|
NIRSEVIMAB-ALIP 50 MG/0.5ML IM SOSY
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
NDC 4928157515
|
| Hospital Charge Code |
4928157515
|
|
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: EmblemHealth Commercial |
$0.50
|
| 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
|
|
|
NIRSEVIMAB-ALIP 50 MG/0.5ML IM SOSY
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
NDC 4928157515
|
| Hospital Charge Code |
4928157515
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.50 |
| Max. Negotiated Rate |
$0.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.50
|
|
|
NITAZOXANIDE 100 MG/5ML PO SUSR
|
Facility
|
OP
|
$10.44
|
|
|
Service Code
|
NDC 6754621221
|
| Hospital Charge Code |
6754621221
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.65 |
| Max. Negotiated Rate |
$8.35 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.74
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.22
|
| Rate for Payer: Aetna Government |
$5.22
|
| Rate for Payer: Brighton Health Commercial |
$7.83
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.35
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7.10
|
| Rate for Payer: EmblemHealth Commercial |
$5.22
|
| Rate for Payer: Group Health Inc Commercial |
$5.22
|
| Rate for Payer: Group Health Inc Medicare |
$3.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6.79
|
|
|
NITAZOXANIDE 100 MG/5ML PO SUSR
|
Facility
|
IP
|
$10.44
|
|
|
Service Code
|
NDC 6754621221
|
| Hospital Charge Code |
6754621221
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$5.22 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.22
|
|
|
NITAZOXANIDE 500 MG PO TABS
|
Facility
|
IP
|
$161.56
|
|
|
Service Code
|
NDC 6754611112
|
| Hospital Charge Code |
6754611112
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$80.78 |
| Max. Negotiated Rate |
$80.78 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$80.78
|
|
|
NITAZOXANIDE 500 MG PO TABS
|
Facility
|
OP
|
$161.56
|
|
|
Service Code
|
NDC 6754611112
|
| Hospital Charge Code |
6754611112
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$56.55 |
| Max. Negotiated Rate |
$129.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$88.86
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$80.78
|
| Rate for Payer: Aetna Government |
$80.78
|
| Rate for Payer: Brighton Health Commercial |
$121.17
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$129.25
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$109.86
|
| Rate for Payer: EmblemHealth Commercial |
$80.78
|
| Rate for Payer: Group Health Inc Commercial |
$80.78
|
| Rate for Payer: Group Health Inc Medicare |
$56.55
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$80.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$80.78
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$105.01
|
|
|
NITHIODOTE 300MG/10ML&12.5 GM/50ML IV KIT
|
Facility
|
IP
|
$3.80
|
|
|
Service Code
|
NDC 6026781200
|
| Hospital Charge Code |
6026781200
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$1.90 |
| Max. Negotiated Rate |
$1.90 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.90
|
|
|
NITHIODOTE 300MG/10ML&12.5 GM/50ML IV KIT
|
Facility
|
OP
|
$3.80
|
|
|
Service Code
|
NDC 6026781200
|
| Hospital Charge Code |
6026781200
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$1.33 |
| Max. Negotiated Rate |
$3.04 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.09
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.90
|
| Rate for Payer: Aetna Government |
$1.90
|
| Rate for Payer: Brighton Health Commercial |
$2.85
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.04
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.58
|
| Rate for Payer: EmblemHealth Commercial |
$1.90
|
| Rate for Payer: Group Health Inc Commercial |
$1.90
|
| Rate for Payer: Group Health Inc Medicare |
$1.33
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.90
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.47
|
|
|
NITROFURANTOIN 25 MG/5ML PO SUSP
|
Facility
|
IP
|
$3.18
|
|
|
Service Code
|
NDC 4338645011
|
| Hospital Charge Code |
4338645011
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.59 |
| Max. Negotiated Rate |
$1.59 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.59
|
|
|
NITROFURANTOIN 25 MG/5ML PO SUSP
|
Facility
|
IP
|
$12.46
|
|
|
Service Code
|
NDC 7040823932
|
| Hospital Charge Code |
7040823932
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.23 |
| Max. Negotiated Rate |
$6.23 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.23
|
|
|
NITROFURANTOIN 25 MG/5ML PO SUSP
|
Facility
|
OP
|
$12.46
|
|
|
Service Code
|
NDC 7040823932
|
| Hospital Charge Code |
7040823932
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.36 |
| Max. Negotiated Rate |
$9.97 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.85
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.23
|
| Rate for Payer: Aetna Government |
$6.23
|
| Rate for Payer: Brighton Health Commercial |
$9.35
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$9.97
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$8.47
|
| Rate for Payer: EmblemHealth Commercial |
$6.23
|
| Rate for Payer: Group Health Inc Commercial |
$6.23
|
| Rate for Payer: Group Health Inc Medicare |
$4.36
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.23
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.23
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8.10
|
|
|
NITROFURANTOIN 25 MG/5ML PO SUSP
|
Facility
|
OP
|
$3.18
|
|
|
Service Code
|
NDC 4338645011
|
| Hospital Charge Code |
4338645011
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.11 |
| Max. Negotiated Rate |
$2.54 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.59
|
| Rate for Payer: Aetna Government |
$1.59
|
| Rate for Payer: Brighton Health Commercial |
$2.38
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.54
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.16
|
| Rate for Payer: EmblemHealth Commercial |
$1.59
|
| Rate for Payer: Group Health Inc Commercial |
$1.59
|
| Rate for Payer: Group Health Inc Medicare |
$1.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.59
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.06
|
|
|
NITROFURANTOIN MACROCRYSTAL 50 MG PO CAPS
|
Facility
|
OP
|
$2.13
|
|
|
Service Code
|
NDC 0115164301
|
| Hospital Charge Code |
0115164301
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.75 |
| Max. Negotiated Rate |
$1.71 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.17
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.07
|
| Rate for Payer: Aetna Government |
$1.07
|
| Rate for Payer: Brighton Health Commercial |
$1.60
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.71
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.45
|
| Rate for Payer: EmblemHealth Commercial |
$1.07
|
| Rate for Payer: Group Health Inc Commercial |
$1.07
|
| Rate for Payer: Group Health Inc Medicare |
$0.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.07
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.07
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.39
|
|
|
NITROFURANTOIN MACROCRYSTAL 50 MG PO CAPS
|
Facility
|
IP
|
$2.13
|
|
|
Service Code
|
NDC 0115164301
|
| Hospital Charge Code |
0115164301
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.07 |
| Max. Negotiated Rate |
$1.07 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.07
|
|
|
NITROFURANTOIN MACROCRYSTAL 50 MG PO CAPS
|
Facility
|
OP
|
$2.27
|
|
|
Service Code
|
NDC 4778130701
|
| Hospital Charge Code |
4778130701
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.80 |
| Max. Negotiated Rate |
$1.82 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.14
|
| Rate for Payer: Aetna Government |
$1.14
|
| Rate for Payer: Brighton Health Commercial |
$1.70
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.82
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.54
|
| Rate for Payer: EmblemHealth Commercial |
$1.14
|
| Rate for Payer: Group Health Inc Commercial |
$1.14
|
| Rate for Payer: Group Health Inc Medicare |
$0.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.48
|
|
|
NITROFURANTOIN MACROCRYSTAL 50 MG PO CAPS
|
Facility
|
IP
|
$2.27
|
|
|
Service Code
|
NDC 4778130701
|
| Hospital Charge Code |
4778130701
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.14 |
| Max. Negotiated Rate |
$1.14 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.14
|
|
|
NITROFURANTOIN MONOHYD MACRO 100 MG PO CAPS
|
Facility
|
OP
|
$4.29
|
|
|
Service Code
|
NDC 5026862511
|
| Hospital Charge Code |
5026862511
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.50 |
| Max. Negotiated Rate |
$3.43 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.36
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.14
|
| Rate for Payer: Aetna Government |
$2.14
|
| Rate for Payer: Brighton Health Commercial |
$3.21
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.43
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.91
|
| Rate for Payer: EmblemHealth Commercial |
$2.14
|
| Rate for Payer: Group Health Inc Commercial |
$2.14
|
| Rate for Payer: Group Health Inc Medicare |
$1.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.79
|
|
|
NITROFURANTOIN MONOHYD MACRO 100 MG PO CAPS
|
Facility
|
IP
|
$2.77
|
|
|
Service Code
|
NDC 0904713761
|
| Hospital Charge Code |
0904713761
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.38 |
| Max. Negotiated Rate |
$1.38 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.38
|
|
|
NITROFURANTOIN MONOHYD MACRO 100 MG PO CAPS
|
Facility
|
OP
|
$2.77
|
|
|
Service Code
|
NDC 0904713761
|
| Hospital Charge Code |
0904713761
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.97 |
| Max. Negotiated Rate |
$2.22 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.52
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.38
|
| Rate for Payer: Aetna Government |
$1.38
|
| Rate for Payer: Brighton Health Commercial |
$2.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.22
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.88
|
| Rate for Payer: EmblemHealth Commercial |
$1.38
|
| Rate for Payer: Group Health Inc Commercial |
$1.38
|
| Rate for Payer: Group Health Inc Medicare |
$0.97
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.80
|
|
|
NITROFURANTOIN MONOHYD MACRO 100 MG PO CAPS
|
Facility
|
IP
|
$4.29
|
|
|
Service Code
|
NDC 5026862511
|
| Hospital Charge Code |
5026862511
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.14 |
| Max. Negotiated Rate |
$2.14 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.14
|
|
|
NITROFURANTOIN MONOHYD MACRO 100 MG PO CAPS
|
Facility
|
IP
|
$4.08
|
|
|
Service Code
|
NDC 7075640411
|
| Hospital Charge Code |
7075640411
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.04 |
| Max. Negotiated Rate |
$2.04 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.04
|
|
|
NITROFURANTOIN MONOHYD MACRO 100 MG PO CAPS
|
Facility
|
OP
|
$4.08
|
|
|
Service Code
|
NDC 7075640411
|
| Hospital Charge Code |
7075640411
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.43 |
| Max. Negotiated Rate |
$3.27 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.04
|
| Rate for Payer: Aetna Government |
$2.04
|
| Rate for Payer: Brighton Health Commercial |
$3.06
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.27
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.78
|
| Rate for Payer: EmblemHealth Commercial |
$2.04
|
| Rate for Payer: Group Health Inc Commercial |
$2.04
|
| Rate for Payer: Group Health Inc Medicare |
$1.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.04
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.65
|
|
|
NITROGLYCERIN 0.1 MG/HR TD PT24
|
Facility
|
IP
|
$1.86
|
|
|
Service Code
|
NDC 0378910293
|
| Hospital Charge Code |
0378910293
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.93 |
| Max. Negotiated Rate |
$0.93 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.93
|
|
|
NITROGLYCERIN 0.1 MG/HR TD PT24
|
Facility
|
IP
|
$1.86
|
|
|
Service Code
|
NDC 0378910216
|
| Hospital Charge Code |
0378910216
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.93 |
| Max. Negotiated Rate |
$0.93 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.93
|
|
|
NITROGLYCERIN 0.1 MG/HR TD PT24
|
Facility
|
OP
|
$1.86
|
|
|
Service Code
|
NDC 0378910293
|
| Hospital Charge Code |
0378910293
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.65 |
| Max. Negotiated Rate |
$1.49 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.02
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.93
|
| Rate for Payer: Aetna Government |
$0.93
|
| Rate for Payer: Brighton Health Commercial |
$1.39
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.49
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.26
|
| Rate for Payer: EmblemHealth Commercial |
$0.93
|
| Rate for Payer: Group Health Inc Commercial |
$0.93
|
| Rate for Payer: Group Health Inc Medicare |
$0.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.93
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.93
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.21
|
|
