|
VALPROATE SODIUM 100 MG/ML IV SOLN
|
Facility
|
OP
|
$1.61
|
|
|
Service Code
|
NDC 6332349401
|
| Hospital Charge Code |
6332349401
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.56 |
| Max. Negotiated Rate |
$1.29 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.88
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.80
|
| Rate for Payer: Aetna Government |
$0.80
|
| Rate for Payer: Brighton Health Commercial |
$1.21
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.29
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.09
|
| Rate for Payer: EmblemHealth Commercial |
$0.80
|
| Rate for Payer: Group Health Inc Commercial |
$0.80
|
| Rate for Payer: Group Health Inc Medicare |
$0.56
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.80
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.05
|
|
|
VALPROATE SODIUM 100 MG/ML IV SOLN
|
Facility
|
OP
|
$0.90
|
|
|
Service Code
|
NDC 2502179705
|
| Hospital Charge Code |
2502179705
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$0.72 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.45
|
| Rate for Payer: Aetna Government |
$0.45
|
| Rate for Payer: Brighton Health Commercial |
$0.68
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.72
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.61
|
| Rate for Payer: EmblemHealth Commercial |
$0.45
|
| Rate for Payer: Group Health Inc Commercial |
$0.45
|
| Rate for Payer: Group Health Inc Medicare |
$0.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.45
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.45
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.59
|
|
|
VALPROATE SODIUM 100 MG/ML IV SOLN
|
Facility
|
IP
|
$1.61
|
|
|
Service Code
|
NDC 6332349401
|
| Hospital Charge Code |
6332349401
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.80 |
| Max. Negotiated Rate |
$0.80 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.80
|
|
|
VALPROATE SODIUM 100 MG/ML IV SOLN
|
Facility
|
IP
|
$0.49
|
|
|
Service Code
|
NDC 6332349416
|
| Hospital Charge Code |
6332349416
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.25 |
| Max. Negotiated Rate |
$0.25 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.25
|
|
|
VALPROATE SODIUM 100 MG/ML IV SOLN
|
Facility
|
IP
|
$1.61
|
|
|
Service Code
|
NDC 6332349405
|
| Hospital Charge Code |
6332349405
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.80 |
| Max. Negotiated Rate |
$0.80 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.80
|
|
|
VALPROATE SODIUM 100 MG/ML IV SOLN
|
Facility
|
IP
|
$4.15
|
|
|
Service Code
|
NDC 0143978501
|
| Hospital Charge Code |
0143978501
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$2.07 |
| Max. Negotiated Rate |
$2.07 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.07
|
|
|
VALPROATE SODIUM 100 MG/ML IV SOLN
|
Facility
|
OP
|
$4.15
|
|
|
Service Code
|
NDC 0143978501
|
| Hospital Charge Code |
0143978501
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$1.45 |
| Max. Negotiated Rate |
$3.32 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.28
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.07
|
| Rate for Payer: Aetna Government |
$2.07
|
| Rate for Payer: Brighton Health Commercial |
$3.11
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.32
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.82
|
| Rate for Payer: EmblemHealth Commercial |
$2.07
|
| Rate for Payer: Group Health Inc Commercial |
$2.07
|
| Rate for Payer: Group Health Inc Medicare |
$1.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.07
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.07
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.70
|
|
|
VALPROATE SODIUM 100 MG/ML IV SOLN
|
Facility
|
IP
|
$0.49
|
|
|
Service Code
|
NDC 6332349441
|
| Hospital Charge Code |
6332349441
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.25 |
| Max. Negotiated Rate |
$0.25 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.25
|
|
|
VALPROATE SODIUM 100 MG/ML IV SOLN
|
Facility
|
IP
|
$0.90
|
|
|
Service Code
|
NDC 2502179705
|
| Hospital Charge Code |
2502179705
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$0.45 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.45
|
|
|
VALPROIC ACID 250 MG/5ML PO SOLN
|
Facility
|
OP
|
$0.30
|
|
|
Service Code
|
NDC 0121467505
|
| Hospital Charge Code |
0121467505
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.24 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.17
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.15
|
| Rate for Payer: Aetna Government |
$0.15
|
| Rate for Payer: Brighton Health Commercial |
$0.23
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.24
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.20
|
| Rate for Payer: EmblemHealth Commercial |
$0.15
|
| Rate for Payer: Group Health Inc Commercial |
$0.15
|
| Rate for Payer: Group Health Inc Medicare |
$0.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.15
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.20
|
|
|
VALPROIC ACID 250 MG/5ML PO SOLN
|
Facility
|
OP
|
$0.15
|
|
|
Service Code
|
NDC 0121067585
|
| Hospital Charge Code |
0121067585
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.12 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.08
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.08
|
| Rate for Payer: Aetna Government |
$0.08
|
| Rate for Payer: Brighton Health Commercial |
$0.11
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.12
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.10
|
| Rate for Payer: EmblemHealth Commercial |
$0.08
|
| Rate for Payer: Group Health Inc Commercial |
$0.08
|
| Rate for Payer: Group Health Inc Medicare |
$0.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.10
|
|
|
VALPROIC ACID 250 MG/5ML PO SOLN
|
Facility
|
IP
|
$0.27
|
|
|
Service Code
|
NDC 0121135000
|
| Hospital Charge Code |
0121135000
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.13 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.13
|
|
|
VALPROIC ACID 250 MG/5ML PO SOLN
|
Facility
|
IP
|
$0.15
|
|
|
Service Code
|
NDC 0121067585
|
| Hospital Charge Code |
0121067585
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.08 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.08
|
|
|
VALPROIC ACID 250 MG/5ML PO SOLN
|
Facility
|
IP
|
$0.30
|
|
|
Service Code
|
NDC 0121467505
|
| Hospital Charge Code |
0121467505
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$0.15 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.15
|
|
|
VALPROIC ACID 250 MG/5ML PO SOLN
|
Facility
|
OP
|
$0.27
|
|
|
Service Code
|
NDC 0121135010
|
| Hospital Charge Code |
0121135010
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.22 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.15
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.13
|
| Rate for Payer: Aetna Government |
$0.13
|
| Rate for Payer: Brighton Health Commercial |
$0.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.22
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.18
|
| Rate for Payer: EmblemHealth Commercial |
$0.13
|
| Rate for Payer: Group Health Inc Commercial |
$0.13
|
| Rate for Payer: Group Health Inc Medicare |
$0.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.13
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.13
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.17
|
|
|
VALPROIC ACID 250 MG/5ML PO SOLN
|
Facility
|
OP
|
$0.27
|
|
|
Service Code
|
NDC 0121135000
|
| Hospital Charge Code |
0121135000
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.22 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.15
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.13
|
| Rate for Payer: Aetna Government |
$0.13
|
| Rate for Payer: Brighton Health Commercial |
$0.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.22
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.18
|
| Rate for Payer: EmblemHealth Commercial |
$0.13
|
| Rate for Payer: Group Health Inc Commercial |
$0.13
|
| Rate for Payer: Group Health Inc Medicare |
$0.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.13
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.13
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.17
|
|
|
VALPROIC ACID 250 MG/5ML PO SOLN
|
Facility
|
IP
|
$0.30
|
|
|
Service Code
|
NDC 0121467500
|
| Hospital Charge Code |
0121467500
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$0.15 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.15
|
|
|
VALPROIC ACID 250 MG/5ML PO SOLN
|
Facility
|
IP
|
$0.27
|
|
|
Service Code
|
NDC 0121135010
|
| Hospital Charge Code |
0121135010
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.13 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.13
|
|
|
VALPROIC ACID 250 MG/5ML PO SOLN
|
Facility
|
OP
|
$0.30
|
|
|
Service Code
|
NDC 0121467500
|
| Hospital Charge Code |
0121467500
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.24 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.17
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.15
|
| Rate for Payer: Aetna Government |
$0.15
|
| Rate for Payer: Brighton Health Commercial |
$0.23
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.24
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.20
|
| Rate for Payer: EmblemHealth Commercial |
$0.15
|
| Rate for Payer: Group Health Inc Commercial |
$0.15
|
| Rate for Payer: Group Health Inc Medicare |
$0.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.15
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.20
|
|
|
VALPROIC ACID 250 MG PO CAPS
|
Facility
|
IP
|
$0.84
|
|
|
Service Code
|
NDC 6945215020
|
| Hospital Charge Code |
6945215020
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.42 |
| Max. Negotiated Rate |
$0.42 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.42
|
|
|
VALPROIC ACID 250 MG PO CAPS
|
Facility
|
OP
|
$0.84
|
|
|
Service Code
|
NDC 6945215020
|
| Hospital Charge Code |
6945215020
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$0.67 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.46
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.42
|
| Rate for Payer: Aetna Government |
$0.42
|
| Rate for Payer: Brighton Health Commercial |
$0.63
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.67
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.57
|
| Rate for Payer: EmblemHealth Commercial |
$0.42
|
| Rate for Payer: Group Health Inc Commercial |
$0.42
|
| Rate for Payer: Group Health Inc Medicare |
$0.29
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.42
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.55
|
|
|
VANCOMYCIN 10 MG/ML (1 MG/0.1 ML) IN PF NS - COMPOUNDED
|
Facility
|
OP
|
$0.11
|
|
|
Service Code
|
HCPCS J3373
|
| Hospital Charge Code |
9999073001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.09 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.06
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.06
|
| Rate for Payer: Aetna Government |
$0.06
|
| Rate for Payer: Brighton Health Commercial |
$0.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.09
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.07
|
| Rate for Payer: EmblemHealth Commercial |
$0.06
|
| Rate for Payer: Group Health Inc Commercial |
$0.06
|
| Rate for Payer: Group Health Inc Medicare |
$0.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.06
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.03
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.07
|
|
|
VANCOMYCIN 10 MG/ML (1 MG/0.1 ML) IN PF NS - COMPOUNDED
|
Facility
|
IP
|
$0.11
|
|
|
Service Code
|
HCPCS J3373
|
| Hospital Charge Code |
9999073001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.06 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.06
|
|
|
VANCOMYCIN 5% OPHTHALMIC DROPS - COMPOUNDED
|
Facility
|
OP
|
$10.98
|
|
|
Service Code
|
NDC 9999701506
|
| Hospital Charge Code |
9999701506
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.84 |
| Max. Negotiated Rate |
$8.79 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.04
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.49
|
| Rate for Payer: Aetna Government |
$5.49
|
| Rate for Payer: Brighton Health Commercial |
$8.24
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.79
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7.47
|
| Rate for Payer: EmblemHealth Commercial |
$5.49
|
| Rate for Payer: Group Health Inc Commercial |
$5.49
|
| Rate for Payer: Group Health Inc Medicare |
$3.84
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.49
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$7.14
|
|
|
VANCOMYCIN 5% OPHTHALMIC DROPS - COMPOUNDED
|
Facility
|
IP
|
$10.98
|
|
|
Service Code
|
NDC 9999701506
|
| Hospital Charge Code |
9999701506
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.49 |
| Max. Negotiated Rate |
$5.49 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.49
|
|
