|
VITAMIN B-12 500 MCG PO TABS [8657]
|
Facility
|
OP
|
$0.19
|
|
|
Service Code
|
NDC 77333093710
|
| Hospital Charge Code |
77333093710
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.16 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.11
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.10
|
| Rate for Payer: Aetna Government |
$0.10
|
| Rate for Payer: Brighton Health Commercial |
$0.15
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.16
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.13
|
| Rate for Payer: Group Health Inc Commercial |
$0.10
|
| Rate for Payer: Group Health Inc Medicare |
$0.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.13
|
|
|
VITAMIN B-12 500 MCG PO TABS [8657]
|
Facility
|
OP
|
$0.19
|
|
|
Service Code
|
NDC 77333093725
|
| Hospital Charge Code |
77333093725
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.16 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.11
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.10
|
| Rate for Payer: Aetna Government |
$0.10
|
| Rate for Payer: Brighton Health Commercial |
$0.15
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.16
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.13
|
| Rate for Payer: Group Health Inc Commercial |
$0.10
|
| Rate for Payer: Group Health Inc Medicare |
$0.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.13
|
|
|
VITAMIN B12 AND FOLATE
|
Facility
|
IP
|
$12.95
|
|
|
Service Code
|
HCPCS 82570
|
| Hospital Charge Code |
40609821
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$5.18
|
|
|
VITAMIN B12 AND FOLATE
|
Facility
|
OP
|
$12.95
|
|
|
Service Code
|
HCPCS 82570
|
| Hospital Charge Code |
40609821
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.63 |
| Max. Negotiated Rate |
$9.71 |
| 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: Affinity Essential Plan 1&2 |
$3.63
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$3.63
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$3.63
|
| Rate for Payer: Brighton Health Commercial |
$9.71
|
| 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 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 |
$6.47
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.18
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5.18
|
| Rate for Payer: Healthfirst QHP |
$5.18
|
| Rate for Payer: Humana Medicare |
$5.28
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$5.18
|
| Rate for Payer: United Healthcare Commercial |
$6.55
|
| Rate for Payer: United Healthcare 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 B-6 50 MG PO TABS [8667]
|
Facility
|
OP
|
$0.17
|
|
|
Service Code
|
NDC 77333094010
|
| Hospital Charge Code |
77333094010
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.14 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.09
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.09
|
| Rate for Payer: Aetna Government |
$0.09
|
| Rate for Payer: Brighton Health Commercial |
$0.13
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.14
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.12
|
| Rate for Payer: Group Health Inc Commercial |
$0.09
|
| Rate for Payer: Group Health Inc Medicare |
$0.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.11
|
|
|
VITAMIN B-6 50 MG PO TABS [8667]
|
Facility
|
OP
|
$0.04
|
|
|
Service Code
|
NDC 00761043620
|
| Hospital Charge Code |
00761043620
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| 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: Brighton Health Commercial |
$0.03
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.03
|
| 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 B-6 50 MG PO TABS [8667]
|
Facility
|
OP
|
$0.28
|
|
|
Service Code
|
NDC 50268085815
|
| Hospital Charge Code |
50268085815
|
|
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
|
|
|
VITAMIN_C
|
Facility
|
IP
|
$24.73
|
|
|
Service Code
|
HCPCS 82180
|
| Hospital Charge Code |
40609700
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$9.89
|
|
|
VITAMIN_C
|
Facility
|
OP
|
$24.73
|
|
|
Service Code
|
HCPCS 82180
|
| Hospital Charge Code |
40609700
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.92 |
| Max. Negotiated Rate |
$18.55 |
| 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: Affinity Essential Plan 1&2 |
$6.92
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$6.92
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$6.92
|
| Rate for Payer: Brighton Health Commercial |
$18.55
|
| 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 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 |
$12.37
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9.89
|
| Rate for Payer: Healthfirst Medicare Advantage |
$9.89
|
| Rate for Payer: Healthfirst QHP |
$9.89
|
| Rate for Payer: Humana Medicare |
$10.09
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$9.89
|
| Rate for Payer: United Healthcare Commercial |
$12.52
|
| Rate for Payer: United Healthcare 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 C 500 MG PO TABS [8680]
|
Facility
|
OP
|
$0.05
|
|
|
Service Code
|
NDC 00904052360
|
| Hospital Charge Code |
00904052360
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.04 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.03
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.02
|
| Rate for Payer: Aetna Government |
$0.02
|
| Rate for Payer: Brighton Health Commercial |
$0.04
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.04
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.03
|
| Rate for Payer: Group Health Inc Commercial |
$0.02
|
| Rate for Payer: Group Health Inc Medicare |
$0.02
|
| 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 |
$0.03
|
|
|
VITAMIN C 500 MG PO TABS [8680]
|
Facility
|
OP
|
$0.07
|
|
|
Service Code
|
NDC 00904052361
|
| Hospital Charge Code |
00904052361
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.04
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.03
|
| Rate for Payer: Aetna Government |
$0.03
|
| Rate for Payer: Brighton Health Commercial |
$0.05
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.05
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.05
|
| Rate for Payer: Group Health Inc Commercial |
$0.03
|
| Rate for Payer: Group Health Inc Medicare |
$0.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.03
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.03
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.04
|
|
|
VITAMIN D 25-HYDROXY
|
Facility
|
IP
|
$74.00
|
|
|
Service Code
|
HCPCS 82306
|
| Hospital Charge Code |
40609731
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$29.60
|
|
|
VITAMIN D 25-HYDROXY
|
Facility
|
OP
|
$74.00
|
|
|
Service Code
|
HCPCS 82306
|
| Hospital Charge Code |
40609731
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.72 |
| Max. Negotiated Rate |
$55.50 |
| 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: Affinity Essential Plan 1&2 |
$20.72
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$20.72
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$20.72
|
| Rate for Payer: Brighton Health Commercial |
$55.50
|
| 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 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 Medicare Advantage |
$29.60
|
| Rate for Payer: Healthfirst QHP |
$29.60
|
| Rate for Payer: Humana Medicare |
$30.19
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$29.60
|
| Rate for Payer: United Healthcare Commercial |
$37.49
|
| Rate for Payer: United Healthcare 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
|
IP
|
$74.00
|
|
|
Service Code
|
HCPCS 82306
|
| Hospital Charge Code |
40602687
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$29.60
|
|
|
VITAMIN D, 25 OH
|
Facility
|
OP
|
$74.00
|
|
|
Service Code
|
HCPCS 82306
|
| Hospital Charge Code |
40602687
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.72 |
| Max. Negotiated Rate |
$55.50 |
| 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: Affinity Essential Plan 1&2 |
$20.72
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$20.72
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$20.72
|
| Rate for Payer: Brighton Health Commercial |
$55.50
|
| 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 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 Medicare Advantage |
$29.60
|
| Rate for Payer: Healthfirst QHP |
$29.60
|
| Rate for Payer: Humana Medicare |
$30.19
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$29.60
|
| Rate for Payer: United Healthcare Commercial |
$37.49
|
| Rate for Payer: United Healthcare 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 D3 10 MCG (400 UNIT) PO TABS [13108]
|
Facility
|
OP
|
$0.23
|
|
|
Service Code
|
NDC 77333094825
|
| Hospital Charge Code |
77333094825
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.18 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.12
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.11
|
| Rate for Payer: Aetna Government |
$0.11
|
| Rate for Payer: Brighton Health Commercial |
$0.17
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.18
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.15
|
| Rate for Payer: Group Health Inc Commercial |
$0.11
|
| Rate for Payer: Group Health Inc Medicare |
$0.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.11
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.11
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.15
|
|
|
VITAMIN D3 10 MCG (400 UNIT) PO TABS [13108]
|
Facility
|
OP
|
$0.19
|
|
|
Service Code
|
NDC 48433010901
|
| Hospital Charge Code |
48433010901
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.15 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.09
|
| Rate for Payer: Aetna Government |
$0.09
|
| Rate for Payer: Brighton Health Commercial |
$0.14
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.15
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.13
|
| Rate for Payer: Group Health Inc Commercial |
$0.09
|
| Rate for Payer: Group Health Inc Medicare |
$0.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.12
|
|
|
VITAMIN D3 10 MCG (400 UNIT) PO TABS [13108]
|
Facility
|
OP
|
$0.02
|
|
|
Service Code
|
NDC 00904582360
|
| Hospital Charge Code |
00904582360
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.01
|
| Rate for Payer: Aetna Government |
$0.01
|
| Rate for Payer: Brighton Health Commercial |
$0.01
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.01
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.01
|
| Rate for Payer: Group Health Inc Commercial |
$0.01
|
| Rate for Payer: Group Health Inc Medicare |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.01
|
|
|
VITAMIN D3 10 MCG (400 UNIT) PO TABS [13108]
|
Facility
|
OP
|
$0.23
|
|
|
Service Code
|
NDC 77333094810
|
| Hospital Charge Code |
77333094810
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.18 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.12
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.11
|
| Rate for Payer: Aetna Government |
$0.11
|
| Rate for Payer: Brighton Health Commercial |
$0.17
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.18
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.15
|
| Rate for Payer: Group Health Inc Commercial |
$0.11
|
| Rate for Payer: Group Health Inc Medicare |
$0.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.11
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.11
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.15
|
|
|
VITAMIN D3 25 MCG (1000 UT) PO TABS [76997]
|
Facility
|
OP
|
$0.21
|
|
|
Service Code
|
NDC 48433010401
|
| Hospital Charge Code |
48433010401
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.17 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.11
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.10
|
| Rate for Payer: Aetna Government |
$0.10
|
| Rate for Payer: Brighton Health Commercial |
$0.16
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.17
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.14
|
| Rate for Payer: Group Health Inc Commercial |
$0.10
|
| Rate for Payer: Group Health Inc Medicare |
$0.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.14
|
|
|
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: Brighton Health Commercial |
$0.05
|
| 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: Brighton Health Commercial |
$0.05
|
| 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 180 MG (400 UNIT) PO CAPS [177894]
|
Facility
|
OP
|
$0.08
|
|
|
Service Code
|
NDC 57896075201
|
| Hospital Charge Code |
57896075201
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.03 |
| 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: Brighton Health Commercial |
$0.06
|
| 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 |
$0.03
|
| 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: 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
|
|
|
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: 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
|
|
