|
VENLAFAXINE SR 150 MG CAP CR
|
Facility
OP
|
$0.57
|
|
| Hospital Charge Code |
41653063
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$0.46 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.31
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.29
|
| Rate for Payer: Aetna Government |
$0.29
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.46
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.39
|
| Rate for Payer: Group Health Inc Commercial |
$0.29
|
| Rate for Payer: Group Health Inc Medicare |
$0.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.29
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.37
|
|
|
VENLAFAXINE SR 150 MG CAP CR
|
Facility
OP
|
$0.57
|
|
| Hospital Charge Code |
41643063
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$0.46 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.31
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.29
|
| Rate for Payer: Aetna Government |
$0.29
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.46
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.39
|
| Rate for Payer: Group Health Inc Commercial |
$0.29
|
| Rate for Payer: Group Health Inc Medicare |
$0.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.29
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.37
|
|
|
VENOGRAM CAVAL INFERIOR
|
Facility
OP
|
$8,393.53
|
|
|
Service Code
|
HCPCS 75825 TC
|
| Hospital Charge Code |
41542598
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$68.72 |
| Max. Negotiated Rate |
$6,714.82 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4,616.44
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4,196.76
|
| Rate for Payer: Aetna Government |
$4,196.76
|
| Rate for Payer: Cash Price |
$3,686.08
|
| Rate for Payer: Cash Price |
$3,686.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6,714.82
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5,707.60
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$68.72
|
| Rate for Payer: Group Health Inc Commercial |
$4,196.76
|
| Rate for Payer: Group Health Inc Medicare |
$2,937.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,196.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,196.76
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$76.35
|
|
|
VENOUS PRESSURE SET
|
Facility
OP
|
$64.85
|
|
| Hospital Charge Code |
40206630
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$22.70 |
| Max. Negotiated Rate |
$51.88 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$35.67
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$32.42
|
| Rate for Payer: Aetna Government |
$32.42
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$51.88
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$44.10
|
| Rate for Payer: Group Health Inc Commercial |
$32.42
|
| Rate for Payer: Group Health Inc Medicare |
$22.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$32.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$32.42
|
|
|
VENTED TIP COVER
|
Facility
OP
|
$0.85
|
|
| Hospital Charge Code |
64903603
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.30 |
| Max. Negotiated Rate |
$0.68 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.47
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.43
|
| Rate for Payer: Aetna Government |
$0.43
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.68
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.58
|
| Rate for Payer: Group Health Inc Commercial |
$0.43
|
| Rate for Payer: Group Health Inc Medicare |
$0.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.43
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.43
|
|
|
VENTILATOR TRANSPORT(IN HOUSE)
|
Facility
OP
|
$421.00
|
|
|
Service Code
|
HCPCS 94799 TC
|
| Hospital Charge Code |
40301560
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$147.35 |
| Max. Negotiated Rate |
$336.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$231.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$210.50
|
| Rate for Payer: Aetna Government |
$210.50
|
| Rate for Payer: Cash Price |
$180.64
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$336.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$286.28
|
| Rate for Payer: Group Health Inc Commercial |
$210.50
|
| Rate for Payer: Group Health Inc Medicare |
$147.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$210.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$210.50
|
|
|
VENTILATOR TRANSPORT(OUTSIDE)
|
Facility
OP
|
$421.00
|
|
|
Service Code
|
HCPCS 94799 TC
|
| Hospital Charge Code |
40301570
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$147.35 |
| Max. Negotiated Rate |
$336.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$231.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$210.50
|
| Rate for Payer: Aetna Government |
$210.50
|
| Rate for Payer: Cash Price |
$180.64
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$336.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$286.28
|
| Rate for Payer: Group Health Inc Commercial |
$210.50
|
| Rate for Payer: Group Health Inc Medicare |
$147.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$210.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$210.50
|
|
|
VENTI PAD
|
Facility
OP
|
$62.37
|
|
| Hospital Charge Code |
40206660
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$21.83 |
| Max. Negotiated Rate |
$49.90 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$34.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$31.18
|
| Rate for Payer: Aetna Government |
$31.18
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$49.90
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$42.41
|
| Rate for Payer: Group Health Inc Commercial |
$31.18
|
| Rate for Payer: Group Health Inc Medicare |
$21.83
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$31.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$31.18
|
|
|
VENTRALIGHT MESH 4 X 6
|
Facility
OP
|
$2,650.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
64905939
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$69.35 |
| Max. Negotiated Rate |
$2,782.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,457.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$69.35
|
| Rate for Payer: Aetna Government |
$69.35
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,325.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,523.75
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,782.50
|
| Rate for Payer: Group Health Inc Commercial |
$1,325.00
|
| Rate for Payer: Group Health Inc Medicare |
$927.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,325.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,325.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,722.50
|
|
|
VENTRALIGHT MESH 4 X 6
|
Facility
IP
|
$2,650.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
64905939
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,325.00 |
| Max. Negotiated Rate |
$1,325.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,325.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,325.00
|
|
|
VENTRALIGHT ST MESH 7' X 9
|
Facility
IP
|
$4,212.50
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
64905941
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,106.25 |
| Max. Negotiated Rate |
$2,106.25 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,106.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,106.25
|
|
|
VENTRALIGHT ST MESH 7' X 9
|
Facility
OP
|
$4,212.50
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
64905941
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$69.35 |
| Max. Negotiated Rate |
$4,423.12 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,316.88
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$69.35
|
| Rate for Payer: Aetna Government |
$69.35
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,106.25
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,422.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$4,423.12
|
| Rate for Payer: Group Health Inc Commercial |
$2,106.25
|
| Rate for Payer: Group Health Inc Medicare |
$1,474.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,106.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,106.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,738.12
|
|
|
VENTRICULAR DRAINAGE
|
Facility
OP
|
$2,459.50
|
|
|
Service Code
|
HCPCS 61020
|
| Hospital Charge Code |
40000550
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$128.73 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,054.06
|
| Rate for Payer: Aetna Government |
$1,054.06
|
| Rate for Payer: Cash Price |
$1,054.06
|
| Rate for Payer: Cash Price |
$1,054.06
|
| Rate for Payer: Cash Price |
$1,054.06
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,054.06
|
| 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 |
$1,054.06
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$128.73
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$895.95
|
| Rate for Payer: Fidelis Essential Plan QHP |
$938.11
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,054.06
|
| Rate for Payer: Fidelis Qualified Health Plan |
$938.11
|
| Rate for Payer: Group Health Inc Commercial |
$1,054.06
|
| Rate for Payer: Group Health Inc Medicare |
$1,054.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,229.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,054.06
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$143.03
|
| Rate for Payer: Healthfirst Medicare Advantage |
$895.95
|
| Rate for Payer: Healthfirst QHP |
$1,054.06
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,054.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,054.06
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$843.25
|
| Rate for Payer: Wellcare Medicare |
$1,001.36
|
|
|
VENTRICULAR LEAD 4092-58CM
|
Facility
OP
|
$1,300.00
|
|
| Hospital Charge Code |
40200397
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$455.00 |
| Max. Negotiated Rate |
$1,040.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$715.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$650.00
|
| Rate for Payer: Aetna Government |
$650.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,040.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$884.00
|
| Rate for Payer: Group Health Inc Commercial |
$650.00
|
| Rate for Payer: Group Health Inc Medicare |
$455.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$650.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$650.00
|
|
|
VENTRICULAR LEAD CAPSURE SENSE
|
Facility
OP
|
$1,900.00
|
|
| Hospital Charge Code |
40200396
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$665.00 |
| Max. Negotiated Rate |
$1,520.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,045.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$950.00
|
| Rate for Payer: Aetna Government |
$950.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,520.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,292.00
|
| Rate for Payer: Group Health Inc Commercial |
$950.00
|
| Rate for Payer: Group Health Inc Medicare |
$665.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$950.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$950.00
|
|
|
VENTRICULAR SHUNT PROCEDURES WITH CC
|
Facility
IP
|
$37,939.33
|
|
|
Service Code
|
MS-DRG 032
|
| Min. Negotiated Rate |
$17,295.87 |
| Max. Negotiated Rate |
$37,939.33 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$31,757.78
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$37,195.42
|
| Rate for Payer: Aetna Government |
$37,195.42
|
| Rate for Payer: Brighton Health Commercial |
$31,230.10
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$37,939.33
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$37,193.97
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$30,694.06
|
| Rate for Payer: Elderplan Medicare Advantage |
$35,335.65
|
| Rate for Payer: EmblemHealth Commercial |
$18,468.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$37,195.42
|
| Rate for Payer: Group Health Inc Commercial |
$37,195.42
|
| Rate for Payer: Group Health Inc Medicare |
$37,195.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$37,195.42
|
| Rate for Payer: Healthfirst Medicare Advantage |
$17,295.87
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$37,195.42
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$37,195.42
|
| Rate for Payer: Wellcare Medicare |
$35,335.65
|
|
|
VENTRICULAR SHUNT PROCEDURES WITH MCC
|
Facility
IP
|
$71,089.57
|
|
|
Service Code
|
MS-DRG 031
|
| Min. Negotiated Rate |
$29,952.65 |
| Max. Negotiated Rate |
$71,089.57 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$60,699.27
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$64,414.31
|
| Rate for Payer: Aetna Government |
$64,414.31
|
| Rate for Payer: Brighton Health Commercial |
$59,690.70
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$65,702.60
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$71,089.57
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$58,666.16
|
| Rate for Payer: Elderplan Medicare Advantage |
$61,193.59
|
| Rate for Payer: EmblemHealth Commercial |
$35,299.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$64,414.31
|
| Rate for Payer: Group Health Inc Commercial |
$64,414.31
|
| Rate for Payer: Group Health Inc Medicare |
$64,414.31
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$64,414.31
|
| Rate for Payer: Healthfirst Medicare Advantage |
$29,952.65
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$64,414.31
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$64,414.31
|
| Rate for Payer: Wellcare Medicare |
$61,193.59
|
|
|
VENTRICULAR SHUNT PROCEDURES WITHOUT CC/MCC
|
Facility
IP
|
$30,429.89
|
|
|
Service Code
|
MS-DRG 033
|
| Min. Negotiated Rate |
$13,872.45 |
| Max. Negotiated Rate |
$30,429.89 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$23,929.66
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$29,833.23
|
| Rate for Payer: Aetna Government |
$29,833.23
|
| Rate for Payer: Brighton Health Commercial |
$23,532.05
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$30,429.89
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$28,025.86
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$23,128.14
|
| Rate for Payer: Elderplan Medicare Advantage |
$28,341.57
|
| Rate for Payer: EmblemHealth Commercial |
$13,916.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$29,833.23
|
| Rate for Payer: Group Health Inc Commercial |
$29,833.23
|
| Rate for Payer: Group Health Inc Medicare |
$29,833.23
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$29,833.23
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13,872.45
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$29,833.23
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$29,833.23
|
| Rate for Payer: Wellcare Medicare |
$28,341.57
|
|
|
VENTRICULOCISTERNOSTOMY 3RD VENTR
|
Facility
OP
|
$3,896.38
|
|
|
Service Code
|
HCPCS 62200
|
| Hospital Charge Code |
40004301
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,363.73 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,143.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,747.13
|
| Rate for Payer: Aetna Government |
$1,747.13
|
| 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: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,708.97
|
| Rate for Payer: Group Health Inc Commercial |
$1,948.19
|
| Rate for Payer: Group Health Inc Medicare |
$1,363.73
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,948.19
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,948.19
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,898.86
|
|
|
VENTRICULOCISTERNOSTOMY (TORKILDS
|
Facility
OP
|
$4,917.42
|
|
|
Service Code
|
HCPCS 62180
|
| Hospital Charge Code |
40004300
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,505.00 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,704.58
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,022.13
|
| Rate for Payer: Aetna Government |
$2,022.13
|
| 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: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,985.39
|
| Rate for Payer: Group Health Inc Commercial |
$2,458.71
|
| Rate for Payer: Group Health Inc Medicare |
$1,721.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,458.71
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,458.71
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,205.99
|
|
|
VENTRICULO PERITONEAL SHUNT
|
Facility
OP
|
$2,484.35
|
|
|
Service Code
|
HCPCS 62192
|
| Hospital Charge Code |
40004336
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$869.52 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,366.39
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,227.13
|
| Rate for Payer: Aetna Government |
$1,227.13
|
| 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: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,197.72
|
| Rate for Payer: Group Health Inc Commercial |
$1,242.18
|
| Rate for Payer: Group Health Inc Medicare |
$869.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,242.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,242.18
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,330.80
|
|
|
VENT TUBE WITH TAB 1.14MM
|
Facility
OP
|
$112.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
40202359
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$39.20 |
| Max. Negotiated Rate |
$117.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$61.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$56.00
|
| Rate for Payer: Aetna Government |
$56.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$56.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$64.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$117.60
|
| Rate for Payer: Group Health Inc Commercial |
$56.00
|
| Rate for Payer: Group Health Inc Medicare |
$39.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$56.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$56.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$72.80
|
|
|
VENT TUBE WITH TAB 1.14MM
|
Facility
IP
|
$112.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
40202359
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$56.00 |
| Max. Negotiated Rate |
$56.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$56.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$56.00
|
|
|
VERAPAMIL 120 MG TAB
|
Facility
OP
|
$0.17
|
|
| Hospital Charge Code |
41653738
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.14 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.09
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.09
|
| Rate for Payer: Aetna Government |
$0.09
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.14
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.12
|
| Rate for Payer: Group Health Inc Commercial |
$0.09
|
| Rate for Payer: Group Health Inc Medicare |
$0.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.11
|
|
|
VERAPAMIL 120 MG TAB
|
Facility
OP
|
$0.17
|
|
| Hospital Charge Code |
41643738
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.14 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.09
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.09
|
| Rate for Payer: Aetna Government |
$0.09
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.14
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.12
|
| Rate for Payer: Group Health Inc Commercial |
$0.09
|
| Rate for Payer: Group Health Inc Medicare |
$0.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.11
|
|
