|
IV PUSH FIRST DRUG
|
Facility
|
OP
|
$2,800.00
|
|
|
Service Code
|
HCPCS 96374
|
| Hospital Charge Code |
5100779
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$36.51 |
| Max. Negotiated Rate |
$840.00 |
| Rate for Payer: Aetna Commercial |
$840.00
|
| Rate for Payer: Aetna Medicare Advantage |
$840.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$714.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$714.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$36.51
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$714.00
|
| Rate for Payer: Cigna Commercial |
$506.53
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$364.00
|
| Rate for Payer: Oxford Commercial |
$707.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$420.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$802.00
|
|
|
IV PUSH FIRST DRUG
|
Facility
|
OP
|
$2,800.00
|
|
|
Service Code
|
HCPCS 96374
|
| Hospital Charge Code |
93082010
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$36.51 |
| Max. Negotiated Rate |
$840.00 |
| Rate for Payer: Aetna Commercial |
$840.00
|
| Rate for Payer: Aetna Medicare Advantage |
$840.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$714.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$714.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$36.51
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$714.00
|
| Rate for Payer: Cigna Commercial |
$506.53
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$364.00
|
| Rate for Payer: Oxford Commercial |
$707.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$420.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$802.00
|
|
|
IV PUSH FIRST DRUG
|
Facility
|
OP
|
$1,076.70
|
|
|
Service Code
|
HCPCS 96374
|
| Hospital Charge Code |
395096374
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$36.51 |
| Max. Negotiated Rate |
$802.00 |
| Rate for Payer: Aetna Commercial |
$323.01
|
| Rate for Payer: Aetna Medicare Advantage |
$323.01
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$274.56
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$274.56
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$36.51
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$274.56
|
| Rate for Payer: Cigna Commercial |
$506.53
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$139.97
|
| Rate for Payer: Oxford Commercial |
$707.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$161.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$802.00
|
|
|
IV PUSH FIRST DRUG
|
Facility
|
OP
|
$2,800.00
|
|
|
Service Code
|
HCPCS 96374
|
| Hospital Charge Code |
8200512
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$36.51 |
| Max. Negotiated Rate |
$840.00 |
| Rate for Payer: Aetna Commercial |
$840.00
|
| Rate for Payer: Aetna Medicare Advantage |
$840.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$714.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$714.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$36.51
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$714.00
|
| Rate for Payer: Cigna Commercial |
$506.53
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$364.00
|
| Rate for Payer: Oxford Commercial |
$707.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$420.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$802.00
|
|
|
IV PUSH FIRST DRUG
|
Facility
|
IP
|
$2,800.00
|
|
|
Service Code
|
HCPCS 96374
|
| Hospital Charge Code |
411096374
|
|
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
|
$2,800.00
|
|
|
Service Code
|
HCPCS 96374
|
| Hospital Charge Code |
2300904
|
|
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
|
$2,800.00
|
|
|
Service Code
|
HCPCS 96374
|
| Hospital Charge Code |
8200512
|
|
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
|
$2,800.00
|
|
|
Service Code
|
HCPCS 96374
|
| Hospital Charge Code |
73092060
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$36.51 |
| Max. Negotiated Rate |
$840.00 |
| Rate for Payer: Aetna Commercial |
$840.00
|
| Rate for Payer: Aetna Medicare Advantage |
$840.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$714.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$714.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$36.51
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$714.00
|
| Rate for Payer: Cigna Commercial |
$506.53
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$364.00
|
| Rate for Payer: Oxford Commercial |
$707.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$420.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$802.00
|
|
|
IV PUSH FIRST DRUG
|
Facility
|
OP
|
$394.88
|
|
|
Service Code
|
HCPCS 96374
|
| Hospital Charge Code |
74308385
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$36.51 |
| Max. Negotiated Rate |
$802.00 |
| Rate for Payer: Aetna Commercial |
$118.46
|
| Rate for Payer: Aetna Medicare Advantage |
$118.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$100.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$100.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$36.51
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$100.69
|
| Rate for Payer: Cigna Commercial |
$506.53
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$51.33
|
| Rate for Payer: Oxford Commercial |
$707.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$59.23
|
| Rate for Payer: UnitedHealthcare Commercial |
$802.00
|
|
|
IV PUSH FIRST DRUG
|
Facility
|
IP
|
$394.88
|
|
|
Service Code
|
HCPCS 96374
|
| Hospital Charge Code |
74308385
|
|
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 |
5700256
|
|
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
|
$440.91
|
|
|
Service Code
|
HCPCS 96374
|
| Hospital Charge Code |
2250411
|
|
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 |
2300904
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$36.51 |
| Max. Negotiated Rate |
$840.00 |
| Rate for Payer: Aetna Commercial |
$840.00
|
| Rate for Payer: Aetna Medicare Advantage |
$840.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$714.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$714.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$36.51
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$714.00
|
| Rate for Payer: Cigna Commercial |
$506.53
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$364.00
|
| Rate for Payer: Oxford Commercial |
$707.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$420.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$802.00
|
|
|
IV PUSH FIRST DRUG
|
Facility
|
IP
|
$2,800.00
|
|
|
Service Code
|
HCPCS 96374
|
| Hospital Charge Code |
100113
|
|
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
|
$2,800.00
|
|
|
Service Code
|
HCPCS 96374
|
| Hospital Charge Code |
1500104
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$36.51 |
| Max. Negotiated Rate |
$840.00 |
| Rate for Payer: Aetna Commercial |
$840.00
|
| Rate for Payer: Aetna Medicare Advantage |
$840.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$714.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$714.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$36.51
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$714.00
|
| Rate for Payer: Cigna Commercial |
$506.53
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$364.00
|
| Rate for Payer: Oxford Commercial |
$707.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$420.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$802.00
|
|
|
IV PUSH FIRST DRUG
|
Facility
|
OP
|
$1,080.95
|
|
|
Service Code
|
HCPCS 96374
|
| Hospital Charge Code |
5790895
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$36.51 |
| Max. Negotiated Rate |
$506.53 |
| Rate for Payer: Aetna Commercial |
$324.29
|
| Rate for Payer: Aetna Medicare Advantage |
$324.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$275.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$275.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$36.51
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$275.64
|
| Rate for Payer: Cigna Commercial |
$506.53
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$140.52
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$162.14
|
|
|
IV PUSH FIRST DRUG
|
Facility
|
OP
|
$440.91
|
|
|
Service Code
|
HCPCS 96374
|
| Hospital Charge Code |
2400612
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$36.51 |
| Max. Negotiated Rate |
$802.00 |
| Rate for Payer: Aetna Commercial |
$132.27
|
| 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 |
$36.51
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$112.43
|
| Rate for Payer: Cigna Commercial |
$506.53
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$57.32
|
| Rate for Payer: Oxford Commercial |
$707.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$66.14
|
| Rate for Payer: UnitedHealthcare Commercial |
$802.00
|
|
|
IV PUSH FIRST DRUG
|
Facility
|
OP
|
$2,800.00
|
|
|
Service Code
|
HCPCS 96374
|
| Hospital Charge Code |
411096374
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$36.51 |
| Max. Negotiated Rate |
$840.00 |
| Rate for Payer: Aetna Commercial |
$840.00
|
| Rate for Payer: Aetna Medicare Advantage |
$840.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$714.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$714.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$36.51
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$714.00
|
| Rate for Payer: Cigna Commercial |
$506.53
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$364.00
|
| Rate for Payer: Oxford Commercial |
$707.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$420.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$802.00
|
|
|
IV PUSH FIRST DRUG
|
Facility
|
IP
|
$1,076.70
|
|
|
Service Code
|
HCPCS 96374
|
| Hospital Charge Code |
395096374
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$161.50 |
| Max. Negotiated Rate |
$161.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$161.50
|
|
|
IV PUSH FIRST DRUG
|
Facility
|
OP
|
$2,800.00
|
|
|
Service Code
|
HCPCS 96374
|
| Hospital Charge Code |
485096374
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$36.51 |
| Max. Negotiated Rate |
$840.00 |
| Rate for Payer: Aetna Commercial |
$840.00
|
| Rate for Payer: Aetna Medicare Advantage |
$840.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$714.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$714.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$36.51
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$714.00
|
| Rate for Payer: Cigna Commercial |
$506.53
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$364.00
|
| Rate for Payer: Oxford Commercial |
$707.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$420.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$802.00
|
|
|
IV PUSH FIRST DRUG
|
Facility
|
IP
|
$2,800.00
|
|
|
Service Code
|
HCPCS 96374
|
| Hospital Charge Code |
485096374
|
|
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
|
$394.88
|
|
|
Service Code
|
HCPCS 96374
|
| Hospital Charge Code |
93500065
|
|
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
|
$2,800.00
|
|
|
Service Code
|
HCPCS 96374
|
| Hospital Charge Code |
73092070
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$36.51 |
| Max. Negotiated Rate |
$840.00 |
| Rate for Payer: Aetna Commercial |
$840.00
|
| Rate for Payer: Aetna Medicare Advantage |
$840.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$714.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$714.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$36.51
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$714.00
|
| Rate for Payer: Cigna Commercial |
$506.53
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$364.00
|
| Rate for Payer: Oxford Commercial |
$707.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$420.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$802.00
|
|
|
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
|
OP
|
$2,800.00
|
|
|
Service Code
|
HCPCS 96374
|
| Hospital Charge Code |
100113
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$36.51 |
| Max. Negotiated Rate |
$840.00 |
| Rate for Payer: Aetna Commercial |
$840.00
|
| Rate for Payer: Aetna Medicare Advantage |
$840.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$714.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$714.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$36.51
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$714.00
|
| Rate for Payer: Cigna Commercial |
$506.53
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$364.00
|
| Rate for Payer: Oxford Commercial |
$707.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$420.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$802.00
|
|