|
IV INF TOCILIZUM COVID19 DOSE1
|
Facility
|
IP
|
$2,250.00
|
|
|
Service Code
|
HCPCS M0249
|
| Hospital Charge Code |
3190M0249
|
|
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 |
3046M0249
|
|
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 |
3047M0249
|
|
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 |
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 |
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
|
OP
|
$2,250.00
|
|
|
Service Code
|
HCPCS M0249
|
| Hospital Charge Code |
3246M0249
|
|
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 |
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 |
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 |
3247M0249
|
|
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 |
3230M0249
|
|
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 DOSE2
|
Facility
|
IP
|
$2,250.00
|
|
|
Service Code
|
HCPCS M0250
|
| Hospital Charge Code |
3047M0250
|
|
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 DOSE2
|
Facility
|
OP
|
$2,250.00
|
|
|
Service Code
|
HCPCS M0250
|
| Hospital Charge Code |
3046M0250
|
|
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 DOSE2
|
Facility
|
IP
|
$2,250.00
|
|
|
Service Code
|
HCPCS M0250
|
| Hospital Charge Code |
3034M0250
|
|
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 DOSE2
|
Facility
|
IP
|
$2,250.00
|
|
|
Service Code
|
HCPCS M0250
|
| Hospital Charge Code |
3046M0250
|
|
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 DOSE2
|
Facility
|
IP
|
$2,250.00
|
|
|
Service Code
|
HCPCS M0250
|
| Hospital Charge Code |
3082M0250
|
|
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 DOSE2
|
Facility
|
IP
|
$2,250.00
|
|
|
Service Code
|
HCPCS M0250
|
| Hospital Charge Code |
4201M0250
|
|
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 DOSE2
|
Facility
|
OP
|
$2,250.00
|
|
|
Service Code
|
HCPCS M0250
|
| Hospital Charge Code |
3049M0250
|
|
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 DOSE2
|
Facility
|
OP
|
$2,250.00
|
|
|
Service Code
|
HCPCS M0250
|
| Hospital Charge Code |
3121M0250
|
|
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 DOSE2
|
Facility
|
IP
|
$2,250.00
|
|
|
Service Code
|
HCPCS M0250
|
| Hospital Charge Code |
3020M0250
|
|
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 DOSE2
|
Facility
|
IP
|
$2,250.00
|
|
|
Service Code
|
HCPCS M0250
|
| Hospital Charge Code |
3120M0250
|
|
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 DOSE2
|
Facility
|
IP
|
$2,250.00
|
|
|
Service Code
|
HCPCS M0250
|
| Hospital Charge Code |
3024M0250
|
|
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 DOSE2
|
Facility
|
OP
|
$2,250.00
|
|
|
Service Code
|
HCPCS M0250
|
| Hospital Charge Code |
3230M0250
|
|
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 DOSE2
|
Facility
|
OP
|
$2,250.00
|
|
|
Service Code
|
HCPCS M0250
|
| Hospital Charge Code |
3020M0250
|
|
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 DOSE2
|
Facility
|
OP
|
$2,250.00
|
|
|
Service Code
|
HCPCS M0250
|
| Hospital Charge Code |
3248M0250
|
|
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 DOSE2
|
Facility
|
OP
|
$2,250.00
|
|
|
Service Code
|
HCPCS M0250
|
| Hospital Charge Code |
3034M0250
|
|
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
|
|
