|
VENELEX OINTMENT 1 ea, 28.35 g
|
Facility
|
IP
|
$89.00
|
|
|
Service Code
|
NDC 58980078011
|
| Hospital Charge Code |
4401533
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$48.95 |
| Max. Negotiated Rate |
$57.85 |
| Rate for Payer: Cash Price |
$66.75
|
| Rate for Payer: Galaxy Health Commercial |
$57.85
|
| Rate for Payer: WellCare Medicare |
$48.95
|
|
|
VENIPUNCTURE
|
Facility
|
IP
|
$28.00
|
|
|
Service Code
|
HCPCS 36415
|
| Hospital Charge Code |
4300999
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.20 |
| Max. Negotiated Rate |
$18.20 |
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: Galaxy Health Commercial |
$18.20
|
|
|
VENIPUNCTURE
|
Facility
|
OP
|
$28.00
|
|
|
Service Code
|
HCPCS 36415
|
| Hospital Charge Code |
4300999
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.20 |
| Max. Negotiated Rate |
$21.00 |
| Rate for Payer: Aetna of NY Commercial |
$19.60
|
| Rate for Payer: Aetna of NY Medicare |
$12.88
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$11.20
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: CDPHP Medicare |
$10.36
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$16.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$8.58
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$7.15
|
| Rate for Payer: EmblemHealth Medicaid |
$7.15
|
| Rate for Payer: EmblemHealth Medicare |
$9.52
|
| Rate for Payer: EmblemHealth Select Care |
$16.80
|
| Rate for Payer: Fidelis Medicare |
$11.20
|
| Rate for Payer: Galaxy Health Commercial |
$18.20
|
| Rate for Payer: Galaxy Health Workers Comp |
$7.01
|
| Rate for Payer: Hamaspik Choice Medicaid |
$7.15
|
| Rate for Payer: Hamaspik Choice Medicare |
$11.20
|
| Rate for Payer: Humana Medicare |
$11.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$19.60
|
| Rate for Payer: Local 1199SEIU Medicare |
$12.88
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$7.51
|
| Rate for Payer: MVP Health Care of NY Commercial |
$21.00
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$15.37
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$15.37
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$15.76
|
| Rate for Payer: MVP Health Care of NY Medicare |
$11.76
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$21.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$4.20
|
| Rate for Payer: United Healthcare Commercial |
$21.00
|
| Rate for Payer: United Healthcare Medicare |
$11.20
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$7.51
|
| Rate for Payer: WellCare Medicare |
$15.40
|
|
|
VENLAFAXINE ER 150 MG CAPSULES
|
Facility
|
OP
|
$18.28
|
|
|
Service Code
|
NDC 904624861
|
| Hospital Charge Code |
4409165
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.74 |
| Max. Negotiated Rate |
$14.62 |
| Rate for Payer: Aetna of NY Commercial |
$12.80
|
| Rate for Payer: Aetna of NY Medicare |
$8.41
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$7.31
|
| Rate for Payer: Cash Price |
$13.71
|
| Rate for Payer: CDPHP Medicare |
$6.76
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$14.62
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$14.62
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$14.62
|
| Rate for Payer: EmblemHealth Medicaid |
$14.62
|
| Rate for Payer: EmblemHealth Medicare |
$6.22
|
| Rate for Payer: EmblemHealth Select Care |
$13.16
|
| Rate for Payer: Fidelis Medicare |
$7.31
|
| Rate for Payer: Galaxy Health Commercial |
$11.88
|
| Rate for Payer: Hamaspik Choice Medicare |
$7.31
|
| Rate for Payer: Humana Medicare |
$7.31
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$12.80
|
| Rate for Payer: Local 1199SEIU Medicare |
$8.41
|
| Rate for Payer: MVP Health Care of NY Commercial |
$13.71
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$10.29
|
| Rate for Payer: MVP Health Care of NY Medicare |
$7.68
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$2.74
|
| Rate for Payer: United Healthcare Medicare |
$7.31
|
| Rate for Payer: WellCare Medicare |
$10.05
|
|
|
VENLAFAXINE ER 150 MG CAPSULES
|
Facility
|
IP
|
$18.28
|
|
|
Service Code
|
NDC 904624861
|
| Hospital Charge Code |
4409165
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.05 |
| Max. Negotiated Rate |
$11.88 |
| Rate for Payer: Cash Price |
$13.71
|
| Rate for Payer: Galaxy Health Commercial |
$11.88
|
| Rate for Payer: WellCare Medicare |
$10.05
|
|
|
VENLAFAXINE HCL 37.5MG TABS 10X10EA
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
NDC 68084084411
|
| Hospital Charge Code |
4400793
|
|
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
|
|
|
VENLAFAXINE HCL 37.5MG TABS 10X10EA
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 68084084411
|
| Hospital Charge Code |
4400793
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.93 |
| Max. Negotiated Rate |
$4.94 |
| 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) Medicare |
$2.47
|
| Rate for Payer: Cash Price |
$4.64
|
| 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 |
$2.47
|
| Rate for Payer: Galaxy Health Commercial |
$4.02
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.47
|
| Rate for Payer: Humana Medicare |
$2.47
|
| 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 |
$4.63
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3.48
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2.60
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$0.93
|
| Rate for Payer: United Healthcare Medicare |
$2.47
|
| Rate for Payer: WellCare Medicare |
$3.40
|
|
|
VENLAFAXINE HCL 50 MG TABLET 50 mg, 100 eaches
|
Facility
|
IP
|
$6.00
|
|
|
Service Code
|
NDC 57237017401
|
| Hospital Charge Code |
4401909
|
|
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
|
|
|
VENLAFAXINE HCL 50 MG TABLET 50 mg, 100 eaches
|
Facility
|
OP
|
$6.00
|
|
|
Service Code
|
NDC 57237017401
|
| Hospital Charge Code |
4401909
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$4.80 |
| 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) Medicare |
$2.40
|
| Rate for Payer: Cash Price |
$4.50
|
| 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 |
$2.40
|
| Rate for Payer: Galaxy Health Commercial |
$3.90
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.40
|
| Rate for Payer: Humana Medicare |
$2.40
|
| 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 |
$2.52
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$0.90
|
| Rate for Payer: United Healthcare Medicare |
$2.40
|
| Rate for Payer: WellCare Medicare |
$3.30
|
|
|
VENLAFAXINE HCL ER 150 MG CAP 150 mg, 90 eaches
|
Facility
|
IP
|
$6.00
|
|
|
Service Code
|
NDC 65862069790
|
| Hospital Charge Code |
4401511
|
|
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
|
|
|
VENLAFAXINE HCL ER 150 MG CAP 150 mg, 90 eaches
|
Facility
|
OP
|
$6.00
|
|
|
Service Code
|
NDC 65862069790
|
| Hospital Charge Code |
4401511
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$4.80 |
| 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) Medicare |
$2.40
|
| Rate for Payer: Cash Price |
$4.50
|
| 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 |
$2.40
|
| Rate for Payer: Galaxy Health Commercial |
$3.90
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.40
|
| Rate for Payer: Humana Medicare |
$2.40
|
| 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 |
$2.52
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$0.90
|
| Rate for Payer: United Healthcare Medicare |
$2.40
|
| Rate for Payer: WellCare Medicare |
$3.30
|
|
|
VENLAFAXINE XR 37.5 MG CAP
|
Facility
|
IP
|
$11.59
|
|
|
Service Code
|
NDC 904646861
|
| Hospital Charge Code |
4401265
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.37 |
| Max. Negotiated Rate |
$7.53 |
| Rate for Payer: Cash Price |
$8.69
|
| Rate for Payer: Galaxy Health Commercial |
$7.53
|
| Rate for Payer: WellCare Medicare |
$6.37
|
|
|
VENLAFAXINE XR 37.5 MG CAP
|
Facility
|
OP
|
$11.59
|
|
|
Service Code
|
NDC 904646861
|
| Hospital Charge Code |
4401265
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.74 |
| Max. Negotiated Rate |
$9.27 |
| Rate for Payer: Aetna of NY Commercial |
$8.11
|
| Rate for Payer: Aetna of NY Medicare |
$5.33
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$4.64
|
| Rate for Payer: Cash Price |
$8.69
|
| Rate for Payer: CDPHP Medicare |
$4.29
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$9.27
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$9.27
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$9.27
|
| Rate for Payer: EmblemHealth Medicaid |
$9.27
|
| Rate for Payer: EmblemHealth Medicare |
$3.94
|
| Rate for Payer: EmblemHealth Select Care |
$8.34
|
| Rate for Payer: Fidelis Medicare |
$4.64
|
| Rate for Payer: Galaxy Health Commercial |
$7.53
|
| Rate for Payer: Hamaspik Choice Medicare |
$4.64
|
| Rate for Payer: Humana Medicare |
$4.64
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$8.11
|
| Rate for Payer: Local 1199SEIU Medicare |
$5.33
|
| Rate for Payer: MVP Health Care of NY Commercial |
$8.69
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$6.53
|
| Rate for Payer: MVP Health Care of NY Medicare |
$4.87
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1.74
|
| Rate for Payer: United Healthcare Medicare |
$4.64
|
| Rate for Payer: WellCare Medicare |
$6.37
|
|
|
VENOFER INJECTION 100MG/5 ML
|
Facility
|
IP
|
$12.00
|
|
|
Service Code
|
HCPCS J1756
|
| Hospital Charge Code |
4409093
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$7.80 |
| Rate for Payer: Aetna of NY Commercial |
$6.60
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.22
|
| Rate for Payer: EmblemHealth Select Care |
$0.22
|
| Rate for Payer: Galaxy Health Commercial |
$7.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$6.60
|
| Rate for Payer: WellCare Medicare |
$6.60
|
|
|
VENOFER INJECTION 100MG/5 ML
|
Facility
|
OP
|
$12.00
|
|
|
Service Code
|
HCPCS J1756
|
| Hospital Charge Code |
4409093
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$9.00 |
| Rate for Payer: Aetna of NY Medicare |
$5.52
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$4.80
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: CDPHP Medicare |
$4.44
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.22
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$0.32
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$0.27
|
| Rate for Payer: EmblemHealth Medicaid |
$0.27
|
| Rate for Payer: EmblemHealth Medicare |
$4.08
|
| Rate for Payer: EmblemHealth Select Care |
$0.22
|
| Rate for Payer: Fidelis Medicare |
$4.80
|
| Rate for Payer: Galaxy Health Commercial |
$7.80
|
| Rate for Payer: Galaxy Health Workers Comp |
$0.26
|
| Rate for Payer: Hamaspik Choice Medicaid |
$0.27
|
| Rate for Payer: Hamaspik Choice Medicare |
$4.80
|
| Rate for Payer: Humana Medicare |
$4.80
|
| Rate for Payer: Local 1199SEIU Medicare |
$5.52
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$0.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$9.00
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$0.58
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$0.58
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$6.76
|
| Rate for Payer: MVP Health Care of NY Medicare |
$5.04
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$0.35
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1.80
|
| Rate for Payer: United Healthcare Commercial |
$0.35
|
| Rate for Payer: United Healthcare Medicare |
$4.80
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$0.28
|
| Rate for Payer: WellCare Medicare |
$6.60
|
|
|
VENOUS BLOOD GAS (VBG)
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
HCPCS 82803
|
| Hospital Charge Code |
4301075
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.00 |
| Max. Negotiated Rate |
$80.00 |
| Rate for Payer: Aetna of NY Commercial |
$65.00
|
| Rate for Payer: Aetna of NY Medicare |
$46.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$40.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: CDPHP Medicare |
$37.00
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$60.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$80.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$80.00
|
| Rate for Payer: EmblemHealth Medicaid |
$80.00
|
| Rate for Payer: EmblemHealth Medicare |
$34.00
|
| Rate for Payer: EmblemHealth Select Care |
$60.00
|
| Rate for Payer: Fidelis Medicare |
$40.00
|
| Rate for Payer: Galaxy Health Commercial |
$65.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$40.00
|
| Rate for Payer: Humana Medicare |
$40.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$65.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$46.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$75.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$56.30
|
| Rate for Payer: MVP Health Care of NY Medicare |
$42.00
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$75.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$15.00
|
| Rate for Payer: United Healthcare Commercial |
$75.00
|
| Rate for Payer: United Healthcare Medicare |
$40.00
|
| Rate for Payer: WellCare Medicare |
$55.00
|
|
|
VENOUS BLOOD GAS (VBG)
|
Facility
|
IP
|
$100.00
|
|
|
Service Code
|
HCPCS 82803
|
| Hospital Charge Code |
4301075
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$65.00 |
| Max. Negotiated Rate |
$65.00 |
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Galaxy Health Commercial |
$65.00
|
|
|
VENTILATION ASSIST AND MANAGEMENT INITIT
|
Facility
|
IP
|
$1,983.00
|
|
|
Service Code
|
HCPCS 94002
|
| Hospital Charge Code |
4530045
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$1,288.95 |
| Max. Negotiated Rate |
$1,288.95 |
| Rate for Payer: Cash Price |
$1,487.25
|
| Rate for Payer: Galaxy Health Commercial |
$1,288.95
|
|
|
VENTILATION ASSIST AND MANAGEMENT INITIT
|
Facility
|
OP
|
$1,983.00
|
|
|
Service Code
|
HCPCS 94002
|
| Hospital Charge Code |
4530045
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$297.45 |
| Max. Negotiated Rate |
$1,586.40 |
| Rate for Payer: Aetna of NY Commercial |
$1,388.10
|
| Rate for Payer: Aetna of NY Medicare |
$912.18
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$793.20
|
| Rate for Payer: Cash Price |
$1,487.25
|
| Rate for Payer: CDPHP Medicare |
$733.71
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,586.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,586.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,586.40
|
| Rate for Payer: EmblemHealth Medicaid |
$1,586.40
|
| Rate for Payer: EmblemHealth Medicare |
$674.22
|
| Rate for Payer: EmblemHealth Select Care |
$1,427.76
|
| Rate for Payer: Fidelis Medicare |
$793.20
|
| Rate for Payer: Galaxy Health Commercial |
$1,288.95
|
| Rate for Payer: Hamaspik Choice Medicare |
$793.20
|
| Rate for Payer: Humana Medicare |
$793.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,388.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$912.18
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,487.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1,116.43
|
| Rate for Payer: MVP Health Care of NY Medicare |
$832.86
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$297.45
|
| Rate for Payer: United Healthcare Medicare |
$793.20
|
| Rate for Payer: WellCare Medicare |
$1,090.65
|
|
|
VENTILATION ASSIST AND MANAGEMENT SUBS D
|
Facility
|
OP
|
$1,983.00
|
|
|
Service Code
|
HCPCS 94003
|
| Hospital Charge Code |
4530046
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$297.45 |
| Max. Negotiated Rate |
$1,586.40 |
| Rate for Payer: Aetna of NY Commercial |
$1,388.10
|
| Rate for Payer: Aetna of NY Medicare |
$912.18
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$793.20
|
| Rate for Payer: Cash Price |
$1,487.25
|
| Rate for Payer: CDPHP Medicare |
$733.71
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,586.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,586.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,586.40
|
| Rate for Payer: EmblemHealth Medicaid |
$1,586.40
|
| Rate for Payer: EmblemHealth Medicare |
$674.22
|
| Rate for Payer: EmblemHealth Select Care |
$1,427.76
|
| Rate for Payer: Fidelis Medicare |
$793.20
|
| Rate for Payer: Galaxy Health Commercial |
$1,288.95
|
| Rate for Payer: Hamaspik Choice Medicare |
$793.20
|
| Rate for Payer: Humana Medicare |
$793.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,388.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$912.18
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,487.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1,116.43
|
| Rate for Payer: MVP Health Care of NY Medicare |
$832.86
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$297.45
|
| Rate for Payer: United Healthcare Medicare |
$793.20
|
| Rate for Payer: WellCare Medicare |
$1,090.65
|
|
|
VENTILATION ASSIST AND MANAGEMENT SUBS D
|
Facility
|
IP
|
$1,983.00
|
|
|
Service Code
|
HCPCS 94003
|
| Hospital Charge Code |
4530046
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$1,288.95 |
| Max. Negotiated Rate |
$1,288.95 |
| Rate for Payer: Cash Price |
$1,487.25
|
| Rate for Payer: Galaxy Health Commercial |
$1,288.95
|
|
|
VENTILATION INITIAL DAY
|
Facility
|
IP
|
$1,983.00
|
|
|
Service Code
|
HCPCS 94002
|
| Hospital Charge Code |
4530006
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$1,288.95 |
| Max. Negotiated Rate |
$1,288.95 |
| Rate for Payer: Cash Price |
$1,487.25
|
| Rate for Payer: Galaxy Health Commercial |
$1,288.95
|
|
|
VENTILATION INITIAL DAY
|
Facility
|
OP
|
$1,983.00
|
|
|
Service Code
|
HCPCS 94002
|
| Hospital Charge Code |
4530006
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$297.45 |
| Max. Negotiated Rate |
$1,586.40 |
| Rate for Payer: Aetna of NY Commercial |
$1,388.10
|
| Rate for Payer: Aetna of NY Medicare |
$912.18
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$793.20
|
| Rate for Payer: Cash Price |
$1,487.25
|
| Rate for Payer: CDPHP Medicare |
$733.71
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,586.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,586.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,586.40
|
| Rate for Payer: EmblemHealth Medicaid |
$1,586.40
|
| Rate for Payer: EmblemHealth Medicare |
$674.22
|
| Rate for Payer: EmblemHealth Select Care |
$1,427.76
|
| Rate for Payer: Fidelis Medicare |
$793.20
|
| Rate for Payer: Galaxy Health Commercial |
$1,288.95
|
| Rate for Payer: Hamaspik Choice Medicare |
$793.20
|
| Rate for Payer: Humana Medicare |
$793.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,388.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$912.18
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,487.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1,116.43
|
| Rate for Payer: MVP Health Care of NY Medicare |
$832.86
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$297.45
|
| Rate for Payer: United Healthcare Medicare |
$793.20
|
| Rate for Payer: WellCare Medicare |
$1,090.65
|
|
|
VENTILATOR CIRCUIT
|
Facility
|
IP
|
$11.33
|
|
| Hospital Charge Code |
4478190
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.36 |
| Max. Negotiated Rate |
$7.36 |
| Rate for Payer: Cash Price |
$8.50
|
| Rate for Payer: Galaxy Health Commercial |
$7.36
|
|
|
VENTILATOR CIRCUIT
|
Facility
|
OP
|
$11.33
|
|
| Hospital Charge Code |
4478190
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.70 |
| Max. Negotiated Rate |
$9.06 |
| Rate for Payer: Aetna of NY Commercial |
$7.93
|
| Rate for Payer: Aetna of NY Medicare |
$5.21
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$4.53
|
| Rate for Payer: Cash Price |
$8.50
|
| Rate for Payer: CDPHP Medicare |
$4.19
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$9.06
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$9.06
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$9.06
|
| Rate for Payer: EmblemHealth Medicaid |
$9.06
|
| Rate for Payer: EmblemHealth Medicare |
$3.85
|
| Rate for Payer: EmblemHealth Select Care |
$8.16
|
| Rate for Payer: Fidelis Medicare |
$4.53
|
| Rate for Payer: Galaxy Health Commercial |
$7.36
|
| Rate for Payer: Hamaspik Choice Medicare |
$4.53
|
| Rate for Payer: Humana Medicare |
$4.53
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$7.93
|
| Rate for Payer: Local 1199SEIU Medicare |
$5.21
|
| Rate for Payer: MVP Health Care of NY Commercial |
$8.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$6.38
|
| Rate for Payer: MVP Health Care of NY Medicare |
$4.76
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1.70
|
| Rate for Payer: United Healthcare Medicare |
$4.53
|
| Rate for Payer: WellCare Medicare |
$6.23
|
|
