|
PNEUMOCOCCAL (23 VALENT)
|
Facility
|
OP
|
$99.25
|
|
|
Service Code
|
HCPCS 90732
|
| Hospital Charge Code |
9400095
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.89 |
| Max. Negotiated Rate |
$133.47 |
| Rate for Payer: Aetna Commercial |
$29.77
|
| Rate for Payer: Aetna Medicare Advantage |
$29.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$25.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$25.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$54.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$25.31
|
| Rate for Payer: Cigna Commercial |
$133.47
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$24.02
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$14.89
|
|
|
PNEUMOCOCCAL IMMUNITY 14TY III
|
Facility
|
OP
|
$114.00
|
|
|
Service Code
|
HCPCS 86317
|
| Hospital Charge Code |
3038510C
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.50 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Aetna Commercial |
$48.57
|
| Rate for Payer: Aetna Medicare Advantage |
$14.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$54.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$54.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$14.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$14.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$54.92
|
| Rate for Payer: Cigna Commercial |
$14.99
|
| Rate for Payer: Cigna Medicare Advantage |
$7.50
|
| Rate for Payer: Clover Medicare Advantage |
$14.24
|
| Rate for Payer: EmblemHealth Commercial |
$44.97
|
| Rate for Payer: Humana Medicare Advantage |
$15.44
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$114.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$14.99
|
| Rate for Payer: Wellcare Ambetter Commercial-Exchange |
$15.89
|
| Rate for Payer: Wellcare Medicare Advantage |
$14.99
|
|
|
PNEUMOCOCCAL IMMUNITY 14 TY IV
|
Facility
|
OP
|
$114.00
|
|
|
Service Code
|
HCPCS 86317
|
| Hospital Charge Code |
3038510D
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.50 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Aetna Commercial |
$48.57
|
| Rate for Payer: Aetna Medicare Advantage |
$14.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$54.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$54.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$14.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$14.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$54.92
|
| Rate for Payer: Cigna Commercial |
$14.99
|
| Rate for Payer: Cigna Medicare Advantage |
$7.50
|
| Rate for Payer: Clover Medicare Advantage |
$14.24
|
| Rate for Payer: EmblemHealth Commercial |
$44.97
|
| Rate for Payer: Humana Medicare Advantage |
$15.44
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$114.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$14.99
|
| Rate for Payer: Wellcare Ambetter Commercial-Exchange |
$15.89
|
| Rate for Payer: Wellcare Medicare Advantage |
$14.99
|
|
|
PNEUMOCOCCAL IMMUNITY 14TYP 1
|
Facility
|
OP
|
$114.00
|
|
|
Service Code
|
HCPCS 86317
|
| Hospital Charge Code |
3038510A
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.50 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Aetna Commercial |
$48.57
|
| Rate for Payer: Aetna Medicare Advantage |
$14.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$54.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$54.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$14.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$14.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$54.92
|
| Rate for Payer: Cigna Commercial |
$14.99
|
| Rate for Payer: Cigna Medicare Advantage |
$7.50
|
| Rate for Payer: Clover Medicare Advantage |
$14.24
|
| Rate for Payer: EmblemHealth Commercial |
$44.97
|
| Rate for Payer: Humana Medicare Advantage |
$15.44
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$114.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$14.99
|
| Rate for Payer: Wellcare Ambetter Commercial-Exchange |
$15.89
|
| Rate for Payer: Wellcare Medicare Advantage |
$14.99
|
|
|
PNEUMOCOCCAL IMMUNITY 14 TYPES
|
Facility
|
OP
|
$114.00
|
|
|
Service Code
|
HCPCS 86317
|
| Hospital Charge Code |
3038510N
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.50 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Aetna Commercial |
$48.57
|
| Rate for Payer: Aetna Medicare Advantage |
$14.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$54.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$54.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$14.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$14.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$54.92
|
| Rate for Payer: Cigna Commercial |
$14.99
|
| Rate for Payer: Cigna Medicare Advantage |
$7.50
|
| Rate for Payer: Clover Medicare Advantage |
$14.24
|
| Rate for Payer: EmblemHealth Commercial |
$44.97
|
| Rate for Payer: Humana Medicare Advantage |
$15.44
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$114.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$14.99
|
| Rate for Payer: Wellcare Ambetter Commercial-Exchange |
$15.89
|
| Rate for Payer: Wellcare Medicare Advantage |
$14.99
|
|
|
PNEUMOCOCCAL IMMUNITY 14 TYPES
|
Facility
|
OP
|
$114.00
|
|
|
Service Code
|
HCPCS 86317
|
| Hospital Charge Code |
3038510F
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.50 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Aetna Commercial |
$48.57
|
| Rate for Payer: Aetna Medicare Advantage |
$14.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$54.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$54.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$14.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$14.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$54.92
|
| Rate for Payer: Cigna Commercial |
$14.99
|
| Rate for Payer: Cigna Medicare Advantage |
$7.50
|
| Rate for Payer: Clover Medicare Advantage |
$14.24
|
| Rate for Payer: EmblemHealth Commercial |
$44.97
|
| Rate for Payer: Humana Medicare Advantage |
$15.44
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$114.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$14.99
|
| Rate for Payer: Wellcare Ambetter Commercial-Exchange |
$15.89
|
| Rate for Payer: Wellcare Medicare Advantage |
$14.99
|
|
|
PNEUMOCOCCAL IMMUNITY 14 TYPES
|
Facility
|
OP
|
$114.00
|
|
|
Service Code
|
HCPCS 86317
|
| Hospital Charge Code |
3038510G
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.50 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Aetna Commercial |
$48.57
|
| Rate for Payer: Aetna Medicare Advantage |
$14.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$54.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$54.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$14.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$14.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$54.92
|
| Rate for Payer: Cigna Commercial |
$14.99
|
| Rate for Payer: Cigna Medicare Advantage |
$7.50
|
| Rate for Payer: Clover Medicare Advantage |
$14.24
|
| Rate for Payer: EmblemHealth Commercial |
$44.97
|
| Rate for Payer: Humana Medicare Advantage |
$15.44
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$114.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$14.99
|
| Rate for Payer: Wellcare Ambetter Commercial-Exchange |
$15.89
|
| Rate for Payer: Wellcare Medicare Advantage |
$14.99
|
|
|
PNEUMOCOCCAL IMMUNITY 14 TYPES
|
Facility
|
OP
|
$114.00
|
|
|
Service Code
|
HCPCS 86317
|
| Hospital Charge Code |
3038510M
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.50 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Aetna Commercial |
$48.57
|
| Rate for Payer: Aetna Medicare Advantage |
$14.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$54.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$54.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$14.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$14.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$54.92
|
| Rate for Payer: Cigna Commercial |
$14.99
|
| Rate for Payer: Cigna Medicare Advantage |
$7.50
|
| Rate for Payer: Clover Medicare Advantage |
$14.24
|
| Rate for Payer: EmblemHealth Commercial |
$44.97
|
| Rate for Payer: Humana Medicare Advantage |
$15.44
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$114.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$14.99
|
| Rate for Payer: Wellcare Ambetter Commercial-Exchange |
$15.89
|
| Rate for Payer: Wellcare Medicare Advantage |
$14.99
|
|
|
PNEUMOCOCCAL IMMUNITY 14 TYPES
|
Facility
|
OP
|
$114.00
|
|
|
Service Code
|
HCPCS 86317
|
| Hospital Charge Code |
3038510K
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.50 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Aetna Commercial |
$48.57
|
| Rate for Payer: Aetna Medicare Advantage |
$14.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$54.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$54.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$14.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$14.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$54.92
|
| Rate for Payer: Cigna Commercial |
$14.99
|
| Rate for Payer: Cigna Medicare Advantage |
$7.50
|
| Rate for Payer: Clover Medicare Advantage |
$14.24
|
| Rate for Payer: EmblemHealth Commercial |
$44.97
|
| Rate for Payer: Humana Medicare Advantage |
$15.44
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$114.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$14.99
|
| Rate for Payer: Wellcare Ambetter Commercial-Exchange |
$15.89
|
| Rate for Payer: Wellcare Medicare Advantage |
$14.99
|
|
|
PNEUMOCOCCAL IMMUNITY 14 TYPES
|
Facility
|
OP
|
$114.00
|
|
|
Service Code
|
HCPCS 86317
|
| Hospital Charge Code |
3038510I
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.50 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Aetna Commercial |
$48.57
|
| Rate for Payer: Aetna Medicare Advantage |
$14.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$54.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$54.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$14.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$14.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$54.92
|
| Rate for Payer: Cigna Commercial |
$14.99
|
| Rate for Payer: Cigna Medicare Advantage |
$7.50
|
| Rate for Payer: Clover Medicare Advantage |
$14.24
|
| Rate for Payer: EmblemHealth Commercial |
$44.97
|
| Rate for Payer: Humana Medicare Advantage |
$15.44
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$114.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$14.99
|
| Rate for Payer: Wellcare Ambetter Commercial-Exchange |
$15.89
|
| Rate for Payer: Wellcare Medicare Advantage |
$14.99
|
|
|
PNEUMOCOCCAL IMMUNITY 14 TYPES
|
Facility
|
OP
|
$114.00
|
|
|
Service Code
|
HCPCS 86317
|
| Hospital Charge Code |
3038510H
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.50 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Aetna Commercial |
$48.57
|
| Rate for Payer: Aetna Medicare Advantage |
$14.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$54.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$54.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$14.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$14.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$54.92
|
| Rate for Payer: Cigna Commercial |
$14.99
|
| Rate for Payer: Cigna Medicare Advantage |
$7.50
|
| Rate for Payer: Clover Medicare Advantage |
$14.24
|
| Rate for Payer: EmblemHealth Commercial |
$44.97
|
| Rate for Payer: Humana Medicare Advantage |
$15.44
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$114.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$14.99
|
| Rate for Payer: Wellcare Ambetter Commercial-Exchange |
$15.89
|
| Rate for Payer: Wellcare Medicare Advantage |
$14.99
|
|
|
PNEUMOCOCCAL IMMUNITY 14 TYPES
|
Facility
|
OP
|
$114.00
|
|
|
Service Code
|
HCPCS 86317
|
| Hospital Charge Code |
3038510E
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.50 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Aetna Commercial |
$48.57
|
| Rate for Payer: Aetna Medicare Advantage |
$14.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$54.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$54.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$14.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$14.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$54.92
|
| Rate for Payer: Cigna Commercial |
$14.99
|
| Rate for Payer: Cigna Medicare Advantage |
$7.50
|
| Rate for Payer: Clover Medicare Advantage |
$14.24
|
| Rate for Payer: EmblemHealth Commercial |
$44.97
|
| Rate for Payer: Humana Medicare Advantage |
$15.44
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$114.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$14.99
|
| Rate for Payer: Wellcare Ambetter Commercial-Exchange |
$15.89
|
| Rate for Payer: Wellcare Medicare Advantage |
$14.99
|
|
|
PNEUMOCOCCAL IMMUNITY 14 TYPES
|
Facility
|
OP
|
$114.00
|
|
|
Service Code
|
HCPCS 86317
|
| Hospital Charge Code |
3038510L
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.50 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Aetna Commercial |
$48.57
|
| Rate for Payer: Aetna Medicare Advantage |
$14.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$54.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$54.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$14.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$14.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$54.92
|
| Rate for Payer: Cigna Commercial |
$14.99
|
| Rate for Payer: Cigna Medicare Advantage |
$7.50
|
| Rate for Payer: Clover Medicare Advantage |
$14.24
|
| Rate for Payer: EmblemHealth Commercial |
$44.97
|
| Rate for Payer: Humana Medicare Advantage |
$15.44
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$114.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$14.99
|
| Rate for Payer: Wellcare Ambetter Commercial-Exchange |
$15.89
|
| Rate for Payer: Wellcare Medicare Advantage |
$14.99
|
|
|
PNEUMOCOCCAL IMMUNITY 14 TYPES
|
Facility
|
OP
|
$114.00
|
|
|
Service Code
|
HCPCS 86317
|
| Hospital Charge Code |
3038510J
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.50 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Aetna Commercial |
$48.57
|
| Rate for Payer: Aetna Medicare Advantage |
$14.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$54.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$54.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$14.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$14.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$54.92
|
| Rate for Payer: Cigna Commercial |
$14.99
|
| Rate for Payer: Cigna Medicare Advantage |
$7.50
|
| Rate for Payer: Clover Medicare Advantage |
$14.24
|
| Rate for Payer: EmblemHealth Commercial |
$44.97
|
| Rate for Payer: Humana Medicare Advantage |
$15.44
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$114.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$14.99
|
| Rate for Payer: Wellcare Ambetter Commercial-Exchange |
$15.89
|
| Rate for Payer: Wellcare Medicare Advantage |
$14.99
|
|
|
PNEUMOCOCCAL IMMUNITY 14TYP II
|
Facility
|
OP
|
$114.00
|
|
|
Service Code
|
HCPCS 86317
|
| Hospital Charge Code |
3038510B
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.50 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Aetna Commercial |
$48.57
|
| Rate for Payer: Aetna Medicare Advantage |
$14.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$54.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$54.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$14.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$14.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$54.92
|
| Rate for Payer: Cigna Commercial |
$14.99
|
| Rate for Payer: Cigna Medicare Advantage |
$7.50
|
| Rate for Payer: Clover Medicare Advantage |
$14.24
|
| Rate for Payer: EmblemHealth Commercial |
$44.97
|
| Rate for Payer: Humana Medicare Advantage |
$15.44
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$114.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$14.99
|
| Rate for Payer: Wellcare Ambetter Commercial-Exchange |
$15.89
|
| Rate for Payer: Wellcare Medicare Advantage |
$14.99
|
|
|
PNEUMOCOCCAL VACCINE INJ
|
Facility
|
OP
|
$581.96
|
|
|
Service Code
|
HCPCS 90732
|
| Hospital Charge Code |
6009021P
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$54.05 |
| Max. Negotiated Rate |
$174.59 |
| Rate for Payer: Aetna Commercial |
$174.59
|
| Rate for Payer: Aetna Medicare Advantage |
$174.59
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$148.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$148.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$54.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$148.40
|
| Rate for Payer: Cigna Commercial |
$133.47
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$140.83
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$87.29
|
|
|
PNEUMOCOCCAL VACCINE INJ
|
Facility
|
IP
|
$581.96
|
|
|
Service Code
|
NDC 6494300
|
| Hospital Charge Code |
6009021
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$87.29 |
| Max. Negotiated Rate |
$87.29 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$87.29
|
|
|
PNEUMOCOCCAL VACCINE INJ
|
Facility
|
IP
|
$581.96
|
|
|
Service Code
|
HCPCS 90732
|
| Hospital Charge Code |
6009021P
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$87.29 |
| Max. Negotiated Rate |
$140.83 |
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$140.83
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$87.29
|
|
|
PNEUMOCOCCAL VACCINE INJ
|
Facility
|
OP
|
$581.96
|
|
|
Service Code
|
NDC 6494300
|
| Hospital Charge Code |
6009021
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$75.65 |
| Max. Negotiated Rate |
$290.98 |
| Rate for Payer: Aetna Commercial |
$174.59
|
| Rate for Payer: Aetna Medicare Advantage |
$174.59
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$148.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$148.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$148.40
|
| Rate for Payer: Cigna Commercial |
$290.98
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$75.65
|
| Rate for Payer: Oxford Commercial |
$290.98
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$87.29
|
| Rate for Payer: UnitedHealthcare Commercial |
$290.98
|
|
|
PNEUMOCYSTIS JROVECII DFA A
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 87015
|
| Hospital Charge Code |
39708006A
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
PNEUMOCYSTIS JROVECII DFA A
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 87015
|
| Hospital Charge Code |
39708006A
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$3.34 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Aetna Commercial |
$21.64
|
| Rate for Payer: Aetna Medicare Advantage |
$6.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$24.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$24.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$6.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$9.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$24.48
|
| Rate for Payer: Cigna Commercial |
$6.68
|
| Rate for Payer: Cigna Medicare Advantage |
$3.34
|
| Rate for Payer: Clover Medicare Advantage |
$6.35
|
| Rate for Payer: EmblemHealth Commercial |
$20.04
|
| Rate for Payer: Humana Medicare Advantage |
$6.88
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$50.70
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$114.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$6.68
|
| Rate for Payer: Wellcare Ambetter Commercial-Exchange |
$7.08
|
| Rate for Payer: Wellcare Medicare Advantage |
$6.68
|
|
|
PNEUMOCYSTIS JROVECII DFA B
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 87281
|
| Hospital Charge Code |
39708006B
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$5.99 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Aetna Commercial |
$38.82
|
| Rate for Payer: Aetna Medicare Advantage |
$11.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$43.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$43.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$11.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$11.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$43.89
|
| Rate for Payer: Cigna Commercial |
$11.98
|
| Rate for Payer: Cigna Medicare Advantage |
$5.99
|
| Rate for Payer: Clover Medicare Advantage |
$11.38
|
| Rate for Payer: EmblemHealth Commercial |
$35.94
|
| Rate for Payer: Humana Medicare Advantage |
$12.34
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$50.70
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$114.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$11.98
|
| Rate for Payer: Wellcare Ambetter Commercial-Exchange |
$12.70
|
| Rate for Payer: Wellcare Medicare Advantage |
$11.98
|
|
|
PNEUMOCYSTIS JROVECII DFA B
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 87281
|
| Hospital Charge Code |
39708006B
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
PNEUMOGRAM
|
Facility
|
OP
|
$1,233.00
|
|
|
Service Code
|
HCPCS 94772
|
| Hospital Charge Code |
83080040
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$138.00 |
| Max. Negotiated Rate |
$1,793.00 |
| Rate for Payer: Aetna Commercial |
$369.90
|
| Rate for Payer: Aetna Medicare Advantage |
$369.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$314.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$314.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$138.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$314.42
|
| Rate for Payer: Cigna Commercial |
$888.63
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$160.29
|
| Rate for Payer: Oxford Commercial |
$1,580.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$184.95
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,793.00
|
|
|
PNEUMOGRAM
|
Facility
|
IP
|
$1,233.00
|
|
|
Service Code
|
HCPCS 94772
|
| Hospital Charge Code |
83080040
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$184.95 |
| Max. Negotiated Rate |
$184.95 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$184.95
|
|
