|
IV PUSH EA ADDL DRUG NEW
|
Facility
|
OP
|
$634.81
|
|
|
Service Code
|
HCPCS 96375
|
| Hospital Charge Code |
5700442
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$18.03 |
| Max. Negotiated Rate |
$201.80 |
| 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 |
$165.05
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$95.22
|
| Rate for Payer: UnitedHealthcare Community & State |
$140.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$55.63
|
| Rate for Payer: Wellcare Medicare Advantage |
$55.63
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$18.03
|
|
|
IV PUSH EA ADDL DRUG NEW
|
Facility
|
IP
|
$339.24
|
|
|
Service Code
|
HCPCS 96375
|
| Hospital Charge Code |
93500075
|
|
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 |
93082040
|
|
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 |
2250412
|
|
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 |
321793675
|
|
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
|
IP
|
$339.24
|
|
|
Service Code
|
HCPCS 96375
|
| Hospital Charge Code |
4501033
|
|
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 |
4501033
|
|
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 |
2300906
|
|
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 |
73050955
|
|
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 |
3400259
|
|
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 |
3400259
|
|
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 |
2301093
|
|
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 |
2301093
|
|
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 |
2250412
|
|
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 |
73050955
|
|
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 |
1500105
|
|
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 |
100114
|
|
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 SAME
|
Facility
|
IP
|
$339.24
|
|
|
Service Code
|
HCPCS 96376
|
| Hospital Charge Code |
2301094
|
|
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 SAME
|
Facility
|
OP
|
$339.24
|
|
|
Service Code
|
HCPCS 96376
|
| Hospital Charge Code |
2301094
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$8.84 |
| Max. Negotiated Rate |
$1,235.00 |
| Rate for Payer: Aetna Commercial |
$128.91
|
| Rate for Payer: Aetna Medicare Advantage |
$101.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$86.51
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$86.51
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$8.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$86.51
|
| Rate for Payer: Cigna Commercial |
$169.62
|
| 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: Wellpoint Medicaid Managed Care |
$9.63
|
|
|
IV PUSH EA ADDL DRUG SAME
|
Facility
|
IP
|
$440.91
|
|
|
Service Code
|
HCPCS 96376
|
| Hospital Charge Code |
395096376
|
|
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 SAME
|
Facility
|
IP
|
$339.24
|
|
|
Service Code
|
HCPCS 96376
|
| Hospital Charge Code |
73050960
|
|
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 SAME
|
Facility
|
OP
|
$339.24
|
|
|
Service Code
|
HCPCS 96376
|
| Hospital Charge Code |
2400614
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$8.84 |
| Max. Negotiated Rate |
$1,235.00 |
| Rate for Payer: Aetna Commercial |
$128.91
|
| Rate for Payer: Aetna Medicare Advantage |
$101.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$86.51
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$86.51
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$8.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$86.51
|
| Rate for Payer: Cigna Commercial |
$169.62
|
| 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: Wellpoint Medicaid Managed Care |
$9.63
|
|
|
IV PUSH EA ADDL DRUG SAME
|
Facility
|
OP
|
$339.24
|
|
|
Service Code
|
HCPCS 96376
|
| Hospital Charge Code |
73050960
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$8.84 |
| Max. Negotiated Rate |
$1,235.00 |
| Rate for Payer: Aetna Commercial |
$128.91
|
| Rate for Payer: Aetna Medicare Advantage |
$101.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$86.51
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$86.51
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$8.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$86.51
|
| Rate for Payer: Cigna Commercial |
$169.62
|
| 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: Wellpoint Medicaid Managed Care |
$9.63
|
|
|
IV PUSH EA ADDL DRUG SAME
|
Facility
|
OP
|
$339.24
|
|
|
Service Code
|
HCPCS 96376
|
| Hospital Charge Code |
2011451
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$8.84 |
| Max. Negotiated Rate |
$1,235.00 |
| Rate for Payer: Aetna Commercial |
$128.91
|
| Rate for Payer: Aetna Medicare Advantage |
$101.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$86.51
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$86.51
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$8.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$86.51
|
| Rate for Payer: Cigna Commercial |
$169.62
|
| 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: Wellpoint Medicaid Managed Care |
$9.63
|
|
|
IV PUSH EA ADDL DRUG SAME
|
Facility
|
IP
|
$2,800.00
|
|
|
Service Code
|
HCPCS 96375
|
| Hospital Charge Code |
321796376
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$420.00 |
| Max. Negotiated Rate |
$420.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$420.00
|
|
