|
VISUAL FIELD COMPUTERIZED
|
Facility
OP
|
$330.23
|
|
|
Service Code
|
HCPCS 92083 TC
|
| Hospital Charge Code |
30305355
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$39.89 |
| Max. Negotiated Rate |
$250.00 |
| 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: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$147.72
|
| Rate for Payer: Cash Price |
$147.72
|
| Rate for Payer: Cash Price |
$147.72
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$204.58
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$173.89
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$39.89
|
| 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 |
$165.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$165.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$44.32
|
|
|
VISUAL FIELD COMPUTERIZED
|
Facility
OP
|
$330.23
|
|
|
Service Code
|
HCPCS 92083 TC
|
| Hospital Charge Code |
42101700
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$39.89 |
| Max. Negotiated Rate |
$250.00 |
| 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: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$147.72
|
| Rate for Payer: Cash Price |
$147.72
|
| Rate for Payer: Cash Price |
$147.72
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$204.58
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$173.89
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$39.89
|
| 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 |
$165.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$165.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$44.32
|
|
|
VISUAL FIELD EXAMINATION(S)
|
Facility
OP
|
$166.60
|
|
|
Service Code
|
HCPCS 92081 TC
|
| Hospital Charge Code |
30301147
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$19.56 |
| Max. Negotiated Rate |
$250.00 |
| 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: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$70.74
|
| Rate for Payer: Cash Price |
$70.74
|
| Rate for Payer: Cash Price |
$70.74
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$204.58
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$173.89
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$19.56
|
| 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 |
$83.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$83.30
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$21.73
|
|
|
VISUAL REINFORCE AUDIOMETRY-PEDS
|
Facility
OP
|
$419.03
|
|
|
Service Code
|
HCPCS 92579
|
| Hospital Charge Code |
42004512
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$38.00 |
| Max. Negotiated Rate |
$335.22 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$230.47
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$180.64
|
| Rate for Payer: Aetna Government |
$180.64
|
| Rate for Payer: Cash Price |
$180.64
|
| Rate for Payer: Cash Price |
$180.64
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$180.64
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$335.22
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$284.94
|
| Rate for Payer: Elderplan Medicare Advantage |
$180.64
|
| Rate for Payer: EmblemHealth Commercial |
$180.64
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$38.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$153.54
|
| Rate for Payer: Fidelis Essential Plan QHP |
$160.77
|
| Rate for Payer: Fidelis Medicare Advantage |
$180.64
|
| Rate for Payer: Fidelis Qualified Health Plan |
$160.77
|
| Rate for Payer: Group Health Inc Commercial |
$180.64
|
| Rate for Payer: Group Health Inc Medicare |
$180.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$209.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$180.64
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$42.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$153.54
|
| Rate for Payer: Healthfirst QHP |
$180.64
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$180.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$180.64
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$144.51
|
| Rate for Payer: Wellcare Medicare |
$171.61
|
|
|
VITAL CAPACITY
|
Facility
OP
|
$419.03
|
|
|
Service Code
|
HCPCS 94150 TC
|
| Hospital Charge Code |
40306950
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$146.66 |
| Max. Negotiated Rate |
$335.22 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$230.47
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$209.52
|
| Rate for Payer: Aetna Government |
$209.52
|
| Rate for Payer: Cash Price |
$180.64
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$335.22
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$284.94
|
| Rate for Payer: Group Health Inc Commercial |
$209.52
|
| Rate for Payer: Group Health Inc Medicare |
$146.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$209.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$209.52
|
|
|
VITAMIN A 10000 UNITS CAP
|
Facility
OP
|
$0.03
|
|
| Hospital Charge Code |
41653251
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.02 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.02
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.02
|
| Rate for Payer: Aetna Government |
$0.02
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.02
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.02
|
| Rate for Payer: Group Health Inc Commercial |
$0.02
|
| Rate for Payer: Group Health Inc Medicare |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.02
|
|
|
VITAMIN A 10000 UNITS CAP
|
Facility
OP
|
$0.03
|
|
| Hospital Charge Code |
41643251
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.02 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.02
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.02
|
| Rate for Payer: Aetna Government |
$0.02
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.02
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.02
|
| Rate for Payer: Group Health Inc Commercial |
$0.02
|
| Rate for Payer: Group Health Inc Medicare |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.02
|
|
|
VITAMIN A 50,000 UNITS/ML INJ
|
Facility
OP
|
$46.58
|
|
| Hospital Charge Code |
41644444
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.30 |
| Max. Negotiated Rate |
$37.26 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$25.62
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$23.29
|
| Rate for Payer: Aetna Government |
$23.29
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$37.26
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$31.67
|
| Rate for Payer: Group Health Inc Commercial |
$23.29
|
| Rate for Payer: Group Health Inc Medicare |
$16.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$23.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$23.29
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$30.28
|
|
|
VITAMIN A 50,000 UNITS/ML INJ
|
Facility
OP
|
$46.58
|
|
| Hospital Charge Code |
41654444
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.30 |
| Max. Negotiated Rate |
$37.26 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$25.62
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$23.29
|
| Rate for Payer: Aetna Government |
$23.29
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$37.26
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$31.67
|
| Rate for Payer: Group Health Inc Commercial |
$23.29
|
| Rate for Payer: Group Health Inc Medicare |
$16.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$23.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$23.29
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$30.28
|
|
|
VITAMIN A & D OINT 5 GRAMS
|
Facility
OP
|
$0.23
|
|
| Hospital Charge Code |
41651513
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.18 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.13
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.12
|
| Rate for Payer: Aetna Government |
$0.12
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.18
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.16
|
| Rate for Payer: Group Health Inc Commercial |
$0.12
|
| Rate for Payer: Group Health Inc Medicare |
$0.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.15
|
|
|
VITAMIN A & D OINT 5 GRAMS
|
Facility
OP
|
$0.23
|
|
| Hospital Charge Code |
41641513
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.18 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.13
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.12
|
| Rate for Payer: Aetna Government |
$0.12
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.18
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.16
|
| Rate for Payer: Group Health Inc Commercial |
$0.12
|
| Rate for Payer: Group Health Inc Medicare |
$0.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.15
|
|
|
VITAMIN A, SERUM
|
Facility
OP
|
$29.03
|
|
|
Service Code
|
HCPCS 84590
|
| Hospital Charge Code |
40609129
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.29 |
| Max. Negotiated Rate |
$18.43 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$15.97
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$11.61
|
| Rate for Payer: Aetna Government |
$11.61
|
| Rate for Payer: Cash Price |
$11.61
|
| Rate for Payer: Cash Price |
$11.61
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$11.61
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$18.43
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$15.60
|
| Rate for Payer: Elderplan Medicare Advantage |
$11.61
|
| Rate for Payer: EmblemHealth Commercial |
$11.61
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$10.45
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$9.87
|
| Rate for Payer: Fidelis Essential Plan QHP |
$10.33
|
| Rate for Payer: Fidelis Medicare Advantage |
$11.61
|
| Rate for Payer: Fidelis Qualified Health Plan |
$10.33
|
| Rate for Payer: Group Health Inc Commercial |
$11.61
|
| Rate for Payer: Group Health Inc Medicare |
$11.61
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$11.61
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$11.61
|
| Rate for Payer: Healthfirst Medicare Advantage |
$11.61
|
| Rate for Payer: Healthfirst QHP |
$11.61
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$11.61
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$11.61
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$9.29
|
| Rate for Payer: Wellcare Medicare |
$10.45
|
|
|
VITAMIN B12 AND FOLATE
|
Facility
OP
|
$12.95
|
|
|
Service Code
|
HCPCS 82570
|
| Hospital Charge Code |
40609821
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.14 |
| Max. Negotiated Rate |
$8.23 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.12
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.18
|
| Rate for Payer: Aetna Government |
$5.18
|
| Rate for Payer: Cash Price |
$5.18
|
| Rate for Payer: Cash Price |
$5.18
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$5.18
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.23
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.96
|
| Rate for Payer: Elderplan Medicare Advantage |
$5.18
|
| Rate for Payer: EmblemHealth Commercial |
$5.18
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$4.66
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4.40
|
| Rate for Payer: Fidelis Essential Plan QHP |
$4.61
|
| Rate for Payer: Fidelis Medicare Advantage |
$5.18
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4.61
|
| Rate for Payer: Group Health Inc Commercial |
$5.18
|
| Rate for Payer: Group Health Inc Medicare |
$5.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.48
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.18
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$5.18
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5.18
|
| Rate for Payer: Healthfirst QHP |
$5.18
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$5.18
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.18
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$4.14
|
| Rate for Payer: Wellcare Medicare |
$4.66
|
|
|
VITAMIN_C
|
Facility
OP
|
$24.73
|
|
|
Service Code
|
HCPCS 82180
|
| Hospital Charge Code |
40609700
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.91 |
| Max. Negotiated Rate |
$15.72 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$13.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$9.89
|
| Rate for Payer: Aetna Government |
$9.89
|
| Rate for Payer: Cash Price |
$9.89
|
| Rate for Payer: Cash Price |
$9.89
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$9.89
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$15.72
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$13.30
|
| Rate for Payer: Elderplan Medicare Advantage |
$9.89
|
| Rate for Payer: EmblemHealth Commercial |
$9.89
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$8.90
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$8.41
|
| Rate for Payer: Fidelis Essential Plan QHP |
$8.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$9.89
|
| Rate for Payer: Fidelis Qualified Health Plan |
$8.80
|
| Rate for Payer: Group Health Inc Commercial |
$9.89
|
| Rate for Payer: Group Health Inc Medicare |
$9.89
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9.89
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$9.89
|
| Rate for Payer: Healthfirst Medicare Advantage |
$9.89
|
| Rate for Payer: Healthfirst QHP |
$9.89
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$9.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$9.89
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$7.91
|
| Rate for Payer: Wellcare Medicare |
$8.90
|
|
|
VITAMIN D 25-HYDROXY
|
Facility
OP
|
$74.00
|
|
|
Service Code
|
HCPCS 82306
|
| Hospital Charge Code |
40609731
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$23.68 |
| Max. Negotiated Rate |
$47.06 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$40.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$29.60
|
| Rate for Payer: Aetna Government |
$29.60
|
| Rate for Payer: Cash Price |
$29.60
|
| Rate for Payer: Cash Price |
$29.60
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$29.60
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$47.06
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$39.82
|
| Rate for Payer: Elderplan Medicare Advantage |
$29.60
|
| Rate for Payer: EmblemHealth Commercial |
$29.60
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$26.64
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$25.16
|
| Rate for Payer: Fidelis Essential Plan QHP |
$26.34
|
| Rate for Payer: Fidelis Medicare Advantage |
$29.60
|
| Rate for Payer: Fidelis Qualified Health Plan |
$26.34
|
| Rate for Payer: Group Health Inc Commercial |
$29.60
|
| Rate for Payer: Group Health Inc Medicare |
$29.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$37.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$29.60
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$29.60
|
| Rate for Payer: Healthfirst Medicare Advantage |
$29.60
|
| Rate for Payer: Healthfirst QHP |
$29.60
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$29.60
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$29.60
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$23.68
|
| Rate for Payer: Wellcare Medicare |
$26.64
|
|
|
VITAMIN D, 25 OH
|
Facility
OP
|
$74.00
|
|
|
Service Code
|
HCPCS 82306
|
| Hospital Charge Code |
40602687
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$23.68 |
| Max. Negotiated Rate |
$47.06 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$40.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$29.60
|
| Rate for Payer: Aetna Government |
$29.60
|
| Rate for Payer: Cash Price |
$29.60
|
| Rate for Payer: Cash Price |
$29.60
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$29.60
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$47.06
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$39.82
|
| Rate for Payer: Elderplan Medicare Advantage |
$29.60
|
| Rate for Payer: EmblemHealth Commercial |
$29.60
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$26.64
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$25.16
|
| Rate for Payer: Fidelis Essential Plan QHP |
$26.34
|
| Rate for Payer: Fidelis Medicare Advantage |
$29.60
|
| Rate for Payer: Fidelis Qualified Health Plan |
$26.34
|
| Rate for Payer: Group Health Inc Commercial |
$29.60
|
| Rate for Payer: Group Health Inc Medicare |
$29.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$37.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$29.60
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$29.60
|
| Rate for Payer: Healthfirst Medicare Advantage |
$29.60
|
| Rate for Payer: Healthfirst QHP |
$29.60
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$29.60
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$29.60
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$23.68
|
| Rate for Payer: Wellcare Medicare |
$26.64
|
|
|
VITAMIN D TABLET 1000 UNITS
|
Facility
OP
|
$0.07
|
|
| Hospital Charge Code |
41656008
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.06 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.04
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.04
|
| Rate for Payer: Aetna Government |
$0.04
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.06
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.05
|
| Rate for Payer: Group Health Inc Commercial |
$0.04
|
| Rate for Payer: Group Health Inc Medicare |
$0.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.04
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.05
|
|
|
VITAMIN D TABLETS 1000 UNITS
|
Facility
OP
|
$0.07
|
|
| Hospital Charge Code |
41646008
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.06 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.04
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.04
|
| Rate for Payer: Aetna Government |
$0.04
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.06
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.05
|
| Rate for Payer: Group Health Inc Commercial |
$0.04
|
| Rate for Payer: Group Health Inc Medicare |
$0.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.04
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.05
|
|
|
VITAMIN E 400 INTL UNITS CAP
|
Facility
OP
|
$1.00
|
|
| Hospital Charge Code |
41640939
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$0.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.50
|
| Rate for Payer: Aetna Government |
$0.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.68
|
| Rate for Payer: Group Health Inc Commercial |
$0.50
|
| Rate for Payer: Group Health Inc Medicare |
$0.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.65
|
|
|
VITAMIN E 400 INTL UNITS CAP
|
Facility
OP
|
$1.00
|
|
| Hospital Charge Code |
41650939
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$0.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.50
|
| Rate for Payer: Aetna Government |
$0.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.68
|
| Rate for Payer: Group Health Inc Commercial |
$0.50
|
| Rate for Payer: Group Health Inc Medicare |
$0.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.65
|
|
|
VITAMIN E 50 INTL UNITS/ML LIQUID
|
Facility
OP
|
$2.00
|
|
| Hospital Charge Code |
41642951
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.70 |
| Max. Negotiated Rate |
$1.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.00
|
| Rate for Payer: Aetna Government |
$1.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.36
|
| Rate for Payer: Group Health Inc Commercial |
$1.00
|
| Rate for Payer: Group Health Inc Medicare |
$0.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.30
|
|
|
VITAMIN E 50 INTL UNITS/ML LIQUID
|
Facility
OP
|
$2.00
|
|
| Hospital Charge Code |
41652951
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.70 |
| Max. Negotiated Rate |
$1.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.00
|
| Rate for Payer: Aetna Government |
$1.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.36
|
| Rate for Payer: Group Health Inc Commercial |
$1.00
|
| Rate for Payer: Group Health Inc Medicare |
$0.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.30
|
|
|
VITAMIN E SERUM
|
Facility
OP
|
$35.45
|
|
|
Service Code
|
HCPCS 84446
|
| Hospital Charge Code |
40609730
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.34 |
| Max. Negotiated Rate |
$22.53 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$19.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$14.18
|
| Rate for Payer: Aetna Government |
$14.18
|
| Rate for Payer: Cash Price |
$14.18
|
| Rate for Payer: Cash Price |
$14.18
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$14.18
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$22.53
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$19.06
|
| Rate for Payer: Elderplan Medicare Advantage |
$14.18
|
| Rate for Payer: EmblemHealth Commercial |
$14.18
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$12.76
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$12.05
|
| Rate for Payer: Fidelis Essential Plan QHP |
$12.62
|
| Rate for Payer: Fidelis Medicare Advantage |
$14.18
|
| Rate for Payer: Fidelis Qualified Health Plan |
$12.62
|
| Rate for Payer: Group Health Inc Commercial |
$14.18
|
| Rate for Payer: Group Health Inc Medicare |
$14.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.18
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$14.18
|
| Rate for Payer: Healthfirst Medicare Advantage |
$14.18
|
| Rate for Payer: Healthfirst QHP |
$14.18
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$14.18
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$14.18
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$11.34
|
| Rate for Payer: Wellcare Medicare |
$12.76
|
|
|
VITAMIN-K ORAL LIQ 1MG/ML
|
Facility
OP
|
$7.31
|
|
| Hospital Charge Code |
41646568
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.56 |
| Max. Negotiated Rate |
$5.85 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.02
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.66
|
| Rate for Payer: Aetna Government |
$3.66
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5.85
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.97
|
| Rate for Payer: Group Health Inc Commercial |
$3.66
|
| Rate for Payer: Group Health Inc Medicare |
$2.56
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.66
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.66
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.75
|
|
|
VITAMIN-K ORAL LIQ 1MG/ML
|
Facility
OP
|
$7.31
|
|
| Hospital Charge Code |
41656568
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.56 |
| Max. Negotiated Rate |
$5.85 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.02
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.66
|
| Rate for Payer: Aetna Government |
$3.66
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5.85
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.97
|
| Rate for Payer: Group Health Inc Commercial |
$3.66
|
| Rate for Payer: Group Health Inc Medicare |
$2.56
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.66
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.66
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.75
|
|
