|
VERAPAMIL 2.5 MG/ML INJ
|
Facility
|
OP
|
$3.00
|
|
| Hospital Charge Code |
41654329
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.05 |
| Max. Negotiated Rate |
$2.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.65
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.50
|
| Rate for Payer: Aetna Government |
$1.50
|
| Rate for Payer: Brighton Health Commercial |
$2.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.04
|
| Rate for Payer: Group Health Inc Commercial |
$1.50
|
| Rate for Payer: Group Health Inc Medicare |
$1.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.95
|
|
|
VERAPAMIL 40 MG TAB
|
Facility
|
OP
|
$0.30
|
|
| Hospital Charge Code |
41643422
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.24 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.17
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.15
|
| Rate for Payer: Aetna Government |
$0.15
|
| Rate for Payer: Brighton Health Commercial |
$0.23
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.24
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.20
|
| Rate for Payer: Group Health Inc Commercial |
$0.15
|
| Rate for Payer: Group Health Inc Medicare |
$0.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.15
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.20
|
|
|
VERAPAMIL 40 MG TAB
|
Facility
|
OP
|
$0.30
|
|
| Hospital Charge Code |
41653422
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.24 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.17
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.15
|
| Rate for Payer: Aetna Government |
$0.15
|
| Rate for Payer: Brighton Health Commercial |
$0.23
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.24
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.20
|
| Rate for Payer: Group Health Inc Commercial |
$0.15
|
| Rate for Payer: Group Health Inc Medicare |
$0.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.15
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.20
|
|
|
VERAPAMIL 60 MG/ML SUSP
|
Facility
|
OP
|
$1.00
|
|
| Hospital Charge Code |
41642817
|
|
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: Brighton Health Commercial |
$0.75
|
| 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
|
|
|
VERAPAMIL 60 MG/ML SUSP
|
Facility
|
OP
|
$1.00
|
|
| Hospital Charge Code |
41652817
|
|
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: Brighton Health Commercial |
$0.75
|
| 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
|
|
|
VERAPAMIL 80 MG TAB
|
Facility
|
OP
|
$1.00
|
|
| Hospital Charge Code |
41653737
|
|
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: Brighton Health Commercial |
$0.75
|
| 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
|
|
|
VERAPAMIL 80 MG TAB
|
Facility
|
OP
|
$1.00
|
|
| Hospital Charge Code |
41643737
|
|
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: Brighton Health Commercial |
$0.75
|
| 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
|
|
|
VERAPAMIL HCL 2.5 MG/ML IV SOLN [8527]
|
Facility
|
OP
|
$6.30
|
|
|
Service Code
|
NDC 42571031387
|
| Hospital Charge Code |
42571031387
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.20 |
| Max. Negotiated Rate |
$6.62 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.46
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.15
|
| Rate for Payer: Aetna Government |
$3.15
|
| Rate for Payer: Brighton Health Commercial |
$3.78
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.15
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.62
|
| Rate for Payer: EmblemHealth Commercial |
$3.15
|
| Rate for Payer: Fidelis Medicare Advantage |
$6.62
|
| Rate for Payer: Group Health Inc Commercial |
$3.15
|
| Rate for Payer: Group Health Inc Medicare |
$2.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.15
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.10
|
|
|
VERAPAMIL HCL 2.5 MG/ML IV SOLN [8527]
|
Facility
|
IP
|
$6.25
|
|
|
Service Code
|
NDC 70756060525
|
| Hospital Charge Code |
70756060525
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3.12 |
| Max. Negotiated Rate |
$3.12 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.12
|
|
|
VERAPAMIL HCL 2.5 MG/ML IV SOLN [8527]
|
Facility
|
OP
|
$6.30
|
|
|
Service Code
|
NDC 42571031397
|
| Hospital Charge Code |
42571031397
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.20 |
| Max. Negotiated Rate |
$6.62 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.46
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.15
|
| Rate for Payer: Aetna Government |
$3.15
|
| Rate for Payer: Brighton Health Commercial |
$3.78
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.15
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.62
|
| Rate for Payer: EmblemHealth Commercial |
$3.15
|
| Rate for Payer: Fidelis Medicare Advantage |
$6.62
|
| Rate for Payer: Group Health Inc Commercial |
$3.15
|
| Rate for Payer: Group Health Inc Medicare |
$2.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.15
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.10
|
|
|
VERAPAMIL HCL 2.5 MG/ML IV SOLN [8527]
|
Facility
|
IP
|
$6.30
|
|
|
Service Code
|
NDC 42571031397
|
| Hospital Charge Code |
42571031397
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3.15 |
| Max. Negotiated Rate |
$3.15 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.15
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.15
|
|
|
VERAPAMIL HCL 2.5 MG/ML IV SOLN [8527]
|
Facility
|
IP
|
$6.30
|
|
|
Service Code
|
NDC 42571031387
|
| Hospital Charge Code |
42571031387
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3.15 |
| Max. Negotiated Rate |
$3.15 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.15
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.15
|
|
|
VERAPAMIL HCL 2.5 MG/ML IV SOLN [8527]
|
Facility
|
OP
|
$6.25
|
|
|
Service Code
|
NDC 70756060525
|
| Hospital Charge Code |
70756060525
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.19 |
| Max. Negotiated Rate |
$6.56 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.44
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.12
|
| Rate for Payer: Aetna Government |
$3.12
|
| Rate for Payer: Brighton Health Commercial |
$3.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.12
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.59
|
| Rate for Payer: EmblemHealth Commercial |
$3.12
|
| Rate for Payer: Fidelis Medicare Advantage |
$6.56
|
| Rate for Payer: Group Health Inc Commercial |
$3.12
|
| Rate for Payer: Group Health Inc Medicare |
$2.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.06
|
|
|
VERAPAMIL HCL 40 MG PO TABS [8529]
|
Facility
|
OP
|
$0.28
|
|
|
Service Code
|
NDC 00591040401
|
| Hospital Charge Code |
00591040401
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.22 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.15
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.14
|
| Rate for Payer: Aetna Government |
$0.14
|
| Rate for Payer: Brighton Health Commercial |
$0.21
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.22
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.19
|
| Rate for Payer: Group Health Inc Commercial |
$0.14
|
| Rate for Payer: Group Health Inc Medicare |
$0.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.18
|
|
|
VERAPAMIL HCL 80 MG PO TABS [8530]
|
Facility
|
OP
|
$0.31
|
|
|
Service Code
|
NDC 23155002601
|
| Hospital Charge Code |
23155002601
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.17
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.15
|
| Rate for Payer: Aetna Government |
$0.15
|
| Rate for Payer: Brighton Health Commercial |
$0.23
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.25
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.21
|
| Rate for Payer: Group Health Inc Commercial |
$0.15
|
| Rate for Payer: Group Health Inc Medicare |
$0.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.15
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.20
|
|
|
VERAPAMIL HCL ER 120 MG PO CP24 [25238]
|
Facility
|
OP
|
$1.75
|
|
|
Service Code
|
NDC 00591288001
|
| Hospital Charge Code |
00591288001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.61 |
| Max. Negotiated Rate |
$1.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.96
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.87
|
| Rate for Payer: Aetna Government |
$0.87
|
| Rate for Payer: Brighton Health Commercial |
$1.31
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.19
|
| Rate for Payer: Group Health Inc Commercial |
$0.87
|
| Rate for Payer: Group Health Inc Medicare |
$0.61
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.87
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.87
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.13
|
|
|
VERAPAMIL HCL ER 120 MG PO TBCR [13184]
|
Facility
|
OP
|
$1.07
|
|
|
Service Code
|
NDC 68462029201
|
| Hospital Charge Code |
68462029201
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.38 |
| Max. Negotiated Rate |
$0.86 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.59
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.54
|
| Rate for Payer: Aetna Government |
$0.54
|
| Rate for Payer: Brighton Health Commercial |
$0.80
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.86
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.73
|
| Rate for Payer: Group Health Inc Commercial |
$0.54
|
| Rate for Payer: Group Health Inc Medicare |
$0.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.54
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.70
|
|
|
VERAPAMIL HCL ER 180 MG PO TBCR [14626]
|
Facility
|
OP
|
$1.44
|
|
|
Service Code
|
NDC 68462029301
|
| Hospital Charge Code |
68462029301
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.50 |
| Max. Negotiated Rate |
$1.15 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.79
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.72
|
| Rate for Payer: Aetna Government |
$0.72
|
| Rate for Payer: Brighton Health Commercial |
$1.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.15
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.98
|
| Rate for Payer: Group Health Inc Commercial |
$0.72
|
| Rate for Payer: Group Health Inc Medicare |
$0.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.72
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.94
|
|
|
VERAPAMIL HCL ER 240 MG PO CP24 [23151]
|
Facility
|
OP
|
$2.06
|
|
|
Service Code
|
NDC 00591288401
|
| Hospital Charge Code |
00591288401
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.72 |
| Max. Negotiated Rate |
$1.65 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.14
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.03
|
| Rate for Payer: Aetna Government |
$1.03
|
| Rate for Payer: Brighton Health Commercial |
$1.55
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.65
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.40
|
| Rate for Payer: Group Health Inc Commercial |
$1.03
|
| Rate for Payer: Group Health Inc Medicare |
$0.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.03
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.03
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.34
|
|
|
VERSAONE BLUNT HASSON
|
Facility
|
OP
|
$71.21
|
|
| Hospital Charge Code |
64907096
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$24.92 |
| Max. Negotiated Rate |
$56.97 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$39.17
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$35.60
|
| Rate for Payer: Aetna Government |
$35.60
|
| Rate for Payer: Brighton Health Commercial |
$53.41
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$56.97
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$48.42
|
| Rate for Payer: Group Health Inc Commercial |
$35.60
|
| Rate for Payer: Group Health Inc Medicare |
$24.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$35.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$35.60
|
|
|
VERSA VEDRO1 DUAL CHAMB PXMAKER
|
Facility
|
OP
|
$10,600.00
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
40009103
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$275.42 |
| Max. Negotiated Rate |
$11,130.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5,830.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$275.42
|
| Rate for Payer: Aetna Government |
$275.42
|
| Rate for Payer: Brighton Health Commercial |
$6,360.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5,300.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6,095.00
|
| Rate for Payer: EmblemHealth Commercial |
$5,300.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$11,130.00
|
| Rate for Payer: Group Health Inc Commercial |
$5,300.00
|
| Rate for Payer: Group Health Inc Medicare |
$3,710.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5,300.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5,300.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6,890.00
|
|
|
VERTICAL BITEWINGS - 7 TO 8 FILMS
|
Facility
|
IP
|
$127.58
|
|
|
Service Code
|
HCPCS D0277
|
| Hospital Charge Code |
42303275
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$283.37
|
|
|
VERTICAL BITEWINGS - 7 TO 8 FILMS
|
Facility
|
OP
|
$127.58
|
|
|
Service Code
|
HCPCS D0277
|
| Hospital Charge Code |
42303275
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$63.79 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$70.17
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$283.37
|
| Rate for Payer: Aetna Government |
$283.37
|
| Rate for Payer: Brighton Health Commercial |
$95.68
|
| Rate for Payer: Cash Price |
$283.37
|
| Rate for Payer: Cash Price |
$283.37
|
| Rate for Payer: Cash Price |
$283.37
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$283.37
|
| 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 |
$283.37
|
| Rate for Payer: EmblemHealth Commercial |
$283.37
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$240.86
|
| Rate for Payer: Fidelis Essential Plan QHP |
$252.20
|
| Rate for Payer: Fidelis Medicare Advantage |
$283.37
|
| Rate for Payer: Fidelis Qualified Health Plan |
$252.20
|
| Rate for Payer: Group Health Inc Commercial |
$283.37
|
| Rate for Payer: Group Health Inc Medicare |
$283.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$63.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$283.37
|
| Rate for Payer: Healthfirst Medicare Advantage |
$240.86
|
| Rate for Payer: Healthfirst QHP |
$283.37
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$283.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$283.37
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$226.70
|
| Rate for Payer: Wellcare Medicare |
$269.20
|
|
|
VEST CHEST HYPO/HYPERTHERM LRG
|
Facility
|
OP
|
$25.30
|
|
| Hospital Charge Code |
64903330
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.86 |
| Max. Negotiated Rate |
$20.24 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$13.92
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12.65
|
| Rate for Payer: Aetna Government |
$12.65
|
| Rate for Payer: Brighton Health Commercial |
$18.98
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$20.24
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$17.20
|
| Rate for Payer: Group Health Inc Commercial |
$12.65
|
| Rate for Payer: Group Health Inc Medicare |
$8.86
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.65
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.65
|
|
|
VESTIBULOPLASTY-(INC GRAFTS, HYPE
|
Facility
|
OP
|
$1,000.00
|
|
|
Service Code
|
HCPCS D7350
|
| Hospital Charge Code |
42301750
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$500.00 |
| Max. Negotiated Rate |
$6,772.21 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$550.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6,772.21
|
| Rate for Payer: Aetna Government |
$6,772.21
|
| Rate for Payer: Brighton Health Commercial |
$750.00
|
| Rate for Payer: Cash Price |
$6,772.21
|
| Rate for Payer: Cash Price |
$6,772.21
|
| Rate for Payer: Cash Price |
$6,772.21
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$6,772.21
|
| 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 |
$6,772.21
|
| Rate for Payer: EmblemHealth Commercial |
$6,772.21
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$5,756.38
|
| Rate for Payer: Fidelis Essential Plan QHP |
$6,027.27
|
| Rate for Payer: Fidelis Medicare Advantage |
$6,772.21
|
| Rate for Payer: Fidelis Qualified Health Plan |
$6,027.27
|
| Rate for Payer: Group Health Inc Commercial |
$6,772.21
|
| Rate for Payer: Group Health Inc Medicare |
$6,772.21
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$500.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6,772.21
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5,756.38
|
| Rate for Payer: Healthfirst QHP |
$6,772.21
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$6,772.21
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6,772.21
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5,417.77
|
| Rate for Payer: Wellcare Medicare |
$6,433.60
|
|
