|
VENLAFAXINE HCL ER 75 MG PO CP24
|
Facility
|
OP
|
$4.20
|
|
|
Service Code
|
NDC 6808470911
|
| Hospital Charge Code |
6808470911
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.47 |
| Max. Negotiated Rate |
$3.36 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.31
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.10
|
| Rate for Payer: Aetna Government |
$2.10
|
| Rate for Payer: Brighton Health Commercial |
$3.15
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.36
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.85
|
| Rate for Payer: EmblemHealth Commercial |
$2.10
|
| Rate for Payer: Group Health Inc Commercial |
$2.10
|
| Rate for Payer: Group Health Inc Medicare |
$1.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.73
|
|
|
VENLAFAXINE HCL ER 75 MG PO CP24
|
Facility
|
OP
|
$4.20
|
|
|
Service Code
|
NDC 6808470901
|
| Hospital Charge Code |
6808470901
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.47 |
| Max. Negotiated Rate |
$3.36 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.31
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.10
|
| Rate for Payer: Aetna Government |
$2.10
|
| Rate for Payer: Brighton Health Commercial |
$3.15
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.36
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.85
|
| Rate for Payer: EmblemHealth Commercial |
$2.10
|
| Rate for Payer: Group Health Inc Commercial |
$2.10
|
| Rate for Payer: Group Health Inc Medicare |
$1.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.73
|
|
|
VENLAFAXINE HCL ER 75 MG PO CP24
|
Facility
|
IP
|
$4.67
|
|
|
Service Code
|
NDC 0093738556
|
| Hospital Charge Code |
0093738556
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.33 |
| Max. Negotiated Rate |
$2.33 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.33
|
|
|
VENTILATION ASSISTANCE AND MANAGEMENT
|
Facility
|
OP
|
$327.32
|
|
|
Service Code
|
EAPG 00067
|
| Min. Negotiated Rate |
$238.37 |
| Max. Negotiated Rate |
$327.32 |
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$238.37
|
| Rate for Payer: Healthfirst Commercial |
$327.32
|
|
|
Ventricular shunt procedures
|
Facility
|
IP
|
$79,010.37
|
|
|
Service Code
|
APR-DRG 0223
|
| Min. Negotiated Rate |
$35,115.72 |
| Max. Negotiated Rate |
$79,010.37 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$79,010.37
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$79,010.37
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$35,115.72
|
| Rate for Payer: Amida Care Medicaid |
$35,115.72
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$79,010.37
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$35,115.72
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$35,115.72
|
| Rate for Payer: Fidelis Qualified Health Plan |
$42,138.86
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$35,115.72
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$35,115.72
|
| Rate for Payer: Healthfirst Commercial |
$77,812.00
|
| Rate for Payer: Healthfirst Essential Plan |
$79,010.37
|
| Rate for Payer: Healthfirst QHP |
$50,560.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$35,115.72
|
| Rate for Payer: SOMOS Essential |
$79,010.37
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$79,010.37
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$79,010.37
|
| Rate for Payer: United Healthcare Medicaid |
$35,115.72
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$35,115.72
|
|
|
Ventricular shunt procedures
|
Facility
|
IP
|
$126,769.12
|
|
|
Service Code
|
APR-DRG 0224
|
| Min. Negotiated Rate |
$56,341.83 |
| Max. Negotiated Rate |
$126,769.12 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$126,769.12
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$126,769.12
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$56,341.83
|
| Rate for Payer: Amida Care Medicaid |
$56,341.83
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$126,769.12
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$56,341.83
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$56,341.83
|
| Rate for Payer: Fidelis Qualified Health Plan |
$67,610.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$56,341.83
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$56,341.83
|
| Rate for Payer: Healthfirst Commercial |
$126,760.00
|
| Rate for Payer: Healthfirst Essential Plan |
$126,769.12
|
| Rate for Payer: Healthfirst QHP |
$87,770.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$56,341.83
|
| Rate for Payer: SOMOS Essential |
$126,769.12
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$126,769.12
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$126,769.12
|
| Rate for Payer: United Healthcare Medicaid |
$56,341.83
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$56,341.83
|
|
|
Ventricular shunt procedures
|
Facility
|
IP
|
$60,684.23
|
|
|
Service Code
|
APR-DRG 0222
|
| Min. Negotiated Rate |
$21,406.00 |
| Max. Negotiated Rate |
$60,684.23 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$60,684.23
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$60,684.23
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$26,970.77
|
| Rate for Payer: Amida Care Medicaid |
$26,970.77
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$60,684.23
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$26,970.77
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$26,970.77
|
| Rate for Payer: Fidelis Qualified Health Plan |
$32,364.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$26,970.77
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$26,970.77
|
| Rate for Payer: Healthfirst Commercial |
$34,917.00
|
| Rate for Payer: Healthfirst Essential Plan |
$60,684.23
|
| Rate for Payer: Healthfirst QHP |
$21,406.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$26,970.77
|
| Rate for Payer: SOMOS Essential |
$60,684.23
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$60,684.23
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$60,684.23
|
| Rate for Payer: United Healthcare Medicaid |
$26,970.77
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$26,970.77
|
|
|
Ventricular shunt procedures
|
Facility
|
IP
|
$54,437.18
|
|
|
Service Code
|
APR-DRG 0221
|
| Min. Negotiated Rate |
$14,809.00 |
| Max. Negotiated Rate |
$54,437.18 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$54,437.18
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$54,437.18
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$24,194.30
|
| Rate for Payer: Amida Care Medicaid |
$24,194.30
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$54,437.18
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$24,194.30
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$24,194.30
|
| Rate for Payer: Fidelis Qualified Health Plan |
$29,033.16
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$24,194.30
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$24,194.30
|
| Rate for Payer: Healthfirst Commercial |
$23,531.00
|
| Rate for Payer: Healthfirst Essential Plan |
$54,437.18
|
| Rate for Payer: Healthfirst QHP |
$14,809.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$24,194.30
|
| Rate for Payer: SOMOS Essential |
$54,437.18
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$54,437.18
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$54,437.18
|
| Rate for Payer: United Healthcare Medicaid |
$24,194.30
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$24,194.30
|
|
|
VERAPAMIL HCL 2.5 MG/ML IV SOLN
|
Facility
|
IP
|
$6.30
|
|
|
Service Code
|
NDC 4257131387
|
| Hospital Charge Code |
4257131387
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$3.15 |
| Max. Negotiated Rate |
$3.15 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.15
|
|
|
VERAPAMIL HCL 2.5 MG/ML IV SOLN
|
Facility
|
OP
|
$17.63
|
|
|
Service Code
|
NDC 0409114465
|
| Hospital Charge Code |
0409114465
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$6.17 |
| Max. Negotiated Rate |
$14.10 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$9.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8.81
|
| Rate for Payer: Aetna Government |
$8.81
|
| Rate for Payer: Brighton Health Commercial |
$13.22
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$14.10
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$11.99
|
| Rate for Payer: EmblemHealth Commercial |
$8.81
|
| Rate for Payer: Group Health Inc Commercial |
$8.81
|
| Rate for Payer: Group Health Inc Medicare |
$6.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.81
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.81
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$11.46
|
|
|
VERAPAMIL HCL 2.5 MG/ML IV SOLN
|
Facility
|
IP
|
$17.63
|
|
|
Service Code
|
NDC 0409114465
|
| Hospital Charge Code |
0409114465
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$8.81 |
| Max. Negotiated Rate |
$8.81 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.81
|
|
|
VERAPAMIL HCL 2.5 MG/ML IV SOLN
|
Facility
|
IP
|
$6.25
|
|
|
Service Code
|
NDC 7075660525
|
| Hospital Charge Code |
7075660525
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$3.12 |
| Max. Negotiated Rate |
$3.12 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.12
|
|
|
VERAPAMIL HCL 2.5 MG/ML IV SOLN
|
Facility
|
IP
|
$6.30
|
|
|
Service Code
|
NDC 4257131397
|
| Hospital Charge Code |
4257131397
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$3.15 |
| Max. Negotiated Rate |
$3.15 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.15
|
|
|
VERAPAMIL HCL 2.5 MG/ML IV SOLN
|
Facility
|
OP
|
$6.25
|
|
|
Service Code
|
NDC 7075660525
|
| Hospital Charge Code |
7075660525
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$2.19 |
| Max. Negotiated Rate |
$5.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.44
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.12
|
| Rate for Payer: Aetna Government |
$3.12
|
| Rate for Payer: Brighton Health Commercial |
$4.69
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.25
|
| Rate for Payer: EmblemHealth Commercial |
$3.12
|
| Rate for Payer: Group Health Inc Commercial |
$3.12
|
| Rate for Payer: Group Health Inc Medicare |
$2.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.06
|
|
|
VERAPAMIL HCL 2.5 MG/ML IV SOLN
|
Facility
|
OP
|
$6.30
|
|
|
Service Code
|
NDC 4257131387
|
| Hospital Charge Code |
4257131387
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$2.21 |
| Max. Negotiated Rate |
$5.04 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.46
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.15
|
| Rate for Payer: Aetna Government |
$3.15
|
| Rate for Payer: Brighton Health Commercial |
$4.72
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5.04
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.28
|
| Rate for Payer: EmblemHealth Commercial |
$3.15
|
| Rate for Payer: Group Health Inc Commercial |
$3.15
|
| Rate for Payer: Group Health Inc Medicare |
$2.21
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.15
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.09
|
|
|
VERAPAMIL HCL 2.5 MG/ML IV SOLN
|
Facility
|
OP
|
$6.30
|
|
|
Service Code
|
NDC 4257131397
|
| Hospital Charge Code |
4257131397
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$2.21 |
| Max. Negotiated Rate |
$5.04 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.46
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.15
|
| Rate for Payer: Aetna Government |
$3.15
|
| Rate for Payer: Brighton Health Commercial |
$4.72
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5.04
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.28
|
| Rate for Payer: EmblemHealth Commercial |
$3.15
|
| Rate for Payer: Group Health Inc Commercial |
$3.15
|
| Rate for Payer: Group Health Inc Medicare |
$2.21
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.15
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.09
|
|
|
VERAPAMIL HCL 40 MG PO TABS
|
Facility
|
OP
|
$0.28
|
|
|
Service Code
|
NDC 0591040401
|
| Hospital Charge Code |
0591040401
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.22 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.15
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.14
|
| Rate for Payer: Aetna Government |
$0.14
|
| Rate for Payer: Brighton Health Commercial |
$0.21
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.22
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.19
|
| Rate for Payer: EmblemHealth Commercial |
$0.14
|
| Rate for Payer: Group Health Inc Commercial |
$0.14
|
| Rate for Payer: Group Health Inc Medicare |
$0.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.18
|
|
|
VERAPAMIL HCL 40 MG PO TABS
|
Facility
|
IP
|
$0.28
|
|
|
Service Code
|
NDC 0591040401
|
| Hospital Charge Code |
0591040401
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.14 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.14
|
|
|
VERAPAMIL HCL 80 MG PO TABS
|
Facility
|
IP
|
$0.31
|
|
|
Service Code
|
NDC 2315502601
|
| Hospital Charge Code |
2315502601
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$0.15 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.15
|
|
|
VERAPAMIL HCL 80 MG PO TABS
|
Facility
|
OP
|
$0.31
|
|
|
Service Code
|
NDC 2315502601
|
| Hospital Charge Code |
2315502601
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.25 |
| 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 |
$0.25
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.21
|
| 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
|
|
|
VERAPAMIL HCL ER 120 MG PO CP24
|
Facility
|
IP
|
$5.37
|
|
|
Service Code
|
NDC 5107991720
|
| Hospital Charge Code |
5107991720
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.68 |
| Max. Negotiated Rate |
$2.68 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.68
|
|
|
VERAPAMIL HCL ER 120 MG PO CP24
|
Facility
|
OP
|
$5.37
|
|
|
Service Code
|
NDC 5107991720
|
| Hospital Charge Code |
5107991720
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.88 |
| Max. Negotiated Rate |
$4.29 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.68
|
| Rate for Payer: Aetna Government |
$2.68
|
| Rate for Payer: Brighton Health Commercial |
$4.02
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.29
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.65
|
| Rate for Payer: EmblemHealth Commercial |
$2.68
|
| Rate for Payer: Group Health Inc Commercial |
$2.68
|
| Rate for Payer: Group Health Inc Medicare |
$1.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.68
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.49
|
|
|
VERAPAMIL HCL ER 120 MG PO CP24
|
Facility
|
OP
|
$5.37
|
|
|
Service Code
|
NDC 5107991701
|
| Hospital Charge Code |
5107991701
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.88 |
| Max. Negotiated Rate |
$4.30 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.69
|
| Rate for Payer: Aetna Government |
$2.69
|
| Rate for Payer: Brighton Health Commercial |
$4.03
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.30
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.65
|
| Rate for Payer: EmblemHealth Commercial |
$2.69
|
| Rate for Payer: Group Health Inc Commercial |
$2.69
|
| Rate for Payer: Group Health Inc Medicare |
$1.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.69
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.69
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.49
|
|
|
VERAPAMIL HCL ER 120 MG PO CP24
|
Facility
|
IP
|
$5.37
|
|
|
Service Code
|
NDC 5107991701
|
| Hospital Charge Code |
5107991701
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.69 |
| Max. Negotiated Rate |
$2.69 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.69
|
|
|
VERAPAMIL HCL ER 120 MG PO TBCR
|
Facility
|
OP
|
$1.07
|
|
|
Service Code
|
NDC 6846229201
|
| Hospital Charge Code |
6846229201
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.38 |
| Max. Negotiated Rate |
$0.86 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.59
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.54
|
| Rate for Payer: Aetna Government |
$0.54
|
| Rate for Payer: Brighton Health Commercial |
$0.80
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.86
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.73
|
| Rate for Payer: EmblemHealth Commercial |
$0.54
|
| Rate for Payer: Group Health Inc Commercial |
$0.54
|
| Rate for Payer: Group Health Inc Medicare |
$0.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.54
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.70
|
|
