|
VENTRALEX HERNIA PATCH LARGE
|
Facility
|
IP
|
$2,939.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
4471008
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,322.55 |
| Max. Negotiated Rate |
$2,057.30 |
| Rate for Payer: Aetna of NY Commercial |
$2,057.30
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1,322.55
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,322.55
|
| Rate for Payer: Cash Price |
$2,204.25
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,469.50
|
| Rate for Payer: EmblemHealth Select Care |
$1,469.50
|
| Rate for Payer: Galaxy Health Commercial |
$1,910.35
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$2,057.30
|
| Rate for Payer: Multiplan Commercial |
$1,322.55
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,910.35
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1,910.35
|
| Rate for Payer: WellCare Medicare |
$1,616.45
|
|
|
VENTRALEX HERNIA PATCH MEDIUM
|
Facility
|
IP
|
$2,492.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
4471007
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,121.40 |
| Max. Negotiated Rate |
$1,744.40 |
| Rate for Payer: Aetna of NY Commercial |
$1,744.40
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1,121.40
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,121.40
|
| Rate for Payer: Cash Price |
$1,869.00
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,246.00
|
| Rate for Payer: EmblemHealth Select Care |
$1,246.00
|
| Rate for Payer: Galaxy Health Commercial |
$1,619.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,744.40
|
| Rate for Payer: Multiplan Commercial |
$1,121.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,619.80
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1,619.80
|
| Rate for Payer: WellCare Medicare |
$1,370.60
|
|
|
VENTRALEX HERNIA PATCH MEDIUM
|
Facility
|
OP
|
$2,492.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
4471007
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$847.28 |
| Max. Negotiated Rate |
$2,006.06 |
| Rate for Payer: Aetna of NY Commercial |
$1,744.40
|
| Rate for Payer: Aetna of NY Medicare |
$1,146.32
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1,121.40
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,121.40
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$922.04
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$1,246.00
|
| Rate for Payer: Cash Price |
$1,869.00
|
| Rate for Payer: CDPHP Commercial |
$2,006.06
|
| Rate for Payer: CDPHP Medicare |
$922.04
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,246.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,993.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,993.60
|
| Rate for Payer: EmblemHealth Medicaid |
$1,993.60
|
| Rate for Payer: EmblemHealth Medicare |
$847.28
|
| Rate for Payer: EmblemHealth Select Care |
$1,246.00
|
| Rate for Payer: Fidelis Medicare |
$949.70
|
| Rate for Payer: Galaxy Health Commercial |
$1,619.80
|
| Rate for Payer: Hamaspik Choice Medicare |
$922.04
|
| Rate for Payer: Humana Medicare |
$922.04
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,744.40
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,146.32
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,619.80
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1,619.80
|
| Rate for Payer: MVP Health Care of NY Medicare |
$968.14
|
| Rate for Payer: United Healthcare Medicare |
$922.04
|
| Rate for Payer: WellCare Medicare |
$1,370.60
|
|
|
VENTRALEX HERNIA PATCH SMALL
|
Facility
|
IP
|
$1,766.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
4471006
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$794.70 |
| Max. Negotiated Rate |
$1,236.20 |
| Rate for Payer: Aetna of NY Commercial |
$1,236.20
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$794.70
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$794.70
|
| Rate for Payer: Cash Price |
$1,324.50
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$883.00
|
| Rate for Payer: EmblemHealth Select Care |
$883.00
|
| Rate for Payer: Galaxy Health Commercial |
$1,147.90
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,236.20
|
| Rate for Payer: Multiplan Commercial |
$794.70
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,147.90
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1,147.90
|
| Rate for Payer: WellCare Medicare |
$971.30
|
|
|
VENTRALEX HERNIA PATCH SMALL
|
Facility
|
OP
|
$1,766.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
4471006
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$600.44 |
| Max. Negotiated Rate |
$1,421.63 |
| Rate for Payer: Aetna of NY Commercial |
$1,236.20
|
| Rate for Payer: Aetna of NY Medicare |
$812.36
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$794.70
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$794.70
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$653.42
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$883.00
|
| Rate for Payer: Cash Price |
$1,324.50
|
| Rate for Payer: CDPHP Commercial |
$1,421.63
|
| Rate for Payer: CDPHP Medicare |
$653.42
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$883.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,412.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,412.80
|
| Rate for Payer: EmblemHealth Medicaid |
$1,412.80
|
| Rate for Payer: EmblemHealth Medicare |
$600.44
|
| Rate for Payer: EmblemHealth Select Care |
$883.00
|
| Rate for Payer: Fidelis Medicare |
$673.02
|
| Rate for Payer: Galaxy Health Commercial |
$1,147.90
|
| Rate for Payer: Hamaspik Choice Medicare |
$653.42
|
| Rate for Payer: Humana Medicare |
$653.42
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,236.20
|
| Rate for Payer: Local 1199SEIU Medicare |
$812.36
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,147.90
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1,147.90
|
| Rate for Payer: MVP Health Care of NY Medicare |
$686.09
|
| Rate for Payer: United Healthcare Medicare |
$653.42
|
| Rate for Payer: WellCare Medicare |
$971.30
|
|
|
VENTRICULAR LEAD
|
Facility
|
OP
|
$2,189.00
|
|
| Hospital Charge Code |
4471349
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$744.26 |
| Max. Negotiated Rate |
$1,762.14 |
| Rate for Payer: Aetna of NY Commercial |
$1,532.30
|
| Rate for Payer: Aetna of NY Medicare |
$1,006.94
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1,641.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,641.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$809.93
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$1,094.50
|
| Rate for Payer: Cash Price |
$1,641.75
|
| Rate for Payer: CDPHP Commercial |
$1,762.14
|
| Rate for Payer: CDPHP Medicare |
$809.93
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,751.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,751.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,751.20
|
| Rate for Payer: EmblemHealth Medicaid |
$1,751.20
|
| Rate for Payer: EmblemHealth Medicare |
$744.26
|
| Rate for Payer: EmblemHealth Select Care |
$1,576.08
|
| Rate for Payer: Fidelis Medicare |
$834.23
|
| Rate for Payer: Galaxy Health Commercial |
$1,422.85
|
| Rate for Payer: Hamaspik Choice Medicare |
$809.93
|
| Rate for Payer: Humana Medicare |
$809.93
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,532.30
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,006.94
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,641.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1,232.41
|
| Rate for Payer: MVP Health Care of NY Medicare |
$850.43
|
| Rate for Payer: United Healthcare Medicare |
$809.93
|
| Rate for Payer: WellCare Medicare |
$1,203.95
|
|
|
VENTRICULAR LEAD
|
Facility
|
IP
|
$2,189.00
|
|
| Hospital Charge Code |
4471349
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,422.85 |
| Max. Negotiated Rate |
$1,422.85 |
| Rate for Payer: Cash Price |
$1,641.75
|
| Rate for Payer: Galaxy Health Commercial |
$1,422.85
|
|
|
VERAPAMIL 120 MG
|
Facility
|
IP
|
$7.21
|
|
|
Service Code
|
NDC 51079089420
|
| Hospital Charge Code |
4409067
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.97 |
| Max. Negotiated Rate |
$4.69 |
| Rate for Payer: Cash Price |
$5.41
|
| Rate for Payer: Galaxy Health Commercial |
$4.69
|
| Rate for Payer: WellCare Medicare |
$3.97
|
|
|
VERAPAMIL 120 MG
|
Facility
|
OP
|
$7.21
|
|
|
Service Code
|
NDC 51079089420
|
| Hospital Charge Code |
4409067
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.45 |
| Max. Negotiated Rate |
$5.80 |
| Rate for Payer: Aetna of NY Commercial |
$5.05
|
| Rate for Payer: Aetna of NY Medicare |
$3.32
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$5.41
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$5.41
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2.67
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$3.60
|
| Rate for Payer: Cash Price |
$5.41
|
| Rate for Payer: CDPHP Commercial |
$5.80
|
| Rate for Payer: CDPHP Medicare |
$2.67
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$5.77
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$5.77
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$5.77
|
| Rate for Payer: EmblemHealth Medicaid |
$5.77
|
| Rate for Payer: EmblemHealth Medicare |
$2.45
|
| Rate for Payer: EmblemHealth Select Care |
$5.19
|
| Rate for Payer: Fidelis Medicare |
$2.75
|
| Rate for Payer: Galaxy Health Commercial |
$4.69
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.67
|
| Rate for Payer: Humana Medicare |
$2.67
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$5.05
|
| Rate for Payer: Local 1199SEIU Medicare |
$3.32
|
| Rate for Payer: MVP Health Care of NY Commercial |
$5.41
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$4.06
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2.80
|
| Rate for Payer: United Healthcare Medicare |
$2.67
|
| Rate for Payer: WellCare Medicare |
$3.97
|
|
|
VERAPAMIL ER 180 MG TABLET 180 mg, 100 eaches
|
Facility
|
OP
|
$6.00
|
|
|
Service Code
|
NDC 68462029301
|
| Hospital Charge Code |
4401397
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.04 |
| Max. Negotiated Rate |
$4.83 |
| Rate for Payer: Aetna of NY Commercial |
$4.20
|
| Rate for Payer: Aetna of NY Medicare |
$2.76
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$4.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$4.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2.22
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$3.00
|
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: CDPHP Commercial |
$4.83
|
| Rate for Payer: CDPHP Medicare |
$2.22
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$4.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$4.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$4.80
|
| Rate for Payer: EmblemHealth Medicaid |
$4.80
|
| Rate for Payer: EmblemHealth Medicare |
$2.04
|
| Rate for Payer: EmblemHealth Select Care |
$4.32
|
| Rate for Payer: Fidelis Medicare |
$2.29
|
| Rate for Payer: Galaxy Health Commercial |
$3.90
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.22
|
| Rate for Payer: Humana Medicare |
$2.22
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$4.20
|
| Rate for Payer: Local 1199SEIU Medicare |
$2.76
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3.38
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2.33
|
| Rate for Payer: United Healthcare Medicare |
$2.22
|
| Rate for Payer: WellCare Medicare |
$3.30
|
|
|
VERAPAMIL ER 180 MG TABLET 180 mg, 100 eaches
|
Facility
|
IP
|
$6.00
|
|
|
Service Code
|
NDC 68462029301
|
| Hospital Charge Code |
4401397
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.30 |
| Max. Negotiated Rate |
$3.90 |
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: Galaxy Health Commercial |
$3.90
|
| Rate for Payer: WellCare Medicare |
$3.30
|
|
|
VERAPAMIL HCL 120MG TABS 100 EA
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 00904292461
|
| Hospital Charge Code |
4400796
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.10 |
| Max. Negotiated Rate |
$4.97 |
| Rate for Payer: Aetna of NY Commercial |
$4.33
|
| Rate for Payer: Aetna of NY Medicare |
$2.84
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$4.64
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$4.64
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2.29
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$3.09
|
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: CDPHP Commercial |
$4.97
|
| Rate for Payer: CDPHP Medicare |
$2.29
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$4.94
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$4.94
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$4.94
|
| Rate for Payer: EmblemHealth Medicaid |
$4.94
|
| Rate for Payer: EmblemHealth Medicare |
$2.10
|
| Rate for Payer: EmblemHealth Select Care |
$4.45
|
| Rate for Payer: Fidelis Medicare |
$2.36
|
| Rate for Payer: Galaxy Health Commercial |
$4.02
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.29
|
| Rate for Payer: Humana Medicare |
$2.29
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$4.33
|
| Rate for Payer: Local 1199SEIU Medicare |
$2.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4.64
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3.48
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2.40
|
| Rate for Payer: United Healthcare Medicare |
$2.29
|
| Rate for Payer: WellCare Medicare |
$3.40
|
|
|
VERAPAMIL HCL 120MG TABS 100 EA
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
NDC 00904292461
|
| Hospital Charge Code |
4400796
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.40 |
| Max. Negotiated Rate |
$4.02 |
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: Galaxy Health Commercial |
$4.02
|
| Rate for Payer: WellCare Medicare |
$3.40
|
|
|
VERAPAMIL HCL 2.5MG/ML SDV 25X2ML
|
Facility
|
OP
|
$117.94
|
|
|
Service Code
|
NDC 00409114405
|
| Hospital Charge Code |
4400797
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$40.10 |
| Max. Negotiated Rate |
$94.94 |
| Rate for Payer: Aetna of NY Commercial |
$82.56
|
| Rate for Payer: Aetna of NY Medicare |
$54.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$88.46
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$88.46
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$43.64
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$58.97
|
| Rate for Payer: Cash Price |
$88.46
|
| Rate for Payer: CDPHP Commercial |
$94.94
|
| Rate for Payer: CDPHP Medicare |
$43.64
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$94.35
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$94.35
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$94.35
|
| Rate for Payer: EmblemHealth Medicaid |
$94.35
|
| Rate for Payer: EmblemHealth Medicare |
$40.10
|
| Rate for Payer: EmblemHealth Select Care |
$84.92
|
| Rate for Payer: Fidelis Medicare |
$44.95
|
| Rate for Payer: Galaxy Health Commercial |
$76.66
|
| Rate for Payer: Hamaspik Choice Medicare |
$43.64
|
| Rate for Payer: Humana Medicare |
$43.64
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$82.56
|
| Rate for Payer: Local 1199SEIU Medicare |
$54.25
|
| Rate for Payer: MVP Health Care of NY Commercial |
$88.46
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$66.40
|
| Rate for Payer: MVP Health Care of NY Medicare |
$45.82
|
| Rate for Payer: United Healthcare Medicare |
$43.64
|
| Rate for Payer: WellCare Medicare |
$64.87
|
|
|
VERAPAMIL HCL 2.5MG/ML SDV 25X2ML
|
Facility
|
IP
|
$117.94
|
|
|
Service Code
|
NDC 00409114405
|
| Hospital Charge Code |
4400797
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$64.87 |
| Max. Negotiated Rate |
$76.66 |
| Rate for Payer: Cash Price |
$88.46
|
| Rate for Payer: Galaxy Health Commercial |
$76.66
|
| Rate for Payer: WellCare Medicare |
$64.87
|
|
|
VERAPAMIL HCL 40MG TABS 100 EA
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
NDC 23155005901
|
| Hospital Charge Code |
4400798
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.40 |
| Max. Negotiated Rate |
$4.02 |
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: Galaxy Health Commercial |
$4.02
|
| Rate for Payer: WellCare Medicare |
$3.40
|
|
|
VERAPAMIL HCL 40MG TABS 100 EA
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 23155005901
|
| Hospital Charge Code |
4400798
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.10 |
| Max. Negotiated Rate |
$4.97 |
| Rate for Payer: Aetna of NY Commercial |
$4.33
|
| Rate for Payer: Aetna of NY Medicare |
$2.84
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$4.64
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$4.64
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2.29
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$3.09
|
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: CDPHP Commercial |
$4.97
|
| Rate for Payer: CDPHP Medicare |
$2.29
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$4.94
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$4.94
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$4.94
|
| Rate for Payer: EmblemHealth Medicaid |
$4.94
|
| Rate for Payer: EmblemHealth Medicare |
$2.10
|
| Rate for Payer: EmblemHealth Select Care |
$4.45
|
| Rate for Payer: Fidelis Medicare |
$2.36
|
| Rate for Payer: Galaxy Health Commercial |
$4.02
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.29
|
| Rate for Payer: Humana Medicare |
$2.29
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$4.33
|
| Rate for Payer: Local 1199SEIU Medicare |
$2.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4.64
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3.48
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2.40
|
| Rate for Payer: United Healthcare Medicare |
$2.29
|
| Rate for Payer: WellCare Medicare |
$3.40
|
|
|
VERTIFLEX KIT
|
Facility
|
IP
|
$30,840.00
|
|
|
Service Code
|
HCPCS C1821
|
| Hospital Charge Code |
4473023
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$13,878.00 |
| Max. Negotiated Rate |
$21,588.00 |
| Rate for Payer: Aetna of NY Commercial |
$21,588.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$13,878.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$13,878.00
|
| Rate for Payer: Cash Price |
$23,130.00
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$15,420.00
|
| Rate for Payer: EmblemHealth Select Care |
$15,420.00
|
| Rate for Payer: Galaxy Health Commercial |
$20,046.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$21,588.00
|
| Rate for Payer: Multiplan Commercial |
$13,878.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$20,046.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$20,046.00
|
| Rate for Payer: WellCare Medicare |
$16,962.00
|
|
|
VERTIFLEX KIT
|
Facility
|
OP
|
$30,840.00
|
|
|
Service Code
|
HCPCS C1821
|
| Hospital Charge Code |
4473023
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,485.60 |
| Max. Negotiated Rate |
$24,826.20 |
| Rate for Payer: Aetna of NY Commercial |
$21,588.00
|
| Rate for Payer: Aetna of NY Medicare |
$14,186.40
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$13,878.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$13,878.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$11,410.80
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$15,420.00
|
| Rate for Payer: Cash Price |
$23,130.00
|
| Rate for Payer: CDPHP Commercial |
$24,826.20
|
| Rate for Payer: CDPHP Medicare |
$11,410.80
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$15,420.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$24,672.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$24,672.00
|
| Rate for Payer: EmblemHealth Medicaid |
$24,672.00
|
| Rate for Payer: EmblemHealth Medicare |
$10,485.60
|
| Rate for Payer: EmblemHealth Select Care |
$15,420.00
|
| Rate for Payer: Fidelis Medicare |
$11,753.12
|
| Rate for Payer: Galaxy Health Commercial |
$20,046.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$11,410.80
|
| Rate for Payer: Humana Medicare |
$11,410.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$21,588.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$14,186.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$20,046.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$20,046.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$11,981.34
|
| Rate for Payer: United Healthcare Medicare |
$11,410.80
|
| Rate for Payer: WellCare Medicare |
$16,962.00
|
|
|
VERTIFLEX SPACER KIT
|
Facility
|
IP
|
$32,382.00
|
|
|
Service Code
|
HCPCS C1821
|
| Hospital Charge Code |
4473022
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$14,571.90 |
| Max. Negotiated Rate |
$22,667.40 |
| Rate for Payer: Aetna of NY Commercial |
$22,667.40
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$14,571.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$14,571.90
|
| Rate for Payer: Cash Price |
$24,286.50
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$16,191.00
|
| Rate for Payer: EmblemHealth Select Care |
$16,191.00
|
| Rate for Payer: Galaxy Health Commercial |
$21,048.30
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$22,667.40
|
| Rate for Payer: Multiplan Commercial |
$14,571.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$21,048.30
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$21,048.30
|
| Rate for Payer: WellCare Medicare |
$17,810.10
|
|
|
VERTIFLEX SPACER KIT
|
Facility
|
OP
|
$32,382.00
|
|
|
Service Code
|
HCPCS C1821
|
| Hospital Charge Code |
4473022
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,009.88 |
| Max. Negotiated Rate |
$26,067.51 |
| Rate for Payer: Aetna of NY Commercial |
$22,667.40
|
| Rate for Payer: Aetna of NY Medicare |
$14,895.72
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$14,571.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$14,571.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$11,981.34
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$16,191.00
|
| Rate for Payer: Cash Price |
$24,286.50
|
| Rate for Payer: CDPHP Commercial |
$26,067.51
|
| Rate for Payer: CDPHP Medicare |
$11,981.34
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$16,191.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$25,905.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$25,905.60
|
| Rate for Payer: EmblemHealth Medicaid |
$25,905.60
|
| Rate for Payer: EmblemHealth Medicare |
$11,009.88
|
| Rate for Payer: EmblemHealth Select Care |
$16,191.00
|
| Rate for Payer: Fidelis Medicare |
$12,340.78
|
| Rate for Payer: Galaxy Health Commercial |
$21,048.30
|
| Rate for Payer: Hamaspik Choice Medicare |
$11,981.34
|
| Rate for Payer: Humana Medicare |
$11,981.34
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$22,667.40
|
| Rate for Payer: Local 1199SEIU Medicare |
$14,895.72
|
| Rate for Payer: MVP Health Care of NY Commercial |
$21,048.30
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$21,048.30
|
| Rate for Payer: MVP Health Care of NY Medicare |
$12,580.41
|
| Rate for Payer: United Healthcare Medicare |
$11,981.34
|
| Rate for Payer: WellCare Medicare |
$17,810.10
|
|
|
VICRYL P-3
|
Facility
|
OP
|
$34.00
|
|
| Hospital Charge Code |
4478154
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$11.56 |
| Max. Negotiated Rate |
$27.37 |
| Rate for Payer: Aetna of NY Commercial |
$23.80
|
| Rate for Payer: Aetna of NY Medicare |
$15.64
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$25.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$25.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$12.58
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$17.00
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: CDPHP Commercial |
$27.37
|
| Rate for Payer: CDPHP Medicare |
$12.58
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$27.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$27.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$27.20
|
| Rate for Payer: EmblemHealth Medicaid |
$27.20
|
| Rate for Payer: EmblemHealth Medicare |
$11.56
|
| Rate for Payer: EmblemHealth Select Care |
$24.48
|
| Rate for Payer: Fidelis Medicare |
$12.96
|
| Rate for Payer: Galaxy Health Commercial |
$22.10
|
| Rate for Payer: Hamaspik Choice Medicare |
$12.58
|
| Rate for Payer: Humana Medicare |
$12.58
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$23.80
|
| Rate for Payer: Local 1199SEIU Medicare |
$15.64
|
| Rate for Payer: MVP Health Care of NY Commercial |
$25.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$19.14
|
| Rate for Payer: MVP Health Care of NY Medicare |
$13.21
|
| Rate for Payer: United Healthcare Medicare |
$12.58
|
| Rate for Payer: WellCare Medicare |
$18.70
|
|
|
VICRYL P-3
|
Facility
|
IP
|
$34.00
|
|
| Hospital Charge Code |
4478154
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$22.10 |
| Max. Negotiated Rate |
$22.10 |
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Galaxy Health Commercial |
$22.10
|
|
|
VICTOZA 3-PAK 18 MG/3 ML PEN 1 ea, 3 mL
|
Facility
|
IP
|
$1,162.00
|
|
|
Service Code
|
NDC 00169406013
|
| Hospital Charge Code |
4401414
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$639.10 |
| Max. Negotiated Rate |
$755.30 |
| Rate for Payer: Cash Price |
$871.50
|
| Rate for Payer: Galaxy Health Commercial |
$755.30
|
| Rate for Payer: WellCare Medicare |
$639.10
|
|
|
VICTOZA 3-PAK 18 MG/3 ML PEN 1 ea, 3 mL
|
Facility
|
OP
|
$1,162.00
|
|
|
Service Code
|
NDC 00169406013
|
| Hospital Charge Code |
4401414
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$395.08 |
| Max. Negotiated Rate |
$935.41 |
| Rate for Payer: Aetna of NY Commercial |
$813.40
|
| Rate for Payer: Aetna of NY Medicare |
$534.52
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$871.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$871.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$429.94
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$581.00
|
| Rate for Payer: Cash Price |
$871.50
|
| Rate for Payer: CDPHP Commercial |
$935.41
|
| Rate for Payer: CDPHP Medicare |
$429.94
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$929.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$929.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$929.60
|
| Rate for Payer: EmblemHealth Medicaid |
$929.60
|
| Rate for Payer: EmblemHealth Medicare |
$395.08
|
| Rate for Payer: EmblemHealth Select Care |
$836.64
|
| Rate for Payer: Fidelis Medicare |
$442.84
|
| Rate for Payer: Galaxy Health Commercial |
$755.30
|
| Rate for Payer: Hamaspik Choice Medicare |
$429.94
|
| Rate for Payer: Humana Medicare |
$429.94
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$813.40
|
| Rate for Payer: Local 1199SEIU Medicare |
$534.52
|
| Rate for Payer: MVP Health Care of NY Commercial |
$871.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$654.21
|
| Rate for Payer: MVP Health Care of NY Medicare |
$451.44
|
| Rate for Payer: United Healthcare Medicare |
$429.94
|
| Rate for Payer: WellCare Medicare |
$639.10
|
|
