|
IV INF TOCILIZUM COVID19 DOSE2
|
Facility
|
IP
|
$2,250.00
|
|
|
Service Code
|
HCPCS M0250
|
| Hospital Charge Code |
4229M0250
|
|
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 |
3047M0250
|
|
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 DOSE2
|
Facility
|
IP
|
$2,250.00
|
|
|
Service Code
|
HCPCS M0250
|
| Hospital Charge Code |
3234M0250
|
|
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 |
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
|
OP
|
$2,250.00
|
|
|
Service Code
|
HCPCS M0250
|
| Hospital Charge Code |
3121M0250
|
|
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 LINE PROTECTOR STRIP
|
Facility
|
OP
|
$347.63
|
|
| Hospital Charge Code |
270649665
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.87 |
| Max. Negotiated Rate |
$173.81 |
| Rate for Payer: Aetna Commercial |
$132.10
|
| Rate for Payer: Aetna Medicare Advantage |
$104.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$88.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$88.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$88.65
|
| Rate for Payer: Cigna Commercial |
$173.81
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$90.38
|
| Rate for Payer: Oxford Commercial |
$69.53
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$52.14
|
| Rate for Payer: UnitedHealthcare Commercial |
$69.53
|
| Rate for Payer: UnitedHealthcare Community & State |
$10.99
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$9.87
|
|
|
IV LINE PROTECTOR STRIP
|
Facility
|
IP
|
$347.63
|
|
| Hospital Charge Code |
270649665
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$52.14 |
| Max. Negotiated Rate |
$52.14 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$52.14
|
|
|
IV PUSH EA ADDL DRUG NEW
|
Facility
|
IP
|
$440.91
|
|
|
Service Code
|
HCPCS 96375
|
| Hospital Charge Code |
395096375
|
|
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 EA ADDL DRUG NEW
|
Facility
|
OP
|
$2,800.00
|
|
|
Service Code
|
HCPCS 96375
|
| Hospital Charge Code |
321096375
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$52.85 |
| Max. Negotiated Rate |
$1,235.00 |
| Rate for Payer: Aetna Commercial |
$151.31
|
| Rate for Payer: Aetna Medicare Advantage |
$180.24
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$201.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$201.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$55.63
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$139.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$201.80
|
| Rate for Payer: Cigna Commercial |
$111.50
|
| Rate for Payer: Cigna Medicare Advantage |
$55.63
|
| Rate for Payer: Clover Medicare Advantage |
$52.85
|
| Rate for Payer: EmblemHealth Commercial |
$166.89
|
| Rate for Payer: Humana Medicare Advantage |
$57.30
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$55.63
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$728.00
|
| Rate for Payer: Oxford Commercial |
$1,092.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$420.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,235.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$88.48
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$55.63
|
| Rate for Payer: Wellcare Medicare Advantage |
$55.63
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$79.52
|
|
|
IV PUSH EA ADDL DRUG NEW
|
Facility
|
OP
|
$339.24
|
|
|
Service Code
|
HCPCS 96375
|
| Hospital Charge Code |
2300906
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$9.63 |
| Max. Negotiated Rate |
$1,235.00 |
| Rate for Payer: Aetna Commercial |
$151.31
|
| Rate for Payer: Aetna Medicare Advantage |
$180.24
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$201.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$201.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$55.63
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$139.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$201.80
|
| Rate for Payer: Cigna Commercial |
$111.50
|
| Rate for Payer: Cigna Medicare Advantage |
$55.63
|
| Rate for Payer: Clover Medicare Advantage |
$52.85
|
| Rate for Payer: EmblemHealth Commercial |
$166.89
|
| Rate for Payer: Humana Medicare Advantage |
$57.30
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$55.63
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$88.20
|
| Rate for Payer: Oxford Commercial |
$1,092.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$50.89
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,235.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$10.72
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$55.63
|
| Rate for Payer: Wellcare Medicare Advantage |
$55.63
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$9.63
|
|
|
IV PUSH EA ADDL DRUG NEW
|
Facility
|
IP
|
$339.24
|
|
|
Service Code
|
HCPCS 96375
|
| Hospital Charge Code |
73190111
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$50.89 |
| Max. Negotiated Rate |
$50.89 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$50.89
|
|
|
IV PUSH EA ADDL DRUG NEW
|
Facility
|
OP
|
$2,800.00
|
|
|
Service Code
|
HCPCS 96375
|
| Hospital Charge Code |
5700257
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$52.85 |
| Max. Negotiated Rate |
$1,235.00 |
| Rate for Payer: Aetna Commercial |
$151.31
|
| Rate for Payer: Aetna Medicare Advantage |
$180.24
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$201.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$201.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$55.63
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$139.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$201.80
|
| Rate for Payer: Cigna Commercial |
$111.50
|
| Rate for Payer: Cigna Medicare Advantage |
$55.63
|
| Rate for Payer: Clover Medicare Advantage |
$52.85
|
| Rate for Payer: EmblemHealth Commercial |
$166.89
|
| Rate for Payer: Humana Medicare Advantage |
$57.30
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$55.63
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$728.00
|
| Rate for Payer: Oxford Commercial |
$1,092.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$420.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,235.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$88.48
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$55.63
|
| Rate for Payer: Wellcare Medicare Advantage |
$55.63
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$79.52
|
|
|
IV PUSH EA ADDL DRUG NEW
|
Facility
|
OP
|
$339.24
|
|
|
Service Code
|
HCPCS 96375
|
| Hospital Charge Code |
73190111
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$9.63 |
| Max. Negotiated Rate |
$1,235.00 |
| Rate for Payer: Aetna Commercial |
$151.31
|
| Rate for Payer: Aetna Medicare Advantage |
$180.24
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$201.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$201.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$55.63
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$139.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$201.80
|
| Rate for Payer: Cigna Commercial |
$111.50
|
| Rate for Payer: Cigna Medicare Advantage |
$55.63
|
| Rate for Payer: Clover Medicare Advantage |
$52.85
|
| Rate for Payer: EmblemHealth Commercial |
$166.89
|
| Rate for Payer: Humana Medicare Advantage |
$57.30
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$55.63
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$88.20
|
| Rate for Payer: Oxford Commercial |
$1,092.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$50.89
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,235.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$10.72
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$55.63
|
| Rate for Payer: Wellcare Medicare Advantage |
$55.63
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$9.63
|
|
|
IV PUSH EA ADDL DRUG NEW
|
Facility
|
IP
|
$339.24
|
|
|
Service Code
|
HCPCS 96375
|
| Hospital Charge Code |
73050950
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$50.89 |
| Max. Negotiated Rate |
$50.89 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$50.89
|
|
|
IV PUSH EA ADDL DRUG NEW
|
Facility
|
OP
|
$2,800.00
|
|
|
Service Code
|
HCPCS 96375
|
| Hospital Charge Code |
321793675
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$52.85 |
| Max. Negotiated Rate |
$1,235.00 |
| Rate for Payer: Aetna Commercial |
$151.31
|
| Rate for Payer: Aetna Medicare Advantage |
$180.24
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$201.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$201.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$55.63
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$139.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$201.80
|
| Rate for Payer: Cigna Commercial |
$111.50
|
| Rate for Payer: Cigna Medicare Advantage |
$55.63
|
| Rate for Payer: Clover Medicare Advantage |
$52.85
|
| Rate for Payer: EmblemHealth Commercial |
$166.89
|
| Rate for Payer: Humana Medicare Advantage |
$57.30
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$55.63
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$728.00
|
| Rate for Payer: Oxford Commercial |
$1,092.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$420.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,235.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$88.48
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$55.63
|
| Rate for Payer: Wellcare Medicare Advantage |
$55.63
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$79.52
|
|
|
IV PUSH EA ADDL DRUG NEW
|
Facility
|
OP
|
$339.24
|
|
|
Service Code
|
HCPCS 96375
|
| Hospital Charge Code |
73050950
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$9.63 |
| Max. Negotiated Rate |
$1,235.00 |
| Rate for Payer: Aetna Commercial |
$151.31
|
| Rate for Payer: Aetna Medicare Advantage |
$180.24
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$201.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$201.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$55.63
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$139.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$201.80
|
| Rate for Payer: Cigna Commercial |
$111.50
|
| Rate for Payer: Cigna Medicare Advantage |
$55.63
|
| Rate for Payer: Clover Medicare Advantage |
$52.85
|
| Rate for Payer: EmblemHealth Commercial |
$166.89
|
| Rate for Payer: Humana Medicare Advantage |
$57.30
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$55.63
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$88.20
|
| Rate for Payer: Oxford Commercial |
$1,092.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$50.89
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,235.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$10.72
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$55.63
|
| Rate for Payer: Wellcare Medicare Advantage |
$55.63
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$9.63
|
|
|
IV PUSH EA ADDL DRUG NEW
|
Facility
|
IP
|
$339.24
|
|
|
Service Code
|
HCPCS 96375
|
| Hospital Charge Code |
73237026
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$50.89 |
| Max. Negotiated Rate |
$50.89 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$50.89
|
|
|
IV PUSH EA ADDL DRUG NEW
|
Facility
|
OP
|
$339.24
|
|
|
Service Code
|
HCPCS 96375
|
| Hospital Charge Code |
93500075
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$9.63 |
| Max. Negotiated Rate |
$1,235.00 |
| Rate for Payer: Aetna Commercial |
$151.31
|
| Rate for Payer: Aetna Medicare Advantage |
$180.24
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$201.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$201.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$55.63
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$139.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$201.80
|
| Rate for Payer: Cigna Commercial |
$111.50
|
| Rate for Payer: Cigna Medicare Advantage |
$55.63
|
| Rate for Payer: Clover Medicare Advantage |
$52.85
|
| Rate for Payer: EmblemHealth Commercial |
$166.89
|
| Rate for Payer: Humana Medicare Advantage |
$57.30
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$55.63
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$88.20
|
| Rate for Payer: Oxford Commercial |
$1,092.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$50.89
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,235.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$10.72
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$55.63
|
| Rate for Payer: Wellcare Medicare Advantage |
$55.63
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$9.63
|
|
|
IV PUSH EA ADDL DRUG NEW
|
Facility
|
OP
|
$339.24
|
|
|
Service Code
|
HCPCS 96375
|
| Hospital Charge Code |
1600520
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$9.63 |
| Max. Negotiated Rate |
$1,235.00 |
| Rate for Payer: Aetna Commercial |
$151.31
|
| Rate for Payer: Aetna Medicare Advantage |
$180.24
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$201.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$201.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$55.63
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$139.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$201.80
|
| Rate for Payer: Cigna Commercial |
$111.50
|
| Rate for Payer: Cigna Medicare Advantage |
$55.63
|
| Rate for Payer: Clover Medicare Advantage |
$52.85
|
| Rate for Payer: EmblemHealth Commercial |
$166.89
|
| Rate for Payer: Humana Medicare Advantage |
$57.30
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$55.63
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$88.20
|
| Rate for Payer: Oxford Commercial |
$1,092.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$50.89
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,235.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$10.72
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$55.63
|
| Rate for Payer: Wellcare Medicare Advantage |
$55.63
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$9.63
|
|
|
IV PUSH EA ADDL DRUG NEW
|
Facility
|
IP
|
$2,800.00
|
|
|
Service Code
|
HCPCS 96375
|
| Hospital Charge Code |
321096375
|
|
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 EA ADDL DRUG NEW
|
Facility
|
OP
|
$339.24
|
|
|
Service Code
|
HCPCS 96375
|
| Hospital Charge Code |
73237026
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$9.63 |
| Max. Negotiated Rate |
$1,235.00 |
| Rate for Payer: Aetna Commercial |
$151.31
|
| Rate for Payer: Aetna Medicare Advantage |
$180.24
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$201.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$201.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$55.63
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$139.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$201.80
|
| Rate for Payer: Cigna Commercial |
$111.50
|
| Rate for Payer: Cigna Medicare Advantage |
$55.63
|
| Rate for Payer: Clover Medicare Advantage |
$52.85
|
| Rate for Payer: EmblemHealth Commercial |
$166.89
|
| Rate for Payer: Humana Medicare Advantage |
$57.30
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$55.63
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$88.20
|
| Rate for Payer: Oxford Commercial |
$1,092.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$50.89
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,235.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$10.72
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$55.63
|
| Rate for Payer: Wellcare Medicare Advantage |
$55.63
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$9.63
|
|
|
IV PUSH EA ADDL DRUG NEW
|
Facility
|
IP
|
$339.24
|
|
|
Service Code
|
HCPCS 96375
|
| Hospital Charge Code |
74308260
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$50.89 |
| Max. Negotiated Rate |
$50.89 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$50.89
|
|
|
IV PUSH EA ADDL DRUG NEW
|
Facility
|
IP
|
$339.24
|
|
|
Service Code
|
HCPCS 96375
|
| Hospital Charge Code |
7411253
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$50.89 |
| Max. Negotiated Rate |
$50.89 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$50.89
|
|
|
IV PUSH EA ADDL DRUG NEW
|
Facility
|
OP
|
$339.24
|
|
|
Service Code
|
HCPCS 96375
|
| Hospital Charge Code |
7411253
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$9.63 |
| Max. Negotiated Rate |
$1,235.00 |
| Rate for Payer: Aetna Commercial |
$151.31
|
| Rate for Payer: Aetna Medicare Advantage |
$180.24
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$201.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$201.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$55.63
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$139.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$201.80
|
| Rate for Payer: Cigna Commercial |
$111.50
|
| Rate for Payer: Cigna Medicare Advantage |
$55.63
|
| Rate for Payer: Clover Medicare Advantage |
$52.85
|
| Rate for Payer: EmblemHealth Commercial |
$166.89
|
| Rate for Payer: Humana Medicare Advantage |
$57.30
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$55.63
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$88.20
|
| Rate for Payer: Oxford Commercial |
$1,092.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$50.89
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,235.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$10.72
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$55.63
|
| Rate for Payer: Wellcare Medicare Advantage |
$55.63
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$9.63
|
|
|
IV PUSH EA ADDL DRUG NEW
|
Facility
|
IP
|
$339.24
|
|
|
Service Code
|
HCPCS 96375
|
| Hospital Charge Code |
93500069
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$50.89 |
| Max. Negotiated Rate |
$50.89 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$50.89
|
|
