|
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
|
OP
|
$2,250.00
|
|
|
Service Code
|
HCPCS M0249
|
| Hospital Charge Code |
3247M0249
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$63.90 |
| Max. Negotiated Rate |
$1,900.30 |
| Rate for Payer: Aetna Commercial |
$1,424.90
|
| Rate for Payer: Aetna Medicare Advantage |
$1,697.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,900.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,900.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$523.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,900.30
|
| Rate for Payer: Cigna Medicare Advantage |
$523.86
|
| Rate for Payer: Clover Medicare Advantage |
$497.67
|
| Rate for Payer: EmblemHealth Commercial |
$1,571.58
|
| Rate for Payer: Humana Medicare Advantage |
$539.58
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$523.86
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$585.00
|
| Rate for Payer: Oxford Commercial |
$140.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$337.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$159.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$71.10
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$523.86
|
| Rate for Payer: Wellcare Medicare Advantage |
$523.86
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$63.90
|
|
|
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
|
OP
|
$2,250.00
|
|
|
Service Code
|
HCPCS M0249
|
| Hospital Charge Code |
3047M0249
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$63.90 |
| Max. Negotiated Rate |
$1,900.30 |
| Rate for Payer: Aetna Commercial |
$1,424.90
|
| Rate for Payer: Aetna Medicare Advantage |
$1,697.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,900.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,900.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$523.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,900.30
|
| Rate for Payer: Cigna Medicare Advantage |
$523.86
|
| Rate for Payer: Clover Medicare Advantage |
$497.67
|
| Rate for Payer: EmblemHealth Commercial |
$1,571.58
|
| Rate for Payer: Humana Medicare Advantage |
$539.58
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$523.86
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$585.00
|
| Rate for Payer: Oxford Commercial |
$140.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$337.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$159.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$71.10
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$523.86
|
| Rate for Payer: Wellcare Medicare Advantage |
$523.86
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$63.90
|
|
|
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
|
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 |
3080M0249
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$63.90 |
| Max. Negotiated Rate |
$1,900.30 |
| Rate for Payer: Aetna Commercial |
$1,424.90
|
| Rate for Payer: Aetna Medicare Advantage |
$1,697.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,900.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,900.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$523.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,900.30
|
| Rate for Payer: Cigna Medicare Advantage |
$523.86
|
| Rate for Payer: Clover Medicare Advantage |
$497.67
|
| Rate for Payer: EmblemHealth Commercial |
$1,571.58
|
| Rate for Payer: Humana Medicare Advantage |
$539.58
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$523.86
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$585.00
|
| Rate for Payer: Oxford Commercial |
$140.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$337.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$159.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$71.10
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$523.86
|
| Rate for Payer: Wellcare Medicare Advantage |
$523.86
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$63.90
|
|
|
IV INF TOCILIZUM COVID19 DOSE1
|
Facility
|
OP
|
$2,250.00
|
|
|
Service Code
|
HCPCS M0249
|
| Hospital Charge Code |
3033M0249
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$63.90 |
| Max. Negotiated Rate |
$1,900.30 |
| Rate for Payer: Aetna Commercial |
$1,424.90
|
| Rate for Payer: Aetna Medicare Advantage |
$1,697.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,900.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,900.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$523.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,900.30
|
| Rate for Payer: Cigna Medicare Advantage |
$523.86
|
| Rate for Payer: Clover Medicare Advantage |
$497.67
|
| Rate for Payer: EmblemHealth Commercial |
$1,571.58
|
| Rate for Payer: Humana Medicare Advantage |
$539.58
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$523.86
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$585.00
|
| Rate for Payer: Oxford Commercial |
$140.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$337.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$159.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$71.10
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$523.86
|
| Rate for Payer: Wellcare Medicare Advantage |
$523.86
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$63.90
|
|
|
IV INF TOCILIZUM COVID19 DOSE1
|
Facility
|
OP
|
$2,250.00
|
|
|
Service Code
|
HCPCS M0249
|
| Hospital Charge Code |
4201M0249
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$63.90 |
| Max. Negotiated Rate |
$1,900.30 |
| Rate for Payer: Aetna Commercial |
$1,424.90
|
| Rate for Payer: Aetna Medicare Advantage |
$1,697.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,900.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,900.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$523.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,900.30
|
| Rate for Payer: Cigna Medicare Advantage |
$523.86
|
| Rate for Payer: Clover Medicare Advantage |
$497.67
|
| Rate for Payer: EmblemHealth Commercial |
$1,571.58
|
| Rate for Payer: Humana Medicare Advantage |
$539.58
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$523.86
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$585.00
|
| Rate for Payer: Oxford Commercial |
$140.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$337.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$159.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$71.10
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$523.86
|
| Rate for Payer: Wellcare Medicare Advantage |
$523.86
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$63.90
|
|
|
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 |
$63.90 |
| Max. Negotiated Rate |
$1,900.30 |
| Rate for Payer: Aetna Commercial |
$1,424.90
|
| Rate for Payer: Aetna Medicare Advantage |
$1,697.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,900.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,900.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$523.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,900.30
|
| Rate for Payer: Cigna Medicare Advantage |
$523.86
|
| Rate for Payer: Clover Medicare Advantage |
$497.67
|
| Rate for Payer: EmblemHealth Commercial |
$1,571.58
|
| Rate for Payer: Humana Medicare Advantage |
$539.58
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$523.86
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$585.00
|
| Rate for Payer: Oxford Commercial |
$140.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$337.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$159.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$71.10
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$523.86
|
| Rate for Payer: Wellcare Medicare Advantage |
$523.86
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$63.90
|
|
|
IV INF TOCILIZUM COVID19 DOSE1
|
Facility
|
IP
|
$2,250.00
|
|
|
Service Code
|
HCPCS M0249
|
| Hospital Charge Code |
3246M0249
|
|
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 |
3042M0249
|
|
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
|
IP
|
$2,250.00
|
|
|
Service Code
|
HCPCS M0249
|
| Hospital Charge Code |
3234M0249
|
|
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 |
$63.90 |
| Max. Negotiated Rate |
$1,900.30 |
| Rate for Payer: Aetna Commercial |
$1,424.90
|
| Rate for Payer: Aetna Medicare Advantage |
$1,697.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,900.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,900.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$523.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,900.30
|
| Rate for Payer: Cigna Medicare Advantage |
$523.86
|
| Rate for Payer: Clover Medicare Advantage |
$497.67
|
| Rate for Payer: EmblemHealth Commercial |
$1,571.58
|
| Rate for Payer: Humana Medicare Advantage |
$539.58
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$523.86
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$585.00
|
| Rate for Payer: Oxford Commercial |
$140.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$337.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$159.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$71.10
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$523.86
|
| Rate for Payer: Wellcare Medicare Advantage |
$523.86
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$63.90
|
|
|
IV INF TOCILIZUM COVID19 DOSE1
|
Facility
|
IP
|
$2,250.00
|
|
|
Service Code
|
HCPCS M0249
|
| Hospital Charge Code |
3121M0249
|
|
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 |
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
|
OP
|
$2,250.00
|
|
|
Service Code
|
HCPCS M0249
|
| Hospital Charge Code |
3234M0249
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$63.90 |
| Max. Negotiated Rate |
$1,900.30 |
| Rate for Payer: Aetna Commercial |
$1,424.90
|
| Rate for Payer: Aetna Medicare Advantage |
$1,697.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,900.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,900.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$523.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,900.30
|
| Rate for Payer: Cigna Medicare Advantage |
$523.86
|
| Rate for Payer: Clover Medicare Advantage |
$497.67
|
| Rate for Payer: EmblemHealth Commercial |
$1,571.58
|
| Rate for Payer: Humana Medicare Advantage |
$539.58
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$523.86
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$585.00
|
| Rate for Payer: Oxford Commercial |
$140.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$337.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$159.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$71.10
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$523.86
|
| Rate for Payer: Wellcare Medicare Advantage |
$523.86
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$63.90
|
|
|
IV INF TOCILIZUM COVID19 DOSE1
|
Facility
|
OP
|
$2,250.00
|
|
|
Service Code
|
HCPCS M0249
|
| Hospital Charge Code |
3190M0249
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$63.90 |
| Max. Negotiated Rate |
$1,900.30 |
| Rate for Payer: Aetna Commercial |
$1,424.90
|
| Rate for Payer: Aetna Medicare Advantage |
$1,697.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,900.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,900.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$523.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,900.30
|
| Rate for Payer: Cigna Medicare Advantage |
$523.86
|
| Rate for Payer: Clover Medicare Advantage |
$497.67
|
| Rate for Payer: EmblemHealth Commercial |
$1,571.58
|
| Rate for Payer: Humana Medicare Advantage |
$539.58
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$523.86
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$585.00
|
| Rate for Payer: Oxford Commercial |
$140.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$337.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$159.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$71.10
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$523.86
|
| Rate for Payer: Wellcare Medicare Advantage |
$523.86
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$63.90
|
|
|
IV INF TOCILIZUM COVID19 DOSE1
|
Facility
|
OP
|
$2,250.00
|
|
|
Service Code
|
HCPCS M0249
|
| Hospital Charge Code |
3043M0249
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$63.90 |
| Max. Negotiated Rate |
$1,900.30 |
| Rate for Payer: Aetna Commercial |
$1,424.90
|
| Rate for Payer: Aetna Medicare Advantage |
$1,697.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,900.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,900.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$523.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,900.30
|
| Rate for Payer: Cigna Medicare Advantage |
$523.86
|
| Rate for Payer: Clover Medicare Advantage |
$497.67
|
| Rate for Payer: EmblemHealth Commercial |
$1,571.58
|
| Rate for Payer: Humana Medicare Advantage |
$539.58
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$523.86
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$585.00
|
| Rate for Payer: Oxford Commercial |
$140.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$337.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$159.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$71.10
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$523.86
|
| Rate for Payer: Wellcare Medicare Advantage |
$523.86
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$63.90
|
|
|
IV INF TOCILIZUM COVID19 DOSE1
|
Facility
|
OP
|
$2,250.00
|
|
|
Service Code
|
HCPCS M0249
|
| Hospital Charge Code |
3120M0249
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$63.90 |
| Max. Negotiated Rate |
$1,900.30 |
| Rate for Payer: Aetna Commercial |
$1,424.90
|
| Rate for Payer: Aetna Medicare Advantage |
$1,697.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,900.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,900.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$523.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,900.30
|
| Rate for Payer: Cigna Medicare Advantage |
$523.86
|
| Rate for Payer: Clover Medicare Advantage |
$497.67
|
| Rate for Payer: EmblemHealth Commercial |
$1,571.58
|
| Rate for Payer: Humana Medicare Advantage |
$539.58
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$523.86
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$585.00
|
| Rate for Payer: Oxford Commercial |
$140.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$337.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$159.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$71.10
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$523.86
|
| Rate for Payer: Wellcare Medicare Advantage |
$523.86
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$63.90
|
|
|
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 |
3037M0249
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$63.90 |
| Max. Negotiated Rate |
$1,900.30 |
| Rate for Payer: Aetna Commercial |
$1,424.90
|
| Rate for Payer: Aetna Medicare Advantage |
$1,697.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,900.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,900.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$523.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,900.30
|
| Rate for Payer: Cigna Medicare Advantage |
$523.86
|
| Rate for Payer: Clover Medicare Advantage |
$497.67
|
| Rate for Payer: EmblemHealth Commercial |
$1,571.58
|
| Rate for Payer: Humana Medicare Advantage |
$539.58
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$523.86
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$585.00
|
| Rate for Payer: Oxford Commercial |
$140.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$337.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$159.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$71.10
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$523.86
|
| Rate for Payer: Wellcare Medicare Advantage |
$523.86
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$63.90
|
|
|
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 |
$63.90 |
| Max. Negotiated Rate |
$1,900.30 |
| Rate for Payer: Aetna Commercial |
$1,424.90
|
| Rate for Payer: Aetna Medicare Advantage |
$1,697.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,900.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,900.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$523.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,900.30
|
| Rate for Payer: Cigna Medicare Advantage |
$523.86
|
| Rate for Payer: Clover Medicare Advantage |
$497.67
|
| Rate for Payer: EmblemHealth Commercial |
$1,571.58
|
| Rate for Payer: Humana Medicare Advantage |
$539.58
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$523.86
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$585.00
|
| Rate for Payer: Oxford Commercial |
$140.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$337.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$159.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$71.10
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$523.86
|
| Rate for Payer: Wellcare Medicare Advantage |
$523.86
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$63.90
|
|
|
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
|
|
