|
VORICONAZOLE 200 MG IV SOLR [33010]
|
Facility
|
IP
|
$72.36
|
|
|
Service Code
|
HCPCS J3465
|
| Hospital Charge Code |
00049319028
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$36.18 |
| Max. Negotiated Rate |
$36.18 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$36.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$36.18
|
|
|
VORICONAZOLE 200 MG IV SOLR [33010]
|
Facility
|
OP
|
$152.58
|
|
|
Service Code
|
HCPCS J3465
|
| Hospital Charge Code |
70436002980
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1.75 |
| Max. Negotiated Rate |
$160.21 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$83.92
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.75
|
| Rate for Payer: Aetna Government |
$1.75
|
| Rate for Payer: Brighton Health Commercial |
$91.55
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$76.29
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$87.73
|
| Rate for Payer: EmblemHealth Commercial |
$76.29
|
| Rate for Payer: Fidelis Medicare Advantage |
$160.21
|
| Rate for Payer: Group Health Inc Commercial |
$76.29
|
| Rate for Payer: Group Health Inc Medicare |
$53.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$76.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$76.29
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$99.18
|
|
|
VORICONAZOLE 200 MG PO TABS [33009]
|
Facility
|
OP
|
$79.52
|
|
|
Service Code
|
NDC 27241006303
|
| Hospital Charge Code |
27241006303
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$27.83 |
| Max. Negotiated Rate |
$63.61 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$43.73
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$39.76
|
| Rate for Payer: Aetna Government |
$39.76
|
| Rate for Payer: Brighton Health Commercial |
$59.64
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$63.61
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$54.07
|
| Rate for Payer: Group Health Inc Commercial |
$39.76
|
| Rate for Payer: Group Health Inc Medicare |
$27.83
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$39.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$39.76
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$51.69
|
|
|
VORICONAZOLE 200 MG TAB
|
Facility
|
OP
|
$86.18
|
|
| Hospital Charge Code |
41642869
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$30.16 |
| Max. Negotiated Rate |
$68.94 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$47.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$43.09
|
| Rate for Payer: Aetna Government |
$43.09
|
| Rate for Payer: Brighton Health Commercial |
$64.64
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$68.94
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$58.60
|
| Rate for Payer: Group Health Inc Commercial |
$43.09
|
| Rate for Payer: Group Health Inc Medicare |
$30.16
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$43.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$43.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$56.02
|
|
|
VORICONAZOLE 200 MG TAB
|
Facility
|
OP
|
$86.18
|
|
| Hospital Charge Code |
41652869
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$30.16 |
| Max. Negotiated Rate |
$68.94 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$47.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$43.09
|
| Rate for Payer: Aetna Government |
$43.09
|
| Rate for Payer: Brighton Health Commercial |
$64.64
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$68.94
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$58.60
|
| Rate for Payer: Group Health Inc Commercial |
$43.09
|
| Rate for Payer: Group Health Inc Medicare |
$30.16
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$43.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$43.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$56.02
|
|
|
VORICONAZOLE 50 MG PO TABS [33008]
|
Facility
|
OP
|
$19.88
|
|
|
Service Code
|
NDC 27241006203
|
| Hospital Charge Code |
27241006203
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.96 |
| Max. Negotiated Rate |
$15.90 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$10.93
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$9.94
|
| Rate for Payer: Aetna Government |
$9.94
|
| Rate for Payer: Brighton Health Commercial |
$14.91
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$15.90
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$13.52
|
| Rate for Payer: Group Health Inc Commercial |
$9.94
|
| Rate for Payer: Group Health Inc Medicare |
$6.96
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12.92
|
|
|
VORICONAZOLE 50 MG PO TABS [33008]
|
Facility
|
OP
|
$12.56
|
|
|
Service Code
|
NDC 43386008803
|
| Hospital Charge Code |
43386008803
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.40 |
| Max. Negotiated Rate |
$10.05 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.91
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.28
|
| Rate for Payer: Aetna Government |
$6.28
|
| Rate for Payer: Brighton Health Commercial |
$9.42
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$10.05
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$8.54
|
| Rate for Payer: Group Health Inc Commercial |
$6.28
|
| Rate for Payer: Group Health Inc Medicare |
$4.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.28
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.28
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8.16
|
|
|
VORICONAZOLE 50 MG TAB
|
Facility
|
OP
|
$23.02
|
|
| Hospital Charge Code |
41652868
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.06 |
| Max. Negotiated Rate |
$18.42 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$12.66
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$11.51
|
| Rate for Payer: Aetna Government |
$11.51
|
| Rate for Payer: Brighton Health Commercial |
$17.26
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$18.42
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$15.65
|
| Rate for Payer: Group Health Inc Commercial |
$11.51
|
| Rate for Payer: Group Health Inc Medicare |
$8.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11.51
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$11.51
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$14.96
|
|
|
VORICONAZOLE 50 MG TAB
|
Facility
|
OP
|
$23.02
|
|
| Hospital Charge Code |
41642868
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.06 |
| Max. Negotiated Rate |
$18.42 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$12.66
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$11.51
|
| Rate for Payer: Aetna Government |
$11.51
|
| Rate for Payer: Brighton Health Commercial |
$17.26
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$18.42
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$15.65
|
| Rate for Payer: Group Health Inc Commercial |
$11.51
|
| Rate for Payer: Group Health Inc Medicare |
$8.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11.51
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$11.51
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$14.96
|
|
|
VORTEX VACUUM MIX SYS
|
Facility
|
OP
|
$348.10
|
|
| Hospital Charge Code |
64905966
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$121.84 |
| Max. Negotiated Rate |
$278.48 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$191.46
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$174.05
|
| Rate for Payer: Aetna Government |
$174.05
|
| Rate for Payer: Brighton Health Commercial |
$261.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$278.48
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$236.71
|
| Rate for Payer: Group Health Inc Commercial |
$174.05
|
| Rate for Payer: Group Health Inc Medicare |
$121.84
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$174.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$174.05
|
|
|
VP SHUNT REVISION
|
Facility
|
OP
|
$16,685.43
|
|
|
Service Code
|
HCPCS 62230
|
| Hospital Charge Code |
40004302
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,505.00 |
| Max. Negotiated Rate |
$12,514.07 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$7,703.44
|
| Rate for Payer: Aetna Government |
$7,703.44
|
| Rate for Payer: Brighton Health Commercial |
$12,514.07
|
| Rate for Payer: Cash Price |
$7,703.44
|
| Rate for Payer: Cash Price |
$7,703.44
|
| Rate for Payer: Cash Price |
$7,703.44
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$7,703.44
|
| 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 |
$7,703.44
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$6,547.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$6,856.06
|
| Rate for Payer: Fidelis Medicare Advantage |
$7,703.44
|
| Rate for Payer: Fidelis Qualified Health Plan |
$6,856.06
|
| Rate for Payer: Group Health Inc Commercial |
$7,703.44
|
| Rate for Payer: Group Health Inc Medicare |
$7,703.44
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8,342.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7,703.44
|
| Rate for Payer: Healthfirst Medicare Advantage |
$6,547.92
|
| Rate for Payer: Healthfirst QHP |
$7,703.44
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$7,703.44
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$7,703.44
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$6,162.75
|
| Rate for Payer: Wellcare Medicare |
$7,318.27
|
|
|
VP SHUNT REVISION
|
Facility
|
IP
|
$16,685.43
|
|
|
Service Code
|
HCPCS 62230
|
| Hospital Charge Code |
40004302
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$7,703.44
|
|
|
VPS ORTHOGNATHIC CASE 2/SPLINT
|
Facility
|
OP
|
$3,950.00
|
|
| Hospital Charge Code |
40203052
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,382.50 |
| Max. Negotiated Rate |
$4,147.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,172.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,975.00
|
| Rate for Payer: Aetna Government |
$1,975.00
|
| Rate for Payer: Brighton Health Commercial |
$2,370.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,975.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,271.25
|
| Rate for Payer: EmblemHealth Commercial |
$1,975.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$4,147.50
|
| Rate for Payer: Group Health Inc Commercial |
$1,975.00
|
| Rate for Payer: Group Health Inc Medicare |
$1,382.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,975.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,975.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,567.50
|
|
|
VSP CUSTOMIZED BUNDLE
|
Facility
|
OP
|
$9,961.33
|
|
|
Service Code
|
HCPCS 76376 TC
|
| Hospital Charge Code |
64906000
|
|
Hospital Revenue Code
|
400
|
| Min. Negotiated Rate |
$3,486.47 |
| Max. Negotiated Rate |
$7,969.06 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5,478.73
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4,980.66
|
| Rate for Payer: Aetna Government |
$4,980.66
|
| Rate for Payer: Brighton Health Commercial |
$7,471.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7,969.06
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6,773.70
|
| Rate for Payer: Group Health Inc Commercial |
$4,980.66
|
| Rate for Payer: Group Health Inc Medicare |
$3,486.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,980.66
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,980.66
|
|
|
VSP RECONSTRUCTION TRAUMA
|
Facility
|
IP
|
$19,179.90
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
64907519
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,589.95 |
| Max. Negotiated Rate |
$9,589.95 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9,589.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9,589.95
|
|
|
VSP RECONSTRUCTION TRAUMA
|
Facility
|
OP
|
$19,179.90
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
64907519
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,712.96 |
| Max. Negotiated Rate |
$20,138.90 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$10,548.94
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$9,589.95
|
| Rate for Payer: Aetna Government |
$9,589.95
|
| Rate for Payer: Brighton Health Commercial |
$11,507.94
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$9,589.95
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$11,028.44
|
| Rate for Payer: EmblemHealth Commercial |
$9,589.95
|
| Rate for Payer: Fidelis Medicare Advantage |
$20,138.90
|
| Rate for Payer: Group Health Inc Commercial |
$9,589.95
|
| Rate for Payer: Group Health Inc Medicare |
$6,712.96
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9,589.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9,589.95
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12,466.94
|
|
|
VULVA W/BX
|
Facility
|
OP
|
$814.00
|
|
|
Service Code
|
HCPCS 56821
|
| Hospital Charge Code |
30301251
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$233.00 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$370.99
|
| Rate for Payer: Aetna Government |
$370.99
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$370.99
|
| Rate for Payer: Cash Price |
$370.99
|
| Rate for Payer: Cash Price |
$370.99
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$370.99
|
| 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 |
$370.99
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$315.34
|
| Rate for Payer: Fidelis Essential Plan QHP |
$330.18
|
| Rate for Payer: Fidelis Medicare Advantage |
$370.99
|
| Rate for Payer: Fidelis Qualified Health Plan |
$330.18
|
| 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 |
$407.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$370.99
|
| Rate for Payer: Healthfirst Medicare Advantage |
$315.34
|
| Rate for Payer: Healthfirst QHP |
$370.99
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$370.99
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$370.99
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$370.99
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$296.79
|
| Rate for Payer: Wellcare Medicare |
$352.44
|
|
|
VULVA W/BX
|
Facility
|
IP
|
$814.00
|
|
|
Service Code
|
HCPCS 56821
|
| Hospital Charge Code |
30301251
|
|
Hospital Revenue Code
|
510
|
| Rate for Payer: Cash Price |
$370.99
|
|
|
V.V. LONG AND SHORT
|
Facility
|
OP
|
$8,393.53
|
|
|
Service Code
|
HCPCS 37718
|
| Hospital Charge Code |
40011075
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,505.00 |
| Max. Negotiated Rate |
$6,295.15 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,134.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,686.08
|
| Rate for Payer: Aetna Government |
$3,686.08
|
| Rate for Payer: Brighton Health Commercial |
$6,295.15
|
| Rate for Payer: Cash Price |
$3,686.08
|
| Rate for Payer: Cash Price |
$3,686.08
|
| Rate for Payer: Cash Price |
$3,686.08
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,686.08
|
| 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 |
$3,686.08
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,133.17
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,280.61
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,686.08
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,280.61
|
| Rate for Payer: Group Health Inc Commercial |
$3,686.08
|
| Rate for Payer: Group Health Inc Medicare |
$3,686.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,196.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,686.08
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,133.17
|
| Rate for Payer: Healthfirst QHP |
$3,686.08
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,686.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,686.08
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,948.86
|
| Rate for Payer: Wellcare Medicare |
$3,501.78
|
|
|
V.V. LONG AND SHORT
|
Facility
|
IP
|
$8,393.53
|
|
|
Service Code
|
HCPCS 37718
|
| Hospital Charge Code |
40011075
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$3,686.08
|
|
|
VWF ACTIVITY
|
Facility
|
OP
|
$57.35
|
|
|
Service Code
|
HCPCS 85245
|
| Hospital Charge Code |
40629756
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$18.35 |
| Max. Negotiated Rate |
$43.01 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$31.54
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$22.94
|
| Rate for Payer: Aetna Government |
$22.94
|
| Rate for Payer: Brighton Health Commercial |
$43.01
|
| Rate for Payer: Cash Price |
$22.94
|
| Rate for Payer: Cash Price |
$22.94
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$22.94
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$36.48
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$30.87
|
| Rate for Payer: Elderplan Medicare Advantage |
$22.94
|
| Rate for Payer: EmblemHealth Commercial |
$22.94
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$19.50
|
| Rate for Payer: Fidelis Essential Plan QHP |
$20.42
|
| Rate for Payer: Fidelis Medicare Advantage |
$22.94
|
| Rate for Payer: Fidelis Qualified Health Plan |
$20.42
|
| Rate for Payer: Group Health Inc Commercial |
$22.94
|
| Rate for Payer: Group Health Inc Medicare |
$22.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$28.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$22.94
|
| Rate for Payer: Healthfirst Medicare Advantage |
$22.94
|
| Rate for Payer: Healthfirst QHP |
$22.94
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$22.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$22.94
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$18.35
|
| Rate for Payer: Wellcare Medicare |
$20.65
|
|
|
VWF ACTIVITY
|
Facility
|
IP
|
$57.35
|
|
|
Service Code
|
HCPCS 85245
|
| Hospital Charge Code |
40629756
|
|
Hospital Revenue Code
|
305
|
| Rate for Payer: Cash Price |
$22.94
|
|
|
VWF AG
|
Facility
|
IP
|
$57.35
|
|
|
Service Code
|
HCPCS 85246
|
| Hospital Charge Code |
40628227
|
|
Hospital Revenue Code
|
305
|
| Rate for Payer: Cash Price |
$22.94
|
|
|
VWF AG
|
Facility
|
OP
|
$57.35
|
|
|
Service Code
|
HCPCS 85246
|
| Hospital Charge Code |
40628227
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$18.35 |
| Max. Negotiated Rate |
$43.01 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$31.54
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$22.94
|
| Rate for Payer: Aetna Government |
$22.94
|
| Rate for Payer: Brighton Health Commercial |
$43.01
|
| Rate for Payer: Cash Price |
$22.94
|
| Rate for Payer: Cash Price |
$22.94
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$22.94
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$36.48
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$30.87
|
| Rate for Payer: Elderplan Medicare Advantage |
$22.94
|
| Rate for Payer: EmblemHealth Commercial |
$22.94
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$19.50
|
| Rate for Payer: Fidelis Essential Plan QHP |
$20.42
|
| Rate for Payer: Fidelis Medicare Advantage |
$22.94
|
| Rate for Payer: Fidelis Qualified Health Plan |
$20.42
|
| Rate for Payer: Group Health Inc Commercial |
$22.94
|
| Rate for Payer: Group Health Inc Medicare |
$22.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$28.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$22.94
|
| Rate for Payer: Healthfirst Medicare Advantage |
$22.94
|
| Rate for Payer: Healthfirst QHP |
$22.94
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$22.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$22.94
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$18.35
|
| Rate for Payer: Wellcare Medicare |
$20.65
|
|
|
VWF AG, MULTIMERIC
|
Facility
|
OP
|
$57.35
|
|
|
Service Code
|
HCPCS 85247
|
| Hospital Charge Code |
30303380
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$18.35 |
| Max. Negotiated Rate |
$43.01 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$31.54
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$22.94
|
| Rate for Payer: Aetna Government |
$22.94
|
| Rate for Payer: Brighton Health Commercial |
$43.01
|
| Rate for Payer: Cash Price |
$22.94
|
| Rate for Payer: Cash Price |
$22.94
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$22.94
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$36.48
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$30.87
|
| Rate for Payer: Elderplan Medicare Advantage |
$22.94
|
| Rate for Payer: EmblemHealth Commercial |
$22.94
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$19.50
|
| Rate for Payer: Fidelis Essential Plan QHP |
$20.42
|
| Rate for Payer: Fidelis Medicare Advantage |
$22.94
|
| Rate for Payer: Fidelis Qualified Health Plan |
$20.42
|
| Rate for Payer: Group Health Inc Commercial |
$22.94
|
| Rate for Payer: Group Health Inc Medicare |
$22.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$28.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$22.94
|
| Rate for Payer: Healthfirst Medicare Advantage |
$22.94
|
| Rate for Payer: Healthfirst QHP |
$22.94
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$22.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$22.94
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$18.35
|
| Rate for Payer: Wellcare Medicare |
$20.65
|
|
