|
EOSINOPHIL COUNT
|
Facility
|
OP
|
$368.00
|
|
|
Service Code
|
HCPCS 85048
|
| Hospital Charge Code |
38473015
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.03 |
| Max. Negotiated Rate |
$184.00 |
| Rate for Payer: Aetna Commercial |
$6.91
|
| Rate for Payer: Aetna Medicare Advantage |
$8.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$9.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$9.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$2.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$9.17
|
| Rate for Payer: Cigna Commercial |
$184.00
|
| Rate for Payer: Cigna Medicare Advantage |
$2.54
|
| Rate for Payer: Clover Medicare Advantage |
$2.41
|
| Rate for Payer: EmblemHealth Commercial |
$7.62
|
| Rate for Payer: Humana Medicare Advantage |
$2.62
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$2.54
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$110.40
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$55.20
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$2.03
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$2.54
|
| Rate for Payer: Wellcare Medicare Advantage |
$2.54
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$9.75
|
|
|
EOSINOPHIL COUNT, PLASMA
|
Facility
|
OP
|
$24.85
|
|
|
Service Code
|
HCPCS 85048
|
| Hospital Charge Code |
3001146
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.66 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$6.91
|
| Rate for Payer: Aetna Medicare Advantage |
$8.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$9.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$9.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$2.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$9.17
|
| Rate for Payer: Cigna Commercial |
$12.43
|
| Rate for Payer: Cigna Medicare Advantage |
$2.54
|
| Rate for Payer: Clover Medicare Advantage |
$2.41
|
| Rate for Payer: EmblemHealth Commercial |
$7.62
|
| Rate for Payer: Humana Medicare Advantage |
$2.62
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$2.54
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$7.46
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3.73
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$2.03
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$2.54
|
| Rate for Payer: Wellcare Medicare Advantage |
$2.54
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.66
|
|
|
EOSINOPHIL COUNT, PLASMA
|
Facility
|
IP
|
$24.85
|
|
|
Service Code
|
HCPCS 85048
|
| Hospital Charge Code |
3001146
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.73 |
| Max. Negotiated Rate |
$3.73 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$3.73
|
|
|
EOSINOPHIL COUNT, URINE
|
Facility
|
IP
|
$222.00
|
|
|
Service Code
|
HCPCS 81015
|
| Hospital Charge Code |
38477031
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$33.30 |
| Max. Negotiated Rate |
$33.30 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$33.30
|
|
|
EOSINOPHIL COUNT, URINE
|
Facility
|
OP
|
$222.00
|
|
|
Service Code
|
HCPCS 81015
|
| Hospital Charge Code |
38477031
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$0.77 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$8.30
|
| Rate for Payer: Aetna Medicare Advantage |
$9.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$11.01
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$11.01
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$3.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$0.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$11.01
|
| Rate for Payer: Cigna Commercial |
$111.00
|
| Rate for Payer: Cigna Medicare Advantage |
$3.05
|
| Rate for Payer: Clover Medicare Advantage |
$2.90
|
| Rate for Payer: EmblemHealth Commercial |
$9.15
|
| Rate for Payer: Humana Medicare Advantage |
$3.14
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$3.05
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$66.60
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$33.30
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$2.44
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$3.05
|
| Rate for Payer: Wellcare Medicare Advantage |
$3.05
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$5.88
|
|
|
EOSINOPHILS (NASAL SMEAR)
|
Facility
|
OP
|
$60.00
|
|
|
Service Code
|
HCPCS 89190
|
| Hospital Charge Code |
3001153
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$1.59 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$15.75
|
| Rate for Payer: Aetna Medicare Advantage |
$18.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$20.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$20.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$5.79
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$4.26
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$20.90
|
| Rate for Payer: Cigna Commercial |
$30.00
|
| Rate for Payer: Cigna Medicare Advantage |
$5.79
|
| Rate for Payer: Clover Medicare Advantage |
$5.50
|
| Rate for Payer: EmblemHealth Commercial |
$17.37
|
| Rate for Payer: Humana Medicare Advantage |
$5.96
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$5.79
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$18.00
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$9.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$4.63
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$5.79
|
| Rate for Payer: Wellcare Medicare Advantage |
$5.79
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.59
|
|
|
EOSINOPHILS (NASAL SMEAR)
|
Facility
|
IP
|
$60.00
|
|
|
Service Code
|
HCPCS 89190
|
| Hospital Charge Code |
3001153
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.00 |
| Max. Negotiated Rate |
$9.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$9.00
|
|
|
EOSINOPHILS NASAL SMEAR
|
Facility
|
OP
|
$60.00
|
|
|
Service Code
|
HCPCS 89190
|
| Hospital Charge Code |
3030087
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$1.59 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$15.75
|
| Rate for Payer: Aetna Medicare Advantage |
$18.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$20.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$20.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$5.79
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$4.26
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$20.90
|
| Rate for Payer: Cigna Commercial |
$30.00
|
| Rate for Payer: Cigna Medicare Advantage |
$5.79
|
| Rate for Payer: Clover Medicare Advantage |
$5.50
|
| Rate for Payer: EmblemHealth Commercial |
$17.37
|
| Rate for Payer: Humana Medicare Advantage |
$5.96
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$5.79
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$18.00
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$9.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$4.63
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$5.79
|
| Rate for Payer: Wellcare Medicare Advantage |
$5.79
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.59
|
|
|
EOSINOPHILS NASAL SMEAR
|
Facility
|
IP
|
$60.00
|
|
|
Service Code
|
HCPCS 89190
|
| Hospital Charge Code |
3030087
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.00 |
| Max. Negotiated Rate |
$9.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$9.00
|
|
|
EOSINOPHILS, NASAL SMEAR
|
Facility
|
IP
|
$123.00
|
|
|
Service Code
|
HCPCS 89190
|
| Hospital Charge Code |
38475097
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$18.45 |
| Max. Negotiated Rate |
$18.45 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$18.45
|
|
|
EOSINOPHILS, NASAL SMEAR
|
Facility
|
OP
|
$123.00
|
|
|
Service Code
|
HCPCS 89190
|
| Hospital Charge Code |
38475097
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$3.26 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$15.75
|
| Rate for Payer: Aetna Medicare Advantage |
$18.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$20.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$20.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$5.79
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$4.26
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$20.90
|
| Rate for Payer: Cigna Commercial |
$61.50
|
| Rate for Payer: Cigna Medicare Advantage |
$5.79
|
| Rate for Payer: Clover Medicare Advantage |
$5.50
|
| Rate for Payer: EmblemHealth Commercial |
$17.37
|
| Rate for Payer: Humana Medicare Advantage |
$5.96
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$5.79
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$36.90
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$18.45
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$4.63
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$5.79
|
| Rate for Payer: Wellcare Medicare Advantage |
$5.79
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$3.26
|
|
|
EOSINOPHILS (URINE)
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 87205
|
| Hospital Charge Code |
3005436
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$3.42 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$11.61
|
| Rate for Payer: Aetna Medicare Advantage |
$13.83
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$15.41
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$15.41
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$4.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$8.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$15.41
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$4.27
|
| Rate for Payer: Clover Medicare Advantage |
$4.06
|
| Rate for Payer: EmblemHealth Commercial |
$12.81
|
| Rate for Payer: Humana Medicare Advantage |
$4.40
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$4.27
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$117.00
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$3.42
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$4.27
|
| Rate for Payer: Wellcare Medicare Advantage |
$4.27
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$10.34
|
|
|
EOSINOPHILS (URINE)
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 87205
|
| Hospital Charge Code |
3005436
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
EPF KIT
|
Facility
|
OP
|
$3,734.50
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
270703555
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$90.00 |
| Max. Negotiated Rate |
$1,867.25 |
| Rate for Payer: Aetna Commercial |
$1,419.11
|
| Rate for Payer: Aetna Medicare Advantage |
$1,120.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$952.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$952.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$746.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$952.30
|
| Rate for Payer: Cigna Commercial |
$1,867.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$903.75
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$821.59
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$560.17
|
| Rate for Payer: UnitedHealthcare Community & State |
$90.00
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$98.96
|
|
|
EPF KIT
|
Facility
|
IP
|
$3,734.50
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
270703555
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$560.17 |
| Max. Negotiated Rate |
$903.75 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$746.90
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$903.75
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$821.59
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$560.17
|
|
|
EPHEDRINE
|
Facility
|
OP
|
$47.35
|
|
| Hospital Charge Code |
270656754
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.14 |
| Max. Negotiated Rate |
$23.68 |
| Rate for Payer: Aetna Commercial |
$17.99
|
| Rate for Payer: Aetna Medicare Advantage |
$14.21
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$12.07
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$12.07
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$12.07
|
| Rate for Payer: Cigna Commercial |
$23.68
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$14.21
|
| Rate for Payer: Oxford Commercial |
$9.47
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$7.10
|
| Rate for Payer: UnitedHealthcare Commercial |
$9.47
|
| Rate for Payer: UnitedHealthcare Community & State |
$1.14
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.25
|
|
|
EPHEDRINE
|
Facility
|
IP
|
$47.35
|
|
| Hospital Charge Code |
270656754
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.10 |
| Max. Negotiated Rate |
$7.10 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$7.10
|
|
|
EPHEDRINE 25 MG CAP
|
Facility
|
OP
|
$2.45
|
|
| Hospital Charge Code |
60627446
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$1.23 |
| Rate for Payer: Aetna Commercial |
$0.93
|
| Rate for Payer: Aetna Medicare Advantage |
$0.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$0.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$0.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$0.62
|
| Rate for Payer: Cigna Commercial |
$1.23
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$0.74
|
| Rate for Payer: Oxford Commercial |
$0.49
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.37
|
| Rate for Payer: UnitedHealthcare Commercial |
$0.49
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.06
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.06
|
|
|
EPHEDRINE 25 MG CAP
|
Facility
|
IP
|
$2.45
|
|
| Hospital Charge Code |
60627446
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.37 |
| Max. Negotiated Rate |
$0.37 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.37
|
|
|
EPHEDRINE/50MG/INJ
|
Facility
|
IP
|
$125.00
|
|
| Hospital Charge Code |
60634723
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$18.75 |
| Max. Negotiated Rate |
$18.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$18.75
|
|
|
EPHEDRINE/50MG/INJ
|
Facility
|
OP
|
$125.00
|
|
| Hospital Charge Code |
60634723
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.01 |
| Max. Negotiated Rate |
$62.50 |
| Rate for Payer: Aetna Commercial |
$47.50
|
| Rate for Payer: Aetna Medicare Advantage |
$37.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$31.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$31.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$31.88
|
| Rate for Payer: Cigna Commercial |
$62.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$37.50
|
| Rate for Payer: Oxford Commercial |
$25.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$18.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$25.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$3.01
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$3.31
|
|
|
EPHEDRINE 50 MG/ML INJ
|
Facility
|
OP
|
$353.63
|
|
|
Service Code
|
NDC 17478051500
|
| Hospital Charge Code |
6012488
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.52 |
| Max. Negotiated Rate |
$176.81 |
| Rate for Payer: Aetna Commercial |
$134.38
|
| Rate for Payer: Aetna Medicare Advantage |
$106.09
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$90.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$90.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$90.18
|
| Rate for Payer: Cigna Commercial |
$176.81
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$106.09
|
| Rate for Payer: Oxford Commercial |
$70.73
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$53.04
|
| Rate for Payer: UnitedHealthcare Commercial |
$70.73
|
| Rate for Payer: UnitedHealthcare Community & State |
$8.52
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$9.37
|
|
|
EPHEDRINE 50 MG/ML INJ
|
Facility
|
IP
|
$353.63
|
|
|
Service Code
|
NDC 17478051500
|
| Hospital Charge Code |
6012488
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$53.04 |
| Max. Negotiated Rate |
$53.04 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$53.04
|
|
|
EPIDERMAL ANTIBODY 2
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 86255
|
| Hospital Charge Code |
38476310
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
EPIDERMAL ANTIBODY 2
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 86255
|
| Hospital Charge Code |
38476310
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.64 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$32.78
|
| Rate for Payer: Aetna Medicare Advantage |
$39.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$43.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$43.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$12.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$15.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$43.50
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$12.05
|
| Rate for Payer: Clover Medicare Advantage |
$11.45
|
| Rate for Payer: EmblemHealth Commercial |
$36.15
|
| Rate for Payer: Humana Medicare Advantage |
$12.41
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$12.05
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$117.00
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$9.64
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$12.05
|
| Rate for Payer: Wellcare Medicare Advantage |
$12.05
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$10.34
|
|
