|
Vaseline Gauze 3 X 9
|
Facility
|
IP
|
$2.50
|
|
| Hospital Charge Code |
3254252
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.25 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$2.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$2.38
|
| Rate for Payer: WPPA Medicare Advantage |
$1,200.00
|
|
|
Vasoactive Intestinal Peptide (Plasma/GI Tube) QST
|
Facility
|
OP
|
$315.00
|
|
|
Service Code
|
HCPCS 84586
|
| Hospital Charge Code |
3553986
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$94.08 |
| Max. Negotiated Rate |
$299.25 |
| Rate for Payer: Aetna Commercial |
$283.50
|
| Rate for Payer: Blue Cross Blue Shield of Kansas Commercial |
$94.08
|
| Rate for Payer: Humana Medicare Advantage |
$132.30
|
| Rate for Payer: UnitedHealthcare Commercial |
$299.25
|
| Rate for Payer: UnitedHealthcare Medicaid |
$126.00
|
| Rate for Payer: WPPA Medicare Advantage |
$189.00
|
|
|
Vasoactive Intestinal Peptide (Plasma/GI Tube) QST
|
Facility
|
IP
|
$315.00
|
|
|
Service Code
|
HCPCS 84586
|
| Hospital Charge Code |
3553986
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$283.50 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$283.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$299.25
|
| Rate for Payer: WPPA Medicare Advantage |
$1,200.00
|
|
|
vasopressin 20 units/mL Sol [HMC]
|
Facility
|
OP
|
$61.40
|
|
|
Service Code
|
NDC 43598091406
|
| Hospital Charge Code |
3805841
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$24.56 |
| Max. Negotiated Rate |
$58.33 |
| Rate for Payer: Aetna Commercial |
$55.26
|
| Rate for Payer: Humana Medicare Advantage |
$25.79
|
| Rate for Payer: UnitedHealthcare Commercial |
$58.33
|
| Rate for Payer: UnitedHealthcare Medicaid |
$24.56
|
| Rate for Payer: WPPA Medicare Advantage |
$36.84
|
|
|
vasopressin 20 units/mL Sol [HMC]
|
Facility
|
IP
|
$61.40
|
|
|
Service Code
|
NDC 43598091406
|
| Hospital Charge Code |
3805841
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$55.26 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$55.26
|
| Rate for Payer: UnitedHealthcare Commercial |
$58.33
|
| Rate for Payer: WPPA Medicare Advantage |
$1,200.00
|
|
|
vasopressin 20 units/mL Sol [HMC]
|
Facility
|
OP
|
$110.00
|
|
|
Service Code
|
NDC 00548970100
|
| Hospital Charge Code |
3805841
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$44.00 |
| Max. Negotiated Rate |
$104.50 |
| Rate for Payer: Aetna Commercial |
$99.00
|
| Rate for Payer: Humana Medicare Advantage |
$46.20
|
| Rate for Payer: UnitedHealthcare Commercial |
$104.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$44.00
|
| Rate for Payer: WPPA Medicare Advantage |
$66.00
|
|
|
vasopressin 20 units/mL Sol [HMC]
|
Facility
|
OP
|
$402.28
|
|
|
Service Code
|
NDC 42023016410
|
| Hospital Charge Code |
3805841
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$160.91 |
| Max. Negotiated Rate |
$382.17 |
| Rate for Payer: Aetna Commercial |
$362.05
|
| Rate for Payer: Humana Medicare Advantage |
$168.96
|
| Rate for Payer: UnitedHealthcare Commercial |
$382.17
|
| Rate for Payer: UnitedHealthcare Medicaid |
$160.91
|
| Rate for Payer: WPPA Medicare Advantage |
$241.37
|
|
|
vasopressin 20 units/mL Sol [HMC]
|
Facility
|
IP
|
$110.00
|
|
|
Service Code
|
NDC 00548970100
|
| Hospital Charge Code |
3805841
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$99.00 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$99.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$104.50
|
| Rate for Payer: WPPA Medicare Advantage |
$1,200.00
|
|
|
vasopressin 20 units/mL Sol [HMC]
|
Facility
|
IP
|
$402.28
|
|
|
Service Code
|
NDC 42023016410
|
| Hospital Charge Code |
3805841
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$362.05 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$362.05
|
| Rate for Payer: UnitedHealthcare Commercial |
$382.17
|
| Rate for Payer: WPPA Medicare Advantage |
$1,200.00
|
|
|
vecuronium 10 mg Pow [HMC]
|
Facility
|
OP
|
$42.68
|
|
|
Service Code
|
NDC 00703291403
|
| Hospital Charge Code |
3170455
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$17.07 |
| Max. Negotiated Rate |
$40.55 |
| Rate for Payer: Aetna Commercial |
$38.41
|
| Rate for Payer: Humana Medicare Advantage |
$17.93
|
| Rate for Payer: UnitedHealthcare Commercial |
$40.55
|
| Rate for Payer: UnitedHealthcare Medicaid |
$17.07
|
| Rate for Payer: WPPA Medicare Advantage |
$25.61
|
|
|
vecuronium 10 mg Pow [HMC]
|
Facility
|
IP
|
$42.68
|
|
|
Service Code
|
NDC 00703291403
|
| Hospital Charge Code |
3170455
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$38.41 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$38.41
|
| Rate for Payer: UnitedHealthcare Commercial |
$40.55
|
| Rate for Payer: WPPA Medicare Advantage |
$1,200.00
|
|
|
vedolizumab 300 mg Pow [HMC]
|
Facility
|
IP
|
$18,199.82
|
|
|
Service Code
|
HCPCS J3380
|
| Hospital Charge Code |
3800425
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1,200.00 |
| Max. Negotiated Rate |
$17,289.83 |
| Rate for Payer: Aetna Commercial |
$16,379.84
|
| Rate for Payer: UnitedHealthcare Commercial |
$17,289.83
|
| Rate for Payer: WPPA Medicare Advantage |
$1,200.00
|
|
|
vedolizumab 300 mg Pow [HMC]
|
Facility
|
OP
|
$18,199.82
|
|
|
Service Code
|
HCPCS J3380
|
| Hospital Charge Code |
3800425
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$21.37 |
| Max. Negotiated Rate |
$17,289.83 |
| Rate for Payer: Aetna Commercial |
$16,379.84
|
| Rate for Payer: Blue Cross Blue Shield of Kansas Commercial |
$35.07
|
| Rate for Payer: Humana Medicare Advantage |
$7,643.92
|
| Rate for Payer: UnitedHealthcare Commercial |
$17,289.83
|
| Rate for Payer: UnitedHealthcare Medicaid |
$21.37
|
| Rate for Payer: WPPA Medicare Advantage |
$10,919.89
|
|
|
Vedolizumab Quantitation with Ab, serum (Entyvio) QST
|
Facility
|
IP
|
$105.00
|
|
|
Service Code
|
HCPCS 80280
|
| Hospital Charge Code |
3556517
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$94.50 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$94.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$99.75
|
| Rate for Payer: WPPA Medicare Advantage |
$1,200.00
|
|
|
Vedolizumab Quantitation with Ab, serum (Entyvio) QST
|
Facility
|
OP
|
$105.00
|
|
|
Service Code
|
HCPCS 80280
|
| Hospital Charge Code |
3556517
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$32.78 |
| Max. Negotiated Rate |
$99.75 |
| Rate for Payer: Aetna Commercial |
$94.50
|
| Rate for Payer: Humana Medicare Advantage |
$44.10
|
| Rate for Payer: UnitedHealthcare Commercial |
$99.75
|
| Rate for Payer: UnitedHealthcare Medicaid |
$32.78
|
| Rate for Payer: WPPA Medicare Advantage |
$63.00
|
|
|
VEIN LIGATION AND STRIPPING
|
Facility
|
IP
|
$10,960.65
|
|
|
Service Code
|
MSDRG 263
|
| Min. Negotiated Rate |
$1,200.00 |
| Max. Negotiated Rate |
$10,960.65 |
| Rate for Payer: UnitedHealthcare Medicaid |
$10,960.65
|
| Rate for Payer: WPPA Medicare Advantage |
$1,200.00
|
|
|
venlafaxine 37.5 mg ERCap [HMC]
|
Facility
|
IP
|
$17.49
|
|
|
Service Code
|
NDC 68382003406
|
| Hospital Charge Code |
3809172
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.74 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$15.74
|
| Rate for Payer: UnitedHealthcare Commercial |
$16.62
|
| Rate for Payer: WPPA Medicare Advantage |
$1,200.00
|
|
|
venlafaxine 37.5 mg ERCap [HMC]
|
Facility
|
OP
|
$16.23
|
|
|
Service Code
|
NDC 68084069801
|
| Hospital Charge Code |
3809172
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.49 |
| Max. Negotiated Rate |
$15.42 |
| Rate for Payer: Aetna Commercial |
$14.61
|
| Rate for Payer: Humana Medicare Advantage |
$6.82
|
| Rate for Payer: UnitedHealthcare Commercial |
$15.42
|
| Rate for Payer: UnitedHealthcare Medicaid |
$6.49
|
| Rate for Payer: WPPA Medicare Advantage |
$9.74
|
|
|
venlafaxine 37.5 mg ERCap [HMC]
|
Facility
|
OP
|
$17.49
|
|
|
Service Code
|
NDC 68382003406
|
| Hospital Charge Code |
3809172
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.00 |
| Max. Negotiated Rate |
$16.62 |
| Rate for Payer: Aetna Commercial |
$15.74
|
| Rate for Payer: Humana Medicare Advantage |
$7.35
|
| Rate for Payer: UnitedHealthcare Commercial |
$16.62
|
| Rate for Payer: UnitedHealthcare Medicaid |
$7.00
|
| Rate for Payer: WPPA Medicare Advantage |
$10.49
|
|
|
venlafaxine 37.5 mg ERCap [HMC]
|
Facility
|
OP
|
$6.85
|
|
|
Service Code
|
NDC 00904707561
|
| Hospital Charge Code |
3809172
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.74 |
| Max. Negotiated Rate |
$6.51 |
| Rate for Payer: Aetna Commercial |
$6.17
|
| Rate for Payer: Humana Medicare Advantage |
$2.88
|
| Rate for Payer: UnitedHealthcare Commercial |
$6.51
|
| Rate for Payer: UnitedHealthcare Medicaid |
$2.74
|
| Rate for Payer: WPPA Medicare Advantage |
$4.11
|
|
|
venlafaxine 37.5 mg ERCap [HMC]
|
Facility
|
IP
|
$16.23
|
|
|
Service Code
|
NDC 68084069801
|
| Hospital Charge Code |
3809172
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.61 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$14.61
|
| Rate for Payer: UnitedHealthcare Commercial |
$15.42
|
| Rate for Payer: WPPA Medicare Advantage |
$1,200.00
|
|
|
venlafaxine 37.5 mg ERCap [HMC]
|
Facility
|
IP
|
$6.85
|
|
|
Service Code
|
NDC 00904707561
|
| Hospital Charge Code |
3809172
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.17 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$6.17
|
| Rate for Payer: UnitedHealthcare Commercial |
$6.51
|
| Rate for Payer: WPPA Medicare Advantage |
$1,200.00
|
|
|
venlafaxine 37.5 mg ERCap [HMC]
|
Facility
|
OP
|
$6.85
|
|
|
Service Code
|
NDC 00904646861
|
| Hospital Charge Code |
3809172
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.74 |
| Max. Negotiated Rate |
$6.51 |
| Rate for Payer: Aetna Commercial |
$6.17
|
| Rate for Payer: Humana Medicare Advantage |
$2.88
|
| Rate for Payer: UnitedHealthcare Commercial |
$6.51
|
| Rate for Payer: UnitedHealthcare Medicaid |
$2.74
|
| Rate for Payer: WPPA Medicare Advantage |
$4.11
|
|
|
venlafaxine 37.5 mg ERCap [HMC]
|
Facility
|
IP
|
$6.85
|
|
|
Service Code
|
NDC 00904646861
|
| Hospital Charge Code |
3809172
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.17 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$6.17
|
| Rate for Payer: UnitedHealthcare Commercial |
$6.51
|
| Rate for Payer: WPPA Medicare Advantage |
$1,200.00
|
|
|
venlafaxine 75 mg ERCap [HMC]
|
Facility
|
OP
|
$6.88
|
|
|
Service Code
|
NDC 00904707761
|
| Hospital Charge Code |
3800287
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.75 |
| Max. Negotiated Rate |
$6.54 |
| Rate for Payer: Aetna Commercial |
$6.19
|
| Rate for Payer: Humana Medicare Advantage |
$2.89
|
| Rate for Payer: UnitedHealthcare Commercial |
$6.54
|
| Rate for Payer: UnitedHealthcare Medicaid |
$2.75
|
| Rate for Payer: WPPA Medicare Advantage |
$4.13
|
|
