|
INFL QUAD VACCINE 0.5ML (4YRS & >
|
Facility
|
IP
|
$34.35
|
|
|
Service Code
|
HCPCS 90674
|
| Hospital Charge Code |
41647850
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.18 |
| Max. Negotiated Rate |
$17.18 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$17.18
|
|
|
INFLUENZA A&B MOLECULAR
|
Facility
|
IP
|
$239.50
|
|
|
Service Code
|
HCPCS 87502
|
| Hospital Charge Code |
40614119
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$95.80
|
|
|
INFLUENZA A&B MOLECULAR
|
Facility
|
OP
|
$239.50
|
|
|
Service Code
|
HCPCS 87502
|
| Hospital Charge Code |
40614119
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$67.06 |
| Max. Negotiated Rate |
$179.62 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$131.72
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$95.80
|
| Rate for Payer: Aetna Government |
$95.80
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$67.06
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$67.06
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$67.06
|
| Rate for Payer: Brighton Health Commercial |
$179.62
|
| Rate for Payer: Cash Price |
$95.80
|
| Rate for Payer: Cash Price |
$95.80
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$95.80
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$135.26
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$114.46
|
| Rate for Payer: Elderplan Medicare Advantage |
$95.80
|
| Rate for Payer: EmblemHealth Commercial |
$95.80
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$81.43
|
| Rate for Payer: Fidelis Essential Plan QHP |
$85.26
|
| Rate for Payer: Fidelis Medicare Advantage |
$95.80
|
| Rate for Payer: Fidelis Qualified Health Plan |
$85.26
|
| Rate for Payer: Group Health Inc Commercial |
$95.80
|
| Rate for Payer: Group Health Inc Medicare |
$95.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$119.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$95.80
|
| Rate for Payer: Healthfirst Medicare Advantage |
$95.80
|
| Rate for Payer: Healthfirst QHP |
$95.80
|
| Rate for Payer: Humana Medicare |
$97.72
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$95.80
|
| Rate for Payer: United Healthcare Commercial |
$107.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$95.80
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$95.80
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$76.64
|
| Rate for Payer: Wellcare Medicare |
$86.22
|
|
|
INFLUENZA A H1N1
|
Facility
|
OP
|
$87.73
|
|
|
Service Code
|
HCPCS 87798
|
| Hospital Charge Code |
40618403
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$24.56 |
| Max. Negotiated Rate |
$65.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$48.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$35.09
|
| Rate for Payer: Aetna Government |
$35.09
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$24.56
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$24.56
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$24.56
|
| Rate for Payer: Brighton Health Commercial |
$65.80
|
| Rate for Payer: Cash Price |
$35.09
|
| Rate for Payer: Cash Price |
$35.09
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$35.09
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$55.78
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$47.20
|
| Rate for Payer: Elderplan Medicare Advantage |
$35.09
|
| Rate for Payer: EmblemHealth Commercial |
$35.09
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$29.83
|
| Rate for Payer: Fidelis Essential Plan QHP |
$31.23
|
| Rate for Payer: Fidelis Medicare Advantage |
$35.09
|
| Rate for Payer: Fidelis Qualified Health Plan |
$31.23
|
| Rate for Payer: Group Health Inc Commercial |
$35.09
|
| Rate for Payer: Group Health Inc Medicare |
$35.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$43.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$35.09
|
| Rate for Payer: Healthfirst Medicare Advantage |
$35.09
|
| Rate for Payer: Healthfirst QHP |
$35.09
|
| Rate for Payer: Humana Medicare |
$35.79
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$35.09
|
| Rate for Payer: United Healthcare Commercial |
$44.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$35.09
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$28.07
|
| Rate for Payer: Wellcare Medicare |
$31.58
|
|
|
INFLUENZA A H1N1
|
Facility
|
IP
|
$87.73
|
|
|
Service Code
|
HCPCS 87798
|
| Hospital Charge Code |
40618403
|
|
Hospital Revenue Code
|
309
|
| Rate for Payer: Cash Price |
$35.09
|
|
|
INFLUENZA A H1N1 (2009)
|
Facility
|
IP
|
$239.50
|
|
|
Service Code
|
HCPCS 87502
|
| Hospital Charge Code |
30303376
|
|
Hospital Revenue Code
|
306
|
| Rate for Payer: Cash Price |
$95.80
|
|
|
INFLUENZA A H1N1 (2009)
|
Facility
|
OP
|
$239.50
|
|
|
Service Code
|
HCPCS 87502
|
| Hospital Charge Code |
30303376
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$67.06 |
| Max. Negotiated Rate |
$179.62 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$131.72
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$95.80
|
| Rate for Payer: Aetna Government |
$95.80
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$67.06
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$67.06
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$67.06
|
| Rate for Payer: Brighton Health Commercial |
$179.62
|
| Rate for Payer: Cash Price |
$95.80
|
| Rate for Payer: Cash Price |
$95.80
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$95.80
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$135.26
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$114.46
|
| Rate for Payer: Elderplan Medicare Advantage |
$95.80
|
| Rate for Payer: EmblemHealth Commercial |
$95.80
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$81.43
|
| Rate for Payer: Fidelis Essential Plan QHP |
$85.26
|
| Rate for Payer: Fidelis Medicare Advantage |
$95.80
|
| Rate for Payer: Fidelis Qualified Health Plan |
$85.26
|
| Rate for Payer: Group Health Inc Commercial |
$95.80
|
| Rate for Payer: Group Health Inc Medicare |
$95.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$119.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$95.80
|
| Rate for Payer: Healthfirst Medicare Advantage |
$95.80
|
| Rate for Payer: Healthfirst QHP |
$95.80
|
| Rate for Payer: Humana Medicare |
$97.72
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$95.80
|
| Rate for Payer: United Healthcare Commercial |
$107.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$95.80
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$95.80
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$76.64
|
| Rate for Payer: Wellcare Medicare |
$86.22
|
|
|
INFLUENZA A H1N1, ADMIN W CO
|
Facility
|
IP
|
$115.43
|
|
|
Service Code
|
HCPCS G0008
|
| Hospital Charge Code |
30304003
|
|
Hospital Revenue Code
|
771
|
| Rate for Payer: Cash Price |
$54.93
|
|
|
INFLUENZA A H1N1, ADMIN W CO
|
Facility
|
OP
|
$115.43
|
|
|
Service Code
|
HCPCS G0008
|
| Hospital Charge Code |
30304003
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$13.36 |
| Max. Negotiated Rate |
$1,336.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$63.49
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$54.93
|
| Rate for Payer: Aetna Government |
$54.93
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$30.06
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$30.06
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$13.36
|
| Rate for Payer: Amida Care Medicaid |
$13.36
|
| Rate for Payer: Brighton Health Commercial |
$86.57
|
| Rate for Payer: Cash Price |
$54.93
|
| Rate for Payer: Cash Price |
$54.93
|
| Rate for Payer: Cash Price |
$54.93
|
| Rate for Payer: Cash Price |
$54.93
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$54.93
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$92.34
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$78.49
|
| Rate for Payer: Elderplan Medicare Advantage |
$54.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,336.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$13.36
|
| Rate for Payer: Fidelis Essential Plan QHP |
$13.36
|
| Rate for Payer: Fidelis Medicare Advantage |
$54.93
|
| Rate for Payer: Fidelis Qualified Health Plan |
$14.03
|
| 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 |
$13.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$54.93
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$13.36
|
| Rate for Payer: Healthfirst Essential Plan |
$30.06
|
| Rate for Payer: Healthfirst Medicare Advantage |
$46.69
|
| Rate for Payer: Healthfirst QHP |
$13.36
|
| Rate for Payer: Humana Medicare |
$56.03
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$54.93
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$13.36
|
| Rate for Payer: SOMOS Essential |
$13.36
|
| Rate for Payer: United Healthcare Commercial |
$44.00
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$30.06
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$14.70
|
| Rate for Payer: United Healthcare Medicaid |
$13.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$54.93
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$54.93
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$43.94
|
| Rate for Payer: Wellcare Medicare |
$52.18
|
|
|
INFLUENZA B AG IF
|
Facility
|
OP
|
$30.63
|
|
|
Service Code
|
HCPCS 87275
|
| Hospital Charge Code |
40613063
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.58 |
| Max. Negotiated Rate |
$22.97 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$16.85
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12.25
|
| Rate for Payer: Aetna Government |
$12.25
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$8.58
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$8.58
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$8.58
|
| Rate for Payer: Brighton Health Commercial |
$22.97
|
| Rate for Payer: Cash Price |
$12.25
|
| Rate for Payer: Cash Price |
$12.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$12.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$19.06
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$16.13
|
| Rate for Payer: Elderplan Medicare Advantage |
$12.25
|
| Rate for Payer: EmblemHealth Commercial |
$12.25
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$10.41
|
| Rate for Payer: Fidelis Essential Plan QHP |
$10.90
|
| Rate for Payer: Fidelis Medicare Advantage |
$12.25
|
| Rate for Payer: Fidelis Qualified Health Plan |
$10.90
|
| Rate for Payer: Group Health Inc Commercial |
$12.25
|
| Rate for Payer: Group Health Inc Medicare |
$12.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.25
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12.25
|
| Rate for Payer: Healthfirst QHP |
$12.25
|
| Rate for Payer: Humana Medicare |
$12.50
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$12.25
|
| Rate for Payer: United Healthcare Commercial |
$15.19
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12.25
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$9.80
|
| Rate for Payer: Wellcare Medicare |
$11.02
|
|
|
INFLUENZA B AG IF
|
Facility
|
IP
|
$30.63
|
|
|
Service Code
|
HCPCS 87275
|
| Hospital Charge Code |
40613063
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$12.25
|
|
|
INFLUENZA QUADRIVALENT VAC
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS 90686
|
| Hospital Charge Code |
41648155
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$23.69 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$20.53
|
| Rate for Payer: Aetna Government |
$20.53
|
| 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 |
$23.69
|
| Rate for Payer: SOMOS Essential |
$23.69
|
| Rate for Payer: United Healthcare Commercial |
$21.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.01
|
|
|
INFLUENZA QUADRIVALENT VAC
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS 90686
|
| Hospital Charge Code |
41648155
|
|
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
|
|
|
INFLUENZA QUAD VACCINE (VCF)0.5ML
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS 90686
|
| Hospital Charge Code |
41657816
|
|
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
|
|
|
INFLUENZA QUAD VACCINE (VCF)0.5ML
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS 90686
|
| Hospital Charge Code |
41657816
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$23.69 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$20.53
|
| Rate for Payer: Aetna Government |
$20.53
|
| 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 |
$23.69
|
| Rate for Payer: SOMOS Essential |
$23.69
|
| Rate for Payer: United Healthcare Commercial |
$21.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.01
|
|
|
INFLUENZA QUAD VACCINE (VCF)0.5ML
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS 90686
|
| Hospital Charge Code |
41647816
|
|
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
|
|
|
INFLUENZA QUAD VACCINE (VCF)0.5ML
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS 90686
|
| Hospital Charge Code |
41647816
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$23.69 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$20.53
|
| Rate for Payer: Aetna Government |
$20.53
|
| 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 |
$23.69
|
| Rate for Payer: SOMOS Essential |
$23.69
|
| Rate for Payer: United Healthcare Commercial |
$21.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.01
|
|
|
INFLUENZA QUAD VAC - FLUARIX
|
Facility
|
IP
|
$32.00
|
|
|
Service Code
|
HCPCS 90686
|
| Hospital Charge Code |
41648165
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.00 |
| Max. Negotiated Rate |
$16.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.00
|
|
|
INFLUENZA QUAD VAC - FLUARIX
|
Facility
|
OP
|
$32.00
|
|
|
Service Code
|
HCPCS 90686
|
| Hospital Charge Code |
41648165
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.20 |
| Max. Negotiated Rate |
$23.69 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$17.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$20.53
|
| Rate for Payer: Aetna Government |
$20.53
|
| Rate for Payer: Brighton Health Commercial |
$19.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$16.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$18.40
|
| Rate for Payer: Group Health Inc Commercial |
$16.00
|
| Rate for Payer: Group Health Inc Medicare |
$11.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$23.69
|
| Rate for Payer: SOMOS Essential |
$23.69
|
| Rate for Payer: United Healthcare Commercial |
$21.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$20.80
|
|
|
INFLUENZA VAC A&B SURF ANT ADJ 0.5 ML IM SUSY [134050]
|
Facility
|
OP
|
$82.00
|
|
|
Service Code
|
HCPCS 90694
|
| Hospital Charge Code |
70461002403
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$66.43 |
| Max. Negotiated Rate |
$82.00 |
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$66.43
|
| Rate for Payer: Aetna Government |
$66.43
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$77.36
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$82.00
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$82.00
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$82.00
|
|
|
INFLUENZA VAC A&B SURF ANT ADJ 0.5 ML IM SUSY [134050]
|
Facility
|
OP
|
$82.00
|
|
|
Service Code
|
HCPCS 90694
|
| Hospital Charge Code |
70461002404
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$66.43 |
| Max. Negotiated Rate |
$82.00 |
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$66.43
|
| Rate for Payer: Aetna Government |
$66.43
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$77.36
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$82.00
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$82.00
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$82.00
|
|
|
INFLUENZA VACCINE (FLUBLOK) 0.5ML
|
Facility
|
OP
|
$111.58
|
|
| Hospital Charge Code |
41658157
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$39.05 |
| Max. Negotiated Rate |
$89.26 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$61.37
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$55.79
|
| Rate for Payer: Aetna Government |
$55.79
|
| Rate for Payer: Brighton Health Commercial |
$83.68
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$89.26
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$75.87
|
| Rate for Payer: Group Health Inc Commercial |
$55.79
|
| Rate for Payer: Group Health Inc Medicare |
$39.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$55.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$55.79
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$72.53
|
|
|
INFLUENZA VACCINE (FLUBLOK) 0.5ML
|
Facility
|
OP
|
$111.58
|
|
| Hospital Charge Code |
41648157
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$39.05 |
| Max. Negotiated Rate |
$89.26 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$61.37
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$55.79
|
| Rate for Payer: Aetna Government |
$55.79
|
| Rate for Payer: Brighton Health Commercial |
$83.68
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$89.26
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$75.87
|
| Rate for Payer: Group Health Inc Commercial |
$55.79
|
| Rate for Payer: Group Health Inc Medicare |
$39.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$55.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$55.79
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$72.53
|
|
|
INFLUENZA VACC QUAD 5ML MDV (VFC)
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS 90688
|
| Hospital Charge Code |
41656648
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$22.13 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$19.91
|
| Rate for Payer: Aetna Government |
$19.91
|
| 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 |
$22.13
|
| Rate for Payer: SOMOS Essential |
$22.13
|
| Rate for Payer: United Healthcare Commercial |
$20.48
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.01
|
|
|
INFLUENZA VACC QUAD 5ML MDV (VFC)
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS 90688
|
| Hospital Charge Code |
41646648
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$22.13 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$19.91
|
| Rate for Payer: Aetna Government |
$19.91
|
| 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 |
$22.13
|
| Rate for Payer: SOMOS Essential |
$22.13
|
| Rate for Payer: United Healthcare Commercial |
$20.48
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.01
|
|
