|
JAMSHIDI NEEDLE 11GX5IN
|
Facility
|
IP
|
$875.00
|
|
| Hospital Charge Code |
270705446
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$131.25 |
| Max. Negotiated Rate |
$131.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$131.25
|
|
|
JAMSHIDI NEEDLE 8G
|
Facility
|
OP
|
$500.00
|
|
| Hospital Charge Code |
270696835
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$14.20 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: Aetna Commercial |
$190.00
|
| Rate for Payer: Aetna Medicare Advantage |
$150.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$127.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$127.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$127.50
|
| Rate for Payer: Cigna Commercial |
$250.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$130.00
|
| Rate for Payer: Oxford Commercial |
$100.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$75.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$100.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$15.80
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$14.20
|
|
|
JAMSHIDI NEEDLE 8G
|
Facility
|
IP
|
$500.00
|
|
| Hospital Charge Code |
270696835
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$75.00 |
| Max. Negotiated Rate |
$75.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$75.00
|
|
|
JANSSEN COV19 VACC AD26 .5ML
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS 91303
|
| Hospital Charge Code |
606390404
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna Commercial |
$0.00
|
| Rate for Payer: Aetna Medicare Advantage |
$0.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$0.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$0.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$0.00
|
| Rate for Payer: Cigna Commercial |
$0.01
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$0.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.00
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.00
|
|
|
JANSSEN COV19 VACC AD26 .5ML
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS 91303
|
| Hospital Charge Code |
606390404
|
|
Hospital Revenue Code
|
636
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$0.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.00
|
|
|
JANSSEN COVID19 BOOSTER ADMIN
|
Facility
|
IP
|
$50.00
|
|
|
Service Code
|
HCPCS 0034A
|
| Hospital Charge Code |
32300034A
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$7.50 |
| Max. Negotiated Rate |
$7.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$7.50
|
|
|
JANSSEN COVID19 BOOSTER ADMIN
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
HCPCS 0034A
|
| Hospital Charge Code |
30480034A
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$1.42 |
| Max. Negotiated Rate |
$159.00 |
| Rate for Payer: Aetna Commercial |
$19.00
|
| Rate for Payer: Aetna Medicare Advantage |
$15.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$12.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$12.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$12.75
|
| Rate for Payer: Cigna Commercial |
$25.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$13.00
|
| Rate for Payer: Oxford Commercial |
$140.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$7.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$159.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$1.58
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.42
|
|
|
JANSSEN COVID19 BOOSTER ADMIN
|
Facility
|
IP
|
$50.00
|
|
|
Service Code
|
HCPCS 0034A
|
| Hospital Charge Code |
36530034A
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$7.50 |
| Max. Negotiated Rate |
$7.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$7.50
|
|
|
JANSSEN COVID19 BOOSTER ADMIN
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
HCPCS 0034A
|
| Hospital Charge Code |
30200034A
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$1.42 |
| Max. Negotiated Rate |
$159.00 |
| Rate for Payer: Aetna Commercial |
$19.00
|
| Rate for Payer: Aetna Medicare Advantage |
$15.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$12.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$12.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$12.75
|
| Rate for Payer: Cigna Commercial |
$25.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$13.00
|
| Rate for Payer: Oxford Commercial |
$140.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$7.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$159.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$1.58
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.42
|
|
|
JANSSEN COVID19 BOOSTER ADMIN
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
HCPCS 0034A
|
| Hospital Charge Code |
30340034A
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$1.42 |
| Max. Negotiated Rate |
$159.00 |
| Rate for Payer: Aetna Commercial |
$19.00
|
| Rate for Payer: Aetna Medicare Advantage |
$15.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$12.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$12.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$12.75
|
| Rate for Payer: Cigna Commercial |
$25.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$13.00
|
| Rate for Payer: Oxford Commercial |
$140.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$7.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$159.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$1.58
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.42
|
|
|
JANSSEN COVID19 BOOSTER ADMIN
|
Facility
|
IP
|
$50.00
|
|
|
Service Code
|
HCPCS 0034A
|
| Hospital Charge Code |
32460034A
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$7.50 |
| Max. Negotiated Rate |
$7.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$7.50
|
|
|
JANSSEN COVID19 BOOSTER ADMIN
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
HCPCS 0034A
|
| Hospital Charge Code |
32300034A
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$1.42 |
| Max. Negotiated Rate |
$159.00 |
| Rate for Payer: Aetna Commercial |
$19.00
|
| Rate for Payer: Aetna Medicare Advantage |
$15.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$12.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$12.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$12.75
|
| Rate for Payer: Cigna Commercial |
$25.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$13.00
|
| Rate for Payer: Oxford Commercial |
$140.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$7.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$159.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$1.58
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.42
|
|
|
JANSSEN COVID19 BOOSTER ADMIN
|
Facility
|
IP
|
$50.00
|
|
|
Service Code
|
HCPCS 0034A
|
| Hospital Charge Code |
30480034A
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$7.50 |
| Max. Negotiated Rate |
$7.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$7.50
|
|
|
JANSSEN COVID19 BOOSTER ADMIN
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
HCPCS 0034A
|
| Hospital Charge Code |
36530034A
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$1.42 |
| Max. Negotiated Rate |
$159.00 |
| Rate for Payer: Aetna Commercial |
$19.00
|
| Rate for Payer: Aetna Medicare Advantage |
$15.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$12.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$12.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$12.75
|
| Rate for Payer: Cigna Commercial |
$25.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$13.00
|
| Rate for Payer: Oxford Commercial |
$140.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$7.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$159.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$1.58
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.42
|
|
|
JANSSEN COVID19 BOOSTER ADMIN
|
Facility
|
IP
|
$50.00
|
|
|
Service Code
|
HCPCS 0034A
|
| Hospital Charge Code |
30430034A
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$7.50 |
| Max. Negotiated Rate |
$7.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$7.50
|
|
|
JANSSEN COVID19 BOOSTER ADMIN
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
HCPCS 0034A
|
| Hospital Charge Code |
48320034A
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$1.42 |
| Max. Negotiated Rate |
$159.00 |
| Rate for Payer: Aetna Commercial |
$19.00
|
| Rate for Payer: Aetna Medicare Advantage |
$15.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$12.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$12.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$12.75
|
| Rate for Payer: Cigna Commercial |
$25.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$13.00
|
| Rate for Payer: Oxford Commercial |
$140.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$7.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$159.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$1.58
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.42
|
|
|
JANSSEN COVID19 BOOSTER ADMIN
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
HCPCS 0034A
|
| Hospital Charge Code |
30370034A
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$1.42 |
| Max. Negotiated Rate |
$159.00 |
| Rate for Payer: Aetna Commercial |
$19.00
|
| Rate for Payer: Aetna Medicare Advantage |
$15.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$12.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$12.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$12.75
|
| Rate for Payer: Cigna Commercial |
$25.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$13.00
|
| Rate for Payer: Oxford Commercial |
$140.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$7.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$159.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$1.58
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.42
|
|
|
JANSSEN COVID19 BOOSTER ADMIN
|
Facility
|
IP
|
$50.00
|
|
|
Service Code
|
HCPCS 0034A
|
| Hospital Charge Code |
48320034A
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$7.50 |
| Max. Negotiated Rate |
$7.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$7.50
|
|
|
JANSSEN COVID19 BOOSTER ADMIN
|
Facility
|
IP
|
$50.00
|
|
|
Service Code
|
HCPCS 0034A
|
| Hospital Charge Code |
48180034A
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$7.50 |
| Max. Negotiated Rate |
$7.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$7.50
|
|
|
JANSSEN COVID19 BOOSTER ADMIN
|
Facility
|
IP
|
$50.00
|
|
|
Service Code
|
HCPCS 0034A
|
| Hospital Charge Code |
45090034A
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$7.50 |
| Max. Negotiated Rate |
$7.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$7.50
|
|
|
JANSSEN COVID19 BOOSTER ADMIN
|
Facility
|
IP
|
$50.00
|
|
|
Service Code
|
HCPCS 0034A
|
| Hospital Charge Code |
30800034A
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$7.50 |
| Max. Negotiated Rate |
$7.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$7.50
|
|
|
JANSSEN COVID19 BOOSTER ADMIN
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
HCPCS 0034A
|
| Hospital Charge Code |
30420034A
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$1.42 |
| Max. Negotiated Rate |
$159.00 |
| Rate for Payer: Aetna Commercial |
$19.00
|
| Rate for Payer: Aetna Medicare Advantage |
$15.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$12.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$12.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$12.75
|
| Rate for Payer: Cigna Commercial |
$25.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$13.00
|
| Rate for Payer: Oxford Commercial |
$140.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$7.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$159.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$1.58
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.42
|
|
|
JANSSEN COVID19 BOOSTER ADMIN
|
Facility
|
IP
|
$50.00
|
|
|
Service Code
|
HCPCS 0034A
|
| Hospital Charge Code |
30420034A
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$7.50 |
| Max. Negotiated Rate |
$7.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$7.50
|
|
|
JANSSEN COVID19 BOOSTER ADMIN
|
Facility
|
IP
|
$50.00
|
|
|
Service Code
|
HCPCS 0034A
|
| Hospital Charge Code |
48220034A
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$7.50 |
| Max. Negotiated Rate |
$7.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$7.50
|
|
|
JANSSEN COVID19 BOOSTER ADMIN
|
Facility
|
IP
|
$50.00
|
|
|
Service Code
|
HCPCS 0034A
|
| Hospital Charge Code |
43080034A
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$7.50 |
| Max. Negotiated Rate |
$7.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$7.50
|
|