|
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 |
$42.85 |
| Max. Negotiated Rate |
$802.00 |
| Rate for Payer: Aetna Commercial |
$421.73
|
| 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) NJ Health |
$42.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$358.47
|
| Rate for Payer: Cigna Commercial |
$506.53
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$182.75
|
| Rate for Payer: Oxford Commercial |
$707.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$210.87
|
| Rate for Payer: UnitedHealthcare Commercial |
$802.00
|
|
|
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
|
OP
|
$1,405.77
|
|
|
Service Code
|
HCPCS 96365
|
| Hospital Charge Code |
93500027
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$42.85 |
| Max. Negotiated Rate |
$802.00 |
| Rate for Payer: Aetna Commercial |
$421.73
|
| 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) NJ Health |
$42.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$358.47
|
| Rate for Payer: Cigna Commercial |
$506.53
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$182.75
|
| Rate for Payer: Oxford Commercial |
$707.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$210.87
|
| Rate for Payer: UnitedHealthcare Commercial |
$802.00
|
|
|
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 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 |
$13.87 |
| Max. Negotiated Rate |
$802.00 |
| Rate for Payer: Aetna Commercial |
$33.30
|
| Rate for Payer: Aetna Medicare Advantage |
$33.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$28.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$28.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$13.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$28.30
|
| Rate for Payer: Cigna Commercial |
$111.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$14.43
|
| Rate for Payer: Oxford Commercial |
$707.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$16.65
|
| Rate for Payer: UnitedHealthcare Commercial |
$802.00
|
|
|
IV INF TOCILIZUM COVID19 DOSE1
|
Facility
|
IP
|
$2,250.00
|
|
|
Service Code
|
HCPCS M0249
|
| Hospital Charge Code |
3047M0249
|
|
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 |
3050M0249
|
|
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 |
3020M0249
|
|
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 |
3120M0249
|
|
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 |
3235M0249
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$91.00 |
| Max. Negotiated Rate |
$675.00 |
| Rate for Payer: Aetna Commercial |
$675.00
|
| Rate for Payer: Aetna Medicare Advantage |
$675.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$573.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$573.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$573.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$292.50
|
| Rate for Payer: Oxford Commercial |
$91.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$337.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$103.00
|
|
|
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 |
3037M0249
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$91.00 |
| Max. Negotiated Rate |
$675.00 |
| Rate for Payer: Aetna Commercial |
$675.00
|
| Rate for Payer: Aetna Medicare Advantage |
$675.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$573.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$573.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$573.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$292.50
|
| Rate for Payer: Oxford Commercial |
$91.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$337.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$103.00
|
|
|
IV INF TOCILIZUM COVID19 DOSE1
|
Facility
|
OP
|
$2,250.00
|
|
|
Service Code
|
HCPCS M0249
|
| Hospital Charge Code |
3046M0249
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$91.00 |
| Max. Negotiated Rate |
$675.00 |
| Rate for Payer: Aetna Commercial |
$675.00
|
| Rate for Payer: Aetna Medicare Advantage |
$675.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$573.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$573.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$573.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$292.50
|
| Rate for Payer: Oxford Commercial |
$91.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$337.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$103.00
|
|
|
IV INF TOCILIZUM COVID19 DOSE1
|
Facility
|
IP
|
$2,250.00
|
|
|
Service Code
|
HCPCS M0249
|
| Hospital Charge Code |
3248M0249
|
|
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 |
3043M0249
|
|
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 |
$91.00 |
| Max. Negotiated Rate |
$675.00 |
| Rate for Payer: Aetna Commercial |
$675.00
|
| Rate for Payer: Aetna Medicare Advantage |
$675.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$573.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$573.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$573.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$292.50
|
| Rate for Payer: Oxford Commercial |
$91.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$337.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$103.00
|
|
|
IV INF TOCILIZUM COVID19 DOSE1
|
Facility
|
IP
|
$2,250.00
|
|
|
Service Code
|
HCPCS M0249
|
| Hospital Charge Code |
4201M0249
|
|
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 |
3037M0249
|
|
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 |
3121M0249
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$91.00 |
| Max. Negotiated Rate |
$675.00 |
| Rate for Payer: Aetna Commercial |
$675.00
|
| Rate for Payer: Aetna Medicare Advantage |
$675.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$573.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$573.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$573.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$292.50
|
| Rate for Payer: Oxford Commercial |
$91.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$337.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$103.00
|
|
|
IV INF TOCILIZUM COVID19 DOSE1
|
Facility
|
OP
|
$2,250.00
|
|
|
Service Code
|
HCPCS M0249
|
| Hospital Charge Code |
3050M0249
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$91.00 |
| Max. Negotiated Rate |
$675.00 |
| Rate for Payer: Aetna Commercial |
$675.00
|
| Rate for Payer: Aetna Medicare Advantage |
$675.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$573.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$573.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$573.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$292.50
|
| Rate for Payer: Oxford Commercial |
$91.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$337.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$103.00
|
|
|
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
|
OP
|
$2,250.00
|
|
|
Service Code
|
HCPCS M0249
|
| Hospital Charge Code |
3237M0249
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$91.00 |
| Max. Negotiated Rate |
$675.00 |
| Rate for Payer: Aetna Commercial |
$675.00
|
| Rate for Payer: Aetna Medicare Advantage |
$675.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$573.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$573.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$573.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$292.50
|
| Rate for Payer: Oxford Commercial |
$91.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$337.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$103.00
|
|
|
IV INF TOCILIZUM COVID19 DOSE1
|
Facility
|
OP
|
$2,250.00
|
|
|
Service Code
|
HCPCS M0249
|
| Hospital Charge Code |
3234M0249
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$91.00 |
| Max. Negotiated Rate |
$675.00 |
| Rate for Payer: Aetna Commercial |
$675.00
|
| Rate for Payer: Aetna Medicare Advantage |
$675.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$573.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$573.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$573.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$292.50
|
| Rate for Payer: Oxford Commercial |
$91.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$337.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$103.00
|
|
|
IV INF TOCILIZUM COVID19 DOSE1
|
Facility
|
IP
|
$2,250.00
|
|
|
Service Code
|
HCPCS M0249
|
| Hospital Charge Code |
3049M0249
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$337.50 |
| Max. Negotiated Rate |
$337.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$337.50
|
|
