|
IV PUSH FIRST DRUG
|
Facility
|
OP
|
$339.24
|
|
|
Service Code
|
HCPCS 96374
|
| Hospital Charge Code |
73050945
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$9.63 |
| Max. Negotiated Rate |
$1,235.00 |
| Rate for Payer: Aetna Commercial |
$687.34
|
| Rate for Payer: Aetna Medicare Advantage |
$818.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$916.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$916.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$252.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$34.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$916.67
|
| Rate for Payer: Cigna Commercial |
$506.53
|
| Rate for Payer: Cigna Medicare Advantage |
$252.70
|
| Rate for Payer: Clover Medicare Advantage |
$240.06
|
| Rate for Payer: EmblemHealth Commercial |
$758.10
|
| Rate for Payer: Humana Medicare Advantage |
$260.28
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$252.70
|
| 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 |
$252.70
|
| Rate for Payer: Wellcare Medicare Advantage |
$252.70
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$9.63
|
|
|
IV PUSH FIRST DRUG
|
Facility
|
IP
|
$339.24
|
|
|
Service Code
|
HCPCS 96374
|
| Hospital Charge Code |
73050945
|
|
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 FIRST DRUG
|
Facility
|
IP
|
$2,800.00
|
|
|
Service Code
|
HCPCS 96374
|
| Hospital Charge Code |
73050940
|
|
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
|
$339.24
|
|
|
Service Code
|
HCPCS 96374
|
| Hospital Charge Code |
74115057
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$9.63 |
| Max. Negotiated Rate |
$1,235.00 |
| Rate for Payer: Aetna Commercial |
$687.34
|
| Rate for Payer: Aetna Medicare Advantage |
$818.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$916.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$916.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$252.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$34.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$916.67
|
| Rate for Payer: Cigna Commercial |
$506.53
|
| Rate for Payer: Cigna Medicare Advantage |
$252.70
|
| Rate for Payer: Clover Medicare Advantage |
$240.06
|
| Rate for Payer: EmblemHealth Commercial |
$758.10
|
| Rate for Payer: Humana Medicare Advantage |
$260.28
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$252.70
|
| 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 |
$252.70
|
| Rate for Payer: Wellcare Medicare Advantage |
$252.70
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$9.63
|
|
|
IV PUSH FIRST DRUG
|
Facility
|
IP
|
$339.24
|
|
|
Service Code
|
HCPCS 96374
|
| Hospital Charge Code |
2400612
|
|
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 FIRST DRUG
|
Facility
|
OP
|
$2,800.00
|
|
|
Service Code
|
HCPCS 96374
|
| Hospital Charge Code |
73092060
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$34.92 |
| Max. Negotiated Rate |
$1,235.00 |
| Rate for Payer: Aetna Commercial |
$687.34
|
| Rate for Payer: Aetna Medicare Advantage |
$818.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$916.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$916.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$252.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$34.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$916.67
|
| Rate for Payer: Cigna Commercial |
$506.53
|
| Rate for Payer: Cigna Medicare Advantage |
$252.70
|
| Rate for Payer: Clover Medicare Advantage |
$240.06
|
| Rate for Payer: EmblemHealth Commercial |
$758.10
|
| Rate for Payer: Humana Medicare Advantage |
$260.28
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$252.70
|
| 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 |
$252.70
|
| Rate for Payer: Wellcare Medicare Advantage |
$252.70
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$79.52
|
|
|
IV PUSH FIRST DRUG
|
Facility
|
OP
|
$2,800.00
|
|
|
Service Code
|
HCPCS 96374
|
| Hospital Charge Code |
73050940
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$34.92 |
| Max. Negotiated Rate |
$1,235.00 |
| Rate for Payer: Aetna Commercial |
$687.34
|
| Rate for Payer: Aetna Medicare Advantage |
$818.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$916.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$916.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$252.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$34.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$916.67
|
| Rate for Payer: Cigna Commercial |
$506.53
|
| Rate for Payer: Cigna Medicare Advantage |
$252.70
|
| Rate for Payer: Clover Medicare Advantage |
$240.06
|
| Rate for Payer: EmblemHealth Commercial |
$758.10
|
| Rate for Payer: Humana Medicare Advantage |
$260.28
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$252.70
|
| 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 |
$252.70
|
| Rate for Payer: Wellcare Medicare Advantage |
$252.70
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$79.52
|
|
|
IV PUSH FIRST DRUG
|
Facility
|
OP
|
$339.24
|
|
|
Service Code
|
HCPCS 96374
|
| Hospital Charge Code |
74116057
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$9.63 |
| Max. Negotiated Rate |
$1,235.00 |
| Rate for Payer: Aetna Commercial |
$687.34
|
| Rate for Payer: Aetna Medicare Advantage |
$818.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$916.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$916.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$252.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$34.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$916.67
|
| Rate for Payer: Cigna Commercial |
$506.53
|
| Rate for Payer: Cigna Medicare Advantage |
$252.70
|
| Rate for Payer: Clover Medicare Advantage |
$240.06
|
| Rate for Payer: EmblemHealth Commercial |
$758.10
|
| Rate for Payer: Humana Medicare Advantage |
$260.28
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$252.70
|
| 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 |
$252.70
|
| Rate for Payer: Wellcare Medicare Advantage |
$252.70
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$9.63
|
|
|
IV PUSH FIRST DRUG
|
Facility
|
OP
|
$2,800.00
|
|
|
Service Code
|
HCPCS 96374
|
| Hospital Charge Code |
1500104
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$34.92 |
| Max. Negotiated Rate |
$1,235.00 |
| Rate for Payer: Aetna Commercial |
$687.34
|
| Rate for Payer: Aetna Medicare Advantage |
$818.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$916.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$916.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$252.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$34.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$916.67
|
| Rate for Payer: Cigna Commercial |
$506.53
|
| Rate for Payer: Cigna Medicare Advantage |
$252.70
|
| Rate for Payer: Clover Medicare Advantage |
$240.06
|
| Rate for Payer: EmblemHealth Commercial |
$758.10
|
| Rate for Payer: Humana Medicare Advantage |
$260.28
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$252.70
|
| 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 |
$252.70
|
| Rate for Payer: Wellcare Medicare Advantage |
$252.70
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$79.52
|
|
|
IV PUSH FIRST DRUG
|
Facility
|
IP
|
$2,800.00
|
|
|
Service Code
|
HCPCS 96374
|
| Hospital Charge Code |
93082010
|
|
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
|
$339.24
|
|
|
Service Code
|
HCPCS 96374
|
| Hospital Charge Code |
4501032
|
|
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 FIRST DRUG
|
Facility
|
IP
|
$2,800.00
|
|
|
Service Code
|
HCPCS 96374
|
| Hospital Charge Code |
3400258
|
|
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
|
$339.24
|
|
|
Service Code
|
HCPCS 96374
|
| Hospital Charge Code |
74116057
|
|
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 FIRST DRUG
|
Facility
|
OP
|
$339.24
|
|
|
Service Code
|
HCPCS 96374
|
| Hospital Charge Code |
2250411
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$9.63 |
| Max. Negotiated Rate |
$1,235.00 |
| Rate for Payer: Aetna Commercial |
$687.34
|
| Rate for Payer: Aetna Medicare Advantage |
$818.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$916.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$916.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$252.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$34.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$916.67
|
| Rate for Payer: Cigna Commercial |
$506.53
|
| Rate for Payer: Cigna Medicare Advantage |
$252.70
|
| Rate for Payer: Clover Medicare Advantage |
$240.06
|
| Rate for Payer: EmblemHealth Commercial |
$758.10
|
| Rate for Payer: Humana Medicare Advantage |
$260.28
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$252.70
|
| 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 |
$252.70
|
| Rate for Payer: Wellcare Medicare Advantage |
$252.70
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$9.63
|
|
|
IV PUSH FIRST DRUG
|
Facility
|
IP
|
$2,800.00
|
|
|
Service Code
|
HCPCS 96374
|
| Hospital Charge Code |
94053140
|
|
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 |
3400258
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$34.92 |
| Max. Negotiated Rate |
$1,235.00 |
| Rate for Payer: Aetna Commercial |
$687.34
|
| Rate for Payer: Aetna Medicare Advantage |
$818.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$916.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$916.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$252.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$34.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$916.67
|
| Rate for Payer: Cigna Commercial |
$506.53
|
| Rate for Payer: Cigna Medicare Advantage |
$252.70
|
| Rate for Payer: Clover Medicare Advantage |
$240.06
|
| Rate for Payer: EmblemHealth Commercial |
$758.10
|
| Rate for Payer: Humana Medicare Advantage |
$260.28
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$252.70
|
| 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 |
$252.70
|
| Rate for Payer: Wellcare Medicare Advantage |
$252.70
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$79.52
|
|
|
IV PUSH FIRST DRUG
|
Facility
|
IP
|
$2,800.00
|
|
|
Service Code
|
HCPCS 96374
|
| Hospital Charge Code |
73092070
|
|
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
|
$339.24
|
|
|
Service Code
|
HCPCS 96374
|
| Hospital Charge Code |
2011449
|
|
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 FIRST DRUG
|
Facility
|
OP
|
$2,800.00
|
|
|
Service Code
|
HCPCS 96374
|
| Hospital Charge Code |
2300904
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$34.92 |
| Max. Negotiated Rate |
$1,235.00 |
| Rate for Payer: Aetna Commercial |
$687.34
|
| Rate for Payer: Aetna Medicare Advantage |
$818.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$916.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$916.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$252.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$34.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$916.67
|
| Rate for Payer: Cigna Commercial |
$506.53
|
| Rate for Payer: Cigna Medicare Advantage |
$252.70
|
| Rate for Payer: Clover Medicare Advantage |
$240.06
|
| Rate for Payer: EmblemHealth Commercial |
$758.10
|
| Rate for Payer: Humana Medicare Advantage |
$260.28
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$252.70
|
| 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 |
$252.70
|
| Rate for Payer: Wellcare Medicare Advantage |
$252.70
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$79.52
|
|
|
IV PUSH FIRST DRUG
|
Facility
|
IP
|
$339.24
|
|
|
Service Code
|
HCPCS 96374
|
| Hospital Charge Code |
73237025
|
|
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 FIRST DRUG
|
Facility
|
OP
|
$339.24
|
|
|
Service Code
|
HCPCS 96374
|
| Hospital Charge Code |
2011449
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$9.63 |
| Max. Negotiated Rate |
$1,235.00 |
| Rate for Payer: Aetna Commercial |
$687.34
|
| Rate for Payer: Aetna Medicare Advantage |
$818.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$916.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$916.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$252.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$34.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$916.67
|
| Rate for Payer: Cigna Commercial |
$506.53
|
| Rate for Payer: Cigna Medicare Advantage |
$252.70
|
| Rate for Payer: Clover Medicare Advantage |
$240.06
|
| Rate for Payer: EmblemHealth Commercial |
$758.10
|
| Rate for Payer: Humana Medicare Advantage |
$260.28
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$252.70
|
| 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 |
$252.70
|
| Rate for Payer: Wellcare Medicare Advantage |
$252.70
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$9.63
|
|
|
IV PUSH FIRST DRUG
|
Facility
|
OP
|
$2,800.00
|
|
|
Service Code
|
HCPCS 96374
|
| Hospital Charge Code |
1600515
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$34.92 |
| Max. Negotiated Rate |
$1,235.00 |
| Rate for Payer: Aetna Commercial |
$687.34
|
| Rate for Payer: Aetna Medicare Advantage |
$818.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$916.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$916.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$252.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$34.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$916.67
|
| Rate for Payer: Cigna Commercial |
$506.53
|
| Rate for Payer: Cigna Medicare Advantage |
$252.70
|
| Rate for Payer: Clover Medicare Advantage |
$240.06
|
| Rate for Payer: EmblemHealth Commercial |
$758.10
|
| Rate for Payer: Humana Medicare Advantage |
$260.28
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$252.70
|
| 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 |
$252.70
|
| Rate for Payer: Wellcare Medicare Advantage |
$252.70
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$79.52
|
|
|
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
|
$1,738.06
|
|
|
Service Code
|
HCPCS 96374
|
| Hospital Charge Code |
5700245
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$260.71 |
| Max. Negotiated Rate |
$260.71 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$260.71
|
|
|
IV PUSH FIRST DRUG
|
Facility
|
OP
|
$2,800.00
|
|
|
Service Code
|
HCPCS 96374
|
| Hospital Charge Code |
5100779
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$34.92 |
| Max. Negotiated Rate |
$1,235.00 |
| Rate for Payer: Aetna Commercial |
$687.34
|
| Rate for Payer: Aetna Medicare Advantage |
$818.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$916.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$916.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$252.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$34.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$916.67
|
| Rate for Payer: Cigna Commercial |
$506.53
|
| Rate for Payer: Cigna Medicare Advantage |
$252.70
|
| Rate for Payer: Clover Medicare Advantage |
$240.06
|
| Rate for Payer: EmblemHealth Commercial |
$758.10
|
| Rate for Payer: Humana Medicare Advantage |
$260.28
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$252.70
|
| 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 |
$252.70
|
| Rate for Payer: Wellcare Medicare Advantage |
$252.70
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$79.52
|
|
