|
IV HYDRA 16-90MIN-INITIAL
|
Facility
|
OP
|
$1,326.52
|
|
|
Service Code
|
HCPCS 96360
|
| Hospital Charge Code |
93500005
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$31.97 |
| Max. Negotiated Rate |
$919.00 |
| Rate for Payer: Aetna Commercial |
$687.34
|
| Rate for Payer: Aetna Medicare Advantage |
$818.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$912.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$912.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$252.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$272.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$912.17
|
| Rate for Payer: Cigna Commercial |
$506.53
|
| Rate for Payer: Cigna Medicare Advantage |
$252.70
|
| Rate for Payer: Clover Medicare Advantage |
$240.06
|
| Rate for Payer: EmblemHealth Commercial |
$758.10
|
| Rate for Payer: Humana Medicare Advantage |
$260.28
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$252.70
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$397.96
|
| Rate for Payer: Oxford Commercial |
$707.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$198.98
|
| Rate for Payer: UnitedHealthcare Commercial |
$919.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$31.97
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$252.70
|
| Rate for Payer: Wellcare Medicare Advantage |
$252.70
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$35.15
|
|
|
IV HYDRA 31-90 INITL AVS
|
Facility
|
OP
|
$1,326.52
|
|
|
Service Code
|
HCPCS 9636059
|
| Hospital Charge Code |
93500011
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$31.97 |
| Max. Negotiated Rate |
$919.00 |
| Rate for Payer: Aetna Commercial |
$504.08
|
| Rate for Payer: Aetna Medicare Advantage |
$397.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$338.26
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$338.26
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$338.26
|
| Rate for Payer: Cigna Commercial |
$663.26
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$397.96
|
| Rate for Payer: Oxford Commercial |
$707.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$198.98
|
| Rate for Payer: UnitedHealthcare Commercial |
$919.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$31.97
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$35.15
|
|
|
IV HYDRA 31-90 INITL AVS
|
Facility
|
IP
|
$1,326.52
|
|
|
Service Code
|
HCPCS 9636059
|
| Hospital Charge Code |
93500011
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$198.98 |
| Max. Negotiated Rate |
$198.98 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$198.98
|
|
|
IV INF 1STMED16-90 INI1VS
|
Facility
|
OP
|
$1,405.77
|
|
|
Service Code
|
HCPCS 96365
|
| Hospital Charge Code |
93500021
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$33.88 |
| Max. Negotiated Rate |
$919.00 |
| Rate for Payer: Aetna Commercial |
$687.34
|
| Rate for Payer: Aetna Medicare Advantage |
$818.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$912.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$912.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$252.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$72.14
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$912.17
|
| Rate for Payer: Cigna Commercial |
$506.53
|
| Rate for Payer: Cigna Medicare Advantage |
$252.70
|
| Rate for Payer: Clover Medicare Advantage |
$240.06
|
| Rate for Payer: EmblemHealth Commercial |
$758.10
|
| Rate for Payer: Humana Medicare Advantage |
$260.28
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$252.70
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$421.73
|
| Rate for Payer: Oxford Commercial |
$707.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$210.87
|
| Rate for Payer: UnitedHealthcare Commercial |
$919.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$33.88
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$252.70
|
| Rate for Payer: Wellcare Medicare Advantage |
$252.70
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$37.25
|
|
|
IV INF 1STMED16-90 INI1VS
|
Facility
|
IP
|
$1,405.77
|
|
|
Service Code
|
HCPCS 96365
|
| Hospital Charge Code |
93500021
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$210.87 |
| Max. Negotiated Rate |
$210.87 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$210.87
|
|
|
IV INF 1STMED16-90 INIAVS
|
Facility
|
IP
|
$1,405.77
|
|
|
Service Code
|
HCPCS 9636559
|
| Hospital Charge Code |
93500033
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$210.87 |
| Max. Negotiated Rate |
$210.87 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$210.87
|
|
|
IV INF 1STMED16-90 INIAVS
|
Facility
|
OP
|
$1,405.77
|
|
|
Service Code
|
HCPCS 9636559
|
| Hospital Charge Code |
93500033
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$33.88 |
| Max. Negotiated Rate |
$919.00 |
| Rate for Payer: Aetna Commercial |
$534.19
|
| Rate for Payer: Aetna Medicare Advantage |
$421.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$358.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$358.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$358.47
|
| Rate for Payer: Cigna Commercial |
$702.88
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$421.73
|
| Rate for Payer: Oxford Commercial |
$707.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$210.87
|
| Rate for Payer: UnitedHealthcare Commercial |
$919.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$33.88
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$37.25
|
|
|
IV INF IMMUNO-GLOBU 20GM
|
Facility
|
IP
|
$1,405.77
|
|
|
Service Code
|
HCPCS 96365
|
| Hospital Charge Code |
93500023
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$210.87 |
| Max. Negotiated Rate |
$210.87 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$210.87
|
|
|
IV INF IMMUNO-GLOBU 20GM
|
Facility
|
OP
|
$1,405.77
|
|
|
Service Code
|
HCPCS 96365
|
| Hospital Charge Code |
93500023
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$33.88 |
| Max. Negotiated Rate |
$919.00 |
| Rate for Payer: Aetna Commercial |
$687.34
|
| Rate for Payer: Aetna Medicare Advantage |
$818.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$912.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$912.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$252.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$72.14
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$912.17
|
| Rate for Payer: Cigna Commercial |
$506.53
|
| Rate for Payer: Cigna Medicare Advantage |
$252.70
|
| Rate for Payer: Clover Medicare Advantage |
$240.06
|
| Rate for Payer: EmblemHealth Commercial |
$758.10
|
| Rate for Payer: Humana Medicare Advantage |
$260.28
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$252.70
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$421.73
|
| Rate for Payer: Oxford Commercial |
$707.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$210.87
|
| Rate for Payer: UnitedHealthcare Commercial |
$919.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$33.88
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$252.70
|
| Rate for Payer: Wellcare Medicare Advantage |
$252.70
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$37.25
|
|
|
IV INF IMMUNO-GLOBU 30GM
|
Facility
|
OP
|
$1,405.77
|
|
|
Service Code
|
HCPCS 96365
|
| Hospital Charge Code |
93500025
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$33.88 |
| Max. Negotiated Rate |
$919.00 |
| Rate for Payer: Aetna Commercial |
$687.34
|
| Rate for Payer: Aetna Medicare Advantage |
$818.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$912.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$912.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$252.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$72.14
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$912.17
|
| Rate for Payer: Cigna Commercial |
$506.53
|
| Rate for Payer: Cigna Medicare Advantage |
$252.70
|
| Rate for Payer: Clover Medicare Advantage |
$240.06
|
| Rate for Payer: EmblemHealth Commercial |
$758.10
|
| Rate for Payer: Humana Medicare Advantage |
$260.28
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$252.70
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$421.73
|
| Rate for Payer: Oxford Commercial |
$707.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$210.87
|
| Rate for Payer: UnitedHealthcare Commercial |
$919.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$33.88
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$252.70
|
| Rate for Payer: Wellcare Medicare Advantage |
$252.70
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$37.25
|
|
|
IV INF IMMUNO-GLOBU 30GM
|
Facility
|
IP
|
$1,405.77
|
|
|
Service Code
|
HCPCS 96365
|
| Hospital Charge Code |
93500025
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$210.87 |
| Max. Negotiated Rate |
$210.87 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$210.87
|
|
|
IV INF IMMUNO-GLOBU 70GM
|
Facility
|
IP
|
$1,405.77
|
|
|
Service Code
|
HCPCS 96365
|
| Hospital Charge Code |
93500027
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$210.87 |
| Max. Negotiated Rate |
$210.87 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$210.87
|
|
|
IV INF IMMUNO-GLOBU 70GM
|
Facility
|
OP
|
$1,405.77
|
|
|
Service Code
|
HCPCS 96365
|
| Hospital Charge Code |
93500027
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$33.88 |
| Max. Negotiated Rate |
$919.00 |
| Rate for Payer: Aetna Commercial |
$687.34
|
| Rate for Payer: Aetna Medicare Advantage |
$818.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$912.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$912.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$252.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$72.14
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$912.17
|
| Rate for Payer: Cigna Commercial |
$506.53
|
| Rate for Payer: Cigna Medicare Advantage |
$252.70
|
| Rate for Payer: Clover Medicare Advantage |
$240.06
|
| Rate for Payer: EmblemHealth Commercial |
$758.10
|
| Rate for Payer: Humana Medicare Advantage |
$260.28
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$252.70
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$421.73
|
| Rate for Payer: Oxford Commercial |
$707.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$210.87
|
| Rate for Payer: UnitedHealthcare Commercial |
$919.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$33.88
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$252.70
|
| Rate for Payer: Wellcare Medicare Advantage |
$252.70
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$37.25
|
|
|
IV INF MED EA ADDTL HR
|
Facility
|
IP
|
$111.00
|
|
|
Service Code
|
HCPCS 96366
|
| Hospital Charge Code |
93500037
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$16.65 |
| Max. Negotiated Rate |
$16.65 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$16.65
|
|
|
IV INF MED EA ADDTL HR
|
Facility
|
OP
|
$111.00
|
|
|
Service Code
|
HCPCS 96366
|
| Hospital Charge Code |
93500037
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$2.68 |
| Max. Negotiated Rate |
$919.00 |
| Rate for Payer: Aetna Commercial |
$151.31
|
| Rate for Payer: Aetna Medicare Advantage |
$180.24
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$200.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$200.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$55.63
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$23.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$200.81
|
| Rate for Payer: Cigna Commercial |
$111.50
|
| Rate for Payer: Cigna Medicare Advantage |
$55.63
|
| Rate for Payer: Clover Medicare Advantage |
$52.85
|
| Rate for Payer: EmblemHealth Commercial |
$166.89
|
| Rate for Payer: Humana Medicare Advantage |
$57.30
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$55.63
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$33.30
|
| Rate for Payer: Oxford Commercial |
$707.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$16.65
|
| Rate for Payer: UnitedHealthcare Commercial |
$919.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$2.68
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$55.63
|
| Rate for Payer: Wellcare Medicare Advantage |
$55.63
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.94
|
|
|
IV INF TOCILIZUM COVID19 DOSE1
|
Facility
|
IP
|
$2,250.00
|
|
|
Service Code
|
HCPCS M0249
|
| Hospital Charge Code |
3048M0249
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$337.50 |
| Max. Negotiated Rate |
$337.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$337.50
|
|
|
IV INF TOCILIZUM COVID19 DOSE1
|
Facility
|
OP
|
$2,250.00
|
|
|
Service Code
|
HCPCS M0249
|
| Hospital Charge Code |
4229M0249
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$54.23 |
| Max. Negotiated Rate |
$1,890.98 |
| Rate for Payer: Aetna Commercial |
$1,424.90
|
| Rate for Payer: Aetna Medicare Advantage |
$1,697.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,890.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,890.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$523.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,890.98
|
| Rate for Payer: Cigna Medicare Advantage |
$523.86
|
| Rate for Payer: Clover Medicare Advantage |
$497.67
|
| Rate for Payer: EmblemHealth Commercial |
$1,571.58
|
| Rate for Payer: Humana Medicare Advantage |
$539.58
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$523.86
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$675.00
|
| Rate for Payer: Oxford Commercial |
$91.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$337.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$159.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$54.23
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$523.86
|
| Rate for Payer: Wellcare Medicare Advantage |
$523.86
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$59.62
|
|
|
IV INF TOCILIZUM COVID19 DOSE1
|
Facility
|
OP
|
$2,250.00
|
|
|
Service Code
|
HCPCS M0249
|
| Hospital Charge Code |
3190M0249
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$54.23 |
| Max. Negotiated Rate |
$1,890.98 |
| Rate for Payer: Aetna Commercial |
$1,424.90
|
| Rate for Payer: Aetna Medicare Advantage |
$1,697.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,890.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,890.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$523.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,890.98
|
| Rate for Payer: Cigna Medicare Advantage |
$523.86
|
| Rate for Payer: Clover Medicare Advantage |
$497.67
|
| Rate for Payer: EmblemHealth Commercial |
$1,571.58
|
| Rate for Payer: Humana Medicare Advantage |
$539.58
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$523.86
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$675.00
|
| Rate for Payer: Oxford Commercial |
$91.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$337.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$159.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$54.23
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$523.86
|
| Rate for Payer: Wellcare Medicare Advantage |
$523.86
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$59.62
|
|
|
IV INF TOCILIZUM COVID19 DOSE1
|
Facility
|
IP
|
$2,250.00
|
|
|
Service Code
|
HCPCS M0249
|
| Hospital Charge Code |
4229M0249
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$337.50 |
| Max. Negotiated Rate |
$337.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$337.50
|
|
|
IV INF TOCILIZUM COVID19 DOSE1
|
Facility
|
IP
|
$2,250.00
|
|
|
Service Code
|
HCPCS M0249
|
| Hospital Charge Code |
3034M0249
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$337.50 |
| Max. Negotiated Rate |
$337.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$337.50
|
|
|
IV INF TOCILIZUM COVID19 DOSE1
|
Facility
|
IP
|
$2,250.00
|
|
|
Service Code
|
HCPCS M0249
|
| Hospital Charge Code |
3080M0249
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$337.50 |
| Max. Negotiated Rate |
$337.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$337.50
|
|
|
IV INF TOCILIZUM COVID19 DOSE1
|
Facility
|
IP
|
$2,250.00
|
|
|
Service Code
|
HCPCS M0249
|
| Hospital Charge Code |
3121M0249
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$337.50 |
| Max. Negotiated Rate |
$337.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$337.50
|
|
|
IV INF TOCILIZUM COVID19 DOSE1
|
Facility
|
IP
|
$2,250.00
|
|
|
Service Code
|
HCPCS M0249
|
| Hospital Charge Code |
3237M0249
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$337.50 |
| Max. Negotiated Rate |
$337.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$337.50
|
|
|
IV INF TOCILIZUM COVID19 DOSE1
|
Facility
|
IP
|
$2,250.00
|
|
|
Service Code
|
HCPCS M0249
|
| Hospital Charge Code |
3230M0249
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$337.50 |
| Max. Negotiated Rate |
$337.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$337.50
|
|
|
IV INF TOCILIZUM COVID19 DOSE1
|
Facility
|
IP
|
$2,250.00
|
|
|
Service Code
|
HCPCS M0249
|
| Hospital Charge Code |
3246M0249
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$337.50 |
| Max. Negotiated Rate |
$337.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$337.50
|
|
