|
INFLUX SPARC 10CC
|
Facility
|
OP
|
$17,750.00
|
|
|
Service Code
|
HCPCS C1765
|
| Hospital Charge Code |
270705826
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$427.77 |
| Max. Negotiated Rate |
$8,875.00 |
| Rate for Payer: Aetna Commercial |
$6,745.00
|
| Rate for Payer: Aetna Medicare Advantage |
$5,325.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4,526.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4,526.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4,526.25
|
| Rate for Payer: Cigna Commercial |
$8,875.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5,325.00
|
| Rate for Payer: Oxford Commercial |
$3,550.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,662.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$3,550.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$427.77
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$470.38
|
|
|
INFLUX SPARC 5CC
|
Facility
|
IP
|
$9,750.00
|
|
|
Service Code
|
HCPCS C1765
|
| Hospital Charge Code |
270705849
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,462.50 |
| Max. Negotiated Rate |
$2,359.50 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,950.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,359.50
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$2,145.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,462.50
|
|
|
INFLUX SPARC 5CC
|
Facility
|
OP
|
$9,750.00
|
|
|
Service Code
|
HCPCS C1765
|
| Hospital Charge Code |
270705849
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$234.97 |
| Max. Negotiated Rate |
$4,875.00 |
| Rate for Payer: Aetna Commercial |
$3,705.00
|
| Rate for Payer: Aetna Medicare Advantage |
$2,925.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,486.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,486.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,950.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,486.25
|
| Rate for Payer: Cigna Commercial |
$4,875.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,359.50
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$2,145.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,462.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$234.97
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$258.38
|
|
|
INF THERAP DIFF DRUG 1ST HR
|
Facility
|
IP
|
$2,800.00
|
|
|
Service Code
|
HCPCS 96367
|
| Hospital Charge Code |
3401041
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$420.00 |
| Max. Negotiated Rate |
$420.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$420.00
|
|
|
INF THERAP DIFF DRUG 1ST HR
|
Facility
|
IP
|
$2,800.00
|
|
|
Service Code
|
HCPCS 96367
|
| Hospital Charge Code |
83653140
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$420.00 |
| Max. Negotiated Rate |
$420.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$420.00
|
|
|
INF THERAP DIFF DRUG 1ST HR
|
Facility
|
IP
|
$2,800.00
|
|
|
Service Code
|
HCPCS 96367
|
| Hospital Charge Code |
395096367
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$420.00 |
| Max. Negotiated Rate |
$420.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$420.00
|
|
|
INF THERAP DIFF DRUG 1ST HR
|
Facility
|
IP
|
$1,334.09
|
|
|
Service Code
|
HCPCS 96367
|
| Hospital Charge Code |
73237023
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$200.11 |
| Max. Negotiated Rate |
$200.11 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$200.11
|
|
|
INF THERAP DIFF DRUG 1ST HR
|
Facility
|
OP
|
$2,800.00
|
|
|
Service Code
|
HCPCS 96367
|
| Hospital Charge Code |
395096367
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$34.85 |
| Max. Negotiated Rate |
$919.00 |
| 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) NJ Health |
$34.85
|
| 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 |
$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 |
$840.00
|
| Rate for Payer: Oxford Commercial |
$707.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$420.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$919.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$67.48
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$85.54
|
| Rate for Payer: Wellcare Medicare Advantage |
$85.54
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$74.20
|
|
|
INF THERAP DIFF DRUG 1ST HR
|
Facility
|
OP
|
$1,334.09
|
|
|
Service Code
|
HCPCS 96367
|
| Hospital Charge Code |
8200517
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$32.15 |
| Max. Negotiated Rate |
$919.00 |
| 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) NJ Health |
$34.85
|
| 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 |
$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 |
$400.23
|
| Rate for Payer: Oxford Commercial |
$707.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$200.11
|
| Rate for Payer: UnitedHealthcare Commercial |
$919.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$32.15
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$85.54
|
| Rate for Payer: Wellcare Medicare Advantage |
$85.54
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$35.35
|
|
|
INF THERAP DIFF DRUG 1ST HR
|
Facility
|
IP
|
$2,800.00
|
|
|
Service Code
|
HCPCS 96367
|
| Hospital Charge Code |
100128
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$420.00 |
| Max. Negotiated Rate |
$420.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$420.00
|
|
|
INF THERAP DIFF DRUG 1ST HR
|
Facility
|
OP
|
$1,334.09
|
|
|
Service Code
|
HCPCS 96367
|
| Hospital Charge Code |
73237023
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$32.15 |
| Max. Negotiated Rate |
$919.00 |
| 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) NJ Health |
$34.85
|
| 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 |
$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 |
$400.23
|
| Rate for Payer: Oxford Commercial |
$707.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$200.11
|
| Rate for Payer: UnitedHealthcare Commercial |
$919.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$32.15
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$85.54
|
| Rate for Payer: Wellcare Medicare Advantage |
$85.54
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$35.35
|
|
|
INF THERAP DIFF DRUG 1ST HR
|
Facility
|
IP
|
$2,800.00
|
|
|
Service Code
|
HCPCS 96367
|
| Hospital Charge Code |
73190099
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$420.00 |
| Max. Negotiated Rate |
$420.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$420.00
|
|
|
INF THERAP DIFF DRUG 1ST HR
|
Facility
|
IP
|
$2,800.00
|
|
|
Service Code
|
HCPCS 96367
|
| Hospital Charge Code |
270339105
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$420.00 |
| Max. Negotiated Rate |
$420.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$420.00
|
|
|
INF THERAP DIFF DRUG 1ST HR
|
Facility
|
OP
|
$2,800.00
|
|
|
Service Code
|
HCPCS 96367
|
| Hospital Charge Code |
73190099
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$34.85 |
| Max. Negotiated Rate |
$919.00 |
| 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) NJ Health |
$34.85
|
| 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 |
$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 |
$840.00
|
| Rate for Payer: Oxford Commercial |
$707.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$420.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$919.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$67.48
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$85.54
|
| Rate for Payer: Wellcare Medicare Advantage |
$85.54
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$74.20
|
|
|
INF THERAP DIFF DRUG 1ST HR
|
Facility
|
OP
|
$1,334.09
|
|
|
Service Code
|
HCPCS 96367
|
| Hospital Charge Code |
73050925
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$32.15 |
| Max. Negotiated Rate |
$919.00 |
| 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) NJ Health |
$34.85
|
| 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 |
$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 |
$400.23
|
| Rate for Payer: Oxford Commercial |
$707.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$200.11
|
| Rate for Payer: UnitedHealthcare Commercial |
$919.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$32.15
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$85.54
|
| Rate for Payer: Wellcare Medicare Advantage |
$85.54
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$35.35
|
|
|
INF THERAP DIFF DRUG 1ST HR
|
Facility
|
IP
|
$2,800.00
|
|
|
Service Code
|
HCPCS 96367
|
| Hospital Charge Code |
3401070
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$420.00 |
| Max. Negotiated Rate |
$420.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$420.00
|
|
|
INF THERAP DIFF DRUG 1ST HR
|
Facility
|
OP
|
$2,800.00
|
|
|
Service Code
|
HCPCS 96367
|
| Hospital Charge Code |
3401041
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$34.85 |
| Max. Negotiated Rate |
$919.00 |
| 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) NJ Health |
$34.85
|
| 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 |
$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 |
$840.00
|
| Rate for Payer: Oxford Commercial |
$707.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$420.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$919.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$67.48
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$85.54
|
| Rate for Payer: Wellcare Medicare Advantage |
$85.54
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$74.20
|
|
|
INF THERAP DIFF DRUG 1ST HR
|
Facility
|
OP
|
$1,334.09
|
|
|
Service Code
|
HCPCS 96367
|
| Hospital Charge Code |
74308245
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$32.15 |
| Max. Negotiated Rate |
$919.00 |
| 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) NJ Health |
$34.85
|
| 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 |
$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 |
$400.23
|
| Rate for Payer: Oxford Commercial |
$707.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$200.11
|
| Rate for Payer: UnitedHealthcare Commercial |
$919.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$32.15
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$85.54
|
| Rate for Payer: Wellcare Medicare Advantage |
$85.54
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$35.35
|
|
|
INF THERAP DIFF DRUG 1ST HR
|
Facility
|
OP
|
$2,800.00
|
|
|
Service Code
|
HCPCS 96367
|
| Hospital Charge Code |
3401070
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$34.85 |
| Max. Negotiated Rate |
$919.00 |
| 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) NJ Health |
$34.85
|
| 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 |
$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 |
$840.00
|
| Rate for Payer: Oxford Commercial |
$707.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$420.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$919.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$67.48
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$85.54
|
| Rate for Payer: Wellcare Medicare Advantage |
$85.54
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$74.20
|
|
|
INF THERAP DIFF DRUG 1ST HR
|
Facility
|
IP
|
$1,334.09
|
|
|
Service Code
|
HCPCS 96367
|
| Hospital Charge Code |
8200517
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$200.11 |
| Max. Negotiated Rate |
$200.11 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$200.11
|
|
|
INF THERAP DIFF DRUG 1ST HR
|
Facility
|
OP
|
$2,800.00
|
|
|
Service Code
|
HCPCS 96367
|
| Hospital Charge Code |
83653140
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$34.85 |
| Max. Negotiated Rate |
$919.00 |
| 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) NJ Health |
$34.85
|
| 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 |
$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 |
$840.00
|
| Rate for Payer: Oxford Commercial |
$707.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$420.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$919.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$67.48
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$85.54
|
| Rate for Payer: Wellcare Medicare Advantage |
$85.54
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$74.20
|
|
|
INF THERAP DIFF DRUG 1ST HR
|
Facility
|
IP
|
$2,145.09
|
|
|
Service Code
|
HCPCS 96367
|
| Hospital Charge Code |
5700404
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$321.76 |
| Max. Negotiated Rate |
$321.76 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$321.76
|
|
|
INF THERAP DIFF DRUG 1ST HR
|
Facility
|
IP
|
$1,334.09
|
|
|
Service Code
|
HCPCS 96367
|
| Hospital Charge Code |
74308245
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$200.11 |
| Max. Negotiated Rate |
$200.11 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$200.11
|
|
|
INF THERAP DIFF DRUG 1ST HR
|
Facility
|
OP
|
$2,145.09
|
|
|
Service Code
|
HCPCS 96367
|
| Hospital Charge Code |
5700404
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$34.85 |
| Max. Negotiated Rate |
$850.00 |
| 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) NJ Health |
$34.85
|
| 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 |
$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 |
$643.53
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$850.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$321.76
|
| Rate for Payer: UnitedHealthcare Community & State |
$140.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$85.54
|
| Rate for Payer: Wellcare Medicare Advantage |
$85.54
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$56.84
|
|
|
INF THERAP DIFF DRUG 1ST HR
|
Facility
|
OP
|
$2,800.00
|
|
|
Service Code
|
HCPCS 96367
|
| Hospital Charge Code |
100128
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$34.85 |
| Max. Negotiated Rate |
$919.00 |
| 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) NJ Health |
$34.85
|
| 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 |
$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 |
$840.00
|
| Rate for Payer: Oxford Commercial |
$707.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$420.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$919.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$67.48
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$85.54
|
| Rate for Payer: Wellcare Medicare Advantage |
$85.54
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$74.20
|
|
