|
IV PUSH EA ADDL DRUG SAME
|
Facility
|
OP
|
$440.91
|
|
|
Service Code
|
HCPCS 96376
|
| Hospital Charge Code |
73050960
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$10.63 |
| Max. Negotiated Rate |
$919.00 |
| Rate for Payer: Aetna Commercial |
$167.55
|
| Rate for Payer: Aetna Medicare Advantage |
$132.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$112.43
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$112.43
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$15.57
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$112.43
|
| Rate for Payer: Cigna Commercial |
$220.46
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$132.27
|
| Rate for Payer: Oxford Commercial |
$707.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$66.14
|
| Rate for Payer: UnitedHealthcare Commercial |
$919.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$10.63
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.68
|
|
|
IV PUSH-EA ADDTL NEW MED
|
Facility
|
IP
|
$465.14
|
|
|
Service Code
|
HCPCS 96375
|
| Hospital Charge Code |
93500073
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$69.77 |
| Max. Negotiated Rate |
$69.77 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$69.77
|
|
|
IV PUSH-EA ADDTL NEW MED
|
Facility
|
OP
|
$465.14
|
|
|
Service Code
|
HCPCS 96375
|
| Hospital Charge Code |
93500073
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$11.21 |
| 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 |
$245.87
|
| 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 |
$139.54
|
| Rate for Payer: Oxford Commercial |
$707.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$69.77
|
| Rate for Payer: UnitedHealthcare Commercial |
$919.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$11.21
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$55.63
|
| Rate for Payer: Wellcare Medicare Advantage |
$55.63
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$12.33
|
|
|
IV PUSH FIRST DRUG
|
Facility
|
OP
|
$440.91
|
|
|
Service Code
|
HCPCS 96374
|
| Hospital Charge Code |
74116057
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$10.63 |
| 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 |
$61.47
|
| 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 |
$132.27
|
| Rate for Payer: Oxford Commercial |
$707.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$66.14
|
| Rate for Payer: UnitedHealthcare Commercial |
$919.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$10.63
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$252.70
|
| Rate for Payer: Wellcare Medicare Advantage |
$252.70
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.68
|
|
|
IV PUSH FIRST DRUG
|
Facility
|
IP
|
$394.88
|
|
|
Service Code
|
HCPCS 96374
|
| Hospital Charge Code |
73050985
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$59.23 |
| Max. Negotiated Rate |
$59.23 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$59.23
|
|
|
IV PUSH FIRST DRUG
|
Facility
|
IP
|
$440.91
|
|
|
Service Code
|
HCPCS 96374
|
| Hospital Charge Code |
74116057
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$66.14 |
| Max. Negotiated Rate |
$66.14 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$66.14
|
|
|
IV PUSH FIRST DRUG
|
Facility
|
OP
|
$2,800.00
|
|
|
Service Code
|
HCPCS 96374
|
| Hospital Charge Code |
485096374
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$61.47 |
| 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 |
$61.47
|
| 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 |
$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 |
$252.70
|
| Rate for Payer: Wellcare Medicare Advantage |
$252.70
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$74.20
|
|
|
IV PUSH FIRST DRUG
|
Facility
|
OP
|
$2,800.00
|
|
|
Service Code
|
HCPCS 96374
|
| Hospital Charge Code |
73092070
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$61.47 |
| 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 |
$61.47
|
| 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 |
$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 |
$252.70
|
| Rate for Payer: Wellcare Medicare Advantage |
$252.70
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$74.20
|
|
|
IV PUSH FIRST DRUG
|
Facility
|
IP
|
$2,800.00
|
|
|
Service Code
|
HCPCS 96374
|
| Hospital Charge Code |
5300145
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$420.00 |
| Max. Negotiated Rate |
$420.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$420.00
|
|
|
IV PUSH FIRST DRUG
|
Facility
|
IP
|
$440.91
|
|
|
Service Code
|
HCPCS 96374
|
| Hospital Charge Code |
2011449
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$66.14 |
| Max. Negotiated Rate |
$66.14 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$66.14
|
|
|
IV PUSH FIRST DRUG
|
Facility
|
OP
|
$440.91
|
|
|
Service Code
|
HCPCS 96374
|
| Hospital Charge Code |
2011449
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$10.63 |
| 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 |
$61.47
|
| 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 |
$132.27
|
| Rate for Payer: Oxford Commercial |
$707.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$66.14
|
| Rate for Payer: UnitedHealthcare Commercial |
$919.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$10.63
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$252.70
|
| Rate for Payer: Wellcare Medicare Advantage |
$252.70
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.68
|
|
|
IV PUSH FIRST DRUG
|
Facility
|
OP
|
$394.88
|
|
|
Service Code
|
HCPCS 96374
|
| Hospital Charge Code |
73050985
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$9.52 |
| 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 |
$61.47
|
| 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 |
$118.46
|
| Rate for Payer: Oxford Commercial |
$707.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$59.23
|
| Rate for Payer: UnitedHealthcare Commercial |
$919.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$9.52
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$252.70
|
| Rate for Payer: Wellcare Medicare Advantage |
$252.70
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$10.46
|
|
|
IV PUSH FIRST DRUG
|
Facility
|
OP
|
$440.91
|
|
|
Service Code
|
HCPCS 96374
|
| Hospital Charge Code |
2250411
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$10.63 |
| 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 |
$61.47
|
| 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 |
$132.27
|
| Rate for Payer: Oxford Commercial |
$707.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$66.14
|
| Rate for Payer: UnitedHealthcare Commercial |
$919.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$10.63
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$252.70
|
| Rate for Payer: Wellcare Medicare Advantage |
$252.70
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.68
|
|
|
IV PUSH FIRST DRUG
|
Facility
|
IP
|
$2,800.00
|
|
|
Service Code
|
HCPCS 96374
|
| Hospital Charge Code |
94053140
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$420.00 |
| Max. Negotiated Rate |
$420.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$420.00
|
|
|
IV PUSH FIRST DRUG
|
Facility
|
OP
|
$394.88
|
|
|
Service Code
|
HCPCS 96374
|
| Hospital Charge Code |
93082030
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$9.52 |
| 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 |
$61.47
|
| 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 |
$118.46
|
| Rate for Payer: Oxford Commercial |
$707.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$59.23
|
| Rate for Payer: UnitedHealthcare Commercial |
$919.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$9.52
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$252.70
|
| Rate for Payer: Wellcare Medicare Advantage |
$252.70
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$10.46
|
|
|
IV PUSH FIRST DRUG
|
Facility
|
OP
|
$394.88
|
|
|
Service Code
|
HCPCS 96374
|
| Hospital Charge Code |
74308385
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$9.52 |
| 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 |
$61.47
|
| 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 |
$118.46
|
| Rate for Payer: Oxford Commercial |
$707.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$59.23
|
| Rate for Payer: UnitedHealthcare Commercial |
$919.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$9.52
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$252.70
|
| Rate for Payer: Wellcare Medicare Advantage |
$252.70
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$10.46
|
|
|
IV PUSH FIRST DRUG
|
Facility
|
OP
|
$440.91
|
|
|
Service Code
|
HCPCS 96374
|
| Hospital Charge Code |
4501032
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$10.63 |
| 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 |
$61.47
|
| 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 |
$132.27
|
| Rate for Payer: Oxford Commercial |
$707.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$66.14
|
| Rate for Payer: UnitedHealthcare Commercial |
$919.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$10.63
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$252.70
|
| Rate for Payer: Wellcare Medicare Advantage |
$252.70
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.68
|
|
|
IV PUSH FIRST DRUG
|
Facility
|
IP
|
$2,800.00
|
|
|
Service Code
|
HCPCS 96374
|
| Hospital Charge Code |
270339101
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$420.00 |
| Max. Negotiated Rate |
$420.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$420.00
|
|
|
IV PUSH FIRST DRUG
|
Facility
|
OP
|
$1,076.70
|
|
|
Service Code
|
HCPCS 96374
|
| Hospital Charge Code |
395096374
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$25.95 |
| 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 |
$61.47
|
| 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 |
$323.01
|
| Rate for Payer: Oxford Commercial |
$707.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$161.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$919.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$25.95
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$252.70
|
| Rate for Payer: Wellcare Medicare Advantage |
$252.70
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$28.53
|
|
|
IV PUSH FIRST DRUG
|
Facility
|
OP
|
$2,800.00
|
|
|
Service Code
|
HCPCS 96374
|
| Hospital Charge Code |
5100779
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$61.47 |
| 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 |
$61.47
|
| 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 |
$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 |
$252.70
|
| Rate for Payer: Wellcare Medicare Advantage |
$252.70
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$74.20
|
|
|
IV PUSH FIRST DRUG
|
Facility
|
IP
|
$394.88
|
|
|
Service Code
|
HCPCS 96374
|
| Hospital Charge Code |
93082030
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$59.23 |
| Max. Negotiated Rate |
$59.23 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$59.23
|
|
|
IV PUSH FIRST DRUG
|
Facility
|
OP
|
$440.91
|
|
|
Service Code
|
HCPCS 96374
|
| Hospital Charge Code |
73050945
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$10.63 |
| 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 |
$61.47
|
| 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 |
$132.27
|
| Rate for Payer: Oxford Commercial |
$707.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$66.14
|
| Rate for Payer: UnitedHealthcare Commercial |
$919.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$10.63
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$252.70
|
| Rate for Payer: Wellcare Medicare Advantage |
$252.70
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.68
|
|
|
IV PUSH FIRST DRUG
|
Facility
|
IP
|
$2,800.00
|
|
|
Service Code
|
HCPCS 96374
|
| Hospital Charge Code |
73050940
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$420.00 |
| Max. Negotiated Rate |
$420.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$420.00
|
|
|
IV PUSH FIRST DRUG
|
Facility
|
IP
|
$440.91
|
|
|
Service Code
|
HCPCS 96374
|
| Hospital Charge Code |
4501032
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$66.14 |
| Max. Negotiated Rate |
$66.14 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$66.14
|
|
|
IV PUSH FIRST DRUG
|
Facility
|
IP
|
$2,800.00
|
|
|
Service Code
|
HCPCS 96374
|
| Hospital Charge Code |
3400258
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$420.00 |
| Max. Negotiated Rate |
$420.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$420.00
|
|
