|
PR I&D SHOULDER DEEP ABSCESS/HEMATOMA
|
Professional
|
Both
|
$1,125.08
|
|
|
Service Code
|
HCPCS 23030
|
| Min. Negotiated Rate |
$212.44 |
| Max. Negotiated Rate |
$682.83 |
| Rate for Payer: Cash Price |
$304.69
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$303.48
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$273.13
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$273.13
|
| Rate for Payer: Fidelis Essential Plan QHP |
$288.31
|
| Rate for Payer: Fidelis Medicare Advantage |
$303.48
|
| Rate for Payer: Fidelis Qualified Health Plan |
$288.31
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$303.48
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$303.48
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$227.61
|
| Rate for Payer: Healthfirst Commercial |
$303.48
|
| Rate for Payer: Healthfirst Essential Plan |
$682.83
|
| Rate for Payer: Healthfirst Medicare Advantage |
$288.31
|
| Rate for Payer: Healthfirst QHP |
$303.48
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$212.44
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$303.48
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$257.96
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$212.44
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$303.48
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$227.61
|
| Rate for Payer: SOMOS Essential |
$227.61
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$303.48
|
|
|
PR I&D SHOULDER INFECTED BURSA
|
Professional
|
Both
|
$982.80
|
|
|
Service Code
|
HCPCS 23031
|
| Min. Negotiated Rate |
$186.93 |
| Max. Negotiated Rate |
$600.84 |
| Rate for Payer: Cash Price |
$266.95
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$267.04
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$240.34
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$240.34
|
| Rate for Payer: Fidelis Essential Plan QHP |
$253.69
|
| Rate for Payer: Fidelis Medicare Advantage |
$267.04
|
| Rate for Payer: Fidelis Qualified Health Plan |
$253.69
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$267.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$267.04
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$200.28
|
| Rate for Payer: Healthfirst Commercial |
$267.04
|
| Rate for Payer: Healthfirst Essential Plan |
$600.84
|
| Rate for Payer: Healthfirst Medicare Advantage |
$253.69
|
| Rate for Payer: Healthfirst QHP |
$267.04
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$186.93
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$267.04
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$226.98
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$186.93
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$267.04
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$200.28
|
| Rate for Payer: SOMOS Essential |
$200.28
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$267.04
|
|
|
PR I&D SUBMUCOSAL ABSCESS RECTUM
|
Professional
|
Both
|
$749.04
|
|
|
Service Code
|
HCPCS 45005
|
| Min. Negotiated Rate |
$141.16 |
| Max. Negotiated Rate |
$453.71 |
| Rate for Payer: Cash Price |
$199.41
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$201.65
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$181.49
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$181.49
|
| Rate for Payer: Fidelis Essential Plan QHP |
$191.57
|
| Rate for Payer: Fidelis Medicare Advantage |
$201.65
|
| Rate for Payer: Fidelis Qualified Health Plan |
$191.57
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$201.65
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$201.65
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$151.24
|
| Rate for Payer: Healthfirst Commercial |
$201.65
|
| Rate for Payer: Healthfirst Essential Plan |
$453.71
|
| Rate for Payer: Healthfirst Medicare Advantage |
$191.57
|
| Rate for Payer: Healthfirst QHP |
$201.65
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$141.16
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$201.65
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$171.40
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$141.16
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$201.65
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$151.24
|
| Rate for Payer: SOMOS Essential |
$151.24
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$201.65
|
|
|
PR I&D THYROGLOSSAL DUCT CYST INFECTED
|
Professional
|
Both
|
$678.93
|
|
|
Service Code
|
HCPCS 60000
|
| Min. Negotiated Rate |
$130.32 |
| Max. Negotiated Rate |
$418.88 |
| Rate for Payer: Cash Price |
$186.66
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$186.17
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$167.55
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$167.55
|
| Rate for Payer: Fidelis Essential Plan QHP |
$176.86
|
| Rate for Payer: Fidelis Medicare Advantage |
$186.17
|
| Rate for Payer: Fidelis Qualified Health Plan |
$176.86
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$186.17
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$186.17
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$139.63
|
| Rate for Payer: Healthfirst Commercial |
$186.17
|
| Rate for Payer: Healthfirst Essential Plan |
$418.88
|
| Rate for Payer: Healthfirst Medicare Advantage |
$176.86
|
| Rate for Payer: Healthfirst QHP |
$186.17
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$130.32
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$186.17
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$158.24
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$130.32
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$186.17
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$139.63
|
| Rate for Payer: SOMOS Essential |
$139.63
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$186.17
|
|
|
PR I&D UPPER ARM/ELBOW DEEP ABSCESS/HEMATOMA
|
Professional
|
Both
|
$959.28
|
|
|
Service Code
|
HCPCS 23930
|
| Min. Negotiated Rate |
$180.60 |
| Max. Negotiated Rate |
$580.50 |
| Rate for Payer: Cash Price |
$258.03
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$258.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$232.20
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$232.20
|
| Rate for Payer: Fidelis Essential Plan QHP |
$245.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$258.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$245.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$258.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$258.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$193.50
|
| Rate for Payer: Healthfirst Commercial |
$258.00
|
| Rate for Payer: Healthfirst Essential Plan |
$580.50
|
| Rate for Payer: Healthfirst Medicare Advantage |
$245.10
|
| Rate for Payer: Healthfirst QHP |
$258.00
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$180.60
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$258.00
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$219.30
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$180.60
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$258.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$193.50
|
| Rate for Payer: SOMOS Essential |
$193.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$258.00
|
|
|
PR I&D VAGINAL HEMATOMA NON-OBSTETRICAL
|
Professional
|
Both
|
$1,395.98
|
|
|
Service Code
|
HCPCS 57023
|
| Min. Negotiated Rate |
$259.94 |
| Max. Negotiated Rate |
$835.51 |
| Rate for Payer: Cash Price |
$377.55
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$371.34
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$334.21
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$334.21
|
| Rate for Payer: Fidelis Essential Plan QHP |
$352.77
|
| Rate for Payer: Fidelis Medicare Advantage |
$371.34
|
| Rate for Payer: Fidelis Qualified Health Plan |
$352.77
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$371.34
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$371.34
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$278.50
|
| Rate for Payer: Healthfirst Commercial |
$371.34
|
| Rate for Payer: Healthfirst Essential Plan |
$835.51
|
| Rate for Payer: Healthfirst Medicare Advantage |
$352.77
|
| Rate for Payer: Healthfirst QHP |
$371.34
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$259.94
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$371.34
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$315.64
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$259.94
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$371.34
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$278.50
|
| Rate for Payer: SOMOS Essential |
$278.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$371.34
|
|
|
PR I&D VAGINAL HEMATOMA OBSTETRICAL/POSTPARTUM
|
Professional
|
Both
|
$791.49
|
|
|
Service Code
|
HCPCS 57022
|
| Min. Negotiated Rate |
$148.28 |
| Max. Negotiated Rate |
$476.62 |
| Rate for Payer: Cash Price |
$213.73
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$211.83
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$190.65
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$190.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$201.24
|
| Rate for Payer: Fidelis Medicare Advantage |
$211.83
|
| Rate for Payer: Fidelis Qualified Health Plan |
$201.24
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$211.83
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$211.83
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$158.87
|
| Rate for Payer: Healthfirst Commercial |
$211.83
|
| Rate for Payer: Healthfirst Essential Plan |
$476.62
|
| Rate for Payer: Healthfirst Medicare Advantage |
$201.24
|
| Rate for Payer: Healthfirst QHP |
$211.83
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$148.28
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$211.83
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$180.06
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$148.28
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$211.83
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$158.87
|
| Rate for Payer: SOMOS Essential |
$158.87
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$211.83
|
|
|
PR I&D VULVA/PERINEAL ABSCESS
|
Professional
|
Both
|
$555.45
|
|
|
Service Code
|
HCPCS 56405
|
| Min. Negotiated Rate |
$104.40 |
| Max. Negotiated Rate |
$335.56 |
| Rate for Payer: Cash Price |
$150.51
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$149.14
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$134.23
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$134.23
|
| Rate for Payer: Fidelis Essential Plan QHP |
$141.68
|
| Rate for Payer: Fidelis Medicare Advantage |
$149.14
|
| Rate for Payer: Fidelis Qualified Health Plan |
$141.68
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$149.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$149.14
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$111.86
|
| Rate for Payer: Healthfirst Commercial |
$149.14
|
| Rate for Payer: Healthfirst Essential Plan |
$335.56
|
| Rate for Payer: Healthfirst Medicare Advantage |
$141.68
|
| Rate for Payer: Healthfirst QHP |
$149.14
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$104.40
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$149.14
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$126.77
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$104.40
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$149.14
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$111.86
|
| Rate for Payer: SOMOS Essential |
$111.86
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$149.14
|
|
|
PR IIV3 VACCINE SPLIT VIRUS 0.25 ML DOSAGE IM USE
|
Professional
|
Both
|
$35.00
|
|
|
Service Code
|
HCPCS 90657
|
| Min. Negotiated Rate |
$7.72 |
| Max. Negotiated Rate |
$24.82 |
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$11.03
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$9.93
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$9.93
|
| Rate for Payer: Fidelis Essential Plan QHP |
$10.48
|
| Rate for Payer: Fidelis Medicare Advantage |
$11.03
|
| Rate for Payer: Fidelis Qualified Health Plan |
$10.48
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11.03
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$11.03
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$8.27
|
| Rate for Payer: Healthfirst Commercial |
$11.03
|
| Rate for Payer: Healthfirst Essential Plan |
$24.82
|
| Rate for Payer: Healthfirst Medicare Advantage |
$10.48
|
| Rate for Payer: Healthfirst QHP |
$11.03
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$7.72
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$11.03
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$9.38
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$7.72
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$11.03
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$8.27
|
| Rate for Payer: SOMOS Essential |
$8.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$11.03
|
|
|
PR IIV3 VACCINE SPLIT VIRUS 0.5 ML DOSAGE IM USE
|
Professional
|
Both
|
$71.82
|
|
|
Service Code
|
HCPCS 90658
|
| Min. Negotiated Rate |
$15.45 |
| Max. Negotiated Rate |
$49.66 |
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$22.07
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$19.86
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$19.86
|
| Rate for Payer: Fidelis Essential Plan QHP |
$20.97
|
| Rate for Payer: Fidelis Medicare Advantage |
$22.07
|
| Rate for Payer: Fidelis Qualified Health Plan |
$20.97
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$22.07
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$22.07
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$16.55
|
| Rate for Payer: Healthfirst Commercial |
$22.07
|
| Rate for Payer: Healthfirst Essential Plan |
$49.66
|
| Rate for Payer: Healthfirst Medicare Advantage |
$20.97
|
| Rate for Payer: Healthfirst QHP |
$22.07
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$15.45
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$22.07
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$18.76
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$15.45
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$22.07
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$16.55
|
| Rate for Payer: SOMOS Essential |
$16.55
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$22.07
|
|
|
PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE
|
Professional
|
Both
|
$635.25
|
|
|
Service Code
|
HCPCS 90686
|
| Rate for Payer: Cash Price |
$22.35
|
|
|
PR IIV VACCINE PRESERV FREE INCREASED AG CONTENT IM
|
Professional
|
Both
|
$107.00
|
|
|
Service Code
|
HCPCS 90662
|
| Min. Negotiated Rate |
$68.71 |
| Max. Negotiated Rate |
$220.86 |
| Rate for Payer: Cash Price |
$73.40
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$98.16
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$88.34
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$88.34
|
| Rate for Payer: Fidelis Essential Plan QHP |
$93.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$98.16
|
| Rate for Payer: Fidelis Qualified Health Plan |
$93.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$98.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$98.16
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$73.62
|
| Rate for Payer: Healthfirst Commercial |
$98.16
|
| Rate for Payer: Healthfirst Essential Plan |
$220.86
|
| Rate for Payer: Healthfirst Medicare Advantage |
$93.25
|
| Rate for Payer: Healthfirst QHP |
$98.16
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$68.71
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$98.16
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$83.44
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$68.71
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$98.16
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$73.62
|
| Rate for Payer: SOMOS Essential |
$73.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$98.16
|
|
|
PR ILEOSCOPY STOMA W/BALLOON DILATION
|
Professional
|
Both
|
$358.51
|
|
|
Service Code
|
HCPCS 44381
|
| Min. Negotiated Rate |
$66.72 |
| Max. Negotiated Rate |
$214.45 |
| Rate for Payer: Cash Price |
$97.11
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$95.31
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$85.78
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$85.78
|
| Rate for Payer: Fidelis Essential Plan QHP |
$90.54
|
| Rate for Payer: Fidelis Medicare Advantage |
$95.31
|
| Rate for Payer: Fidelis Qualified Health Plan |
$90.54
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$95.31
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$95.31
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$71.48
|
| Rate for Payer: Healthfirst Commercial |
$95.31
|
| Rate for Payer: Healthfirst Essential Plan |
$214.45
|
| Rate for Payer: Healthfirst Medicare Advantage |
$90.54
|
| Rate for Payer: Healthfirst QHP |
$95.31
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$66.72
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$95.31
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$81.01
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$66.72
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$95.31
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$71.48
|
| Rate for Payer: SOMOS Essential |
$71.48
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$95.31
|
|
|
PR ILEOSCOPY STOMA W/BX SINGLE/MULTIPLE
|
Professional
|
Both
|
$315.25
|
|
|
Service Code
|
HCPCS 44382
|
| Min. Negotiated Rate |
$58.88 |
| Max. Negotiated Rate |
$189.27 |
| Rate for Payer: Cash Price |
$84.76
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$84.12
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$75.71
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$75.71
|
| Rate for Payer: Fidelis Essential Plan QHP |
$79.91
|
| Rate for Payer: Fidelis Medicare Advantage |
$84.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$79.91
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$84.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$84.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$63.09
|
| Rate for Payer: Healthfirst Commercial |
$84.12
|
| Rate for Payer: Healthfirst Essential Plan |
$189.27
|
| Rate for Payer: Healthfirst Medicare Advantage |
$79.91
|
| Rate for Payer: Healthfirst QHP |
$84.12
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$58.88
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$84.12
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$71.50
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$58.88
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$84.12
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$63.09
|
| Rate for Payer: SOMOS Essential |
$63.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$84.12
|
|
|
PR ILEOSCOPY STOMA W/PLMT OF ENDOSCOPIC STENT
|
Professional
|
Both
|
$648.10
|
|
|
Service Code
|
HCPCS 44384
|
| Min. Negotiated Rate |
$120.28 |
| Max. Negotiated Rate |
$386.62 |
| Rate for Payer: Cash Price |
$172.37
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$171.83
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$154.65
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$154.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$163.24
|
| Rate for Payer: Fidelis Medicare Advantage |
$171.83
|
| Rate for Payer: Fidelis Qualified Health Plan |
$163.24
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$171.83
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$171.83
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$128.87
|
| Rate for Payer: Healthfirst Commercial |
$171.83
|
| Rate for Payer: Healthfirst Essential Plan |
$386.62
|
| Rate for Payer: Healthfirst Medicare Advantage |
$163.24
|
| Rate for Payer: Healthfirst QHP |
$171.83
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$120.28
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$171.83
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$146.06
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$120.28
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$171.83
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$128.87
|
| Rate for Payer: SOMOS Essential |
$128.87
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$171.83
|
|
|
PR ILEOSCOPY THRU STOMA DX W/COLLJ SPEC WHEN PRFMD
|
Professional
|
Both
|
$239.68
|
|
|
Service Code
|
HCPCS 44380
|
| Min. Negotiated Rate |
$46.28 |
| Max. Negotiated Rate |
$148.75 |
| Rate for Payer: Cash Price |
$65.91
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$66.11
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$59.50
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$59.50
|
| Rate for Payer: Fidelis Essential Plan QHP |
$62.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$66.11
|
| Rate for Payer: Fidelis Qualified Health Plan |
$62.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$66.11
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$66.11
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$49.58
|
| Rate for Payer: Healthfirst Commercial |
$66.11
|
| Rate for Payer: Healthfirst Essential Plan |
$148.75
|
| Rate for Payer: Healthfirst Medicare Advantage |
$62.80
|
| Rate for Payer: Healthfirst QHP |
$66.11
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$46.28
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$66.11
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$56.19
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$46.28
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$66.11
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$49.58
|
| Rate for Payer: SOMOS Essential |
$49.58
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$66.11
|
|
|
PR ILEOSTOMY/JEJUNOSTOMY NON-TUBE
|
Professional
|
Both
|
$4,606.70
|
|
|
Service Code
|
HCPCS 44310
|
| Min. Negotiated Rate |
$856.13 |
| Max. Negotiated Rate |
$2,751.84 |
| Rate for Payer: Cash Price |
$1,232.96
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,223.04
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,100.74
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,100.74
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,161.89
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,223.04
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,161.89
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,223.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,223.04
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$917.28
|
| Rate for Payer: Healthfirst Commercial |
$1,223.04
|
| Rate for Payer: Healthfirst Essential Plan |
$2,751.84
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,161.89
|
| Rate for Payer: Healthfirst QHP |
$1,223.04
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$856.13
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,223.04
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,039.58
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$856.13
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,223.04
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$917.28
|
| Rate for Payer: SOMOS Essential |
$917.28
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,223.04
|
|
|
PR ILIAC ART ANGIO,CARDIAC CATH
|
Professional
|
Both
|
$60.66
|
|
|
Service Code
|
HCPCS G0278
|
| Min. Negotiated Rate |
$10.64 |
| Max. Negotiated Rate |
$34.20 |
| Rate for Payer: Cash Price |
$16.01
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$15.20
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$13.68
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$13.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$14.44
|
| Rate for Payer: Fidelis Medicare Advantage |
$15.20
|
| Rate for Payer: Fidelis Qualified Health Plan |
$14.44
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$15.20
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$11.40
|
| Rate for Payer: Healthfirst Commercial |
$15.20
|
| Rate for Payer: Healthfirst Essential Plan |
$34.20
|
| Rate for Payer: Healthfirst Medicare Advantage |
$14.44
|
| Rate for Payer: Healthfirst QHP |
$15.20
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$10.64
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$15.20
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$12.92
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$10.64
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$15.20
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$11.40
|
| Rate for Payer: SOMOS Essential |
$11.40
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$15.20
|
|
|
PRILOCAINE HCL 4 % IJ SOLN
|
Facility
|
OP
|
$0.53
|
|
|
Service Code
|
NDC 6631263014
|
| Hospital Charge Code |
6631263014
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.19 |
| Max. Negotiated Rate |
$0.43 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.29
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.27
|
| Rate for Payer: Aetna Government |
$0.27
|
| Rate for Payer: Brighton Health Commercial |
$0.40
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.43
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.36
|
| Rate for Payer: EmblemHealth Commercial |
$0.27
|
| Rate for Payer: Group Health Inc Commercial |
$0.27
|
| Rate for Payer: Group Health Inc Medicare |
$0.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.27
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.35
|
|
|
PRILOCAINE HCL 4 % IJ SOLN
|
Facility
|
IP
|
$0.53
|
|
|
Service Code
|
NDC 6631263014
|
| Hospital Charge Code |
6631263014
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.27 |
| Max. Negotiated Rate |
$0.27 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.27
|
|
|
PR IM ADM INTRANSL/ORAL 1 VACCINE
|
Professional
|
Both
|
$68.60
|
|
|
Service Code
|
HCPCS 90473
|
| Min. Negotiated Rate |
$13.23 |
| Max. Negotiated Rate |
$42.52 |
| Rate for Payer: Cash Price |
$19.13
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$18.90
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$17.01
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$17.01
|
| Rate for Payer: Fidelis Essential Plan QHP |
$17.95
|
| Rate for Payer: Fidelis Medicare Advantage |
$18.90
|
| Rate for Payer: Fidelis Qualified Health Plan |
$17.95
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$18.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$18.90
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$14.18
|
| Rate for Payer: Healthfirst Commercial |
$18.90
|
| Rate for Payer: Healthfirst Essential Plan |
$42.52
|
| Rate for Payer: Healthfirst Medicare Advantage |
$17.95
|
| Rate for Payer: Healthfirst QHP |
$18.90
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$13.23
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$18.90
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$16.07
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$13.23
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$18.90
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$14.18
|
| Rate for Payer: SOMOS Essential |
$14.18
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$18.90
|
|
|
PR IM ADM INTRANSL/ORAL EA VACCINE
|
Professional
|
Both
|
$48.83
|
|
|
Service Code
|
HCPCS 90474
|
| Min. Negotiated Rate |
$9.48 |
| Max. Negotiated Rate |
$30.49 |
| Rate for Payer: Cash Price |
$13.72
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$13.55
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$12.20
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$12.20
|
| Rate for Payer: Fidelis Essential Plan QHP |
$12.87
|
| Rate for Payer: Fidelis Medicare Advantage |
$13.55
|
| Rate for Payer: Fidelis Qualified Health Plan |
$12.87
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$13.55
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.55
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$10.16
|
| Rate for Payer: Healthfirst Commercial |
$13.55
|
| Rate for Payer: Healthfirst Essential Plan |
$30.49
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12.87
|
| Rate for Payer: Healthfirst QHP |
$13.55
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$9.48
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$13.55
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$11.52
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$9.48
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$13.55
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$10.16
|
| Rate for Payer: SOMOS Essential |
$10.16
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$13.55
|
|
|
PR IM ADM PRQ ID SUBQ/IM NJXS 1 VACCINE
|
Professional
|
Both
|
$84.42
|
|
|
Service Code
|
HCPCS 90471
|
| Min. Negotiated Rate |
$16.48 |
| Max. Negotiated Rate |
$52.99 |
| Rate for Payer: Cash Price |
$23.84
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$23.55
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$21.20
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$21.20
|
| Rate for Payer: Fidelis Essential Plan QHP |
$22.37
|
| Rate for Payer: Fidelis Medicare Advantage |
$23.55
|
| Rate for Payer: Fidelis Qualified Health Plan |
$22.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$23.55
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$23.55
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$17.66
|
| Rate for Payer: Healthfirst Commercial |
$23.55
|
| Rate for Payer: Healthfirst Essential Plan |
$52.99
|
| Rate for Payer: Healthfirst Medicare Advantage |
$22.37
|
| Rate for Payer: Healthfirst QHP |
$23.55
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$16.48
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$23.55
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$20.02
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$16.48
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$23.55
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$17.66
|
| Rate for Payer: SOMOS Essential |
$17.66
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$23.55
|
|
|
PR IM ADM PRQ ID SUBQ/IM NJXS EA VACCINE
|
Professional
|
Both
|
$60.34
|
|
|
Service Code
|
HCPCS 90472
|
| Min. Negotiated Rate |
$11.65 |
| Max. Negotiated Rate |
$37.46 |
| Rate for Payer: Cash Price |
$16.86
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$16.65
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$14.98
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$14.98
|
| Rate for Payer: Fidelis Essential Plan QHP |
$15.82
|
| Rate for Payer: Fidelis Medicare Advantage |
$16.65
|
| Rate for Payer: Fidelis Qualified Health Plan |
$15.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.65
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.65
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$12.49
|
| Rate for Payer: Healthfirst Commercial |
$16.65
|
| Rate for Payer: Healthfirst Essential Plan |
$37.46
|
| Rate for Payer: Healthfirst Medicare Advantage |
$15.82
|
| Rate for Payer: Healthfirst QHP |
$16.65
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$11.65
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$16.65
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$14.15
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$11.65
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$16.65
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$12.49
|
| Rate for Payer: SOMOS Essential |
$12.49
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$16.65
|
|
|
PR IM ADM THRU 18YR ANY RTE 1ST/ONLY COMPT VAC/TOX
|
Professional
|
Both
|
$94.47
|
|
|
Service Code
|
HCPCS 90460
|
| Min. Negotiated Rate |
$18.33 |
| Max. Negotiated Rate |
$58.93 |
| Rate for Payer: Cash Price |
$26.52
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$26.19
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$23.57
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$23.57
|
| Rate for Payer: Fidelis Essential Plan QHP |
$24.88
|
| Rate for Payer: Fidelis Medicare Advantage |
$26.19
|
| Rate for Payer: Fidelis Qualified Health Plan |
$24.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$26.19
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$26.19
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$19.64
|
| Rate for Payer: Healthfirst Commercial |
$26.19
|
| Rate for Payer: Healthfirst Essential Plan |
$58.93
|
| Rate for Payer: Healthfirst Medicare Advantage |
$24.88
|
| Rate for Payer: Healthfirst QHP |
$26.19
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$18.33
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$26.19
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$22.26
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$18.33
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$26.19
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$19.64
|
| Rate for Payer: SOMOS Essential |
$19.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$26.19
|
|
