|
VANGRD DCM CR TIB 10MMX71/75MM
|
Facility
OP
|
$2,208.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40202084
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.17 |
| Max. Negotiated Rate |
$2,318.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,214.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$339.17
|
| Rate for Payer: Aetna Government |
$339.17
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,104.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,269.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,318.40
|
| Rate for Payer: Group Health Inc Commercial |
$1,104.00
|
| Rate for Payer: Group Health Inc Medicare |
$772.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,104.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,104.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,435.20
|
|
|
VANGRD DCM CR TIB 10MMX71/75MM
|
Facility
IP
|
$2,208.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40202084
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,104.00 |
| Max. Negotiated Rate |
$1,104.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,104.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,104.00
|
|
|
VANILLYLMANDELIC ACID, 24-HR U
|
Facility
OP
|
$38.75
|
|
|
Service Code
|
HCPCS 84585
|
| Hospital Charge Code |
40609825
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$12.40 |
| Max. Negotiated Rate |
$24.65 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$21.31
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$15.50
|
| Rate for Payer: Aetna Government |
$15.50
|
| Rate for Payer: Cash Price |
$15.50
|
| Rate for Payer: Cash Price |
$15.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$15.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$24.65
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$20.86
|
| Rate for Payer: Elderplan Medicare Advantage |
$15.50
|
| Rate for Payer: EmblemHealth Commercial |
$15.50
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$13.95
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$13.18
|
| Rate for Payer: Fidelis Essential Plan QHP |
$13.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$15.50
|
| Rate for Payer: Fidelis Qualified Health Plan |
$13.80
|
| Rate for Payer: Group Health Inc Commercial |
$15.50
|
| Rate for Payer: Group Health Inc Medicare |
$15.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$19.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$15.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$15.50
|
| Rate for Payer: Healthfirst Medicare Advantage |
$15.50
|
| Rate for Payer: Healthfirst QHP |
$15.50
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$15.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$15.50
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$12.40
|
| Rate for Payer: Wellcare Medicare |
$13.95
|
|
|
VANILLYMANDELIC ACID 24 HR URINE
|
Facility
OP
|
$38.75
|
|
|
Service Code
|
HCPCS 84585
|
| Hospital Charge Code |
40608260
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.40 |
| Max. Negotiated Rate |
$24.65 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$21.31
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$15.50
|
| Rate for Payer: Aetna Government |
$15.50
|
| Rate for Payer: Cash Price |
$15.50
|
| Rate for Payer: Cash Price |
$15.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$15.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$24.65
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$20.86
|
| Rate for Payer: Elderplan Medicare Advantage |
$15.50
|
| Rate for Payer: EmblemHealth Commercial |
$15.50
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$13.95
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$13.18
|
| Rate for Payer: Fidelis Essential Plan QHP |
$13.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$15.50
|
| Rate for Payer: Fidelis Qualified Health Plan |
$13.80
|
| Rate for Payer: Group Health Inc Commercial |
$15.50
|
| Rate for Payer: Group Health Inc Medicare |
$15.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$19.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$15.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$15.50
|
| Rate for Payer: Healthfirst Medicare Advantage |
$15.50
|
| Rate for Payer: Healthfirst QHP |
$15.50
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$15.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$15.50
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$12.40
|
| Rate for Payer: Wellcare Medicare |
$13.95
|
|
|
VARADY TYPE VEIN HOOKS D/E
|
Facility
OP
|
$337.50
|
|
| Hospital Charge Code |
64903609
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$118.12 |
| Max. Negotiated Rate |
$270.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$185.62
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$168.75
|
| Rate for Payer: Aetna Government |
$168.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$270.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$229.50
|
| Rate for Payer: Group Health Inc Commercial |
$168.75
|
| Rate for Payer: Group Health Inc Medicare |
$118.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$168.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$168.75
|
|
|
VARADY TYPE VEIN HOOKS D/E
|
Facility
OP
|
$337.50
|
|
| Hospital Charge Code |
64903607
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$118.12 |
| Max. Negotiated Rate |
$270.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$185.62
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$168.75
|
| Rate for Payer: Aetna Government |
$168.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$270.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$229.50
|
| Rate for Payer: Group Health Inc Commercial |
$168.75
|
| Rate for Payer: Group Health Inc Medicare |
$118.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$168.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$168.75
|
|
|
VARICELLA VACC (VFC) 0.5ML SQ VIA
|
Facility
IP
|
$0.01
|
|
|
Service Code
|
HCPCS 90716
|
| Hospital Charge Code |
41659573
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
|
|
VARICELLA VACC (VFC) 0.5ML SQ VIA
|
Facility
OP
|
$0.01
|
|
|
Service Code
|
HCPCS 90716
|
| Hospital Charge Code |
41659573
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$153.87 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$153.87
|
| Rate for Payer: Aetna Government |
$153.87
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.01
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.01
|
| Rate for Payer: Group Health Inc Commercial |
$0.01
|
| Rate for Payer: Group Health Inc Medicare |
$0.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.01
|
|
|
VARICELLA VACC (VFC) 0.5ML SQ VIA
|
Facility
IP
|
$0.01
|
|
|
Service Code
|
HCPCS 90716
|
| Hospital Charge Code |
41649573
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
|
|
VARICELLA VACC (VFC) 0.5ML SQ VIA
|
Facility
OP
|
$0.01
|
|
|
Service Code
|
HCPCS 90716
|
| Hospital Charge Code |
41649573
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$153.87 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$153.87
|
| Rate for Payer: Aetna Government |
$153.87
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.01
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.01
|
| Rate for Payer: Group Health Inc Commercial |
$0.01
|
| Rate for Payer: Group Health Inc Medicare |
$0.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.01
|
|
|
VARICELLA VIRUS VACCINE INJ
|
Facility
OP
|
$172.19
|
|
| Hospital Charge Code |
41652431
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$60.27 |
| Max. Negotiated Rate |
$137.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$94.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$86.10
|
| Rate for Payer: Aetna Government |
$86.10
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$137.75
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$117.09
|
| Rate for Payer: Group Health Inc Commercial |
$86.10
|
| Rate for Payer: Group Health Inc Medicare |
$60.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$86.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$86.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$111.92
|
|
|
VARICELLA VIRUS VACCINE INJ
|
Facility
OP
|
$172.19
|
|
| Hospital Charge Code |
41642431
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$60.27 |
| Max. Negotiated Rate |
$137.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$94.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$86.10
|
| Rate for Payer: Aetna Government |
$86.10
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$137.75
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$117.09
|
| Rate for Payer: Group Health Inc Commercial |
$86.10
|
| Rate for Payer: Group Health Inc Medicare |
$60.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$86.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$86.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$111.92
|
|
|
VARICELLA ZOSTER AB
|
Facility
OP
|
$32.20
|
|
|
Service Code
|
HCPCS 86787
|
| Hospital Charge Code |
40617759
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.30 |
| Max. Negotiated Rate |
$20.48 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$17.71
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12.88
|
| Rate for Payer: Aetna Government |
$12.88
|
| Rate for Payer: Cash Price |
$12.88
|
| Rate for Payer: Cash Price |
$12.88
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$12.88
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$20.48
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$17.32
|
| Rate for Payer: Elderplan Medicare Advantage |
$12.88
|
| Rate for Payer: EmblemHealth Commercial |
$12.88
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$11.59
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$10.95
|
| Rate for Payer: Fidelis Essential Plan QHP |
$11.46
|
| Rate for Payer: Fidelis Medicare Advantage |
$12.88
|
| Rate for Payer: Fidelis Qualified Health Plan |
$11.46
|
| Rate for Payer: Group Health Inc Commercial |
$12.88
|
| Rate for Payer: Group Health Inc Medicare |
$12.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.88
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$12.88
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12.88
|
| Rate for Payer: Healthfirst QHP |
$12.88
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$12.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12.88
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$10.30
|
| Rate for Payer: Wellcare Medicare |
$11.59
|
|
|
VARICELLA-ZOSTER AB, IGM
|
Facility
OP
|
$32.20
|
|
|
Service Code
|
HCPCS 86787
|
| Hospital Charge Code |
40729383
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.30 |
| Max. Negotiated Rate |
$20.48 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$17.71
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12.88
|
| Rate for Payer: Aetna Government |
$12.88
|
| Rate for Payer: Cash Price |
$12.88
|
| Rate for Payer: Cash Price |
$12.88
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$12.88
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$20.48
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$17.32
|
| Rate for Payer: Elderplan Medicare Advantage |
$12.88
|
| Rate for Payer: EmblemHealth Commercial |
$12.88
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$11.59
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$10.95
|
| Rate for Payer: Fidelis Essential Plan QHP |
$11.46
|
| Rate for Payer: Fidelis Medicare Advantage |
$12.88
|
| Rate for Payer: Fidelis Qualified Health Plan |
$11.46
|
| Rate for Payer: Group Health Inc Commercial |
$12.88
|
| Rate for Payer: Group Health Inc Medicare |
$12.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.88
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$12.88
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12.88
|
| Rate for Payer: Healthfirst QHP |
$12.88
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$12.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12.88
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$10.30
|
| Rate for Payer: Wellcare Medicare |
$11.59
|
|
|
VARICELLA ZOSTER IMMUNE GLOBULIN 625 UNI
|
Facility
OP
|
$190.00
|
|
| Hospital Charge Code |
41641669
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$66.50 |
| Max. Negotiated Rate |
$152.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$104.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$95.00
|
| Rate for Payer: Aetna Government |
$95.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$152.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$129.20
|
| Rate for Payer: Group Health Inc Commercial |
$95.00
|
| Rate for Payer: Group Health Inc Medicare |
$66.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$95.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$95.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$123.50
|
|
|
VARICELLA ZOSTER IMMUNE GLOBULIN 625 UNI
|
Facility
OP
|
$190.00
|
|
| Hospital Charge Code |
41651669
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$66.50 |
| Max. Negotiated Rate |
$152.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$104.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$95.00
|
| Rate for Payer: Aetna Government |
$95.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$152.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$129.20
|
| Rate for Payer: Group Health Inc Commercial |
$95.00
|
| Rate for Payer: Group Health Inc Medicare |
$66.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$95.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$95.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$123.50
|
|
|
VARICELLA-ZOSTER V AB, IGG
|
Facility
OP
|
$32.20
|
|
|
Service Code
|
HCPCS 86787
|
| Hospital Charge Code |
40729382
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.30 |
| Max. Negotiated Rate |
$20.48 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$17.71
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12.88
|
| Rate for Payer: Aetna Government |
$12.88
|
| Rate for Payer: Cash Price |
$12.88
|
| Rate for Payer: Cash Price |
$12.88
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$12.88
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$20.48
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$17.32
|
| Rate for Payer: Elderplan Medicare Advantage |
$12.88
|
| Rate for Payer: EmblemHealth Commercial |
$12.88
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$11.59
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$10.95
|
| Rate for Payer: Fidelis Essential Plan QHP |
$11.46
|
| Rate for Payer: Fidelis Medicare Advantage |
$12.88
|
| Rate for Payer: Fidelis Qualified Health Plan |
$11.46
|
| Rate for Payer: Group Health Inc Commercial |
$12.88
|
| Rate for Payer: Group Health Inc Medicare |
$12.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.88
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$12.88
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12.88
|
| Rate for Payer: Healthfirst QHP |
$12.88
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$12.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12.88
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$10.30
|
| Rate for Payer: Wellcare Medicare |
$11.59
|
|
|
VARICELLA ZOSTER VIRUS CULTURE
|
Facility
OP
|
$65.18
|
|
|
Service Code
|
HCPCS 87252
|
| Hospital Charge Code |
40619191
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.86 |
| Max. Negotiated Rate |
$41.43 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$35.85
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$26.07
|
| Rate for Payer: Aetna Government |
$26.07
|
| Rate for Payer: Cash Price |
$26.07
|
| Rate for Payer: Cash Price |
$26.07
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$26.07
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$41.43
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$35.06
|
| Rate for Payer: Elderplan Medicare Advantage |
$26.07
|
| Rate for Payer: EmblemHealth Commercial |
$26.07
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$23.46
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$22.16
|
| Rate for Payer: Fidelis Essential Plan QHP |
$23.20
|
| Rate for Payer: Fidelis Medicare Advantage |
$26.07
|
| Rate for Payer: Fidelis Qualified Health Plan |
$23.20
|
| Rate for Payer: Group Health Inc Commercial |
$26.07
|
| Rate for Payer: Group Health Inc Medicare |
$26.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$32.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$26.07
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$26.07
|
| Rate for Payer: Healthfirst Medicare Advantage |
$26.07
|
| Rate for Payer: Healthfirst QHP |
$26.07
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$26.07
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$26.07
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$20.86
|
| Rate for Payer: Wellcare Medicare |
$23.46
|
|
|
VARICOCELECTOMY
|
Facility
OP
|
$9,417.43
|
|
|
Service Code
|
HCPCS 55535
|
| Hospital Charge Code |
40123070
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$465.84 |
| Max. Negotiated Rate |
$8,748.99 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,485.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8,748.99
|
| Rate for Payer: Aetna Government |
$8,748.99
|
| Rate for Payer: Cash Price |
$8,748.99
|
| Rate for Payer: Cash Price |
$8,748.99
|
| Rate for Payer: Cash Price |
$8,748.99
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$8,748.99
|
| 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 |
$8,748.99
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$465.84
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$7,436.64
|
| Rate for Payer: Fidelis Essential Plan QHP |
$7,786.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$8,748.99
|
| Rate for Payer: Fidelis Qualified Health Plan |
$7,786.60
|
| Rate for Payer: Group Health Inc Commercial |
$8,748.99
|
| Rate for Payer: Group Health Inc Medicare |
$8,748.99
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,708.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8,748.99
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$517.60
|
| Rate for Payer: Healthfirst Medicare Advantage |
$7,436.64
|
| Rate for Payer: Healthfirst QHP |
$8,748.99
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$8,748.99
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8,748.99
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$6,999.19
|
| Rate for Payer: Wellcare Medicare |
$8,311.54
|
|
|
VARIZIG 125 UNITS
|
Facility
OP
|
$3,899.00
|
|
| Hospital Charge Code |
41648411
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1,364.65 |
| Max. Negotiated Rate |
$3,119.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,144.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,949.50
|
| Rate for Payer: Aetna Government |
$1,949.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3,119.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,651.32
|
| Rate for Payer: Group Health Inc Commercial |
$1,949.50
|
| Rate for Payer: Group Health Inc Medicare |
$1,364.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,949.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,949.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,534.35
|
|
|
VARIZIG 125 UNITS
|
Facility
OP
|
$3,899.00
|
|
| Hospital Charge Code |
41658411
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1,364.65 |
| Max. Negotiated Rate |
$3,119.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,144.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,949.50
|
| Rate for Payer: Aetna Government |
$1,949.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3,119.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,651.32
|
| Rate for Payer: Group Health Inc Commercial |
$1,949.50
|
| Rate for Payer: Group Health Inc Medicare |
$1,364.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,949.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,949.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,534.35
|
|
|
VASC SOLN VENTURE OTW CATH 5821
|
Facility
OP
|
$1,400.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
66526591
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7.08 |
| Max. Negotiated Rate |
$1,470.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$770.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$7.08
|
| Rate for Payer: Aetna Government |
$7.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$700.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$805.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,470.00
|
| Rate for Payer: Group Health Inc Commercial |
$700.00
|
| Rate for Payer: Group Health Inc Medicare |
$490.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$700.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$700.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$910.00
|
|
|
VASC SOLN VENTURE OTW CATH 5821
|
Facility
IP
|
$1,400.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
66526591
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$700.00 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$700.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$700.00
|
|
|
Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; arterial, other than hemorrhage or tumor (eg, congenital or acquired arterial malformations, arteriovenous malformations, arteriovenous fistulas, aneurysms, pseudoaneurysms)
|
Facility
OP
|
$20,278.00
|
|
|
Service Code
|
CPT 37242
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$516.49 |
| Max. Negotiated Rate |
$20,278.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,485.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$20,278.00
|
| Rate for Payer: Aetna Government |
$20,278.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$20,278.00
|
| 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 |
$20,278.00
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$516.49
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$17,236.30
|
| Rate for Payer: Fidelis Essential Plan QHP |
$18,047.42
|
| Rate for Payer: Fidelis Medicare Advantage |
$20,278.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$18,047.42
|
| Rate for Payer: Group Health Inc Commercial |
$20,278.00
|
| Rate for Payer: Group Health Inc Medicare |
$20,278.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$20,278.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$573.88
|
| Rate for Payer: Healthfirst Medicare Advantage |
$17,236.30
|
| Rate for Payer: Healthfirst QHP |
$20,278.00
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$20,278.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$20,278.00
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$16,222.40
|
| Rate for Payer: Wellcare Medicare |
$19,264.10
|
|
|
Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for tumors, organ ischemia, or infarction
|
Facility
OP
|
$12,721.98
|
|
|
Service Code
|
CPT 37243
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$587.11 |
| Max. Negotiated Rate |
$12,721.98 |
| Rate for Payer: Wellcare Medicare |
$12,085.88
|
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4,065.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12,721.98
|
| Rate for Payer: Aetna Government |
$12,721.98
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$12,721.98
|
| 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 |
$12,721.98
|
| Rate for Payer: EmblemHealth Commercial |
$12,721.98
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$587.11
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$10,813.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$11,322.56
|
| Rate for Payer: Fidelis Medicare Advantage |
$12,721.98
|
| Rate for Payer: Fidelis Qualified Health Plan |
$11,322.56
|
| Rate for Payer: Group Health Inc Commercial |
$12,721.98
|
| Rate for Payer: Group Health Inc Medicare |
$12,721.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12,721.98
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$652.34
|
| Rate for Payer: Healthfirst Medicare Advantage |
$10,813.68
|
| Rate for Payer: Healthfirst QHP |
$12,721.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$12,721.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12,721.98
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$10,177.58
|
|
