|
IP
|
$184.02
|
|
|
Service Code
|
HCPCS Q5118
|
| Hospital Charge Code |
00069031501
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$92.01 |
| Max. Negotiated Rate |
$92.01 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$92.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$92.01
|
|
|
BEVACIZUMAB-BVZR 10MG
|
Facility
|
OP
|
$55.94
|
|
|
Service Code
|
HCPCS Q5118
|
| Hospital Charge Code |
41646100
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.06 |
| 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: Affinity Essential Plan 1&2 |
$15.06
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$15.06
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$15.06
|
| Rate for Payer: Brighton Health Commercial |
$33.56
|
| 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 Medicare Advantage |
$18.28
|
| Rate for Payer: Healthfirst QHP |
$21.51
|
| Rate for Payer: Humana Medicare |
$21.94
|
| 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: United Healthcare Commercial |
$33.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21.51
|
| 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 |
41656100
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.06 |
| 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: Affinity Essential Plan 1&2 |
$15.06
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$15.06
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$15.06
|
| Rate for Payer: Brighton Health Commercial |
$33.56
|
| 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 Medicare Advantage |
$18.28
|
| Rate for Payer: Healthfirst QHP |
$21.51
|
| Rate for Payer: Humana Medicare |
$21.94
|
| 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: United Healthcare Commercial |
$33.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21.51
|
| 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
|
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 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 |
41656103
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.06 |
| 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: Affinity Essential Plan 1&2 |
$15.06
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$15.06
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$15.06
|
| Rate for Payer: Brighton Health Commercial |
$33.56
|
| 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 Medicare Advantage |
$18.28
|
| Rate for Payer: Healthfirst QHP |
$21.51
|
| Rate for Payer: Humana Medicare |
$21.94
|
| 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: United Healthcare Commercial |
$33.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21.51
|
| 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
|
OP
|
$55.94
|
|
|
Service Code
|
HCPCS Q5118
|
| Hospital Charge Code |
41646103
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.06 |
| 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: Affinity Essential Plan 1&2 |
$15.06
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$15.06
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$15.06
|
| Rate for Payer: Brighton Health Commercial |
$33.56
|
| 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 Medicare Advantage |
$18.28
|
| Rate for Payer: Healthfirst QHP |
$21.51
|
| Rate for Payer: Humana Medicare |
$21.94
|
| 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: United Healthcare Commercial |
$33.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21.51
|
| 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 400 MG/16ML IV SOLN [171637]
|
Facility
|
OP
|
$184.02
|
|
|
Service Code
|
HCPCS Q5118
|
| Hospital Charge Code |
00069034201
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$17.21 |
| Max. Negotiated Rate |
$119.61 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$101.21
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$21.51
|
| Rate for Payer: Aetna Government |
$21.51
|
| Rate for Payer: Brighton Health Commercial |
$110.41
|
| 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 |
$92.01
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$105.81
|
| Rate for Payer: Elderplan Medicare Advantage |
$21.51
|
| Rate for Payer: EmblemHealth Commercial |
$92.01
|
| Rate for Payer: Fidelis Medicare Advantage |
$21.51
|
| 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 |
$92.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$92.01
|
| Rate for Payer: Healthfirst Medicare Advantage |
$18.28
|
| Rate for Payer: Healthfirst QHP |
$21.51
|
| Rate for Payer: Humana Medicare |
$21.94
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$21.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21.51
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$119.61
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$17.21
|
|
|
BEVACIZUMAB-BVZR 400 MG/16ML IV SOLN [171637]
|
Facility
|
IP
|
$184.02
|
|
|
Service Code
|
HCPCS Q5118
|
| Hospital Charge Code |
00069034201
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$92.01 |
| Max. Negotiated Rate |
$92.01 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$92.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$92.01
|
|
|
BEVACIZUMAB-MALY 100 MG/4ML IV SOLN [186421]
|
Facility
|
IP
|
$215.58
|
|
|
Service Code
|
NDC 70121175407
|
| Hospital Charge Code |
70121175407
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$107.79 |
| Max. Negotiated Rate |
$107.79 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$107.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$107.79
|
|
|
BEVACIZUMAB-MALY 100 MG/4ML IV SOLN [186421]
|
Facility
|
OP
|
$215.58
|
|
|
Service Code
|
NDC 70121175407
|
| Hospital Charge Code |
70121175407
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$75.45 |
| Max. Negotiated Rate |
$226.36 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$118.57
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$107.79
|
| Rate for Payer: Aetna Government |
$107.79
|
| Rate for Payer: Brighton Health Commercial |
$129.35
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$107.79
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$123.96
|
| Rate for Payer: EmblemHealth Commercial |
$107.79
|
| Rate for Payer: Fidelis Medicare Advantage |
$226.36
|
| Rate for Payer: Group Health Inc Commercial |
$107.79
|
| Rate for Payer: Group Health Inc Medicare |
$75.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$107.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$107.79
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$140.13
|
|
|
BEVACIZUMAB-MALY 100 MG/4ML IV SOLN [186421]
|
Facility
|
OP
|
$215.58
|
|
|
Service Code
|
NDC 70121175401
|
| Hospital Charge Code |
70121175401
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$75.45 |
| Max. Negotiated Rate |
$226.36 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$118.57
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$107.79
|
| Rate for Payer: Aetna Government |
$107.79
|
| Rate for Payer: Brighton Health Commercial |
$129.35
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$107.79
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$123.96
|
| Rate for Payer: EmblemHealth Commercial |
$107.79
|
| Rate for Payer: Fidelis Medicare Advantage |
$226.36
|
| Rate for Payer: Group Health Inc Commercial |
$107.79
|
| Rate for Payer: Group Health Inc Medicare |
$75.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$107.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$107.79
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$140.13
|
|
