|
VALPROIC ACID 250 MG CAP
|
Facility
OP
|
$1.00
|
|
| Hospital Charge Code |
41642230
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$0.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.50
|
| Rate for Payer: Aetna Government |
$0.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.68
|
| Rate for Payer: Group Health Inc Commercial |
$0.50
|
| Rate for Payer: Group Health Inc Medicare |
$0.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.65
|
|
|
VALVE BACKCHECK
|
Facility
OP
|
$7.20
|
|
| Hospital Charge Code |
64907319
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.52 |
| Max. Negotiated Rate |
$5.76 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.96
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.60
|
| Rate for Payer: Aetna Government |
$3.60
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5.76
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.90
|
| Rate for Payer: Group Health Inc Commercial |
$3.60
|
| Rate for Payer: Group Health Inc Medicare |
$2.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.60
|
|
|
VALVE BRONCIAL PRELD 7MM
|
Facility
OP
|
$5,300.00
|
|
| Hospital Charge Code |
64906890
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$1,855.00 |
| Max. Negotiated Rate |
$4,240.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,915.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,650.00
|
| Rate for Payer: Aetna Government |
$2,650.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4,240.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3,604.00
|
| Rate for Payer: Group Health Inc Commercial |
$2,650.00
|
| Rate for Payer: Group Health Inc Medicare |
$1,855.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,650.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,650.00
|
|
|
VALVE DRAIN FOR CHEST HEIMLICH
|
Facility
OP
|
$74.76
|
|
| Hospital Charge Code |
64903041
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$26.17 |
| Max. Negotiated Rate |
$59.81 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$41.12
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$37.38
|
| Rate for Payer: Aetna Government |
$37.38
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$59.81
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$50.84
|
| Rate for Payer: Group Health Inc Commercial |
$37.38
|
| Rate for Payer: Group Health Inc Medicare |
$26.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$37.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$37.38
|
|
|
VALVE GLAUCOMA DRAINAGE AHMED
|
Facility
IP
|
$700.00
|
|
|
Service Code
|
HCPCS C1780
|
| Hospital Charge Code |
64906278
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$350.00 |
| Max. Negotiated Rate |
$350.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$350.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$350.00
|
|
|
VALVE GLAUCOMA DRAINAGE AHMED
|
Facility
OP
|
$700.00
|
|
|
Service Code
|
HCPCS C1780
|
| Hospital Charge Code |
64906278
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.26 |
| Max. Negotiated Rate |
$735.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$385.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.26
|
| Rate for Payer: Aetna Government |
$2.26
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$350.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$402.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$735.00
|
| Rate for Payer: Group Health Inc Commercial |
$350.00
|
| Rate for Payer: Group Health Inc Medicare |
$245.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$350.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$350.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$455.00
|
|
|
VALVE PASSY-MUIR PURPLE
|
Facility
OP
|
$308.62
|
|
| Hospital Charge Code |
64903883
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$108.02 |
| Max. Negotiated Rate |
$246.90 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$169.74
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$154.31
|
| Rate for Payer: Aetna Government |
$154.31
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$246.90
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$209.86
|
| Rate for Payer: Group Health Inc Commercial |
$154.31
|
| Rate for Payer: Group Health Inc Medicare |
$108.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$154.31
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$154.31
|
|
|
VALVE SHUNT INLINE PRGRM CRTS
|
Facility
OP
|
$4,156.67
|
|
| Hospital Charge Code |
64906236
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,454.83 |
| Max. Negotiated Rate |
$3,325.34 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,286.17
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,078.34
|
| Rate for Payer: Aetna Government |
$2,078.34
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3,325.34
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,826.54
|
| Rate for Payer: Group Health Inc Commercial |
$2,078.34
|
| Rate for Payer: Group Health Inc Medicare |
$1,454.83
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,078.34
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,078.34
|
|
|
VALVULOPLASTY FEMORAL VEIN
|
Facility
OP
|
$13,920.70
|
|
|
Service Code
|
HCPCS 34501
|
| Hospital Charge Code |
40034319
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,021.63 |
| Max. Negotiated Rate |
$6,960.35 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3,387.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6,354.94
|
| Rate for Payer: Aetna Government |
$6,354.94
|
| Rate for Payer: Cash Price |
$6,354.94
|
| Rate for Payer: Cash Price |
$6,354.94
|
| Rate for Payer: Cash Price |
$6,354.94
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$6,354.94
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$6,354.94
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,021.63
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$5,401.70
|
| Rate for Payer: Fidelis Essential Plan QHP |
$5,655.90
|
| Rate for Payer: Fidelis Medicare Advantage |
$6,354.94
|
| Rate for Payer: Fidelis Qualified Health Plan |
$5,655.90
|
| Rate for Payer: Group Health Inc Commercial |
$6,354.94
|
| Rate for Payer: Group Health Inc Medicare |
$6,354.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6,960.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6,354.94
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,135.14
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5,401.70
|
| Rate for Payer: Healthfirst QHP |
$6,354.94
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$6,354.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6,354.94
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5,083.95
|
| Rate for Payer: Wellcare Medicare |
$6,037.19
|
|
|
VALVULOTOME EXPAND 2.0-5.0
|
Facility
OP
|
$4,947.50
|
|
| Hospital Charge Code |
64903051
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,731.62 |
| Max. Negotiated Rate |
$3,958.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,721.12
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,473.75
|
| Rate for Payer: Aetna Government |
$2,473.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3,958.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3,364.30
|
| Rate for Payer: Group Health Inc Commercial |
$2,473.75
|
| Rate for Payer: Group Health Inc Medicare |
$1,731.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,473.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,473.75
|
|
|
VANCOMYCIN
|
Facility
OP
|
$33.85
|
|
|
Service Code
|
HCPCS 80202
|
| Hospital Charge Code |
40602045
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.83 |
| Max. Negotiated Rate |
$21.53 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$18.62
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$13.54
|
| Rate for Payer: Aetna Government |
$13.54
|
| Rate for Payer: Cash Price |
$13.54
|
| Rate for Payer: Cash Price |
$13.54
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$13.54
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$21.53
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$18.22
|
| Rate for Payer: Elderplan Medicare Advantage |
$13.54
|
| Rate for Payer: EmblemHealth Commercial |
$13.54
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$12.19
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$11.51
|
| Rate for Payer: Fidelis Essential Plan QHP |
$12.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$13.54
|
| Rate for Payer: Fidelis Qualified Health Plan |
$12.05
|
| Rate for Payer: Group Health Inc Commercial |
$13.54
|
| Rate for Payer: Group Health Inc Medicare |
$13.54
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.54
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$13.54
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13.54
|
| Rate for Payer: Healthfirst QHP |
$13.54
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$13.54
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$13.54
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$10.83
|
| Rate for Payer: Wellcare Medicare |
$12.19
|
|
|
VANCOMYCIN 1000 MG INJ
|
Facility
OP
|
$16.25
|
|
|
Service Code
|
HCPCS J3370
|
| Hospital Charge Code |
41653951
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.17 |
| Max. Negotiated Rate |
$10.56 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$8.94
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.84
|
| Rate for Payer: Aetna Government |
$2.84
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.12
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$9.34
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2.17
|
| Rate for Payer: Group Health Inc Commercial |
$8.12
|
| Rate for Payer: Group Health Inc Medicare |
$5.69
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2.41
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2.73
|
| Rate for Payer: SOMOS Essential |
$2.73
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$10.56
|
|
|
VANCOMYCIN 1000 MG INJ
|
Facility
OP
|
$16.25
|
|
|
Service Code
|
HCPCS J3370
|
| Hospital Charge Code |
41643951
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.17 |
| Max. Negotiated Rate |
$10.56 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$8.94
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.84
|
| Rate for Payer: Aetna Government |
$2.84
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.12
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$9.34
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2.17
|
| Rate for Payer: Group Health Inc Commercial |
$8.12
|
| Rate for Payer: Group Health Inc Medicare |
$5.69
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2.41
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2.73
|
| Rate for Payer: SOMOS Essential |
$2.73
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$10.56
|
|
|
VANCOMYCIN 1000 MG INJ
|
Facility
IP
|
$16.25
|
|
|
Service Code
|
HCPCS J3370
|
| Hospital Charge Code |
41643951
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.12 |
| Max. Negotiated Rate |
$8.12 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.12
|
|
|
VANCOMYCIN 1000 MG INJ
|
Facility
IP
|
$16.25
|
|
|
Service Code
|
HCPCS J3370
|
| Hospital Charge Code |
41653951
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.12 |
| Max. Negotiated Rate |
$8.12 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.12
|
|
|
VANCOMYCIN 5000MG PER 500MG
|
Facility
IP
|
$45.00
|
|
|
Service Code
|
HCPCS J3370
|
| Hospital Charge Code |
41657123
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.50 |
| Max. Negotiated Rate |
$22.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$22.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$22.50
|
|
|
VANCOMYCIN 5000MG PER 500MG
|
Facility
OP
|
$45.00
|
|
|
Service Code
|
HCPCS J3370
|
| Hospital Charge Code |
41657123
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.17 |
| Max. Negotiated Rate |
$29.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$24.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.84
|
| Rate for Payer: Aetna Government |
$2.84
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$22.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$25.88
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2.17
|
| Rate for Payer: Group Health Inc Commercial |
$22.50
|
| Rate for Payer: Group Health Inc Medicare |
$15.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$22.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$22.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2.41
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2.73
|
| Rate for Payer: SOMOS Essential |
$2.73
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$29.25
|
|
|
VANCOMYCIN, 5000MG PER 500MG
|
Facility
OP
|
$45.00
|
|
|
Service Code
|
HCPCS J3370
|
| Hospital Charge Code |
41647123
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.17 |
| Max. Negotiated Rate |
$29.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$24.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.84
|
| Rate for Payer: Aetna Government |
$2.84
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$22.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$25.88
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2.17
|
| Rate for Payer: Group Health Inc Commercial |
$22.50
|
| Rate for Payer: Group Health Inc Medicare |
$15.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$22.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$22.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2.41
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2.73
|
| Rate for Payer: SOMOS Essential |
$2.73
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$29.25
|
|
|
VANCOMYCIN, 5000MG PER 500MG
|
Facility
IP
|
$45.00
|
|
|
Service Code
|
HCPCS J3370
|
| Hospital Charge Code |
41647123
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.50 |
| Max. Negotiated Rate |
$22.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$22.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$22.50
|
|
|
VANCOMYCIN 5 MG/ML INJ PEDIATRICS
|
Facility
IP
|
$1.00
|
|
|
Service Code
|
HCPCS J3370
|
| Hospital Charge Code |
41644138
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.50 |
| Max. Negotiated Rate |
$0.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.50
|
|
|
VANCOMYCIN 5 MG/ML INJ PEDIATRICS
|
Facility
OP
|
$1.00
|
|
|
Service Code
|
HCPCS J3370
|
| Hospital Charge Code |
41654138
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$2.84 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.84
|
| Rate for Payer: Aetna Government |
$2.84
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.58
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2.17
|
| Rate for Payer: Group Health Inc Commercial |
$0.50
|
| Rate for Payer: Group Health Inc Medicare |
$0.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2.41
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2.73
|
| Rate for Payer: SOMOS Essential |
$2.73
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.65
|
|
|
VANCOMYCIN 5 MG/ML INJ PEDIATRICS
|
Facility
IP
|
$1.00
|
|
|
Service Code
|
HCPCS J3370
|
| Hospital Charge Code |
41654138
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.50 |
| Max. Negotiated Rate |
$0.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.50
|
|
|
VANCOMYCIN 5 MG/ML INJ PEDIATRICS
|
Facility
OP
|
$1.00
|
|
|
Service Code
|
HCPCS J3370
|
| Hospital Charge Code |
41644138
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$2.84 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.84
|
| Rate for Payer: Aetna Government |
$2.84
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.58
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2.17
|
| Rate for Payer: Group Health Inc Commercial |
$0.50
|
| Rate for Payer: Group Health Inc Medicare |
$0.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2.41
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2.73
|
| Rate for Payer: SOMOS Essential |
$2.73
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.65
|
|
|
VANCOMYCIN 750 MG/D5W 250 ML PREMIX
|
Facility
OP
|
$17.90
|
|
| Hospital Charge Code |
41644659
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.26 |
| Max. Negotiated Rate |
$11.64 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$9.84
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8.95
|
| Rate for Payer: Aetna Government |
$8.95
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.95
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$10.29
|
| Rate for Payer: Group Health Inc Commercial |
$8.95
|
| Rate for Payer: Group Health Inc Medicare |
$6.26
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.95
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$11.64
|
|
|
VANCOMYCIN 750 MG/D5W 250 ML PREMIX
|
Facility
IP
|
$17.90
|
|
| Hospital Charge Code |
41654659
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.95 |
| Max. Negotiated Rate |
$8.95 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.95
|
|
