|
LYSOZYME (MURAMIDASE)
|
Facility
|
OP
|
$204.00
|
|
|
Service Code
|
HCPCS 85549
|
| Hospital Charge Code |
3006392
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$5.41 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$51.00
|
| Rate for Payer: Aetna Medicare Advantage |
$60.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$67.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$67.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$18.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$54.21
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$67.68
|
| Rate for Payer: Cigna Commercial |
$102.00
|
| Rate for Payer: Cigna Medicare Advantage |
$18.75
|
| Rate for Payer: Clover Medicare Advantage |
$17.81
|
| Rate for Payer: EmblemHealth Commercial |
$56.25
|
| Rate for Payer: Humana Medicare Advantage |
$19.31
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$18.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$61.20
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$30.60
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$15.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$18.75
|
| Rate for Payer: Wellcare Medicare Advantage |
$18.75
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$5.41
|
|
|
LYSOZYME (MURAMIDASE)
|
Facility
|
IP
|
$204.00
|
|
|
Service Code
|
HCPCS 85549
|
| Hospital Charge Code |
3006392
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$30.60 |
| Max. Negotiated Rate |
$30.60 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$30.60
|
|
|
LYSOZYME (MURAMIDASE)
|
Facility
|
IP
|
$280.00
|
|
|
Service Code
|
HCPCS 85549
|
| Hospital Charge Code |
38473055
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$42.00 |
| Max. Negotiated Rate |
$42.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$42.00
|
|
|
LYSOZYME (MURAMIDASE)
|
Facility
|
OP
|
$280.00
|
|
|
Service Code
|
HCPCS 85549
|
| Hospital Charge Code |
38473055
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$7.42 |
| Max. Negotiated Rate |
$140.00 |
| Rate for Payer: Aetna Commercial |
$51.00
|
| Rate for Payer: Aetna Medicare Advantage |
$60.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$67.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$67.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$18.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$54.21
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$67.68
|
| Rate for Payer: Cigna Commercial |
$140.00
|
| Rate for Payer: Cigna Medicare Advantage |
$18.75
|
| Rate for Payer: Clover Medicare Advantage |
$17.81
|
| Rate for Payer: EmblemHealth Commercial |
$56.25
|
| Rate for Payer: Humana Medicare Advantage |
$19.31
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$18.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$84.00
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$42.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$15.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$18.75
|
| Rate for Payer: Wellcare Medicare Advantage |
$18.75
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$7.42
|
|
|
LYSOZYME,SERUM
|
Facility
|
OP
|
$128.90
|
|
|
Service Code
|
HCPCS 85549
|
| Hospital Charge Code |
39900176
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$3.42 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$51.00
|
| Rate for Payer: Aetna Medicare Advantage |
$60.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$67.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$67.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$18.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$54.21
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$67.68
|
| Rate for Payer: Cigna Commercial |
$64.45
|
| Rate for Payer: Cigna Medicare Advantage |
$18.75
|
| Rate for Payer: Clover Medicare Advantage |
$17.81
|
| Rate for Payer: EmblemHealth Commercial |
$56.25
|
| Rate for Payer: Humana Medicare Advantage |
$19.31
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$18.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$38.67
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$19.34
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$15.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$18.75
|
| Rate for Payer: Wellcare Medicare Advantage |
$18.75
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$3.42
|
|
|
LYSOZYME,SERUM
|
Facility
|
IP
|
$128.90
|
|
|
Service Code
|
HCPCS 85549
|
| Hospital Charge Code |
39900176
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$19.34 |
| Max. Negotiated Rate |
$19.34 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$19.34
|
|
|
LYSOZYME (URINE MURAMIDASE)
|
Facility
|
IP
|
$204.00
|
|
|
Service Code
|
HCPCS 85549
|
| Hospital Charge Code |
3030285
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$30.60 |
| Max. Negotiated Rate |
$30.60 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$30.60
|
|
|
LYSOZYME (URINE MURAMIDASE)
|
Facility
|
OP
|
$204.00
|
|
|
Service Code
|
HCPCS 85549
|
| Hospital Charge Code |
3030285
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$5.41 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$51.00
|
| Rate for Payer: Aetna Medicare Advantage |
$60.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$67.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$67.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$18.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$54.21
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$67.68
|
| Rate for Payer: Cigna Commercial |
$102.00
|
| Rate for Payer: Cigna Medicare Advantage |
$18.75
|
| Rate for Payer: Clover Medicare Advantage |
$17.81
|
| Rate for Payer: EmblemHealth Commercial |
$56.25
|
| Rate for Payer: Humana Medicare Advantage |
$19.31
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$18.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$61.20
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$30.60
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$15.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$18.75
|
| Rate for Payer: Wellcare Medicare Advantage |
$18.75
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$5.41
|
|
|
LYTES 1
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 82438
|
| Hospital Charge Code |
39708030A
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
LYTES 1
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 82438
|
| Hospital Charge Code |
39708030A
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$13.60
|
| Rate for Payer: Aetna Medicare Advantage |
$16.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$18.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$18.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$5.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$6.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$18.05
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$5.00
|
| Rate for Payer: Clover Medicare Advantage |
$4.75
|
| Rate for Payer: EmblemHealth Commercial |
$15.00
|
| Rate for Payer: Humana Medicare Advantage |
$5.15
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$5.00
|
| 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 |
$4.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$5.00
|
| Rate for Payer: Wellcare Medicare Advantage |
$5.00
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$10.34
|
|
|
LYTES 2
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 84302
|
| Hospital Charge Code |
39708030B
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.89 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$13.22
|
| Rate for Payer: Aetna Medicare Advantage |
$15.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$17.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$17.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$4.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$5.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$17.54
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$4.86
|
| Rate for Payer: Clover Medicare Advantage |
$4.62
|
| Rate for Payer: EmblemHealth Commercial |
$14.58
|
| Rate for Payer: Humana Medicare Advantage |
$5.01
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$4.86
|
| 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 |
$3.89
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$4.86
|
| Rate for Payer: Wellcare Medicare Advantage |
$4.86
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$10.34
|
|
|
LYTES 2
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 84302
|
| Hospital Charge Code |
366884302
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.89 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$13.22
|
| Rate for Payer: Aetna Medicare Advantage |
$15.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$17.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$17.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$4.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$5.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$17.54
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$4.86
|
| Rate for Payer: Clover Medicare Advantage |
$4.62
|
| Rate for Payer: EmblemHealth Commercial |
$14.58
|
| Rate for Payer: Humana Medicare Advantage |
$5.01
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$4.86
|
| 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 |
$3.89
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$4.86
|
| Rate for Payer: Wellcare Medicare Advantage |
$4.86
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$10.34
|
|
|
LYTES 2
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 84302
|
| Hospital Charge Code |
366884302
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
LYTES 2
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 84302
|
| Hospital Charge Code |
39708030B
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
LYTES 24H SODIUM
|
Facility
|
IP
|
$517.00
|
|
|
Service Code
|
HCPCS 82340
|
| Hospital Charge Code |
38479473
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$77.55 |
| Max. Negotiated Rate |
$77.55 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$77.55
|
|
|
LYTES 24H SODIUM
|
Facility
|
OP
|
$517.00
|
|
|
Service Code
|
HCPCS 82340
|
| Hospital Charge Code |
38479473
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.82 |
| Max. Negotiated Rate |
$258.50 |
| Rate for Payer: Aetna Commercial |
$16.40
|
| Rate for Payer: Aetna Medicare Advantage |
$19.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$21.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$21.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$6.03
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$6.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$21.77
|
| Rate for Payer: Cigna Commercial |
$258.50
|
| Rate for Payer: Cigna Medicare Advantage |
$6.03
|
| Rate for Payer: Clover Medicare Advantage |
$5.73
|
| Rate for Payer: EmblemHealth Commercial |
$18.09
|
| Rate for Payer: Humana Medicare Advantage |
$6.21
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$6.03
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$155.10
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$77.55
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$4.82
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$6.03
|
| Rate for Payer: Wellcare Medicare Advantage |
$6.03
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$13.70
|
|
|
LYTES 3
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 84311
|
| Hospital Charge Code |
39708030C
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.48 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$22.03
|
| Rate for Payer: Aetna Medicare Advantage |
$26.24
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$29.24
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$29.24
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$8.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$7.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$29.24
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$8.10
|
| Rate for Payer: Clover Medicare Advantage |
$7.70
|
| Rate for Payer: EmblemHealth Commercial |
$24.30
|
| Rate for Payer: Humana Medicare Advantage |
$8.34
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$8.10
|
| 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 |
$6.48
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$8.10
|
| Rate for Payer: Wellcare Medicare Advantage |
$8.10
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$10.34
|
|
|
LYTES 3
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 84311
|
| Hospital Charge Code |
39708030C
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
LYTES CHLORIDE
|
Facility
|
IP
|
$107.00
|
|
|
Service Code
|
HCPCS 82436
|
| Hospital Charge Code |
38479475
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.05 |
| Max. Negotiated Rate |
$16.05 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$16.05
|
|
|
LYTES CHLORIDE
|
Facility
|
OP
|
$107.00
|
|
|
Service Code
|
HCPCS 82436
|
| Hospital Charge Code |
38479475
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.84 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$15.64
|
| Rate for Payer: Aetna Medicare Advantage |
$18.63
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$20.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$20.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$5.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$5.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$20.76
|
| Rate for Payer: Cigna Commercial |
$53.50
|
| Rate for Payer: Cigna Medicare Advantage |
$5.75
|
| Rate for Payer: Clover Medicare Advantage |
$5.46
|
| Rate for Payer: EmblemHealth Commercial |
$17.25
|
| Rate for Payer: Humana Medicare Advantage |
$5.92
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$5.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$32.10
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$16.05
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$4.60
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$5.75
|
| Rate for Payer: Wellcare Medicare Advantage |
$5.75
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.84
|
|
|
LYTES POTASIUM
|
Facility
|
IP
|
$119.00
|
|
|
Service Code
|
HCPCS 84133
|
| Hospital Charge Code |
38479474
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.85 |
| Max. Negotiated Rate |
$17.85 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$17.85
|
|
|
LYTES POTASIUM
|
Facility
|
OP
|
$119.00
|
|
|
Service Code
|
HCPCS 84133
|
| Hospital Charge Code |
38479474
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.15 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$12.87
|
| Rate for Payer: Aetna Medicare Advantage |
$15.33
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$17.07
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$17.07
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$4.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$7.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$17.07
|
| Rate for Payer: Cigna Commercial |
$59.50
|
| Rate for Payer: Cigna Medicare Advantage |
$4.73
|
| Rate for Payer: Clover Medicare Advantage |
$4.49
|
| Rate for Payer: EmblemHealth Commercial |
$14.19
|
| Rate for Payer: Humana Medicare Advantage |
$4.87
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$4.73
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$35.70
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$17.85
|
| Rate for Payer: UnitedHealthcare Commercial |
$124.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$3.78
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$4.73
|
| Rate for Payer: Wellcare Medicare Advantage |
$4.73
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$3.15
|
|
|
LYTU CHLORIDE URINE
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 82436
|
| Hospital Charge Code |
3036012C
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
LYTU CHLORIDE URINE
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 82436
|
| Hospital Charge Code |
3036012C
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.60 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$15.64
|
| Rate for Payer: Aetna Medicare Advantage |
$18.63
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$20.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$20.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$5.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$5.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$20.76
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$5.75
|
| Rate for Payer: Clover Medicare Advantage |
$5.46
|
| Rate for Payer: EmblemHealth Commercial |
$17.25
|
| Rate for Payer: Humana Medicare Advantage |
$5.92
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$5.75
|
| 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 |
$4.60
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$5.75
|
| Rate for Payer: Wellcare Medicare Advantage |
$5.75
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$10.34
|
|
|
LYTU POTASSIUM SERUM PLSMA WB
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 84132
|
| Hospital Charge Code |
3036012B
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
