|
CHEMO INTO CNS
|
Facility
|
IP
|
$1,234.69
|
|
|
Service Code
|
HCPCS 96450
|
| Hospital Charge Code |
3407001
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$185.20 |
| Max. Negotiated Rate |
$185.20 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$185.20
|
|
|
CHEMO INTO CNS
|
Facility
|
OP
|
$1,234.69
|
|
|
Service Code
|
HCPCS 96450
|
| Hospital Charge Code |
3407001
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$29.76 |
| Max. Negotiated Rate |
$2,770.00 |
| Rate for Payer: Aetna Commercial |
$1,067.36
|
| Rate for Payer: Aetna Medicare Advantage |
$1,271.41
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,416.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,416.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$392.41
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,416.48
|
| Rate for Payer: Cigna Commercial |
$786.58
|
| Rate for Payer: Cigna Medicare Advantage |
$274.69
|
| Rate for Payer: Clover Medicare Advantage |
$372.79
|
| Rate for Payer: EmblemHealth Commercial |
$1,177.23
|
| Rate for Payer: Humana Medicare Advantage |
$404.18
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$392.41
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$370.41
|
| Rate for Payer: Oxford Commercial |
$1,580.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$185.20
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,770.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$29.76
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$392.41
|
| Rate for Payer: Wellcare Medicare Advantage |
$392.41
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$32.72
|
|
|
CHEMO INTRATHECAL RESERVOIR
|
Facility
|
IP
|
$884.30
|
|
|
Service Code
|
HCPCS 96542
|
| Hospital Charge Code |
3401107
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$132.65 |
| Max. Negotiated Rate |
$132.65 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$132.65
|
|
|
CHEMO INTRATHECAL RESERVOIR
|
Facility
|
OP
|
$884.30
|
|
|
Service Code
|
HCPCS 96542
|
| Hospital Charge Code |
3401107
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$21.31 |
| Max. Negotiated Rate |
$2,770.00 |
| Rate for Payer: Aetna Commercial |
$1,067.36
|
| Rate for Payer: Aetna Medicare Advantage |
$1,271.41
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,416.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,416.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$392.41
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,416.48
|
| Rate for Payer: Cigna Commercial |
$786.58
|
| Rate for Payer: Cigna Medicare Advantage |
$274.69
|
| Rate for Payer: Clover Medicare Advantage |
$372.79
|
| Rate for Payer: EmblemHealth Commercial |
$1,177.23
|
| Rate for Payer: Humana Medicare Advantage |
$404.18
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$392.41
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$265.29
|
| Rate for Payer: Oxford Commercial |
$1,580.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$132.65
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,770.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$21.31
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$392.41
|
| Rate for Payer: Wellcare Medicare Advantage |
$392.41
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$23.43
|
|
|
CHEMO IV 16-90-EA ADD VAS
|
Facility
|
OP
|
$1,242.40
|
|
|
Service Code
|
HCPCS 96413
|
| Hospital Charge Code |
3409035
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$29.94 |
| Max. Negotiated Rate |
$2,770.00 |
| Rate for Payer: Aetna Commercial |
$1,067.36
|
| Rate for Payer: Aetna Medicare Advantage |
$1,271.41
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,416.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,416.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$392.41
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,416.48
|
| Rate for Payer: Cigna Commercial |
$786.58
|
| Rate for Payer: Cigna Medicare Advantage |
$274.69
|
| Rate for Payer: Clover Medicare Advantage |
$372.79
|
| Rate for Payer: EmblemHealth Commercial |
$1,177.23
|
| Rate for Payer: Humana Medicare Advantage |
$404.18
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$392.41
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$372.72
|
| Rate for Payer: Oxford Commercial |
$1,580.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$186.36
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,770.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$29.94
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$392.41
|
| Rate for Payer: Wellcare Medicare Advantage |
$392.41
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$32.92
|
|
|
CHEMO IV 16-90-EA ADD VAS
|
Facility
|
IP
|
$1,242.40
|
|
|
Service Code
|
HCPCS 96413
|
| Hospital Charge Code |
3409035
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$186.36 |
| Max. Negotiated Rate |
$186.36 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$186.36
|
|
|
CHEMO IV INFUS EACH ADDL SEQ
|
Facility
|
OP
|
$293.10
|
|
|
Service Code
|
HCPCS 96417
|
| Hospital Charge Code |
3401105
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$7.06 |
| Max. Negotiated Rate |
$2,770.00 |
| 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 |
$308.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$308.77
|
| 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) PPO |
$308.77
|
| Rate for Payer: Cigna Commercial |
$171.47
|
| Rate for Payer: Cigna Medicare Advantage |
$59.88
|
| 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 |
$87.93
|
| Rate for Payer: Oxford Commercial |
$1,580.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$43.97
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,770.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$7.06
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$85.54
|
| Rate for Payer: Wellcare Medicare Advantage |
$85.54
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$7.77
|
|
|
CHEMO IV INFUS EACH ADDL SEQ
|
Facility
|
IP
|
$293.10
|
|
|
Service Code
|
HCPCS 96417
|
| Hospital Charge Code |
3401105
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$43.97 |
| Max. Negotiated Rate |
$43.97 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$43.97
|
|
|
CHEMO, IV INFUSION, ADDL HR 1
|
Facility
|
OP
|
$293.10
|
|
|
Service Code
|
HCPCS 96415
|
| Hospital Charge Code |
3401045
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$7.06 |
| Max. Negotiated Rate |
$2,770.00 |
| 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 |
$308.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$308.77
|
| 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) PPO |
$308.77
|
| Rate for Payer: Cigna Commercial |
$171.47
|
| Rate for Payer: Cigna Medicare Advantage |
$59.88
|
| 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 |
$87.93
|
| Rate for Payer: Oxford Commercial |
$1,580.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$43.97
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,770.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$7.06
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$85.54
|
| Rate for Payer: Wellcare Medicare Advantage |
$85.54
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$7.77
|
|
|
CHEMO, IV INFUSION, ADDL HR 1
|
Facility
|
IP
|
$293.10
|
|
|
Service Code
|
HCPCS 96415
|
| Hospital Charge Code |
3401045
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$43.97 |
| Max. Negotiated Rate |
$43.97 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$43.97
|
|
|
CHEMO, IV INFUSION, ADDL HR 7
|
Facility
|
OP
|
$293.10
|
|
|
Service Code
|
HCPCS 96415
|
| Hospital Charge Code |
3401050
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$7.06 |
| Max. Negotiated Rate |
$2,770.00 |
| 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 |
$308.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$308.77
|
| 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) PPO |
$308.77
|
| Rate for Payer: Cigna Commercial |
$171.47
|
| Rate for Payer: Cigna Medicare Advantage |
$59.88
|
| 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 |
$87.93
|
| Rate for Payer: Oxford Commercial |
$1,580.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$43.97
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,770.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$7.06
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$85.54
|
| Rate for Payer: Wellcare Medicare Advantage |
$85.54
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$7.77
|
|
|
CHEMO, IV INFUSION, ADDL HR 7
|
Facility
|
IP
|
$293.10
|
|
|
Service Code
|
HCPCS 96415
|
| Hospital Charge Code |
3401050
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$43.97 |
| Max. Negotiated Rate |
$43.97 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$43.97
|
|
|
CHEMO, IV INFUSION, ADDL HR 8
|
Facility
|
IP
|
$234.48
|
|
|
Service Code
|
HCPCS 96415
|
| Hospital Charge Code |
3401055
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$35.17 |
| Max. Negotiated Rate |
$35.17 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$35.17
|
|
|
CHEMO, IV INFUSION, ADDL HR 8
|
Facility
|
OP
|
$234.48
|
|
|
Service Code
|
HCPCS 96415
|
| Hospital Charge Code |
3401055
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$5.65 |
| Max. Negotiated Rate |
$2,770.00 |
| 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 |
$308.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$308.77
|
| 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) PPO |
$308.77
|
| Rate for Payer: Cigna Commercial |
$171.47
|
| Rate for Payer: Cigna Medicare Advantage |
$59.88
|
| 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 |
$70.34
|
| Rate for Payer: Oxford Commercial |
$1,580.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$35.17
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,770.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$5.65
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$85.54
|
| Rate for Payer: Wellcare Medicare Advantage |
$85.54
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$6.21
|
|
|
CHEMO IV PUSH-1ST MD INFU
|
Facility
|
OP
|
$280.00
|
|
|
Service Code
|
HCPCS 96409
|
| Hospital Charge Code |
93500083
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$6.75 |
| Max. Negotiated Rate |
$2,770.00 |
| Rate for Payer: Aetna Commercial |
$1,067.36
|
| Rate for Payer: Aetna Medicare Advantage |
$1,271.41
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,416.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,416.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$392.41
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,416.48
|
| Rate for Payer: Cigna Commercial |
$786.58
|
| Rate for Payer: Cigna Medicare Advantage |
$274.69
|
| Rate for Payer: Clover Medicare Advantage |
$372.79
|
| Rate for Payer: EmblemHealth Commercial |
$1,177.23
|
| Rate for Payer: Humana Medicare Advantage |
$404.18
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$392.41
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$84.00
|
| Rate for Payer: Oxford Commercial |
$1,580.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$42.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,770.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$6.75
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$392.41
|
| Rate for Payer: Wellcare Medicare Advantage |
$392.41
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$7.42
|
|
|
CHEMO IV PUSH-1ST MD INFU
|
Facility
|
IP
|
$280.00
|
|
|
Service Code
|
HCPCS 96409
|
| Hospital Charge Code |
93500083
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$42.00 |
| Max. Negotiated Rate |
$42.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$42.00
|
|
|
CHEMO, IV PUSH, ADDL DRUG
|
Facility
|
OP
|
$584.75
|
|
|
Service Code
|
HCPCS 96411
|
| Hospital Charge Code |
3401095
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$14.09 |
| Max. Negotiated Rate |
$2,770.00 |
| 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 |
$308.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$308.77
|
| 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) PPO |
$308.77
|
| Rate for Payer: Cigna Commercial |
$171.47
|
| Rate for Payer: Cigna Medicare Advantage |
$59.88
|
| 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 |
$175.43
|
| Rate for Payer: Oxford Commercial |
$1,580.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$87.71
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,770.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$14.09
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$85.54
|
| Rate for Payer: Wellcare Medicare Advantage |
$85.54
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$15.50
|
|
|
CHEMO, IV PUSH, ADDL DRUG
|
Facility
|
IP
|
$584.75
|
|
|
Service Code
|
HCPCS 96411
|
| Hospital Charge Code |
3401095
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$87.71 |
| Max. Negotiated Rate |
$87.71 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$87.71
|
|
|
CHEMO IV PUSH EACH ADDT MED
|
Facility
|
OP
|
$402.60
|
|
|
Service Code
|
HCPCS 96411
|
| Hospital Charge Code |
93500085
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$9.70 |
| Max. Negotiated Rate |
$2,770.00 |
| 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 |
$308.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$308.77
|
| 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) PPO |
$308.77
|
| Rate for Payer: Cigna Commercial |
$171.47
|
| Rate for Payer: Cigna Medicare Advantage |
$59.88
|
| 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 |
$120.78
|
| Rate for Payer: Oxford Commercial |
$1,580.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$60.39
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,770.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$9.70
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$85.54
|
| Rate for Payer: Wellcare Medicare Advantage |
$85.54
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$10.67
|
|
|
CHEMO IV PUSH EACH ADDT MED
|
Facility
|
IP
|
$402.60
|
|
|
Service Code
|
HCPCS 96411
|
| Hospital Charge Code |
93500085
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$60.39 |
| Max. Negotiated Rate |
$60.39 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$60.39
|
|
|
CHEMO IV PUSH INITIAL MED
|
Facility
|
IP
|
$431.00
|
|
|
Service Code
|
HCPCS 96409
|
| Hospital Charge Code |
93500081
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$64.65 |
| Max. Negotiated Rate |
$64.65 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$64.65
|
|
|
CHEMO IV PUSH INITIAL MED
|
Facility
|
OP
|
$431.00
|
|
|
Service Code
|
HCPCS 96409
|
| Hospital Charge Code |
93500081
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$10.39 |
| Max. Negotiated Rate |
$2,770.00 |
| Rate for Payer: Aetna Commercial |
$1,067.36
|
| Rate for Payer: Aetna Medicare Advantage |
$1,271.41
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,416.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,416.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$392.41
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,416.48
|
| Rate for Payer: Cigna Commercial |
$786.58
|
| Rate for Payer: Cigna Medicare Advantage |
$274.69
|
| Rate for Payer: Clover Medicare Advantage |
$372.79
|
| Rate for Payer: EmblemHealth Commercial |
$1,177.23
|
| Rate for Payer: Humana Medicare Advantage |
$404.18
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$392.41
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$129.30
|
| Rate for Payer: Oxford Commercial |
$1,580.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$64.65
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,770.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$10.39
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$392.41
|
| Rate for Payer: Wellcare Medicare Advantage |
$392.41
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.42
|
|
|
CHEMO IV PUSH SINGLE DRUG
|
Facility
|
IP
|
$584.75
|
|
|
Service Code
|
HCPCS 96409
|
| Hospital Charge Code |
485096409
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$87.71 |
| Max. Negotiated Rate |
$87.71 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$87.71
|
|
|
CHEMO IV PUSH SINGLE DRUG
|
Facility
|
OP
|
$584.75
|
|
|
Service Code
|
HCPCS 96409
|
| Hospital Charge Code |
485096409
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$14.09 |
| Max. Negotiated Rate |
$2,770.00 |
| Rate for Payer: Aetna Commercial |
$1,067.36
|
| Rate for Payer: Aetna Medicare Advantage |
$1,271.41
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,416.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,416.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$392.41
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,416.48
|
| Rate for Payer: Cigna Commercial |
$786.58
|
| Rate for Payer: Cigna Medicare Advantage |
$274.69
|
| Rate for Payer: Clover Medicare Advantage |
$372.79
|
| Rate for Payer: EmblemHealth Commercial |
$1,177.23
|
| Rate for Payer: Humana Medicare Advantage |
$404.18
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$392.41
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$175.43
|
| Rate for Payer: Oxford Commercial |
$1,580.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$87.71
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,770.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$14.09
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$392.41
|
| Rate for Payer: Wellcare Medicare Advantage |
$392.41
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$15.50
|
|
|
CHEMO, IV PUSH, SNGL DRUG
|
Facility
|
OP
|
$584.75
|
|
|
Service Code
|
HCPCS 96409
|
| Hospital Charge Code |
3401090
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$14.09 |
| Max. Negotiated Rate |
$2,770.00 |
| Rate for Payer: Aetna Commercial |
$1,067.36
|
| Rate for Payer: Aetna Medicare Advantage |
$1,271.41
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,416.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,416.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$392.41
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,416.48
|
| Rate for Payer: Cigna Commercial |
$786.58
|
| Rate for Payer: Cigna Medicare Advantage |
$274.69
|
| Rate for Payer: Clover Medicare Advantage |
$372.79
|
| Rate for Payer: EmblemHealth Commercial |
$1,177.23
|
| Rate for Payer: Humana Medicare Advantage |
$404.18
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$392.41
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$175.43
|
| Rate for Payer: Oxford Commercial |
$1,580.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$87.71
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,770.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$14.09
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$392.41
|
| Rate for Payer: Wellcare Medicare Advantage |
$392.41
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$15.50
|
|
