|
VINORELBINE 10 MG/ML INJ 5 ML
|
Facility
IP
|
$14.82
|
|
|
Service Code
|
HCPCS J9390
|
| Hospital Charge Code |
41654335
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.41 |
| Max. Negotiated Rate |
$7.41 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.41
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.41
|
|
|
VIOKACE 39,150-10,440-39,150 UNIT
|
Facility
OP
|
$4.38
|
|
| Hospital Charge Code |
41658410
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.53 |
| Max. Negotiated Rate |
$3.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.41
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.19
|
| Rate for Payer: Aetna Government |
$2.19
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.98
|
| Rate for Payer: Group Health Inc Commercial |
$2.19
|
| Rate for Payer: Group Health Inc Medicare |
$1.53
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.19
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.85
|
|
|
VIOKACE 39,150-10,440-39,150 UNIT
|
Facility
OP
|
$4.38
|
|
| Hospital Charge Code |
41648410
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.53 |
| Max. Negotiated Rate |
$3.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.41
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.19
|
| Rate for Payer: Aetna Government |
$2.19
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.98
|
| Rate for Payer: Group Health Inc Commercial |
$2.19
|
| Rate for Payer: Group Health Inc Medicare |
$1.53
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.19
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.85
|
|
|
VIPERSLIDE LUBRICANT, 100ML
|
Facility
OP
|
$1,800.00
|
|
| Hospital Charge Code |
40006515
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$630.00 |
| Max. Negotiated Rate |
$1,440.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$990.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$900.00
|
| Rate for Payer: Aetna Government |
$900.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,440.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,224.00
|
| Rate for Payer: Group Health Inc Commercial |
$900.00
|
| Rate for Payer: Group Health Inc Medicare |
$630.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$900.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$900.00
|
|
|
VIPERSLIDE LUBRICANT, 100ML BAGS
|
Facility
OP
|
$1,900.00
|
|
| Hospital Charge Code |
40005134
|
|
Hospital Revenue Code
|
272
|
| 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
|
|
|
VIPERTRACK RADIOPAQUE TAPE
|
Facility
OP
|
$1,800.00
|
|
| Hospital Charge Code |
40005135
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$630.00 |
| Max. Negotiated Rate |
$1,440.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$990.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$900.00
|
| Rate for Payer: Aetna Government |
$900.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,440.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,224.00
|
| Rate for Payer: Group Health Inc Commercial |
$900.00
|
| Rate for Payer: Group Health Inc Medicare |
$630.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$900.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$900.00
|
|
|
VIPERTRACK RADIOPAQUE TAPE
|
Facility
OP
|
$3,100.00
|
|
| Hospital Charge Code |
40006516
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,085.00 |
| Max. Negotiated Rate |
$2,480.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,705.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,550.00
|
| Rate for Payer: Aetna Government |
$1,550.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,480.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,108.00
|
| Rate for Payer: Group Health Inc Commercial |
$1,550.00
|
| Rate for Payer: Group Health Inc Medicare |
$1,085.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,550.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,550.00
|
|
|
VIPERWIRE ADVANCE .014 TIP
|
Facility
OP
|
$1,900.00
|
|
| Hospital Charge Code |
40006514
|
|
Hospital Revenue Code
|
272
|
| 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
|
|
|
VIPERWIRE ADVANCE, .014 TIP
|
Facility
OP
|
$9,990.00
|
|
| Hospital Charge Code |
40005133
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,496.50 |
| Max. Negotiated Rate |
$7,992.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5,494.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4,995.00
|
| Rate for Payer: Aetna Government |
$4,995.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7,992.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6,793.20
|
| Rate for Payer: Group Health Inc Commercial |
$4,995.00
|
| Rate for Payer: Group Health Inc Medicare |
$3,496.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,995.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,995.00
|
|
|
VIP, PLASMA
|
Facility
OP
|
$88.33
|
|
|
Service Code
|
HCPCS 84586
|
| Hospital Charge Code |
40609127
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$28.26 |
| Max. Negotiated Rate |
$56.16 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$48.58
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$35.33
|
| Rate for Payer: Aetna Government |
$35.33
|
| Rate for Payer: Cash Price |
$35.33
|
| Rate for Payer: Cash Price |
$35.33
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$35.33
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$56.16
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$47.52
|
| Rate for Payer: Elderplan Medicare Advantage |
$35.33
|
| Rate for Payer: EmblemHealth Commercial |
$35.33
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$31.80
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$30.03
|
| Rate for Payer: Fidelis Essential Plan QHP |
$31.44
|
| Rate for Payer: Fidelis Medicare Advantage |
$35.33
|
| Rate for Payer: Fidelis Qualified Health Plan |
$31.44
|
| Rate for Payer: Group Health Inc Commercial |
$35.33
|
| Rate for Payer: Group Health Inc Medicare |
$35.33
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$44.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$35.33
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$35.33
|
| Rate for Payer: Healthfirst Medicare Advantage |
$35.33
|
| Rate for Payer: Healthfirst QHP |
$35.33
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$35.33
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$35.33
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$28.26
|
| Rate for Payer: Wellcare Medicare |
$31.80
|
|
|
VIRAL CULTURE, GENERAL
|
Facility
OP
|
$65.18
|
|
|
Service Code
|
HCPCS 87252
|
| Hospital Charge Code |
40619189
|
|
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
|
|
|
VIRAL CULTURE, RAPID, CMV
|
Facility
OP
|
$48.90
|
|
|
Service Code
|
HCPCS 87254
|
| Hospital Charge Code |
40619192
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.65 |
| Max. Negotiated Rate |
$31.10 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$26.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$19.56
|
| Rate for Payer: Aetna Government |
$19.56
|
| Rate for Payer: Cash Price |
$19.56
|
| Rate for Payer: Cash Price |
$19.56
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$19.56
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$31.10
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$26.31
|
| Rate for Payer: Elderplan Medicare Advantage |
$19.56
|
| Rate for Payer: EmblemHealth Commercial |
$19.56
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$17.60
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$16.63
|
| Rate for Payer: Fidelis Essential Plan QHP |
$17.41
|
| Rate for Payer: Fidelis Medicare Advantage |
$19.56
|
| Rate for Payer: Fidelis Qualified Health Plan |
$17.41
|
| Rate for Payer: Group Health Inc Commercial |
$19.56
|
| Rate for Payer: Group Health Inc Medicare |
$19.56
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$24.45
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$19.56
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$19.56
|
| Rate for Payer: Healthfirst Medicare Advantage |
$19.56
|
| Rate for Payer: Healthfirst QHP |
$19.56
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$19.56
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$19.56
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$15.65
|
| Rate for Payer: Wellcare Medicare |
$17.60
|
|
|
VIRAL ILLNESS WITH MCC
|
Facility
IP
|
$30,670.34
|
|
|
Service Code
|
MS-DRG 865
|
| Min. Negotiated Rate |
$13,982.07 |
| Max. Negotiated Rate |
$30,670.34 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$24,180.33
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$30,068.96
|
| Rate for Payer: Aetna Government |
$30,068.96
|
| Rate for Payer: Brighton Health Commercial |
$23,778.55
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$30,670.34
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$28,319.43
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$23,370.41
|
| Rate for Payer: Elderplan Medicare Advantage |
$28,565.51
|
| Rate for Payer: EmblemHealth Commercial |
$14,062.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$30,068.96
|
| Rate for Payer: Group Health Inc Commercial |
$30,068.96
|
| Rate for Payer: Group Health Inc Medicare |
$30,068.96
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$30,068.96
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13,982.07
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$30,068.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$30,068.96
|
| Rate for Payer: Wellcare Medicare |
$28,565.51
|
|
|
VIRAL ILLNESS WITHOUT MCC
|
Facility
IP
|
$20,455.01
|
|
|
Service Code
|
MS-DRG 866
|
| Min. Negotiated Rate |
$7,869.28 |
| Max. Negotiated Rate |
$20,455.01 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$13,531.49
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$20,053.93
|
| Rate for Payer: Aetna Government |
$20,053.93
|
| Rate for Payer: Brighton Health Commercial |
$13,306.65
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$20,455.01
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$15,847.76
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$13,078.25
|
| Rate for Payer: Elderplan Medicare Advantage |
$19,051.23
|
| Rate for Payer: EmblemHealth Commercial |
$7,869.28
|
| Rate for Payer: Fidelis Medicare Advantage |
$20,053.93
|
| Rate for Payer: Group Health Inc Commercial |
$20,053.93
|
| Rate for Payer: Group Health Inc Medicare |
$20,053.93
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$20,053.93
|
| Rate for Payer: Healthfirst Medicare Advantage |
$9,325.08
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$20,053.93
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$20,053.93
|
| Rate for Payer: Wellcare Medicare |
$19,051.23
|
|
|
VIRAL MENINGITIS WITH CC/MCC
|
Facility
IP
|
$34,544.58
|
|
|
Service Code
|
MS-DRG 075
|
| Min. Negotiated Rate |
$15,748.27 |
| Max. Negotiated Rate |
$34,544.58 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$28,218.98
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$33,867.24
|
| Rate for Payer: Aetna Government |
$33,867.24
|
| Rate for Payer: Brighton Health Commercial |
$27,750.10
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$34,544.58
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$33,049.41
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$27,273.79
|
| Rate for Payer: Elderplan Medicare Advantage |
$32,173.88
|
| Rate for Payer: EmblemHealth Commercial |
$16,410.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$33,867.24
|
| Rate for Payer: Group Health Inc Commercial |
$33,867.24
|
| Rate for Payer: Group Health Inc Medicare |
$33,867.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$33,867.24
|
| Rate for Payer: Healthfirst Medicare Advantage |
$15,748.27
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$33,867.24
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$33,867.24
|
| Rate for Payer: Wellcare Medicare |
$32,173.88
|
|
|
VIRAL MENINGITIS WITHOUT CC/MCC
|
Facility
IP
|
$20,522.89
|
|
|
Service Code
|
MS-DRG 076
|
| Min. Negotiated Rate |
$7,910.44 |
| Max. Negotiated Rate |
$20,522.89 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$13,602.26
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$20,120.48
|
| Rate for Payer: Aetna Government |
$20,120.48
|
| Rate for Payer: Brighton Health Commercial |
$13,376.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$20,522.89
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$15,930.65
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$13,146.66
|
| Rate for Payer: Elderplan Medicare Advantage |
$19,114.46
|
| Rate for Payer: EmblemHealth Commercial |
$7,910.44
|
| Rate for Payer: Fidelis Medicare Advantage |
$20,120.48
|
| Rate for Payer: Group Health Inc Commercial |
$20,120.48
|
| Rate for Payer: Group Health Inc Medicare |
$20,120.48
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$20,120.48
|
| Rate for Payer: Healthfirst Medicare Advantage |
$9,356.02
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$20,120.48
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$20,120.48
|
| Rate for Payer: Wellcare Medicare |
$19,114.46
|
|
|
VIRTUAL SURGICAL ORTHO BUNDL
|
Facility
OP
|
$2,870.00
|
|
| Hospital Charge Code |
64905706
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,004.50 |
| Max. Negotiated Rate |
$2,296.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,578.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,435.00
|
| Rate for Payer: Aetna Government |
$1,435.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,296.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,951.60
|
| Rate for Payer: Group Health Inc Commercial |
$1,435.00
|
| Rate for Payer: Group Health Inc Medicare |
$1,004.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,435.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,435.00
|
|
|
VIRUS INOCULATION SHELL VIA
|
Facility
OP
|
$48.90
|
|
|
Service Code
|
HCPCS 87254
|
| Hospital Charge Code |
40619614
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.65 |
| Max. Negotiated Rate |
$31.10 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$26.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$19.56
|
| Rate for Payer: Aetna Government |
$19.56
|
| Rate for Payer: Cash Price |
$19.56
|
| Rate for Payer: Cash Price |
$19.56
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$19.56
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$31.10
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$26.31
|
| Rate for Payer: Elderplan Medicare Advantage |
$19.56
|
| Rate for Payer: EmblemHealth Commercial |
$19.56
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$17.60
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$16.63
|
| Rate for Payer: Fidelis Essential Plan QHP |
$17.41
|
| Rate for Payer: Fidelis Medicare Advantage |
$19.56
|
| Rate for Payer: Fidelis Qualified Health Plan |
$17.41
|
| Rate for Payer: Group Health Inc Commercial |
$19.56
|
| Rate for Payer: Group Health Inc Medicare |
$19.56
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$24.45
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$19.56
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$19.56
|
| Rate for Payer: Healthfirst Medicare Advantage |
$19.56
|
| Rate for Payer: Healthfirst QHP |
$19.56
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$19.56
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$19.56
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$15.65
|
| Rate for Payer: Wellcare Medicare |
$17.60
|
|
|
VISCOELASTIC OCUCOAT 1.0ML
|
Facility
OP
|
$100.00
|
|
| Hospital Charge Code |
64907060
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$35.00 |
| Max. Negotiated Rate |
$80.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$55.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$50.00
|
| Rate for Payer: Aetna Government |
$50.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$80.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$68.00
|
| Rate for Payer: Group Health Inc Commercial |
$50.00
|
| Rate for Payer: Group Health Inc Medicare |
$35.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$50.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$50.00
|
|
|
VISCOSITY SERUM
|
Facility
OP
|
$29.15
|
|
|
Service Code
|
HCPCS 85810
|
| Hospital Charge Code |
40609705
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$9.34 |
| Max. Negotiated Rate |
$18.56 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$16.03
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$11.67
|
| Rate for Payer: Aetna Government |
$11.67
|
| Rate for Payer: Cash Price |
$11.67
|
| Rate for Payer: Cash Price |
$11.67
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$11.67
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$18.56
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$15.71
|
| Rate for Payer: Elderplan Medicare Advantage |
$11.67
|
| Rate for Payer: EmblemHealth Commercial |
$11.67
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$10.50
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$9.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$10.39
|
| Rate for Payer: Fidelis Medicare Advantage |
$11.67
|
| Rate for Payer: Fidelis Qualified Health Plan |
$10.39
|
| Rate for Payer: Group Health Inc Commercial |
$11.67
|
| Rate for Payer: Group Health Inc Medicare |
$11.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$11.67
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$11.67
|
| Rate for Payer: Healthfirst Medicare Advantage |
$11.67
|
| Rate for Payer: Healthfirst QHP |
$11.67
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$11.67
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$11.67
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$9.34
|
| Rate for Payer: Wellcare Medicare |
$10.50
|
|
|
VISIA AF ICD
|
Facility
OP
|
$29,190.00
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
66571495
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,988.80 |
| Max. Negotiated Rate |
$30,649.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$16,054.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,988.80
|
| Rate for Payer: Aetna Government |
$3,988.80
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$14,595.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$16,784.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$30,649.50
|
| Rate for Payer: Group Health Inc Commercial |
$14,595.00
|
| Rate for Payer: Group Health Inc Medicare |
$10,216.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14,595.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14,595.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$18,973.50
|
|
|
VISIA AF ICD
|
Facility
IP
|
$29,190.00
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
66571495
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$14,595.00 |
| Max. Negotiated Rate |
$14,595.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14,595.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14,595.00
|
|
|
VISION SCREENING
|
Facility
OP
|
$36.36
|
|
|
Service Code
|
HCPCS 99173
|
| Hospital Charge Code |
30301297
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$3.02 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$20.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.02
|
| Rate for Payer: Aetna Government |
$3.02
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$204.58
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$173.89
|
| Rate for Payer: Group Health Inc Commercial |
$250.00
|
| Rate for Payer: Group Health Inc Medicare |
$250.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$18.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$18.18
|
|
|
VISTASEQ HEREDITARY CANCER PANEL
|
Facility
OP
|
$0.01
|
|
|
Service Code
|
HCPCS 81162
|
| Hospital Charge Code |
40601029
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$1,824.88 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,824.88
|
| Rate for Payer: Aetna Government |
$1,824.88
|
| Rate for Payer: Brighton Health Commercial |
$1,824.88
|
| Rate for Payer: Cash Price |
$1,824.88
|
| Rate for Payer: Cash Price |
$1,824.88
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,824.88
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.01
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.01
|
| Rate for Payer: Elderplan Medicare Advantage |
$1,824.88
|
| Rate for Payer: EmblemHealth Commercial |
$1,824.88
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,642.39
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,551.15
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,624.14
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,824.88
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,624.14
|
| Rate for Payer: Group Health Inc Commercial |
$1,824.88
|
| Rate for Payer: Group Health Inc Medicare |
$1,824.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,824.88
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,824.88
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,824.88
|
| Rate for Payer: Healthfirst QHP |
$1,824.88
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,824.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,824.88
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,459.90
|
| Rate for Payer: Wellcare Medicare |
$1,642.39
|
|
|
VISUAL FIELD
|
Facility
OP
|
$166.60
|
|
|
Service Code
|
HCPCS 92082 TC
|
| Hospital Charge Code |
42101600
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$29.17 |
| Max. Negotiated Rate |
$133.28 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$91.63
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$83.30
|
| Rate for Payer: Aetna Government |
$83.30
|
| Rate for Payer: Cash Price |
$70.74
|
| Rate for Payer: Cash Price |
$70.74
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$133.28
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$113.29
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$29.17
|
| Rate for Payer: Group Health Inc Commercial |
$83.30
|
| Rate for Payer: Group Health Inc Medicare |
$58.31
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$83.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$83.30
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$32.41
|
|
