|
VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITHOUT CC/MCC
|
Facility
|
IP
|
$22,551.75
|
|
|
Service Code
|
MSDRG 807
|
| Min. Negotiated Rate |
$5,610.62 |
| Max. Negotiated Rate |
$22,551.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$9,647.65
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$16,401.27
|
| Rate for Payer: Aetna Government |
$16,401.27
|
| Rate for Payer: Brighton Health Commercial |
$9,487.35
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$16,729.30
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$11,299.11
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$9,324.51
|
| Rate for Payer: Elderplan Medicare Advantage |
$15,581.21
|
| Rate for Payer: EmblemHealth Commercial |
$5,610.62
|
| Rate for Payer: Fidelis Medicare Advantage |
$16,401.27
|
| Rate for Payer: Group Health Inc Commercial |
$16,401.27
|
| Rate for Payer: Group Health Inc Medicare |
$16,401.27
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16,401.27
|
| Rate for Payer: Healthfirst Medicare Advantage |
$7,626.59
|
| Rate for Payer: Humana Medicare |
$22,551.75
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$16,401.27
|
| Rate for Payer: United Healthcare Commercial |
$13,012.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16,401.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$16,401.27
|
| Rate for Payer: Wellcare Medicare |
$15,581.21
|
|
|
VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITH CC
|
Facility
|
IP
|
$29,065.27
|
|
|
Service Code
|
MSDRG 797
|
| Min. Negotiated Rate |
$8,539.84 |
| Max. Negotiated Rate |
$29,065.27 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$14,684.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$21,138.38
|
| Rate for Payer: Aetna Government |
$21,138.38
|
| Rate for Payer: Brighton Health Commercial |
$14,440.55
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$21,561.15
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$17,198.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$14,192.69
|
| Rate for Payer: Elderplan Medicare Advantage |
$20,081.46
|
| Rate for Payer: EmblemHealth Commercial |
$8,539.84
|
| Rate for Payer: Fidelis Medicare Advantage |
$21,138.38
|
| Rate for Payer: Group Health Inc Commercial |
$21,138.38
|
| Rate for Payer: Group Health Inc Medicare |
$21,138.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$21,138.38
|
| Rate for Payer: Healthfirst Medicare Advantage |
$9,829.35
|
| Rate for Payer: Humana Medicare |
$29,065.27
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$21,138.38
|
| Rate for Payer: United Healthcare Commercial |
$19,805.46
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21,138.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$21,138.38
|
| Rate for Payer: Wellcare Medicare |
$20,081.46
|
|
|
VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITH MCC
|
Facility
|
IP
|
$37,121.33
|
|
|
Service Code
|
MSDRG 796
|
| Min. Negotiated Rate |
$12,162.80 |
| Max. Negotiated Rate |
$37,121.33 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$20,914.31
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$26,997.33
|
| Rate for Payer: Aetna Government |
$26,997.33
|
| Rate for Payer: Brighton Health Commercial |
$20,566.80
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$27,537.28
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$24,494.35
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$20,213.79
|
| Rate for Payer: Elderplan Medicare Advantage |
$25,647.46
|
| Rate for Payer: EmblemHealth Commercial |
$12,162.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$26,997.33
|
| Rate for Payer: Group Health Inc Commercial |
$26,997.33
|
| Rate for Payer: Group Health Inc Medicare |
$26,997.33
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$26,997.33
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12,553.76
|
| Rate for Payer: Humana Medicare |
$37,121.33
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$26,997.33
|
| Rate for Payer: United Healthcare Commercial |
$28,207.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$26,997.33
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$26,997.33
|
| Rate for Payer: Wellcare Medicare |
$25,647.46
|
|
|
VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITHOUT CC/MCC
|
Facility
|
IP
|
$25,999.17
|
|
|
Service Code
|
MSDRG 798
|
| Min. Negotiated Rate |
$6,956.04 |
| Max. Negotiated Rate |
$25,999.17 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$11,961.14
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$18,908.49
|
| Rate for Payer: Aetna Government |
$18,908.49
|
| Rate for Payer: Brighton Health Commercial |
$11,762.40
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$19,286.66
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$14,421.34
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$11,901.11
|
| Rate for Payer: Elderplan Medicare Advantage |
$17,963.07
|
| Rate for Payer: EmblemHealth Commercial |
$6,956.04
|
| Rate for Payer: Fidelis Medicare Advantage |
$18,908.49
|
| Rate for Payer: Group Health Inc Commercial |
$18,908.49
|
| Rate for Payer: Group Health Inc Medicare |
$18,908.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$18,908.49
|
| Rate for Payer: Healthfirst Medicare Advantage |
$8,792.45
|
| Rate for Payer: Humana Medicare |
$25,999.17
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$18,908.49
|
| Rate for Payer: United Healthcare Commercial |
$16,607.63
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18,908.49
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$18,908.49
|
| Rate for Payer: Wellcare Medicare |
$17,963.07
|
|
|
VAGINAL DELIVRY INCL ANTE/POSTPAR
|
Facility
|
OP
|
$8,701.05
|
|
|
Service Code
|
HCPCS 59400
|
| Hospital Charge Code |
40002233
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,505.00 |
| Max. Negotiated Rate |
$6,525.79 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4,785.58
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,473.00
|
| Rate for Payer: Aetna Government |
$2,473.00
|
| Rate for Payer: Brighton Health Commercial |
$6,525.79
|
| 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: Group Health Inc Commercial |
$4,350.52
|
| Rate for Payer: Group Health Inc Medicare |
$3,045.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,350.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,350.52
|
|
|
VAGINAL EXAMINATION TRAY
|
Facility
|
OP
|
$25.52
|
|
| Hospital Charge Code |
40206610
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.93 |
| Max. Negotiated Rate |
$20.42 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$14.04
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12.76
|
| Rate for Payer: Aetna Government |
$12.76
|
| Rate for Payer: Brighton Health Commercial |
$19.14
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$20.42
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$17.35
|
| Rate for Payer: Group Health Inc Commercial |
$12.76
|
| Rate for Payer: Group Health Inc Medicare |
$8.93
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.76
|
|
|
VAGINAL HYSTERECTOMY
|
Facility
|
IP
|
$12,937.43
|
|
|
Service Code
|
HCPCS 58260
|
| Hospital Charge Code |
40052280
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$5,751.94
|
|
|
VAGINAL HYSTERECTOMY
|
Facility
|
OP
|
$12,937.43
|
|
|
Service Code
|
HCPCS 58260
|
| Hospital Charge Code |
40052280
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,505.00 |
| Max. Negotiated Rate |
$9,703.07 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,485.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5,751.94
|
| Rate for Payer: Aetna Government |
$5,751.94
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$4,026.36
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$4,026.36
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$4,026.36
|
| Rate for Payer: Brighton Health Commercial |
$9,703.07
|
| Rate for Payer: Cash Price |
$5,751.94
|
| Rate for Payer: Cash Price |
$5,751.94
|
| Rate for Payer: Cash Price |
$5,751.94
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$5,751.94
|
| 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 |
$5,751.94
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4,889.15
|
| Rate for Payer: Fidelis Essential Plan QHP |
$5,119.23
|
| Rate for Payer: Fidelis Medicare Advantage |
$5,751.94
|
| Rate for Payer: Fidelis Qualified Health Plan |
$5,119.23
|
| Rate for Payer: Group Health Inc Commercial |
$5,751.94
|
| Rate for Payer: Group Health Inc Medicare |
$5,751.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6,468.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5,751.94
|
| Rate for Payer: Healthfirst Medicare Advantage |
$4,889.15
|
| Rate for Payer: Healthfirst QHP |
$5,751.94
|
| Rate for Payer: Humana Medicare |
$5,866.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$5,751.94
|
| Rate for Payer: United Healthcare Commercial |
$1,835.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,751.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5,751.94
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$4,601.55
|
| Rate for Payer: Wellcare Medicare |
$5,464.34
|
|
|
VAGINAL L&D CHARGE
|
Facility
|
OP
|
$1,700.00
|
|
| Hospital Charge Code |
40251100
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$595.00 |
| Max. Negotiated Rate |
$8,223.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$935.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$850.00
|
| Rate for Payer: Aetna Government |
$850.00
|
| Rate for Payer: Brighton Health Commercial |
$1,275.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,360.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,156.00
|
| Rate for Payer: Group Health Inc Commercial |
$850.00
|
| Rate for Payer: Group Health Inc Medicare |
$595.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$850.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$850.00
|
| Rate for Payer: United Healthcare Commercial |
$8,223.00
|
|
|
VAGINAL SPECULUM
|
Facility
|
OP
|
$6.73
|
|
| Hospital Charge Code |
40207616
|
|
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: Brighton Health Commercial |
$5.05
|
| 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
|
|
|
VAGOTOMY, PYLOROPLASTY
|
Facility
|
OP
|
$3,239.70
|
|
|
Service Code
|
HCPCS 43640
|
| Hospital Charge Code |
40011080
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,133.90 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,781.84
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,401.25
|
| Rate for Payer: Aetna Government |
$1,401.25
|
| Rate for Payer: Brighton Health Commercial |
$2,429.78
|
| 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: Group Health Inc Commercial |
$1,619.85
|
| Rate for Payer: Group Health Inc Medicare |
$1,133.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,619.85
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,619.85
|
| Rate for Payer: United Healthcare Commercial |
$1,496.00
|
|
|
VAGUS NERVE
|
Facility
|
IP
|
$792.83
|
|
|
Service Code
|
HCPCS 64408
|
| Hospital Charge Code |
30305023
|
|
Hospital Revenue Code
|
510
|
| Rate for Payer: Cash Price |
$342.51
|
|
|
VAGUS NERVE
|
Facility
|
OP
|
$792.83
|
|
|
Service Code
|
HCPCS 64408
|
| Hospital Charge Code |
30305023
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$222.00 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$342.51
|
| Rate for Payer: Aetna Government |
$342.51
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$239.76
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$239.76
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$239.76
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$342.51
|
| Rate for Payer: Cash Price |
$342.51
|
| Rate for Payer: Cash Price |
$342.51
|
| Rate for Payer: Cash Price |
$342.51
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$342.51
|
| 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 |
$342.51
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$291.13
|
| Rate for Payer: Fidelis Essential Plan QHP |
$304.83
|
| Rate for Payer: Fidelis Medicare Advantage |
$342.51
|
| Rate for Payer: Fidelis Qualified Health Plan |
$304.83
|
| 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 |
$396.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$342.51
|
| Rate for Payer: Healthfirst Medicare Advantage |
$291.13
|
| Rate for Payer: Healthfirst QHP |
$342.51
|
| Rate for Payer: Humana Medicare |
$349.36
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$342.51
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$342.51
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$342.51
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$342.51
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$274.01
|
| Rate for Payer: Wellcare Medicare |
$325.38
|
|
|
VALACYCLOVIR HCL 500 MG PO TABS [13133]
|
Facility
|
OP
|
$7.22
|
|
|
Service Code
|
NDC 51079009303
|
| Hospital Charge Code |
51079009303
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.53 |
| Max. Negotiated Rate |
$5.78 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.97
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.61
|
| Rate for Payer: Aetna Government |
$3.61
|
| Rate for Payer: Brighton Health Commercial |
$5.42
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5.78
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.91
|
| Rate for Payer: Group Health Inc Commercial |
$3.61
|
| Rate for Payer: Group Health Inc Medicare |
$2.53
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.61
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.61
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.70
|
|
|
VALACYCLOVIR HCL 500 MG PO TABS [13133]
|
Facility
|
OP
|
$7.22
|
|
|
Service Code
|
NDC 57237004230
|
| Hospital Charge Code |
57237004230
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.53 |
| Max. Negotiated Rate |
$5.78 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.97
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.61
|
| Rate for Payer: Aetna Government |
$3.61
|
| Rate for Payer: Brighton Health Commercial |
$5.42
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5.78
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.91
|
| Rate for Payer: Group Health Inc Commercial |
$3.61
|
| Rate for Payer: Group Health Inc Medicare |
$2.53
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.61
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.61
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.70
|
|
|
VALACYCLOVIR HCL 500 MG PO TABS [13133]
|
Facility
|
OP
|
$7.07
|
|
|
Service Code
|
NDC 65862044890
|
| Hospital Charge Code |
65862044890
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.47 |
| Max. Negotiated Rate |
$5.66 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.89
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.54
|
| Rate for Payer: Aetna Government |
$3.54
|
| Rate for Payer: Brighton Health Commercial |
$5.30
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5.66
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.81
|
| Rate for Payer: Group Health Inc Commercial |
$3.54
|
| Rate for Payer: Group Health Inc Medicare |
$2.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.54
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.60
|
|
|
VALACYCLOVIR HCL 500 MG PO TABS [13133]
|
Facility
|
OP
|
$7.07
|
|
|
Service Code
|
NDC 65862044830
|
| Hospital Charge Code |
65862044830
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.47 |
| Max. Negotiated Rate |
$5.66 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.89
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.54
|
| Rate for Payer: Aetna Government |
$3.54
|
| Rate for Payer: Brighton Health Commercial |
$5.30
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5.66
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.81
|
| Rate for Payer: Group Health Inc Commercial |
$3.54
|
| Rate for Payer: Group Health Inc Medicare |
$2.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.54
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.60
|
|
|
VALACYCLOVIR HCL 500MG TABLET
|
Facility
|
OP
|
$7.30
|
|
| Hospital Charge Code |
41650312
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.56 |
| Max. Negotiated Rate |
$5.84 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.02
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.65
|
| Rate for Payer: Aetna Government |
$3.65
|
| Rate for Payer: Brighton Health Commercial |
$5.48
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5.84
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.96
|
| Rate for Payer: Group Health Inc Commercial |
$3.65
|
| Rate for Payer: Group Health Inc Medicare |
$2.56
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.65
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.65
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.74
|
|
|
VALACYCLOVIR HCL 500MG TABLET
|
Facility
|
OP
|
$7.30
|
|
| Hospital Charge Code |
41640312
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.56 |
| Max. Negotiated Rate |
$5.84 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.02
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.65
|
| Rate for Payer: Aetna Government |
$3.65
|
| Rate for Payer: Brighton Health Commercial |
$5.48
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5.84
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.96
|
| Rate for Payer: Group Health Inc Commercial |
$3.65
|
| Rate for Payer: Group Health Inc Medicare |
$2.56
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.65
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.65
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.74
|
|
|
VALGANCICLOVIR 450 MG TAB
|
Facility
|
IP
|
$95.50
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
41642623
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$47.75 |
| Max. Negotiated Rate |
$47.75 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$47.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$47.75
|
|
|
VALGANCICLOVIR 450 MG TAB
|
Facility
|
OP
|
$95.50
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
41652623
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$33.42 |
| Max. Negotiated Rate |
$62.08 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$52.52
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$47.75
|
| Rate for Payer: Aetna Government |
$47.75
|
| Rate for Payer: Brighton Health Commercial |
$57.30
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$47.75
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$54.91
|
| Rate for Payer: Group Health Inc Commercial |
$47.75
|
| Rate for Payer: Group Health Inc Medicare |
$33.42
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$47.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$47.75
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$62.08
|
|
|
VALGANCICLOVIR 450 MG TAB
|
Facility
|
IP
|
$95.50
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
41652623
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$47.75 |
| Max. Negotiated Rate |
$47.75 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$47.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$47.75
|
|
|
VALGANCICLOVIR 450 MG TAB
|
Facility
|
OP
|
$95.50
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
41642623
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$33.42 |
| Max. Negotiated Rate |
$62.08 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$52.52
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$47.75
|
| Rate for Payer: Aetna Government |
$47.75
|
| Rate for Payer: Brighton Health Commercial |
$57.30
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$47.75
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$54.91
|
| Rate for Payer: Group Health Inc Commercial |
$47.75
|
| Rate for Payer: Group Health Inc Medicare |
$33.42
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$47.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$47.75
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$62.08
|
|
|
VALGANCICLOVIR 50 MG/ML SUSP
|
Facility
|
OP
|
$13.14
|
|
| Hospital Charge Code |
41655609
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.60 |
| Max. Negotiated Rate |
$10.51 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.23
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.57
|
| Rate for Payer: Aetna Government |
$6.57
|
| Rate for Payer: Brighton Health Commercial |
$9.86
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$10.51
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$8.94
|
| Rate for Payer: Group Health Inc Commercial |
$6.57
|
| Rate for Payer: Group Health Inc Medicare |
$4.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.57
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.57
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8.54
|
|
|
VALGANCICLOVIR 50 MG/ML SUSP
|
Facility
|
OP
|
$13.14
|
|
| Hospital Charge Code |
41645609
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.60 |
| Max. Negotiated Rate |
$10.51 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.23
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.57
|
| Rate for Payer: Aetna Government |
$6.57
|
| Rate for Payer: Brighton Health Commercial |
$9.86
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$10.51
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$8.94
|
| Rate for Payer: Group Health Inc Commercial |
$6.57
|
| Rate for Payer: Group Health Inc Medicare |
$4.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.57
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.57
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8.54
|
|
