|
VANCOMYCIN 750 MG/D5W 250 ML PREMIX
|
Facility
OP
|
$17.90
|
|
| Hospital Charge Code |
41654659
|
|
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
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 INJ
|
Facility
OP
|
$4.31
|
|
|
Service Code
|
HCPCS J3370
|
| Hospital Charge Code |
41645202
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.51 |
| Max. Negotiated Rate |
$2.84 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.37
|
| 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 |
$2.16
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.48
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2.17
|
| Rate for Payer: Group Health Inc Commercial |
$2.16
|
| Rate for Payer: Group Health Inc Medicare |
$1.51
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.16
|
| 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 |
$2.80
|
|
|
VANCOMYCIN 750 MG INJ
|
Facility
IP
|
$4.31
|
|
|
Service Code
|
HCPCS J3370
|
| Hospital Charge Code |
41645202
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.16 |
| Max. Negotiated Rate |
$2.16 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.16
|
|
|
VANCOMYCIN 750 MG INJ
|
Facility
IP
|
$4.31
|
|
|
Service Code
|
HCPCS J3370
|
| Hospital Charge Code |
41655202
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.16 |
| Max. Negotiated Rate |
$2.16 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.16
|
|
|
VANCOMYCIN 750 MG INJ
|
Facility
OP
|
$4.31
|
|
|
Service Code
|
HCPCS J3370
|
| Hospital Charge Code |
41655202
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.51 |
| Max. Negotiated Rate |
$2.84 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.37
|
| 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 |
$2.16
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.48
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2.17
|
| Rate for Payer: Group Health Inc Commercial |
$2.16
|
| Rate for Payer: Group Health Inc Medicare |
$1.51
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.16
|
| 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 |
$2.80
|
|
|
VANCOMYCIN FLUSH 5 MG/ML INJ
|
Facility
OP
|
$6.00
|
|
| Hospital Charge Code |
41654137
|
|
Hospital Revenue Code
|
250
|
| 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: Cigna HMO/Network Benefit Plan/Open Access |
$4.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.08
|
| 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
|
|
|
VANCOMYCIN FLUSH 5 MG/ML INJ
|
Facility
OP
|
$6.00
|
|
| Hospital Charge Code |
41644137
|
|
Hospital Revenue Code
|
250
|
| 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: Cigna HMO/Network Benefit Plan/Open Access |
$4.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.08
|
| 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
|
|
|
VANCOMYCIN OPHTH 50MG/ML
|
Facility
OP
|
$11.00
|
|
| Hospital Charge Code |
41656635
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.85 |
| Max. Negotiated Rate |
$8.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.05
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.50
|
| Rate for Payer: Aetna Government |
$5.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7.48
|
| Rate for Payer: Group Health Inc Commercial |
$5.50
|
| Rate for Payer: Group Health Inc Medicare |
$3.85
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$7.15
|
|
|
VANCOMYCIN OPHTH 50MG/ML
|
Facility
OP
|
$11.00
|
|
| Hospital Charge Code |
41646635
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.85 |
| Max. Negotiated Rate |
$8.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.05
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.50
|
| Rate for Payer: Aetna Government |
$5.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7.48
|
| Rate for Payer: Group Health Inc Commercial |
$5.50
|
| Rate for Payer: Group Health Inc Medicare |
$3.85
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$7.15
|
|
|
VANCOMYCIN ORAL
|
Facility
OP
|
$0.54
|
|
|
Service Code
|
HCPCS J3370
|
| Hospital Charge Code |
41652997
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.19 |
| Max. Negotiated Rate |
$2.84 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.30
|
| 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 |
$0.27
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.31
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2.17
|
| Rate for Payer: Group Health Inc Commercial |
$0.27
|
| Rate for Payer: Group Health Inc Medicare |
$0.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.27
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.27
|
| 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 |
$0.35
|
|
|
VANCOMYCIN ORAL
|
Facility
OP
|
$0.54
|
|
|
Service Code
|
HCPCS J3370
|
| Hospital Charge Code |
41642997
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.19 |
| Max. Negotiated Rate |
$2.84 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.30
|
| 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 |
$0.27
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.31
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2.17
|
| Rate for Payer: Group Health Inc Commercial |
$0.27
|
| Rate for Payer: Group Health Inc Medicare |
$0.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.27
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.27
|
| 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 |
$0.35
|
|
|
VANCOMYCIN ORAL
|
Facility
IP
|
$0.54
|
|
|
Service Code
|
HCPCS J3370
|
| Hospital Charge Code |
41642997
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.27 |
| Max. Negotiated Rate |
$0.27 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.27
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.27
|
|
|
VANCOMYCIN ORAL
|
Facility
IP
|
$0.54
|
|
|
Service Code
|
HCPCS J3370
|
| Hospital Charge Code |
41652997
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.27 |
| Max. Negotiated Rate |
$0.27 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.27
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.27
|
|
|
VANCOMYCIN ORAL SOL 125MG/5ML
|
Facility
OP
|
$2.00
|
|
|
Service Code
|
HCPCS J3370
|
| Hospital Charge Code |
41657103
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.70 |
| Max. Negotiated Rate |
$2.84 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.10
|
| 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 |
$1.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.15
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2.17
|
| Rate for Payer: Group Health Inc Commercial |
$1.00
|
| Rate for Payer: Group Health Inc Medicare |
$0.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.00
|
| 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 |
$1.30
|
|
|
VANCOMYCIN ORAL SOL 125MG/5ML
|
Facility
OP
|
$2.00
|
|
| Hospital Charge Code |
41647103
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.70 |
| Max. Negotiated Rate |
$1.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.00
|
| Rate for Payer: Aetna Government |
$1.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.36
|
| Rate for Payer: Group Health Inc Commercial |
$1.00
|
| Rate for Payer: Group Health Inc Medicare |
$0.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.30
|
|
|
VANCOMYCIN ORAL SOL 125MG/5ML
|
Facility
IP
|
$2.00
|
|
|
Service Code
|
HCPCS J3370
|
| Hospital Charge Code |
41657103
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$1.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.00
|
|
|
VANCOMYCIN PEAK
|
Facility
OP
|
$33.85
|
|
|
Service Code
|
HCPCS 80202
|
| Hospital Charge Code |
40602600
|
|
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 TROUGH
|
Facility
OP
|
$33.85
|
|
|
Service Code
|
HCPCS 80202
|
| Hospital Charge Code |
40602595
|
|
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
|
|
|
VANCO ORAL SOL 125MG/5ML
|
Facility
OP
|
$2.00
|
|
| Hospital Charge Code |
41645873
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.70 |
| Max. Negotiated Rate |
$1.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.00
|
| Rate for Payer: Aetna Government |
$1.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.36
|
| Rate for Payer: Group Health Inc Commercial |
$1.00
|
| Rate for Payer: Group Health Inc Medicare |
$0.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.30
|
|
|
VANCO ORAL SOL 125MG/5ML
|
Facility
OP
|
$2.00
|
|
| Hospital Charge Code |
41655873
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.70 |
| Max. Negotiated Rate |
$1.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.00
|
| Rate for Payer: Aetna Government |
$1.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.36
|
| Rate for Payer: Group Health Inc Commercial |
$1.00
|
| Rate for Payer: Group Health Inc Medicare |
$0.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.30
|
|
|
VANCO ORAL SOL 250MG/10ML
|
Facility
OP
|
$3.00
|
|
| Hospital Charge Code |
41655875
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.05 |
| Max. Negotiated Rate |
$2.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.65
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.50
|
| Rate for Payer: Aetna Government |
$1.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.04
|
| Rate for Payer: Group Health Inc Commercial |
$1.50
|
| Rate for Payer: Group Health Inc Medicare |
$1.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.95
|
|
|
VANCO ORAL SOL 250MG/10ML SOL
|
Facility
OP
|
$3.00
|
|
| Hospital Charge Code |
41645875
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.05 |
| Max. Negotiated Rate |
$2.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.65
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.50
|
| Rate for Payer: Aetna Government |
$1.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.04
|
| Rate for Payer: Group Health Inc Commercial |
$1.50
|
| Rate for Payer: Group Health Inc Medicare |
$1.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.95
|
|
|
VANCO ORAL SOL 500MG/20ML
|
Facility
OP
|
$5.00
|
|
| Hospital Charge Code |
41655877
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.75 |
| Max. Negotiated Rate |
$4.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.50
|
| Rate for Payer: Aetna Government |
$2.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.40
|
| Rate for Payer: Group Health Inc Commercial |
$2.50
|
| Rate for Payer: Group Health Inc Medicare |
$1.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.25
|
|
|
VANCO ORAL SOL 500MG/20ML
|
Facility
OP
|
$5.00
|
|
| Hospital Charge Code |
41645877
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.75 |
| Max. Negotiated Rate |
$4.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.50
|
| Rate for Payer: Aetna Government |
$2.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.40
|
| Rate for Payer: Group Health Inc Commercial |
$2.50
|
| Rate for Payer: Group Health Inc Medicare |
$1.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.25
|
|
