|
ESTRIDIOL
|
Facility
|
OP
|
$205.65
|
|
|
Service Code
|
HCPCS 82670
|
| Hospital Charge Code |
39900418
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.84 |
| Max. Negotiated Rate |
$156.00 |
| Rate for Payer: Aetna Commercial |
$76.00
|
| Rate for Payer: Aetna Medicare Advantage |
$90.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$101.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$101.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$27.94
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$41.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$101.35
|
| Rate for Payer: Cigna Commercial |
$102.83
|
| Rate for Payer: Cigna Medicare Advantage |
$27.94
|
| Rate for Payer: Clover Medicare Advantage |
$26.54
|
| Rate for Payer: EmblemHealth Commercial |
$83.82
|
| Rate for Payer: Humana Medicare Advantage |
$28.78
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$27.94
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$53.47
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$30.85
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$22.35
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$27.94
|
| Rate for Payer: Wellcare Medicare Advantage |
$27.94
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$5.84
|
|
|
ESTRIDIOL
|
Facility
|
IP
|
$205.65
|
|
|
Service Code
|
HCPCS 82670
|
| Hospital Charge Code |
39900418
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$30.85 |
| Max. Negotiated Rate |
$30.85 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$30.85
|
|
|
ESTRIOL
|
Facility
|
OP
|
$520.00
|
|
|
Service Code
|
HCPCS 82677
|
| Hospital Charge Code |
38472263
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.77 |
| Max. Negotiated Rate |
$260.00 |
| Rate for Payer: Aetna Commercial |
$65.77
|
| Rate for Payer: Aetna Medicare Advantage |
$78.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$87.71
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$87.71
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$24.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$46.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$87.71
|
| Rate for Payer: Cigna Commercial |
$260.00
|
| Rate for Payer: Cigna Medicare Advantage |
$24.18
|
| Rate for Payer: Clover Medicare Advantage |
$22.97
|
| Rate for Payer: EmblemHealth Commercial |
$72.54
|
| Rate for Payer: Humana Medicare Advantage |
$24.91
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$24.18
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$135.20
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$78.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$19.34
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$24.18
|
| Rate for Payer: Wellcare Medicare Advantage |
$24.18
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$14.77
|
|
|
ESTRIOL
|
Facility
|
IP
|
$520.00
|
|
|
Service Code
|
HCPCS 82677
|
| Hospital Charge Code |
38472263
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$78.00 |
| Max. Negotiated Rate |
$78.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$78.00
|
|
|
ESTRIOL,SERUM
|
Facility
|
OP
|
$166.25
|
|
|
Service Code
|
HCPCS 82677
|
| Hospital Charge Code |
39900076
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.72 |
| Max. Negotiated Rate |
$156.00 |
| Rate for Payer: Aetna Commercial |
$65.77
|
| Rate for Payer: Aetna Medicare Advantage |
$78.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$87.71
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$87.71
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$24.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$46.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$87.71
|
| Rate for Payer: Cigna Commercial |
$83.12
|
| Rate for Payer: Cigna Medicare Advantage |
$24.18
|
| Rate for Payer: Clover Medicare Advantage |
$22.97
|
| Rate for Payer: EmblemHealth Commercial |
$72.54
|
| Rate for Payer: Humana Medicare Advantage |
$24.91
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$24.18
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$43.23
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$24.94
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$19.34
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$24.18
|
| Rate for Payer: Wellcare Medicare Advantage |
$24.18
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$4.72
|
|
|
ESTRIOL,SERUM
|
Facility
|
IP
|
$166.25
|
|
|
Service Code
|
HCPCS 82677
|
| Hospital Charge Code |
39900076
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$24.94 |
| Max. Negotiated Rate |
$24.94 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$24.94
|
|
|
ESTROGEN RECEPTOR ASSAY
|
Facility
|
IP
|
$961.00
|
|
|
Service Code
|
HCPCS 84233
|
| Hospital Charge Code |
38474004
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$144.15 |
| Max. Negotiated Rate |
$144.15 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$144.15
|
|
|
ESTROGEN RECEPTOR ASSAY
|
Facility
|
OP
|
$961.00
|
|
|
Service Code
|
HCPCS 84233
|
| Hospital Charge Code |
38474004
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$27.29 |
| Max. Negotiated Rate |
$480.50 |
| Rate for Payer: Aetna Commercial |
$239.03
|
| Rate for Payer: Aetna Medicare Advantage |
$284.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$318.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$318.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$87.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$29.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$318.78
|
| Rate for Payer: Cigna Commercial |
$480.50
|
| Rate for Payer: Cigna Medicare Advantage |
$87.88
|
| Rate for Payer: Clover Medicare Advantage |
$83.49
|
| Rate for Payer: EmblemHealth Commercial |
$263.64
|
| Rate for Payer: Humana Medicare Advantage |
$90.52
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$87.88
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$249.86
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$144.15
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$70.30
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$87.88
|
| Rate for Payer: Wellcare Medicare Advantage |
$87.88
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$27.29
|
|
|
ESTROGENS, FRACTIONATED, SERUM
|
Facility
|
IP
|
$533.00
|
|
|
Service Code
|
HCPCS 82671
|
| Hospital Charge Code |
38472266
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$79.95 |
| Max. Negotiated Rate |
$79.95 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$79.95
|
|
|
ESTROGENS, FRACTIONATED, SERUM
|
Facility
|
OP
|
$533.00
|
|
|
Service Code
|
HCPCS 82671
|
| Hospital Charge Code |
38472266
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.14 |
| Max. Negotiated Rate |
$266.50 |
| Rate for Payer: Aetna Commercial |
$87.86
|
| Rate for Payer: Aetna Medicare Advantage |
$104.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$117.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$117.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$32.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$67.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$117.17
|
| Rate for Payer: Cigna Commercial |
$266.50
|
| Rate for Payer: Cigna Medicare Advantage |
$32.30
|
| Rate for Payer: Clover Medicare Advantage |
$30.68
|
| Rate for Payer: EmblemHealth Commercial |
$96.90
|
| Rate for Payer: Humana Medicare Advantage |
$33.27
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$32.30
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$138.58
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$79.95
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$25.84
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$32.30
|
| Rate for Payer: Wellcare Medicare Advantage |
$32.30
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$15.14
|
|
|
ESTROGENS,TOTAL,SERUM
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 82672
|
| Hospital Charge Code |
39900075
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.08 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$59.02
|
| Rate for Payer: Aetna Medicare Advantage |
$70.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$78.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$78.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$21.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$41.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$78.72
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$21.70
|
| Rate for Payer: Clover Medicare Advantage |
$20.61
|
| Rate for Payer: EmblemHealth Commercial |
$65.10
|
| Rate for Payer: Humana Medicare Advantage |
$22.35
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$21.70
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$101.40
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$17.36
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$21.70
|
| Rate for Payer: Wellcare Medicare Advantage |
$21.70
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.08
|
|
|
ESTROGENS,TOTAL,SERUM
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 82672
|
| Hospital Charge Code |
39900075
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
ESTROGEN TOTAL
|
Facility
|
OP
|
$633.00
|
|
|
Service Code
|
HCPCS 82672
|
| Hospital Charge Code |
38472272
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.36 |
| Max. Negotiated Rate |
$316.50 |
| Rate for Payer: Aetna Commercial |
$59.02
|
| Rate for Payer: Aetna Medicare Advantage |
$70.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$78.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$78.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$21.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$41.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$78.72
|
| Rate for Payer: Cigna Commercial |
$316.50
|
| Rate for Payer: Cigna Medicare Advantage |
$21.70
|
| Rate for Payer: Clover Medicare Advantage |
$20.61
|
| Rate for Payer: EmblemHealth Commercial |
$65.10
|
| Rate for Payer: Humana Medicare Advantage |
$22.35
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$21.70
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$164.58
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$94.95
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$17.36
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$21.70
|
| Rate for Payer: Wellcare Medicare Advantage |
$21.70
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$17.98
|
|
|
ESTROGEN TOTAL
|
Facility
|
IP
|
$633.00
|
|
|
Service Code
|
HCPCS 82672
|
| Hospital Charge Code |
38472272
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$94.95 |
| Max. Negotiated Rate |
$94.95 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$94.95
|
|
|
ESTROL
|
Facility
|
OP
|
$520.00
|
|
|
Service Code
|
HCPCS 82677
|
| Hospital Charge Code |
38479405
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.77 |
| Max. Negotiated Rate |
$260.00 |
| Rate for Payer: Aetna Commercial |
$65.77
|
| Rate for Payer: Aetna Medicare Advantage |
$78.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$87.71
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$87.71
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$24.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$46.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$87.71
|
| Rate for Payer: Cigna Commercial |
$260.00
|
| Rate for Payer: Cigna Medicare Advantage |
$24.18
|
| Rate for Payer: Clover Medicare Advantage |
$22.97
|
| Rate for Payer: EmblemHealth Commercial |
$72.54
|
| Rate for Payer: Humana Medicare Advantage |
$24.91
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$24.18
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$135.20
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$78.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$19.34
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$24.18
|
| Rate for Payer: Wellcare Medicare Advantage |
$24.18
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$14.77
|
|
|
ESTROL
|
Facility
|
IP
|
$520.00
|
|
|
Service Code
|
HCPCS 82677
|
| Hospital Charge Code |
38479405
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$78.00 |
| Max. Negotiated Rate |
$78.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$78.00
|
|
|
ESTRONE
|
Facility
|
IP
|
$176.00
|
|
|
Service Code
|
HCPCS 82679
|
| Hospital Charge Code |
38477176
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$26.40 |
| Max. Negotiated Rate |
$26.40 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$26.40
|
|
|
ESTRONE
|
Facility
|
OP
|
$119.00
|
|
|
Service Code
|
HCPCS 82379
|
| Hospital Charge Code |
38478113
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.38 |
| Max. Negotiated Rate |
$156.00 |
| Rate for Payer: Aetna Commercial |
$45.89
|
| Rate for Payer: Aetna Medicare Advantage |
$54.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$61.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$61.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$16.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$15.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$61.20
|
| Rate for Payer: Cigna Commercial |
$59.50
|
| Rate for Payer: Cigna Medicare Advantage |
$16.87
|
| Rate for Payer: Clover Medicare Advantage |
$16.03
|
| Rate for Payer: EmblemHealth Commercial |
$50.61
|
| Rate for Payer: Humana Medicare Advantage |
$17.38
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$16.87
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$30.94
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$17.85
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$13.50
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$16.87
|
| Rate for Payer: Wellcare Medicare Advantage |
$16.87
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$3.38
|
|
|
ESTRONE
|
Facility
|
OP
|
$176.00
|
|
|
Service Code
|
HCPCS 82679
|
| Hospital Charge Code |
38477176
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$156.00 |
| Rate for Payer: Aetna Commercial |
$67.86
|
| Rate for Payer: Aetna Medicare Advantage |
$80.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$90.51
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$90.51
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$24.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$41.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$90.51
|
| Rate for Payer: Cigna Commercial |
$88.00
|
| Rate for Payer: Cigna Medicare Advantage |
$24.95
|
| Rate for Payer: Clover Medicare Advantage |
$23.70
|
| Rate for Payer: EmblemHealth Commercial |
$74.85
|
| Rate for Payer: Humana Medicare Advantage |
$25.70
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$24.95
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$45.76
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$26.40
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$19.96
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$24.95
|
| Rate for Payer: Wellcare Medicare Advantage |
$24.95
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$5.00
|
|
|
ESTRONE
|
Facility
|
IP
|
$119.00
|
|
|
Service Code
|
HCPCS 82379
|
| Hospital Charge Code |
38478113
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.85 |
| Max. Negotiated Rate |
$17.85 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$17.85
|
|
|
ESTRONE,SERUM
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 82679
|
| Hospital Charge Code |
39900077
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.08 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$67.86
|
| Rate for Payer: Aetna Medicare Advantage |
$80.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$90.51
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$90.51
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$24.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$41.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$90.51
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$24.95
|
| Rate for Payer: Clover Medicare Advantage |
$23.70
|
| Rate for Payer: EmblemHealth Commercial |
$74.85
|
| Rate for Payer: Humana Medicare Advantage |
$25.70
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$24.95
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$101.40
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$19.96
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$24.95
|
| Rate for Payer: Wellcare Medicare Advantage |
$24.95
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.08
|
|
|
ESTRONE,SERUM
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 82679
|
| Hospital Charge Code |
39900077
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
ETHAMBUTOL
|
Facility
|
IP
|
$309.00
|
|
|
Service Code
|
HCPCS 80299
|
| Hospital Charge Code |
3009822
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$46.35 |
| Max. Negotiated Rate |
$46.35 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$46.35
|
|
|
ETHAMBUTOL
|
Facility
|
OP
|
$309.00
|
|
|
Service Code
|
HCPCS 80299
|
| Hospital Charge Code |
3009822
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.78 |
| Max. Negotiated Rate |
$156.00 |
| Rate for Payer: Aetna Commercial |
$50.70
|
| Rate for Payer: Aetna Medicare Advantage |
$60.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$67.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$67.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$18.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$9.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$67.62
|
| Rate for Payer: Cigna Commercial |
$154.50
|
| Rate for Payer: Cigna Medicare Advantage |
$18.64
|
| Rate for Payer: Clover Medicare Advantage |
$17.71
|
| Rate for Payer: EmblemHealth Commercial |
$55.92
|
| Rate for Payer: Humana Medicare Advantage |
$19.20
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$18.64
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$80.34
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$46.35
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$14.91
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$18.64
|
| Rate for Payer: Wellcare Medicare Advantage |
$18.64
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$8.78
|
|
|
ETHAMBUTOL 400 MG TAB
|
Facility
|
OP
|
$11.93
|
|
|
Service Code
|
NDC 68850001202
|
| Hospital Charge Code |
6009435
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.34 |
| Max. Negotiated Rate |
$5.96 |
| Rate for Payer: Aetna Commercial |
$4.53
|
| Rate for Payer: Aetna Medicare Advantage |
$3.58
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3.04
|
| Rate for Payer: Cigna Commercial |
$5.96
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3.10
|
| Rate for Payer: Oxford Commercial |
$2.39
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.79
|
| Rate for Payer: UnitedHealthcare Commercial |
$2.39
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.38
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.34
|
|
