|
VACCINE ADMIN INITIAL
|
Facility
|
IP
|
$20.38
|
|
|
Service Code
|
HCPCS 90471
|
| Hospital Charge Code |
93500178
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$3.06 |
| Max. Negotiated Rate |
$3.06 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$3.06
|
|
|
VACCINE ADMIN INITIAL
|
Facility
|
OP
|
$20.38
|
|
|
Service Code
|
HCPCS 90471
|
| Hospital Charge Code |
93500178
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$310.30 |
| Rate for Payer: Aetna Commercial |
$232.67
|
| Rate for Payer: Aetna Medicare Advantage |
$277.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$310.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$310.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$85.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$20.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$310.30
|
| Rate for Payer: Cigna Commercial |
$171.47
|
| Rate for Payer: Cigna Medicare Advantage |
$85.54
|
| Rate for Payer: Clover Medicare Advantage |
$81.26
|
| Rate for Payer: EmblemHealth Commercial |
$256.62
|
| Rate for Payer: Humana Medicare Advantage |
$88.11
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$85.54
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5.30
|
| Rate for Payer: Oxford Commercial |
$140.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3.06
|
| Rate for Payer: UnitedHealthcare Commercial |
$159.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.64
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$85.54
|
| Rate for Payer: Wellcare Medicare Advantage |
$85.54
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.58
|
|
|
VACCINE ADMIN INITIAL
|
Facility
|
OP
|
$20.38
|
|
|
Service Code
|
HCPCS 90471
|
| Hospital Charge Code |
87502260
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$310.30 |
| Rate for Payer: Aetna Commercial |
$232.67
|
| Rate for Payer: Aetna Medicare Advantage |
$277.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$310.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$310.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$85.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$20.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$310.30
|
| Rate for Payer: Cigna Commercial |
$171.47
|
| Rate for Payer: Cigna Medicare Advantage |
$85.54
|
| Rate for Payer: Clover Medicare Advantage |
$81.26
|
| Rate for Payer: EmblemHealth Commercial |
$256.62
|
| Rate for Payer: Humana Medicare Advantage |
$88.11
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$85.54
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5.30
|
| Rate for Payer: Oxford Commercial |
$140.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3.06
|
| Rate for Payer: UnitedHealthcare Commercial |
$159.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.64
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$85.54
|
| Rate for Payer: Wellcare Medicare Advantage |
$85.54
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.58
|
|
|
VACCINE ADMIN INITIAL
|
Facility
|
IP
|
$20.38
|
|
|
Service Code
|
HCPCS 90471
|
| Hospital Charge Code |
87502260
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$3.06 |
| Max. Negotiated Rate |
$3.06 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$3.06
|
|
|
VACCINE ADMIN INITIAL
|
Facility
|
OP
|
$20.38
|
|
|
Service Code
|
HCPCS 90471
|
| Hospital Charge Code |
93950061
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$310.30 |
| Rate for Payer: Aetna Commercial |
$232.67
|
| Rate for Payer: Aetna Medicare Advantage |
$277.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$310.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$310.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$85.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$20.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$310.30
|
| Rate for Payer: Cigna Commercial |
$171.47
|
| Rate for Payer: Cigna Medicare Advantage |
$85.54
|
| Rate for Payer: Clover Medicare Advantage |
$81.26
|
| Rate for Payer: EmblemHealth Commercial |
$256.62
|
| Rate for Payer: Humana Medicare Advantage |
$88.11
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$85.54
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5.30
|
| Rate for Payer: Oxford Commercial |
$140.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3.06
|
| Rate for Payer: UnitedHealthcare Commercial |
$159.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.64
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$85.54
|
| Rate for Payer: Wellcare Medicare Advantage |
$85.54
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.58
|
|
|
VACCINE ADMIN INITIAL
|
Facility
|
OP
|
$20.38
|
|
|
Service Code
|
HCPCS 90471
|
| Hospital Charge Code |
83652701
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$310.30 |
| Rate for Payer: Aetna Commercial |
$232.67
|
| Rate for Payer: Aetna Medicare Advantage |
$277.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$310.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$310.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$85.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$20.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$310.30
|
| Rate for Payer: Cigna Commercial |
$171.47
|
| Rate for Payer: Cigna Medicare Advantage |
$85.54
|
| Rate for Payer: Clover Medicare Advantage |
$81.26
|
| Rate for Payer: EmblemHealth Commercial |
$256.62
|
| Rate for Payer: Humana Medicare Advantage |
$88.11
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$85.54
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5.30
|
| Rate for Payer: Oxford Commercial |
$140.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3.06
|
| Rate for Payer: UnitedHealthcare Commercial |
$159.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.64
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$85.54
|
| Rate for Payer: Wellcare Medicare Advantage |
$85.54
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.58
|
|
|
VACCINE ADMIN INITIAL
|
Facility
|
OP
|
$20.38
|
|
|
Service Code
|
HCPCS 90471
|
| Hospital Charge Code |
911031
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$310.30 |
| Rate for Payer: Aetna Commercial |
$232.67
|
| Rate for Payer: Aetna Medicare Advantage |
$277.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$310.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$310.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$85.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$20.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$310.30
|
| Rate for Payer: Cigna Commercial |
$171.47
|
| Rate for Payer: Cigna Medicare Advantage |
$85.54
|
| Rate for Payer: Clover Medicare Advantage |
$81.26
|
| Rate for Payer: EmblemHealth Commercial |
$256.62
|
| Rate for Payer: Humana Medicare Advantage |
$88.11
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$85.54
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5.30
|
| Rate for Payer: Oxford Commercial |
$140.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3.06
|
| Rate for Payer: UnitedHealthcare Commercial |
$159.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.64
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$85.54
|
| Rate for Payer: Wellcare Medicare Advantage |
$85.54
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.58
|
|
|
VACCINE ADMIN INITIAL
|
Facility
|
IP
|
$20.38
|
|
|
Service Code
|
HCPCS 90471
|
| Hospital Charge Code |
93950061
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$3.06 |
| Max. Negotiated Rate |
$3.06 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$3.06
|
|
|
VACCINE ADMIN INITIAL
|
Facility
|
IP
|
$20.38
|
|
|
Service Code
|
HCPCS 90471
|
| Hospital Charge Code |
83652701
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$3.06 |
| Max. Negotiated Rate |
$3.06 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$3.06
|
|
|
VACCINE ADMIN INITIAL
|
Facility
|
IP
|
$20.38
|
|
|
Service Code
|
HCPCS 90471
|
| Hospital Charge Code |
911031
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$3.06 |
| Max. Negotiated Rate |
$3.06 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$3.06
|
|
|
VACCINE ADMIN INITIAL
|
Facility
|
OP
|
$20.38
|
|
|
Service Code
|
HCPCS 90471
|
| Hospital Charge Code |
5700285
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$310.30 |
| Rate for Payer: Aetna Commercial |
$232.67
|
| Rate for Payer: Aetna Medicare Advantage |
$277.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$310.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$310.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$85.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$20.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$310.30
|
| Rate for Payer: Cigna Commercial |
$171.47
|
| Rate for Payer: Cigna Medicare Advantage |
$85.54
|
| Rate for Payer: Clover Medicare Advantage |
$81.26
|
| Rate for Payer: EmblemHealth Commercial |
$256.62
|
| Rate for Payer: Humana Medicare Advantage |
$88.11
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$85.54
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5.30
|
| Rate for Payer: Oxford Commercial |
$140.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3.06
|
| Rate for Payer: UnitedHealthcare Commercial |
$159.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.64
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$85.54
|
| Rate for Payer: Wellcare Medicare Advantage |
$85.54
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.58
|
|
|
VACCINE ADMINISTRATION 1ST VAC
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
HCPCS 90471
|
| Hospital Charge Code |
3408010
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$4.50 |
| Max. Negotiated Rate |
$4.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$4.50
|
|
|
VACCINE ADMINISTRATION 1ST VAC
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
HCPCS 90471
|
| Hospital Charge Code |
3408010
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$0.85 |
| Max. Negotiated Rate |
$310.30 |
| Rate for Payer: Aetna Commercial |
$232.67
|
| Rate for Payer: Aetna Medicare Advantage |
$277.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$310.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$310.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$85.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$20.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$310.30
|
| Rate for Payer: Cigna Commercial |
$171.47
|
| Rate for Payer: Cigna Medicare Advantage |
$85.54
|
| Rate for Payer: Clover Medicare Advantage |
$81.26
|
| Rate for Payer: EmblemHealth Commercial |
$256.62
|
| Rate for Payer: Humana Medicare Advantage |
$88.11
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$85.54
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$7.80
|
| Rate for Payer: Oxford Commercial |
$140.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$159.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.95
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$85.54
|
| Rate for Payer: Wellcare Medicare Advantage |
$85.54
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.85
|
|
|
VACCINE ADMIN PNEUMO
|
Facility
|
OP
|
$20.38
|
|
|
Service Code
|
HCPCS 90471
|
| Hospital Charge Code |
5792175
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$310.30 |
| Rate for Payer: Aetna Commercial |
$232.67
|
| Rate for Payer: Aetna Medicare Advantage |
$277.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$310.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$310.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$85.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$20.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$310.30
|
| Rate for Payer: Cigna Commercial |
$171.47
|
| Rate for Payer: Cigna Medicare Advantage |
$85.54
|
| Rate for Payer: Clover Medicare Advantage |
$81.26
|
| Rate for Payer: EmblemHealth Commercial |
$256.62
|
| Rate for Payer: Humana Medicare Advantage |
$88.11
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$85.54
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5.30
|
| Rate for Payer: Oxford Commercial |
$140.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3.06
|
| Rate for Payer: UnitedHealthcare Commercial |
$159.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.64
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$85.54
|
| Rate for Payer: Wellcare Medicare Advantage |
$85.54
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.58
|
|
|
VACCINE ADMIN PNEUMO
|
Facility
|
OP
|
$20.38
|
|
|
Service Code
|
HCPCS 90471
|
| Hospital Charge Code |
87502055
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$310.30 |
| Rate for Payer: Aetna Commercial |
$232.67
|
| Rate for Payer: Aetna Medicare Advantage |
$277.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$310.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$310.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$85.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$20.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$310.30
|
| Rate for Payer: Cigna Commercial |
$171.47
|
| Rate for Payer: Cigna Medicare Advantage |
$85.54
|
| Rate for Payer: Clover Medicare Advantage |
$81.26
|
| Rate for Payer: EmblemHealth Commercial |
$256.62
|
| Rate for Payer: Humana Medicare Advantage |
$88.11
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$85.54
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5.30
|
| Rate for Payer: Oxford Commercial |
$140.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3.06
|
| Rate for Payer: UnitedHealthcare Commercial |
$159.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.64
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$85.54
|
| Rate for Payer: Wellcare Medicare Advantage |
$85.54
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.58
|
|
|
VACCINE ADMIN PNEUMO
|
Facility
|
IP
|
$260.00
|
|
|
Service Code
|
HCPCS 90471
|
| Hospital Charge Code |
73237029
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$39.00 |
| Max. Negotiated Rate |
$39.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$39.00
|
|
|
VACCINE ADMIN PNEUMO
|
Facility
|
OP
|
$20.38
|
|
|
Service Code
|
HCPCS 90471
|
| Hospital Charge Code |
260121
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$310.30 |
| Rate for Payer: Aetna Commercial |
$232.67
|
| Rate for Payer: Aetna Medicare Advantage |
$277.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$310.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$310.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$85.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$20.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$310.30
|
| Rate for Payer: Cigna Commercial |
$171.47
|
| Rate for Payer: Cigna Medicare Advantage |
$85.54
|
| Rate for Payer: Clover Medicare Advantage |
$81.26
|
| Rate for Payer: EmblemHealth Commercial |
$256.62
|
| Rate for Payer: Humana Medicare Advantage |
$88.11
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$85.54
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5.30
|
| Rate for Payer: Oxford Commercial |
$140.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3.06
|
| Rate for Payer: UnitedHealthcare Commercial |
$159.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.64
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$85.54
|
| Rate for Payer: Wellcare Medicare Advantage |
$85.54
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.58
|
|
|
VACCINE ADMIN PNEUMO
|
Facility
|
OP
|
$260.00
|
|
|
Service Code
|
HCPCS 90471
|
| Hospital Charge Code |
73237029
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$7.38 |
| Max. Negotiated Rate |
$310.30 |
| Rate for Payer: Aetna Commercial |
$232.67
|
| Rate for Payer: Aetna Medicare Advantage |
$277.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$310.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$310.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$85.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$20.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$310.30
|
| Rate for Payer: Cigna Commercial |
$171.47
|
| Rate for Payer: Cigna Medicare Advantage |
$85.54
|
| Rate for Payer: Clover Medicare Advantage |
$81.26
|
| Rate for Payer: EmblemHealth Commercial |
$256.62
|
| Rate for Payer: Humana Medicare Advantage |
$88.11
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$85.54
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$67.60
|
| Rate for Payer: Oxford Commercial |
$140.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$39.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$159.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$8.22
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$85.54
|
| Rate for Payer: Wellcare Medicare Advantage |
$85.54
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$7.38
|
|
|
VACCINE ADMIN PNEUMO
|
Facility
|
OP
|
$20.38
|
|
|
Service Code
|
HCPCS 90471
|
| Hospital Charge Code |
93500179
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$310.30 |
| Rate for Payer: Aetna Commercial |
$232.67
|
| Rate for Payer: Aetna Medicare Advantage |
$277.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$310.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$310.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$85.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$20.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$310.30
|
| Rate for Payer: Cigna Commercial |
$171.47
|
| Rate for Payer: Cigna Medicare Advantage |
$85.54
|
| Rate for Payer: Clover Medicare Advantage |
$81.26
|
| Rate for Payer: EmblemHealth Commercial |
$256.62
|
| Rate for Payer: Humana Medicare Advantage |
$88.11
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$85.54
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5.30
|
| Rate for Payer: Oxford Commercial |
$140.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3.06
|
| Rate for Payer: UnitedHealthcare Commercial |
$159.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.64
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$85.54
|
| Rate for Payer: Wellcare Medicare Advantage |
$85.54
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.58
|
|
|
VACCINE ADMIN PNEUMO
|
Facility
|
OP
|
$20.38
|
|
|
Service Code
|
HCPCS 90471
|
| Hospital Charge Code |
83652521
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$310.30 |
| Rate for Payer: Aetna Commercial |
$232.67
|
| Rate for Payer: Aetna Medicare Advantage |
$277.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$310.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$310.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$85.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$20.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$310.30
|
| Rate for Payer: Cigna Commercial |
$171.47
|
| Rate for Payer: Cigna Medicare Advantage |
$85.54
|
| Rate for Payer: Clover Medicare Advantage |
$81.26
|
| Rate for Payer: EmblemHealth Commercial |
$256.62
|
| Rate for Payer: Humana Medicare Advantage |
$88.11
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$85.54
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5.30
|
| Rate for Payer: Oxford Commercial |
$140.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3.06
|
| Rate for Payer: UnitedHealthcare Commercial |
$159.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.64
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$85.54
|
| Rate for Payer: Wellcare Medicare Advantage |
$85.54
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.58
|
|
|
VACCINE ADMIN PNEUMO
|
Facility
|
IP
|
$20.38
|
|
|
Service Code
|
HCPCS 90471
|
| Hospital Charge Code |
911030
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$3.06 |
| Max. Negotiated Rate |
$3.06 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$3.06
|
|
|
VACCINE ADMIN PNEUMO
|
Facility
|
IP
|
$20.38
|
|
|
Service Code
|
HCPCS 90471
|
| Hospital Charge Code |
93500179
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$3.06 |
| Max. Negotiated Rate |
$3.06 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$3.06
|
|
|
VACCINE ADMIN PNEUMO
|
Facility
|
IP
|
$20.38
|
|
|
Service Code
|
HCPCS 90471
|
| Hospital Charge Code |
5792175
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$3.06 |
| Max. Negotiated Rate |
$3.06 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$3.06
|
|
|
VACCINE ADMIN PNEUMO
|
Facility
|
IP
|
$156.00
|
|
|
Service Code
|
HCPCS 90471
|
| Hospital Charge Code |
3408045
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$23.40 |
| Max. Negotiated Rate |
$23.40 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$23.40
|
|
|
VACCINE ADMIN PNEUMO
|
Facility
|
IP
|
$20.38
|
|
|
Service Code
|
HCPCS 90471
|
| Hospital Charge Code |
87502055
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$3.06 |
| Max. Negotiated Rate |
$3.06 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$3.06
|
|
