|
Zyprexa Zydis 10mg
|
Facility
|
OP
|
$156.11
|
|
|
Service Code
|
NDC 2445485
|
| Hospital Charge Code |
60630193
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.76 |
| Max. Negotiated Rate |
$78.06 |
| Rate for Payer: Aetna Commercial |
$59.32
|
| Rate for Payer: Aetna Medicare Advantage |
$46.83
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$39.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$39.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$39.81
|
| Rate for Payer: Cigna Commercial |
$78.06
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$46.83
|
| Rate for Payer: Oxford Commercial |
$31.22
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$23.42
|
| Rate for Payer: UnitedHealthcare Commercial |
$31.22
|
| Rate for Payer: UnitedHealthcare Community & State |
$3.76
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$4.14
|
|
|
Zyprexa Zydis 10mg
|
Facility
|
IP
|
$156.11
|
|
|
Service Code
|
NDC 2445485
|
| Hospital Charge Code |
60630193
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$23.42 |
| Max. Negotiated Rate |
$23.42 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$23.42
|
|
|
ZYRTEC-D 5/120MG TAB
|
Facility
|
IP
|
$40.00
|
|
| Hospital Charge Code |
60635534
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$6.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.00
|
|
|
ZYRTEC-D 5/120MG TAB
|
Facility
|
OP
|
$40.00
|
|
| Hospital Charge Code |
60635534
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.96 |
| Max. Negotiated Rate |
$20.00 |
| Rate for Payer: Aetna Commercial |
$15.20
|
| Rate for Payer: Aetna Medicare Advantage |
$12.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$10.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$10.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$10.20
|
| Rate for Payer: Cigna Commercial |
$20.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$12.00
|
| Rate for Payer: Oxford Commercial |
$8.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$8.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.96
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.06
|
|
|
ZYVOX 100MG/5ML SUSP
|
Facility
|
IP
|
$342.00
|
|
| Hospital Charge Code |
60635407
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$51.30 |
| Max. Negotiated Rate |
$51.30 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$51.30
|
|
|
ZYVOX 100MG/5ML SUSP
|
Facility
|
OP
|
$342.00
|
|
| Hospital Charge Code |
60635407
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.24 |
| Max. Negotiated Rate |
$171.00 |
| Rate for Payer: Aetna Commercial |
$129.96
|
| Rate for Payer: Aetna Medicare Advantage |
$102.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$87.21
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$87.21
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$87.21
|
| Rate for Payer: Cigna Commercial |
$171.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$102.60
|
| Rate for Payer: Oxford Commercial |
$68.40
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$51.30
|
| Rate for Payer: UnitedHealthcare Commercial |
$68.40
|
| Rate for Payer: UnitedHealthcare Community & State |
$8.24
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$9.06
|
|
|
ZZZ_DO NOT USE
|
Facility
|
IP
|
$45,253.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270697476
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,787.95 |
| Max. Negotiated Rate |
$10,951.23 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$9,050.60
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$10,951.23
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$9,955.66
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6,787.95
|
|
|
ZZZ_DO NOT USE
|
Facility
|
OP
|
$45,253.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
270697476
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,090.60 |
| Max. Negotiated Rate |
$22,626.50 |
| Rate for Payer: Aetna Commercial |
$17,196.14
|
| Rate for Payer: Aetna Medicare Advantage |
$13,575.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$11,539.51
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$11,539.51
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$9,050.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$11,539.51
|
| Rate for Payer: Cigna Commercial |
$22,626.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$10,951.23
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$9,955.66
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$6,787.95
|
| Rate for Payer: UnitedHealthcare Community & State |
$1,090.60
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1,199.20
|
|
