|
VASOPRESSIN 20 UNIT/ML IV SOLN
|
Facility
|
IP
|
$60.00
|
|
|
Service Code
|
HCPCS J2598
|
| Hospital Charge Code |
0548970100
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$30.00 |
| Max. Negotiated Rate |
$30.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$30.00
|
|
|
VASOPRESSIN 20 UNIT/ML IV SOLN
|
Facility
|
OP
|
$189.66
|
|
|
Service Code
|
HCPCS J2598
|
| Hospital Charge Code |
4236757087
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.93 |
| Max. Negotiated Rate |
$151.73 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$104.31
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$94.83
|
| Rate for Payer: Aetna Government |
$94.83
|
| Rate for Payer: Brighton Health Commercial |
$142.24
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$151.73
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$128.97
|
| Rate for Payer: EmblemHealth Commercial |
$94.83
|
| Rate for Payer: Group Health Inc Commercial |
$94.83
|
| Rate for Payer: Group Health Inc Medicare |
$66.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$94.83
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$94.83
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.93
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$123.28
|
|
|
VASOPRESSIN 20 UNIT/ML IV SOLN
|
Facility
|
IP
|
$60.00
|
|
|
Service Code
|
HCPCS J2598
|
| Hospital Charge Code |
0517102025
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$30.00 |
| Max. Negotiated Rate |
$30.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$30.00
|
|
|
VASOPRESSIN 20 UNIT/ML IV SOLN
|
Facility
|
IP
|
$126.13
|
|
|
Service Code
|
HCPCS J2598
|
| Hospital Charge Code |
7012116425
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$63.06 |
| Max. Negotiated Rate |
$63.06 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$63.06
|
|
|
VASOPRESSIN 20 UNIT/ML IV SOLN
|
Facility
|
OP
|
$60.00
|
|
|
Service Code
|
HCPCS J2598
|
| Hospital Charge Code |
0517102025
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.93 |
| Max. Negotiated Rate |
$48.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$33.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$30.00
|
| Rate for Payer: Aetna Government |
$30.00
|
| Rate for Payer: Brighton Health Commercial |
$45.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$48.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$40.80
|
| Rate for Payer: EmblemHealth Commercial |
$30.00
|
| Rate for Payer: Group Health Inc Commercial |
$30.00
|
| Rate for Payer: Group Health Inc Medicare |
$21.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$30.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$30.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.93
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$39.00
|
|
|
VASOPRESSIN 20 UNIT/ML IV SOLN
|
Facility
|
IP
|
$180.18
|
|
|
Service Code
|
HCPCS J2598
|
| Hospital Charge Code |
5515037125
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$90.09 |
| Max. Negotiated Rate |
$90.09 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$90.09
|
|
|
VASOPRESSIN 20 UNIT/ML IV SOLN
|
Facility
|
IP
|
$189.66
|
|
|
Service Code
|
HCPCS J2598
|
| Hospital Charge Code |
4236757087
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$94.83 |
| Max. Negotiated Rate |
$94.83 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$94.83
|
|
|
VASOPRESSIN-DEXTROSE 20-5 UT/100ML-% IV SOLN
|
Facility
|
OP
|
$2.55
|
|
|
Service Code
|
NDC 4202323701
|
| Hospital Charge Code |
4202323701
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.89 |
| Max. Negotiated Rate |
$2.04 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.27
|
| Rate for Payer: Aetna Government |
$1.27
|
| Rate for Payer: Brighton Health Commercial |
$1.91
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.04
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.73
|
| Rate for Payer: EmblemHealth Commercial |
$1.27
|
| Rate for Payer: Group Health Inc Commercial |
$1.27
|
| Rate for Payer: Group Health Inc Medicare |
$0.89
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.27
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.66
|
|
|
VASOPRESSIN-DEXTROSE 20-5 UT/100ML-% IV SOLN
|
Facility
|
OP
|
$2.55
|
|
|
Service Code
|
NDC 4202323710
|
| Hospital Charge Code |
4202323710
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.89 |
| Max. Negotiated Rate |
$2.04 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.27
|
| Rate for Payer: Aetna Government |
$1.27
|
| Rate for Payer: Brighton Health Commercial |
$1.91
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.04
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.73
|
| Rate for Payer: EmblemHealth Commercial |
$1.27
|
| Rate for Payer: Group Health Inc Commercial |
$1.27
|
| Rate for Payer: Group Health Inc Medicare |
$0.89
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.27
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.66
|
|
|
VASOPRESSIN-DEXTROSE 20-5 UT/100ML-% IV SOLN
|
Facility
|
IP
|
$2.55
|
|
|
Service Code
|
NDC 4202323710
|
| Hospital Charge Code |
4202323710
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$1.27 |
| Max. Negotiated Rate |
$1.27 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.27
|
|
|
VASOPRESSIN-DEXTROSE 20-5 UT/100ML-% IV SOLN
|
Facility
|
IP
|
$2.55
|
|
|
Service Code
|
NDC 4202323701
|
| Hospital Charge Code |
4202323701
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$1.27 |
| Max. Negotiated Rate |
$1.27 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.27
|
|
|
VASOPRESSIN-DEXTROSE 40-5 UT/100ML-% IV SOLN
|
Facility
|
OP
|
$5.10
|
|
|
Service Code
|
NDC 4202321910
|
| Hospital Charge Code |
4202321910
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$1.78 |
| Max. Negotiated Rate |
$4.08 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.80
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.55
|
| Rate for Payer: Aetna Government |
$2.55
|
| Rate for Payer: Brighton Health Commercial |
$3.82
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.08
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.47
|
| Rate for Payer: EmblemHealth Commercial |
$2.55
|
| Rate for Payer: Group Health Inc Commercial |
$2.55
|
| Rate for Payer: Group Health Inc Medicare |
$1.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.55
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.55
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.31
|
|
|
VASOPRESSIN-DEXTROSE 40-5 UT/100ML-% IV SOLN
|
Facility
|
IP
|
$5.10
|
|
|
Service Code
|
NDC 4202321901
|
| Hospital Charge Code |
4202321901
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$2.55 |
| Max. Negotiated Rate |
$2.55 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.55
|
|
|
VASOPRESSIN-DEXTROSE 40-5 UT/100ML-% IV SOLN
|
Facility
|
OP
|
$5.10
|
|
|
Service Code
|
NDC 4202321901
|
| Hospital Charge Code |
4202321901
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$1.78 |
| Max. Negotiated Rate |
$4.08 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.80
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.55
|
| Rate for Payer: Aetna Government |
$2.55
|
| Rate for Payer: Brighton Health Commercial |
$3.82
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.08
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.47
|
| Rate for Payer: EmblemHealth Commercial |
$2.55
|
| Rate for Payer: Group Health Inc Commercial |
$2.55
|
| Rate for Payer: Group Health Inc Medicare |
$1.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.55
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.55
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.31
|
|
|
VASOPRESSIN-DEXTROSE 40-5 UT/100ML-% IV SOLN
|
Facility
|
IP
|
$5.10
|
|
|
Service Code
|
NDC 4202321910
|
| Hospital Charge Code |
4202321910
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$2.55 |
| Max. Negotiated Rate |
$2.55 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.55
|
|
|
VECURONIUM BROMIDE 10 MG IV SOLR
|
Facility
|
IP
|
$6.60
|
|
|
Service Code
|
NDC 5515023510
|
| Hospital Charge Code |
5515023510
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$3.30 |
| Max. Negotiated Rate |
$3.30 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.30
|
|
|
VECURONIUM BROMIDE 10 MG IV SOLR
|
Facility
|
IP
|
$6.00
|
|
|
Service Code
|
NDC 6745743800
|
| Hospital Charge Code |
6745743800
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$3.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.00
|
|
|
VECURONIUM BROMIDE 10 MG IV SOLR
|
Facility
|
IP
|
$6.00
|
|
|
Service Code
|
NDC 6745743810
|
| Hospital Charge Code |
6745743810
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$3.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.00
|
|
|
VECURONIUM BROMIDE 10 MG IV SOLR
|
Facility
|
IP
|
$10.20
|
|
|
Service Code
|
NDC 4733593144
|
| Hospital Charge Code |
4733593144
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$5.10 |
| Max. Negotiated Rate |
$5.10 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.10
|
|
|
VECURONIUM BROMIDE 10 MG IV SOLR
|
Facility
|
OP
|
$6.00
|
|
|
Service Code
|
NDC 6745743810
|
| Hospital Charge Code |
6745743810
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$2.10 |
| Max. Negotiated Rate |
$4.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.00
|
| Rate for Payer: Aetna Government |
$3.00
|
| Rate for Payer: Brighton Health Commercial |
$4.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.08
|
| Rate for Payer: EmblemHealth Commercial |
$3.00
|
| Rate for Payer: Group Health Inc Commercial |
$3.00
|
| Rate for Payer: Group Health Inc Medicare |
$2.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.90
|
|
|
VECURONIUM BROMIDE 10 MG IV SOLR
|
Facility
|
OP
|
$6.00
|
|
|
Service Code
|
NDC 6745743800
|
| Hospital Charge Code |
6745743800
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$2.10 |
| Max. Negotiated Rate |
$4.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.00
|
| Rate for Payer: Aetna Government |
$3.00
|
| Rate for Payer: Brighton Health Commercial |
$4.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.08
|
| Rate for Payer: EmblemHealth Commercial |
$3.00
|
| Rate for Payer: Group Health Inc Commercial |
$3.00
|
| Rate for Payer: Group Health Inc Medicare |
$2.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.90
|
|
|
VECURONIUM BROMIDE 10 MG IV SOLR
|
Facility
|
IP
|
$6.60
|
|
|
Service Code
|
NDC 5515023501
|
| Hospital Charge Code |
5515023501
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$3.30 |
| Max. Negotiated Rate |
$3.30 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.30
|
|
|
VECURONIUM BROMIDE 10 MG IV SOLR
|
Facility
|
OP
|
$10.20
|
|
|
Service Code
|
NDC 4733593144
|
| Hospital Charge Code |
4733593144
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$3.57 |
| Max. Negotiated Rate |
$8.16 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.61
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.10
|
| Rate for Payer: Aetna Government |
$5.10
|
| Rate for Payer: Brighton Health Commercial |
$7.65
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.16
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.94
|
| Rate for Payer: EmblemHealth Commercial |
$5.10
|
| Rate for Payer: Group Health Inc Commercial |
$5.10
|
| Rate for Payer: Group Health Inc Medicare |
$3.57
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6.63
|
|
|
VECURONIUM BROMIDE 10 MG IV SOLR
|
Facility
|
OP
|
$6.60
|
|
|
Service Code
|
NDC 5515023510
|
| Hospital Charge Code |
5515023510
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$2.31 |
| Max. Negotiated Rate |
$5.28 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.63
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.30
|
| Rate for Payer: Aetna Government |
$3.30
|
| Rate for Payer: Brighton Health Commercial |
$4.95
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5.28
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.49
|
| Rate for Payer: EmblemHealth Commercial |
$3.30
|
| Rate for Payer: Group Health Inc Commercial |
$3.30
|
| Rate for Payer: Group Health Inc Medicare |
$2.31
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.30
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.29
|
|
|
VECURONIUM BROMIDE 10 MG IV SOLR
|
Facility
|
OP
|
$6.60
|
|
|
Service Code
|
NDC 5515023501
|
| Hospital Charge Code |
5515023501
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$2.31 |
| Max. Negotiated Rate |
$5.28 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.63
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.30
|
| Rate for Payer: Aetna Government |
$3.30
|
| Rate for Payer: Brighton Health Commercial |
$4.95
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5.28
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.49
|
| Rate for Payer: EmblemHealth Commercial |
$3.30
|
| Rate for Payer: Group Health Inc Commercial |
$3.30
|
| Rate for Payer: Group Health Inc Medicare |
$2.31
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.30
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.29
|
|
