|
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
|
|
|
VERAPAMIL HCL ER 180 MG PO TBCR
|
Facility
|
IP
|
$1.44
|
|
|
Service Code
|
NDC 6846229301
|
| Hospital Charge Code |
6846229301
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.72 |
| Max. Negotiated Rate |
$0.72 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.72
|
|
|
VERAPAMIL HCL ER 180 MG PO TBCR
|
Facility
|
OP
|
$1.44
|
|
|
Service Code
|
NDC 6846229301
|
| Hospital Charge Code |
6846229301
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.50 |
| Max. Negotiated Rate |
$1.15 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.79
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.72
|
| Rate for Payer: Aetna Government |
$0.72
|
| Rate for Payer: Brighton Health Commercial |
$1.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.15
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.98
|
| Rate for Payer: EmblemHealth Commercial |
$0.72
|
| Rate for Payer: Group Health Inc Commercial |
$0.72
|
| Rate for Payer: Group Health Inc Medicare |
$0.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.72
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.94
|
|
|
VERAPAMIL HCL ER 240 MG PO CP24
|
Facility
|
IP
|
$2.06
|
|
|
Service Code
|
NDC 0591288401
|
| Hospital Charge Code |
0591288401
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.03 |
| Max. Negotiated Rate |
$1.03 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.03
|
|
|
VERAPAMIL HCL ER 240 MG PO CP24
|
Facility
|
OP
|
$2.06
|
|
|
Service Code
|
NDC 0591288401
|
| Hospital Charge Code |
0591288401
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.72 |
| Max. Negotiated Rate |
$1.65 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.14
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.03
|
| Rate for Payer: Aetna Government |
$1.03
|
| Rate for Payer: Brighton Health Commercial |
$1.55
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.65
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.40
|
| Rate for Payer: EmblemHealth Commercial |
$1.03
|
| Rate for Payer: Group Health Inc Commercial |
$1.03
|
| Rate for Payer: Group Health Inc Medicare |
$0.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.03
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.03
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.34
|
|
|
VERAPAMIL HCL ER 240 MG PO TBCR
|
Facility
|
OP
|
$1.64
|
|
|
Service Code
|
NDC 6846226001
|
| Hospital Charge Code |
6846226001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$1.31 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.82
|
| Rate for Payer: Aetna Government |
$0.82
|
| Rate for Payer: Brighton Health Commercial |
$1.23
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.31
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.11
|
| Rate for Payer: EmblemHealth Commercial |
$0.82
|
| Rate for Payer: Group Health Inc Commercial |
$0.82
|
| Rate for Payer: Group Health Inc Medicare |
$0.57
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.82
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.06
|
|
|
VERAPAMIL HCL ER 240 MG PO TBCR
|
Facility
|
IP
|
$1.64
|
|
|
Service Code
|
NDC 6846226001
|
| Hospital Charge Code |
6846226001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.82 |
| Max. Negotiated Rate |
$0.82 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.82
|
|
|
VERTIGINOUS DIAGNOSES EXCEPT FOR BENIGN VERTIGO
|
Facility
|
OP
|
$240.87
|
|
|
Service Code
|
EAPG 00561
|
| Min. Negotiated Rate |
$175.89 |
| Max. Negotiated Rate |
$240.87 |
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$175.89
|
| Rate for Payer: Healthfirst Commercial |
$240.87
|
|
|
Vertigo & other labyrinth disorders
|
Facility
|
IP
|
$39,716.46
|
|
|
Service Code
|
APR-DRG 1111
|
| Min. Negotiated Rate |
$5,294.00 |
| Max. Negotiated Rate |
$39,716.46 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$39,716.46
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$39,716.46
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$17,651.76
|
| Rate for Payer: Amida Care Medicaid |
$17,651.76
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$39,716.46
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$17,651.76
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$17,651.76
|
| Rate for Payer: Fidelis Qualified Health Plan |
$21,182.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17,651.76
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$17,651.76
|
| Rate for Payer: Healthfirst Commercial |
$8,967.00
|
| Rate for Payer: Healthfirst Essential Plan |
$39,716.46
|
| Rate for Payer: Healthfirst QHP |
$5,294.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$17,651.76
|
| Rate for Payer: SOMOS Essential |
$39,716.46
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$39,716.46
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$39,716.46
|
| Rate for Payer: United Healthcare Medicaid |
$17,651.76
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$17,651.76
|
|
|
Vertigo & other labyrinth disorders
|
Facility
|
IP
|
$45,673.33
|
|
|
Service Code
|
APR-DRG 1114
|
| Min. Negotiated Rate |
$7,793.00 |
| Max. Negotiated Rate |
$45,673.33 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$45,673.33
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$45,673.33
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$20,299.26
|
| Rate for Payer: Amida Care Medicaid |
$20,299.26
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$45,673.33
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$20,299.26
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$20,299.26
|
| Rate for Payer: Fidelis Qualified Health Plan |
$24,359.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$20,299.26
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$20,299.26
|
| Rate for Payer: Healthfirst Commercial |
$14,126.00
|
| Rate for Payer: Healthfirst Essential Plan |
$45,673.33
|
| Rate for Payer: Healthfirst QHP |
$7,793.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$20,299.26
|
| Rate for Payer: SOMOS Essential |
$45,673.33
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$45,673.33
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$45,673.33
|
| Rate for Payer: United Healthcare Medicaid |
$20,299.26
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$20,299.26
|
|
|
Vertigo & other labyrinth disorders
|
Facility
|
IP
|
$41,543.80
|
|
|
Service Code
|
APR-DRG 1112
|
| Min. Negotiated Rate |
$6,283.00 |
| Max. Negotiated Rate |
$41,543.80 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$41,543.80
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$41,543.80
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$18,463.91
|
| Rate for Payer: Amida Care Medicaid |
$18,463.91
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$41,543.80
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$18,463.91
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$18,463.91
|
| Rate for Payer: Fidelis Qualified Health Plan |
$22,156.69
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$18,463.91
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$18,463.91
|
| Rate for Payer: Healthfirst Commercial |
$10,525.00
|
| Rate for Payer: Healthfirst Essential Plan |
$41,543.80
|
| Rate for Payer: Healthfirst QHP |
$6,283.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$18,463.91
|
| Rate for Payer: SOMOS Essential |
$41,543.80
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$41,543.80
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$41,543.80
|
| Rate for Payer: United Healthcare Medicaid |
$18,463.91
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$18,463.91
|
|
|
Vertigo & other labyrinth disorders
|
Facility
|
IP
|
$45,428.87
|
|
|
Service Code
|
APR-DRG 1113
|
| Min. Negotiated Rate |
$7,483.00 |
| Max. Negotiated Rate |
$45,428.87 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$45,428.87
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$45,428.87
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$20,190.61
|
| Rate for Payer: Amida Care Medicaid |
$20,190.61
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$45,428.87
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$20,190.61
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$20,190.61
|
| Rate for Payer: Fidelis Qualified Health Plan |
$24,228.73
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$20,190.61
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$20,190.61
|
| Rate for Payer: Healthfirst Commercial |
$14,043.00
|
| Rate for Payer: Healthfirst Essential Plan |
$45,428.87
|
| Rate for Payer: Healthfirst QHP |
$7,483.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$20,190.61
|
| Rate for Payer: SOMOS Essential |
$45,428.87
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$45,428.87
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$45,428.87
|
| Rate for Payer: United Healthcare Medicaid |
$20,190.61
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$20,190.61
|
|
|
VINBLASTINE SULFATE 1 MG/ML IV SOLN
|
Facility
|
OP
|
$6.45
|
|
|
Service Code
|
HCPCS J9360
|
| Hospital Charge Code |
6332327810
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$2.26 |
| Max. Negotiated Rate |
$5.30 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.35
|
| Rate for Payer: Aetna Government |
$3.35
|
| Rate for Payer: Brighton Health Commercial |
$4.84
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5.16
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.39
|
| Rate for Payer: EmblemHealth Commercial |
$3.23
|
| Rate for Payer: Group Health Inc Commercial |
$3.23
|
| Rate for Payer: Group Health Inc Medicare |
$2.26
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.23
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.23
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$5.30
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.19
|
|
|
VINBLASTINE SULFATE 1 MG/ML IV SOLN
|
Facility
|
IP
|
$6.45
|
|
|
Service Code
|
HCPCS J9360
|
| Hospital Charge Code |
6332327810
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$3.23 |
| Max. Negotiated Rate |
$3.23 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.23
|
|
|
VINCRISTINE SULFATE 2 MG/2ML IV SOLN
|
Facility
|
IP
|
$21.30
|
|
|
Service Code
|
HCPCS J9370
|
| Hospital Charge Code |
6170330906
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$10.65 |
| Max. Negotiated Rate |
$10.65 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.65
|
|
|
VINCRISTINE SULFATE 2 MG/2ML IV SOLN
|
Facility
|
IP
|
$18.06
|
|
|
Service Code
|
HCPCS J9370
|
| Hospital Charge Code |
0703441211
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$9.03 |
| Max. Negotiated Rate |
$9.03 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.03
|
|
|
VINCRISTINE SULFATE 2 MG/2ML IV SOLN
|
Facility
|
OP
|
$9.24
|
|
|
Service Code
|
HCPCS J9370
|
| Hospital Charge Code |
6170330916
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$3.23 |
| Max. Negotiated Rate |
$8.22 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.08
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.03
|
| Rate for Payer: Aetna Government |
$5.03
|
| Rate for Payer: Brighton Health Commercial |
$6.93
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7.39
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.28
|
| Rate for Payer: EmblemHealth Commercial |
$4.62
|
| Rate for Payer: Group Health Inc Commercial |
$4.62
|
| Rate for Payer: Group Health Inc Medicare |
$3.23
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.62
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$8.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6.01
|
|
|
VINCRISTINE SULFATE 2 MG/2ML IV SOLN
|
Facility
|
OP
|
$18.06
|
|
|
Service Code
|
HCPCS J9370
|
| Hospital Charge Code |
0703441211
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$5.03 |
| Max. Negotiated Rate |
$14.45 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$9.93
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.03
|
| Rate for Payer: Aetna Government |
$5.03
|
| Rate for Payer: Brighton Health Commercial |
$13.54
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$14.45
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$12.28
|
| Rate for Payer: EmblemHealth Commercial |
$9.03
|
| Rate for Payer: Group Health Inc Commercial |
$9.03
|
| Rate for Payer: Group Health Inc Medicare |
$6.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.03
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9.03
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$8.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$11.74
|
|
|
VINCRISTINE SULFATE 2 MG/2ML IV SOLN
|
Facility
|
IP
|
$9.24
|
|
|
Service Code
|
HCPCS J9370
|
| Hospital Charge Code |
6170330916
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$4.62 |
| Max. Negotiated Rate |
$4.62 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.62
|
|
|
VINCRISTINE SULFATE 2 MG/2ML IV SOLN
|
Facility
|
OP
|
$21.30
|
|
|
Service Code
|
HCPCS J9370
|
| Hospital Charge Code |
6170330906
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$5.03 |
| Max. Negotiated Rate |
$17.04 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$11.71
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.03
|
| Rate for Payer: Aetna Government |
$5.03
|
| Rate for Payer: Brighton Health Commercial |
$15.97
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$17.04
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$14.48
|
| Rate for Payer: EmblemHealth Commercial |
$10.65
|
| Rate for Payer: Group Health Inc Commercial |
$10.65
|
| Rate for Payer: Group Health Inc Medicare |
$7.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.65
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$10.65
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$8.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$13.85
|
|
|
VINORELBINE TARTRATE 10 MG/ML IV SOLN
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
HCPCS J9390
|
| Hospital Charge Code |
2502120401
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$7.68 |
| Max. Negotiated Rate |
$24.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$16.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$10.01
|
| Rate for Payer: Aetna Government |
$10.01
|
| Rate for Payer: Brighton Health Commercial |
$22.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$24.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$20.40
|
| Rate for Payer: EmblemHealth Commercial |
$15.00
|
| Rate for Payer: Group Health Inc Commercial |
$15.00
|
| Rate for Payer: Group Health Inc Medicare |
$10.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$15.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$7.68
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$19.50
|
|
|
VINORELBINE TARTRATE 10 MG/ML IV SOLN
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
HCPCS J9390
|
| Hospital Charge Code |
2502120401
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$15.00 |
| Max. Negotiated Rate |
$15.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15.00
|
|
|
VINORELBINE TARTRATE 50 MG/5ML IV SOLN
|
Facility
|
OP
|
$21.60
|
|
|
Service Code
|
HCPCS J9390
|
| Hospital Charge Code |
2502120405
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$7.56 |
| Max. Negotiated Rate |
$17.28 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$11.88
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$10.01
|
| Rate for Payer: Aetna Government |
$10.01
|
| Rate for Payer: Brighton Health Commercial |
$16.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$17.28
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$14.69
|
| Rate for Payer: EmblemHealth Commercial |
$10.80
|
| Rate for Payer: Group Health Inc Commercial |
$10.80
|
| Rate for Payer: Group Health Inc Medicare |
$7.56
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$10.80
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$7.68
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$14.04
|
|
|
VINORELBINE TARTRATE 50 MG/5ML IV SOLN
|
Facility
|
IP
|
$21.60
|
|
|
Service Code
|
HCPCS J9390
|
| Hospital Charge Code |
2502120405
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$10.80 |
| Max. Negotiated Rate |
$10.80 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.80
|
|
|
Viral illness
|
Facility
|
IP
|
$41,784.75
|
|
|
Service Code
|
APR-DRG 7232
|
| Min. Negotiated Rate |
$6,252.00 |
| Max. Negotiated Rate |
$41,784.75 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$41,784.75
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$41,784.75
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$18,571.00
|
| Rate for Payer: Amida Care Medicaid |
$18,571.00
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$41,784.75
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$18,571.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$18,571.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$22,285.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$18,571.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$18,571.00
|
| Rate for Payer: Healthfirst Commercial |
$10,708.00
|
| Rate for Payer: Healthfirst Essential Plan |
$41,784.75
|
| Rate for Payer: Healthfirst QHP |
$6,252.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$18,571.00
|
| Rate for Payer: SOMOS Essential |
$41,784.75
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$41,784.75
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$41,784.75
|
| Rate for Payer: United Healthcare Medicaid |
$18,571.00
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$18,571.00
|
|
