|
PNEUMOCOCCAL 13 VALENT(VFC)0.5IM
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS 90670
|
| Hospital Charge Code |
41659564
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$273.47 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$241.38
|
| Rate for Payer: Aetna Government |
$241.38
|
| 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 |
$0.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$273.47
|
| Rate for Payer: SOMOS Essential |
$273.47
|
| Rate for Payer: United Healthcare Commercial |
$257.99
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.01
|
|
|
PNEUMOCOCCAL 13 VALENT(VFC)0.5IM
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS 90670
|
| Hospital Charge Code |
41659564
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
|
|
PNEUMOCOCCAL 15-VAL CONJ VACC 0.5 ML IM SUSY [180884]
|
Facility
|
OP
|
$550.50
|
|
|
Service Code
|
NDC 00006432901
|
| Hospital Charge Code |
00006432902
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$192.68 |
| Max. Negotiated Rate |
$440.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$302.78
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$275.25
|
| Rate for Payer: Aetna Government |
$275.25
|
| Rate for Payer: Brighton Health Commercial |
$412.88
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$440.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$374.34
|
| Rate for Payer: Group Health Inc Commercial |
$275.25
|
| Rate for Payer: Group Health Inc Medicare |
$192.68
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$275.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$275.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$357.82
|
|
|
PNEUMOCOCCAL 15-VAL CONJ VACC 0.5 ML IM SUSY [180884]
|
Facility
|
OP
|
$533.81
|
|
|
Service Code
|
NDC 00006432903
|
| Hospital Charge Code |
00006432903
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$186.83 |
| Max. Negotiated Rate |
$427.05 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$293.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$266.90
|
| Rate for Payer: Aetna Government |
$266.90
|
| Rate for Payer: Brighton Health Commercial |
$400.36
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$427.05
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$362.99
|
| Rate for Payer: Group Health Inc Commercial |
$266.90
|
| Rate for Payer: Group Health Inc Medicare |
$186.83
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$266.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$266.90
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$346.98
|
|
|
PNEUMOCOCCAL 15-VAL CONJ VACC 0.5 ML IM SUSY [180884]
|
Facility
|
OP
|
$550.50
|
|
|
Service Code
|
NDC 00006432902
|
| Hospital Charge Code |
00006432902
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$192.68 |
| Max. Negotiated Rate |
$440.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$302.78
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$275.25
|
| Rate for Payer: Aetna Government |
$275.25
|
| Rate for Payer: Brighton Health Commercial |
$412.88
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$440.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$374.34
|
| Rate for Payer: Group Health Inc Commercial |
$275.25
|
| Rate for Payer: Group Health Inc Medicare |
$192.68
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$275.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$275.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$357.82
|
|
|
PNEUMOCOCCAL 20VAL CONJ
|
Facility
|
OP
|
$480.09
|
|
|
Service Code
|
HCPCS 90677
|
| Hospital Charge Code |
41650340
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$168.03 |
| Max. Negotiated Rate |
$315.92 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$264.05
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$264.74
|
| Rate for Payer: Aetna Government |
$264.74
|
| Rate for Payer: Brighton Health Commercial |
$288.05
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$240.04
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$276.05
|
| Rate for Payer: Group Health Inc Commercial |
$240.04
|
| Rate for Payer: Group Health Inc Medicare |
$168.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$240.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$240.04
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$315.92
|
| Rate for Payer: SOMOS Essential |
$315.92
|
| Rate for Payer: United Healthcare Commercial |
$283.72
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$312.06
|
|
|
PNEUMOCOCCAL 20VAL CONJ
|
Facility
|
IP
|
$480.09
|
|
|
Service Code
|
HCPCS 90677
|
| Hospital Charge Code |
41650340
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$240.04 |
| Max. Negotiated Rate |
$240.04 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$240.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$240.04
|
|
|
PNEUMOCOCCAL 20VAL CONJ
|
Facility
|
IP
|
$480.09
|
|
|
Service Code
|
HCPCS 90677
|
| Hospital Charge Code |
41640340
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$240.04 |
| Max. Negotiated Rate |
$240.04 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$240.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$240.04
|
|
|
PNEUMOCOCCAL 20VAL CONJ
|
Facility
|
OP
|
$480.09
|
|
|
Service Code
|
HCPCS 90677
|
| Hospital Charge Code |
41640340
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$168.03 |
| Max. Negotiated Rate |
$315.92 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$264.05
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$264.74
|
| Rate for Payer: Aetna Government |
$264.74
|
| Rate for Payer: Brighton Health Commercial |
$288.05
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$240.04
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$276.05
|
| Rate for Payer: Group Health Inc Commercial |
$240.04
|
| Rate for Payer: Group Health Inc Medicare |
$168.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$240.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$240.04
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$315.92
|
| Rate for Payer: SOMOS Essential |
$315.92
|
| Rate for Payer: United Healthcare Commercial |
$283.72
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$312.06
|
|
|
PNEUMOCOCCAL 20-VAL CONJ VACC 0.5 ML IM SUSY [180721]
|
Facility
|
OP
|
$627.54
|
|
|
Service Code
|
HCPCS J90677
|
| Hospital Charge Code |
00005200010
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$219.64 |
| Max. Negotiated Rate |
$502.04 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$345.15
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$313.77
|
| Rate for Payer: Aetna Government |
$313.77
|
| Rate for Payer: Brighton Health Commercial |
$470.66
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$502.04
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$426.73
|
| Rate for Payer: Group Health Inc Commercial |
$313.77
|
| Rate for Payer: Group Health Inc Medicare |
$219.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$313.77
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$313.77
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$407.90
|
|
|
PNEUMOCOCCAL 20-VAL CONJ VACC 0.5 ML IM SUSY [180721]
|
Facility
|
OP
|
$647.12
|
|
|
Service Code
|
HCPCS J90677
|
| Hospital Charge Code |
00005200002
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$226.49 |
| Max. Negotiated Rate |
$517.70 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$355.92
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$323.56
|
| Rate for Payer: Aetna Government |
$323.56
|
| Rate for Payer: Brighton Health Commercial |
$485.34
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$517.70
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$440.04
|
| Rate for Payer: Group Health Inc Commercial |
$323.56
|
| Rate for Payer: Group Health Inc Medicare |
$226.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$323.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$323.56
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$420.63
|
|
|
PNEUMOCOCCAL IM (14 SEROTYPE)
|
Facility
|
OP
|
$32.20
|
|
|
Service Code
|
HCPCS 86609
|
| Hospital Charge Code |
40619167
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.02 |
| Max. Negotiated Rate |
$24.15 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$17.71
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12.88
|
| Rate for Payer: Aetna Government |
$12.88
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$9.02
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$9.02
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$9.02
|
| Rate for Payer: Brighton Health Commercial |
$24.15
|
| Rate for Payer: Cash Price |
$12.88
|
| Rate for Payer: Cash Price |
$12.88
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$12.88
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$20.48
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$17.32
|
| Rate for Payer: Elderplan Medicare Advantage |
$12.88
|
| Rate for Payer: EmblemHealth Commercial |
$12.88
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$10.95
|
| Rate for Payer: Fidelis Essential Plan QHP |
$11.46
|
| Rate for Payer: Fidelis Medicare Advantage |
$12.88
|
| Rate for Payer: Fidelis Qualified Health Plan |
$11.46
|
| Rate for Payer: Group Health Inc Commercial |
$12.88
|
| Rate for Payer: Group Health Inc Medicare |
$12.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.88
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12.88
|
| Rate for Payer: Healthfirst QHP |
$12.88
|
| Rate for Payer: Humana Medicare |
$13.14
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$12.88
|
| Rate for Payer: United Healthcare Commercial |
$16.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12.88
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$10.30
|
| Rate for Payer: Wellcare Medicare |
$11.59
|
|
|
PNEUMOCOCCAL IM (14 SEROTYPE)
|
Facility
|
IP
|
$32.20
|
|
|
Service Code
|
HCPCS 86609
|
| Hospital Charge Code |
40619167
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$12.88
|
|
|
PNEUMOCOCCAL VACCINE 13-VALENT (PEDIATRI
|
Facility
|
IP
|
$218.00
|
|
|
Service Code
|
HCPCS 90670
|
| Hospital Charge Code |
41645407
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$109.00 |
| Max. Negotiated Rate |
$109.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$109.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$109.00
|
|
|
PNEUMOCOCCAL VACCINE 13-VALENT (PEDIATRI
|
Facility
|
OP
|
$218.00
|
|
|
Service Code
|
HCPCS 90670
|
| Hospital Charge Code |
41645407
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$76.30 |
| Max. Negotiated Rate |
$273.47 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$119.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$241.38
|
| Rate for Payer: Aetna Government |
$241.38
|
| Rate for Payer: Brighton Health Commercial |
$130.80
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$109.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$125.35
|
| Rate for Payer: Group Health Inc Commercial |
$109.00
|
| Rate for Payer: Group Health Inc Medicare |
$76.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$109.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$109.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$273.47
|
| Rate for Payer: SOMOS Essential |
$273.47
|
| Rate for Payer: United Healthcare Commercial |
$257.99
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$141.70
|
|
|
PNEUMOCOCCAL VACCINE 13-VALENT (PEDIATRI
|
Facility
|
OP
|
$218.00
|
|
|
Service Code
|
HCPCS 90670
|
| Hospital Charge Code |
41655407
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$76.30 |
| Max. Negotiated Rate |
$273.47 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$119.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$241.38
|
| Rate for Payer: Aetna Government |
$241.38
|
| Rate for Payer: Brighton Health Commercial |
$130.80
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$109.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$125.35
|
| Rate for Payer: Group Health Inc Commercial |
$109.00
|
| Rate for Payer: Group Health Inc Medicare |
$76.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$109.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$109.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$273.47
|
| Rate for Payer: SOMOS Essential |
$273.47
|
| Rate for Payer: United Healthcare Commercial |
$257.99
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$141.70
|
|
|
PNEUMOCOCCAL VACCINE 13-VALENT (PEDIATRI
|
Facility
|
IP
|
$218.00
|
|
|
Service Code
|
HCPCS 90670
|
| Hospital Charge Code |
41655407
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$109.00 |
| Max. Negotiated Rate |
$109.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$109.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$109.00
|
|
|
PNEUMOCOCCAL VACCINE 23-VALENT (ADULT) 0
|
Facility
|
IP
|
$208.13
|
|
|
Service Code
|
HCPCS 90732
|
| Hospital Charge Code |
41642934
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$104.06 |
| Max. Negotiated Rate |
$104.06 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$104.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$104.06
|
|
|
PNEUMOCOCCAL VACCINE 23-VALENT (ADULT) 0
|
Facility
|
OP
|
$208.13
|
|
|
Service Code
|
HCPCS 90732
|
| Hospital Charge Code |
41652934
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$43.68 |
| Max. Negotiated Rate |
$4,368.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$114.47
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$125.92
|
| Rate for Payer: Aetna Government |
$125.92
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$98.28
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$98.28
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$43.68
|
| Rate for Payer: Amida Care Medicaid |
$43.68
|
| Rate for Payer: Brighton Health Commercial |
$124.88
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$104.06
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$119.67
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$4,368.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$43.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$43.68
|
| Rate for Payer: Fidelis Qualified Health Plan |
$45.86
|
| Rate for Payer: Group Health Inc Commercial |
$104.06
|
| Rate for Payer: Group Health Inc Medicare |
$72.85
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$43.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$104.06
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$43.68
|
| Rate for Payer: Healthfirst Essential Plan |
$98.28
|
| Rate for Payer: Healthfirst QHP |
$43.68
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$43.68
|
| Rate for Payer: SOMOS Essential |
$43.68
|
| Rate for Payer: United Healthcare Commercial |
$133.47
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$98.28
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$48.05
|
| Rate for Payer: United Healthcare Medicaid |
$43.68
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$135.28
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$43.68
|
|
|
PNEUMOCOCCAL VACCINE 23-VALENT (ADULT) 0
|
Facility
|
IP
|
$208.13
|
|
|
Service Code
|
HCPCS 90732
|
| Hospital Charge Code |
41652934
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$104.06 |
| Max. Negotiated Rate |
$104.06 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$104.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$104.06
|
|
|
PNEUMOCOCCAL VACCINE 23-VALENT (ADULT) 0
|
Facility
|
OP
|
$208.13
|
|
|
Service Code
|
HCPCS 90732
|
| Hospital Charge Code |
41642934
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$43.68 |
| Max. Negotiated Rate |
$4,368.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$114.47
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$125.92
|
| Rate for Payer: Aetna Government |
$125.92
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$98.28
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$98.28
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$43.68
|
| Rate for Payer: Amida Care Medicaid |
$43.68
|
| Rate for Payer: Brighton Health Commercial |
$124.88
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$104.06
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$119.67
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$4,368.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$43.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$43.68
|
| Rate for Payer: Fidelis Qualified Health Plan |
$45.86
|
| Rate for Payer: Group Health Inc Commercial |
$104.06
|
| Rate for Payer: Group Health Inc Medicare |
$72.85
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$43.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$104.06
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$43.68
|
| Rate for Payer: Healthfirst Essential Plan |
$98.28
|
| Rate for Payer: Healthfirst QHP |
$43.68
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$43.68
|
| Rate for Payer: SOMOS Essential |
$43.68
|
| Rate for Payer: United Healthcare Commercial |
$133.47
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$98.28
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$48.05
|
| Rate for Payer: United Healthcare Medicaid |
$43.68
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$135.28
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$43.68
|
|
|
PNEUMOCOCCAL VACCINE (ADULT)
|
Facility
|
OP
|
$208.13
|
|
|
Service Code
|
HCPCS 90732
|
| Hospital Charge Code |
30300146
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$43.68 |
| Max. Negotiated Rate |
$4,368.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$114.47
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$125.92
|
| Rate for Payer: Aetna Government |
$125.92
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$98.28
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$98.28
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$43.68
|
| Rate for Payer: Amida Care Medicaid |
$43.68
|
| Rate for Payer: Brighton Health Commercial |
$124.88
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$104.06
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$119.67
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$4,368.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$43.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$43.68
|
| Rate for Payer: Fidelis Qualified Health Plan |
$45.86
|
| Rate for Payer: Group Health Inc Commercial |
$104.06
|
| Rate for Payer: Group Health Inc Medicare |
$72.85
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$43.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$104.06
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$43.68
|
| Rate for Payer: Healthfirst Essential Plan |
$98.28
|
| Rate for Payer: Healthfirst QHP |
$43.68
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$43.68
|
| Rate for Payer: SOMOS Essential |
$43.68
|
| Rate for Payer: United Healthcare Commercial |
$133.47
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$98.28
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$48.05
|
| Rate for Payer: United Healthcare Medicaid |
$43.68
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$135.28
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$43.68
|
|
|
PNEUMOCOCCAL VACCINE (ADULT)
|
Facility
|
IP
|
$208.13
|
|
|
Service Code
|
HCPCS 90732
|
| Hospital Charge Code |
30300146
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$104.06 |
| Max. Negotiated Rate |
$104.06 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$104.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$104.06
|
|
|
PNEUMOCOCCAL VAC POLYVALENT 25 MCG/0.5ML IJ INJ [11037]
|
Facility
|
OP
|
$280.99
|
|
|
Service Code
|
HCPCS 90732
|
| Hospital Charge Code |
00006483703
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$43.68 |
| Max. Negotiated Rate |
$4,368.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$154.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$125.92
|
| Rate for Payer: Aetna Government |
$125.92
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$98.28
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$98.28
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$43.68
|
| Rate for Payer: Amida Care Medicaid |
$43.68
|
| Rate for Payer: Brighton Health Commercial |
$210.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$224.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$191.08
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$4,368.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$43.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$43.68
|
| Rate for Payer: Fidelis Qualified Health Plan |
$45.86
|
| Rate for Payer: Group Health Inc Commercial |
$140.50
|
| Rate for Payer: Group Health Inc Medicare |
$98.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$43.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$140.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$43.68
|
| Rate for Payer: Healthfirst Essential Plan |
$98.28
|
| Rate for Payer: Healthfirst QHP |
$43.68
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$133.47
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$141.48
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$141.48
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$141.48
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$43.68
|
| Rate for Payer: SOMOS Essential |
$43.68
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$98.28
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$48.05
|
| Rate for Payer: United Healthcare Medicaid |
$43.68
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$182.65
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$43.68
|
|
|
PNEUMOC VAC/ADMIN/RCVD
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS 4040F
|
| Hospital Charge Code |
30307861
|
|
Hospital Revenue Code
|
969
|
| Max. Negotiated Rate |
$2,915.00 |
| 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 |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Group Health Inc Commercial |
$0.01
|
| Rate for Payer: Group Health Inc Medicare |
$0.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
|
