|
VASCULAR GRAFT 1
|
Facility
IP
|
$23.51
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
40200231
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11.76 |
| Max. Negotiated Rate |
$11.76 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$11.76
|
|
|
VASCULAR GRAFT 1
|
Facility
OP
|
$23.51
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
40200231
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8.23 |
| Max. Negotiated Rate |
$322.77 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$12.93
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$322.77
|
| Rate for Payer: Aetna Government |
$322.77
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$11.76
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$13.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$24.69
|
| Rate for Payer: Group Health Inc Commercial |
$11.76
|
| Rate for Payer: Group Health Inc Medicare |
$8.23
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$11.76
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$15.28
|
|
|
VASCULAR GRAFT (S47045)
|
Facility
IP
|
$1,200.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
40200232
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$600.00 |
| Max. Negotiated Rate |
$600.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$600.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$600.00
|
|
|
VASCULAR GRAFT (S47045)
|
Facility
OP
|
$1,200.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
40200232
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$322.77 |
| Max. Negotiated Rate |
$1,260.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$660.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$322.77
|
| Rate for Payer: Aetna Government |
$322.77
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$600.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$690.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,260.00
|
| Rate for Payer: Group Health Inc Commercial |
$600.00
|
| Rate for Payer: Group Health Inc Medicare |
$420.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$600.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$600.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$780.00
|
|
|
VASCULAR GRAFT (V06080)
|
Facility
OP
|
$1,348.04
|
|
| Hospital Charge Code |
40202090
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$471.81 |
| Max. Negotiated Rate |
$1,078.43 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$741.42
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$674.02
|
| Rate for Payer: Aetna Government |
$674.02
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,078.43
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$916.67
|
| Rate for Payer: Group Health Inc Commercial |
$674.02
|
| Rate for Payer: Group Health Inc Medicare |
$471.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$674.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$674.02
|
|
|
VASCULAR GRAFT (V47050)
|
Facility
OP
|
$1,075.88
|
|
| Hospital Charge Code |
40202080
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$376.56 |
| Max. Negotiated Rate |
$860.70 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$591.73
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$537.94
|
| Rate for Payer: Aetna Government |
$537.94
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$860.70
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$731.60
|
| Rate for Payer: Group Health Inc Commercial |
$537.94
|
| Rate for Payer: Group Health Inc Medicare |
$376.56
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$537.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$537.94
|
|
|
VASCULAR SOL GUIDELINER CATHETER
|
Facility
OP
|
$790.00
|
|
| Hospital Charge Code |
66572918
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$276.50 |
| Max. Negotiated Rate |
$632.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$434.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$395.00
|
| Rate for Payer: Aetna Government |
$395.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$632.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$537.20
|
| Rate for Payer: Group Health Inc Commercial |
$395.00
|
| Rate for Payer: Group Health Inc Medicare |
$276.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$395.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$395.00
|
|
|
VASCULAR SOL GUIDELINER XL CATH
|
Facility
OP
|
$838.00
|
|
| Hospital Charge Code |
66572917
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$293.30 |
| Max. Negotiated Rate |
$670.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$460.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$419.00
|
| Rate for Payer: Aetna Government |
$419.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$670.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$569.84
|
| Rate for Payer: Group Health Inc Commercial |
$419.00
|
| Rate for Payer: Group Health Inc Medicare |
$293.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$419.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$419.00
|
|
|
VASCULAR STUDY, COMPLETE
|
Facility
OP
|
$705.83
|
|
|
Service Code
|
HCPCS 93975 TC
|
| Hospital Charge Code |
41301527
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$235.69 |
| Max. Negotiated Rate |
$564.66 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$388.21
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$352.92
|
| Rate for Payer: Aetna Government |
$352.92
|
| Rate for Payer: Cash Price |
$283.37
|
| Rate for Payer: Cash Price |
$283.37
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$564.66
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$479.96
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$235.69
|
| Rate for Payer: Group Health Inc Commercial |
$352.92
|
| Rate for Payer: Group Health Inc Medicare |
$247.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$352.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$352.92
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$261.88
|
|
|
VASCULAR STUDY, LIMITED
|
Facility
OP
|
$339.45
|
|
|
Service Code
|
HCPCS 93976 TC
|
| Hospital Charge Code |
41301528
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$118.81 |
| Max. Negotiated Rate |
$271.56 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$186.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$169.72
|
| Rate for Payer: Aetna Government |
$169.72
|
| Rate for Payer: Cash Price |
$127.14
|
| Rate for Payer: Cash Price |
$127.14
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$271.56
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$230.83
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$134.85
|
| Rate for Payer: Group Health Inc Commercial |
$169.72
|
| Rate for Payer: Group Health Inc Medicare |
$118.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$169.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$169.72
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$149.83
|
|
|
VASCULAR STUDY TCP02
|
Facility
OP
|
$330.23
|
|
|
Service Code
|
HCPCS 93922 TC
|
| Hospital Charge Code |
42500113
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$78.29 |
| Max. Negotiated Rate |
$264.18 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$181.63
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$165.12
|
| Rate for Payer: Aetna Government |
$165.12
|
| Rate for Payer: Cash Price |
$147.72
|
| Rate for Payer: Cash Price |
$147.72
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$264.18
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$224.56
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$78.29
|
| Rate for Payer: Group Health Inc Commercial |
$165.12
|
| Rate for Payer: Group Health Inc Medicare |
$115.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$165.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$165.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$86.99
|
|
|
VASECTOMY
|
Facility
OP
|
$5,365.58
|
|
|
Service Code
|
HCPCS 55250
|
| Hospital Charge Code |
40123095
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,505.00 |
| Max. Negotiated Rate |
$208,457.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,355.42
|
| Rate for Payer: Aetna Government |
$2,355.42
|
| Rate for Payer: Amida Care Medicaid |
$2,084.57
|
| Rate for Payer: Cash Price |
$2,355.42
|
| Rate for Payer: Cash Price |
$2,355.42
|
| Rate for Payer: Cash Price |
$2,355.42
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,355.42
|
| 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 |
$2,355.42
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$208,457.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,084.57
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,084.57
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,355.42
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,188.80
|
| Rate for Payer: Group Health Inc Commercial |
$2,355.42
|
| Rate for Payer: Group Health Inc Medicare |
$2,355.42
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,084.57
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,355.42
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,084.57
|
| Rate for Payer: Healthfirst Essential Plan |
$4,690.28
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,002.11
|
| Rate for Payer: Healthfirst QHP |
$2,084.57
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,355.42
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,084.57
|
| Rate for Payer: SOMOS Essential |
$4,690.28
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,355.42
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,884.34
|
| Rate for Payer: Wellcare Medicare |
$2,237.65
|
|
|
Vasectomy, unilateral or bilateral (separate procedure), including postoperative semen examination(s)
|
Facility
OP
|
$208,457.00
|
|
|
Service Code
|
CPT 55250
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,505.00 |
| Max. Negotiated Rate |
$208,457.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,355.42
|
| Rate for Payer: Aetna Government |
$2,355.42
|
| Rate for Payer: Amida Care Medicaid |
$2,084.57
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,355.42
|
| 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 |
$2,355.42
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$208,457.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,084.57
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,084.57
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,355.42
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,188.80
|
| Rate for Payer: Group Health Inc Commercial |
$2,355.42
|
| Rate for Payer: Group Health Inc Medicare |
$2,355.42
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,084.57
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,355.42
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,084.57
|
| Rate for Payer: Healthfirst Essential Plan |
$4,690.28
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,002.11
|
| Rate for Payer: Healthfirst QHP |
$2,084.57
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,355.42
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,084.57
|
| Rate for Payer: SOMOS Essential |
$4,690.28
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,355.42
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,884.34
|
| Rate for Payer: Wellcare Medicare |
$2,237.65
|
|
|
VASELINE GAUZE
|
Facility
OP
|
$6.73
|
|
| Hospital Charge Code |
40206615
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.36 |
| Max. Negotiated Rate |
$5.38 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.36
|
| Rate for Payer: Aetna Government |
$3.36
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5.38
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.58
|
| Rate for Payer: Group Health Inc Commercial |
$3.36
|
| Rate for Payer: Group Health Inc Medicare |
$2.36
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.36
|
|
|
VAS GRAFT R06020080L
|
Facility
OP
|
$1,652.45
|
|
| Hospital Charge Code |
40207022
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$578.36 |
| Max. Negotiated Rate |
$1,321.96 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$908.85
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$826.22
|
| Rate for Payer: Aetna Government |
$826.22
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,321.96
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,123.67
|
| Rate for Payer: Group Health Inc Commercial |
$826.22
|
| Rate for Payer: Group Health Inc Medicare |
$578.36
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$826.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$826.22
|
|
|
VAS GRAFT RR47010045L
|
Facility
OP
|
$1,293.82
|
|
| Hospital Charge Code |
40207019
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$452.84 |
| Max. Negotiated Rate |
$1,035.06 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$711.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$646.91
|
| Rate for Payer: Aetna Government |
$646.91
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,035.06
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$879.80
|
| Rate for Payer: Group Health Inc Commercial |
$646.91
|
| Rate for Payer: Group Health Inc Medicare |
$452.84
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$646.91
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$646.91
|
|
|
VAS GRAFT RRT06060080L
|
Facility
OP
|
$2,241.42
|
|
| Hospital Charge Code |
40207021
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$784.50 |
| Max. Negotiated Rate |
$1,793.14 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,232.78
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,120.71
|
| Rate for Payer: Aetna Government |
$1,120.71
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,793.14
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,524.17
|
| Rate for Payer: Group Health Inc Commercial |
$1,120.71
|
| Rate for Payer: Group Health Inc Medicare |
$784.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,120.71
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,120.71
|
|
|
VASOPRESSIN 20 UNITS/ML INJ
|
Facility
OP
|
$9.00
|
|
| Hospital Charge Code |
41643641
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.15 |
| Max. Negotiated Rate |
$7.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.50
|
| Rate for Payer: Aetna Government |
$4.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.12
|
| Rate for Payer: Group Health Inc Commercial |
$4.50
|
| Rate for Payer: Group Health Inc Medicare |
$3.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.85
|
|
|
VASOPRESSIN 20 UNITS/ML INJ
|
Facility
OP
|
$9.00
|
|
| Hospital Charge Code |
41653641
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.15 |
| Max. Negotiated Rate |
$7.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.50
|
| Rate for Payer: Aetna Government |
$4.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.12
|
| Rate for Payer: Group Health Inc Commercial |
$4.50
|
| Rate for Payer: Group Health Inc Medicare |
$3.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.85
|
|
|
VAXNEUVANCE VFC-PNEUMC 15-VALENT
|
Facility
IP
|
$0.01
|
|
|
Service Code
|
HCPCS 90671
|
| Hospital Charge Code |
41640399
|
|
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
|
|
|
VAXNEUVANCE VFC-PNEUMC 15-VALENT
|
Facility
OP
|
$0.01
|
|
|
Service Code
|
HCPCS 90671
|
| Hospital Charge Code |
41650399
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$268.77 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.01
|
| Rate for Payer: Aetna Government |
$0.01
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.01
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.01
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$221.58
|
| 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: Healthfirst CHP/FHP/Medicaid |
$246.20
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$268.77
|
| Rate for Payer: SOMOS Essential |
$268.77
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.01
|
|
|
VAXNEUVANCE VFC-PNEUMC 15-VALENT
|
Facility
IP
|
$0.01
|
|
|
Service Code
|
HCPCS 90671
|
| Hospital Charge Code |
41650399
|
|
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
|
|
|
VAXNEUVANCE VFC-PNEUMC 15-VALENT
|
Facility
OP
|
$0.01
|
|
|
Service Code
|
HCPCS 90671
|
| Hospital Charge Code |
41640399
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$268.77 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.01
|
| Rate for Payer: Aetna Government |
$0.01
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.01
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.01
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$221.58
|
| 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: Healthfirst CHP/FHP/Medicaid |
$246.20
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$268.77
|
| Rate for Payer: SOMOS Essential |
$268.77
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.01
|
|
|
V BOSS 12X80 10MM
|
Facility
OP
|
$18,136.45
|
|
| Hospital Charge Code |
64904427
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$6,347.76 |
| Max. Negotiated Rate |
$14,509.16 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$9,975.05
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$9,068.22
|
| Rate for Payer: Aetna Government |
$9,068.22
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$14,509.16
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$12,332.79
|
| Rate for Payer: Group Health Inc Commercial |
$9,068.22
|
| Rate for Payer: Group Health Inc Medicare |
$6,347.76
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9,068.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9,068.22
|
|
|
VB ROLL 11 X 14 24.5MM
|
Facility
OP
|
$10,950.00
|
|
| Hospital Charge Code |
64904010
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$3,832.50 |
| Max. Negotiated Rate |
$8,760.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6,022.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5,475.00
|
| Rate for Payer: Aetna Government |
$5,475.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8,760.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7,446.00
|
| Rate for Payer: Group Health Inc Commercial |
$5,475.00
|
| Rate for Payer: Group Health Inc Medicare |
$3,832.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5,475.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5,475.00
|
|
