|
LYSIS OF LABIAL LESION (S)
|
Facility
|
IP
|
$14,977.64
|
|
|
Service Code
|
HCPCS 56441
|
| Hospital Charge Code |
1600000536
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,246.65 |
| Max. Negotiated Rate |
$2,246.65 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,246.65
|
|
|
LYSIS PENIL CIRCUMIC LESION
|
Facility
|
OP
|
$12,062.25
|
|
|
Service Code
|
HCPCS 54162
|
| Hospital Charge Code |
1600000583
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$342.57 |
| Max. Negotiated Rate |
$9,008.64 |
| Rate for Payer: Aetna Commercial |
$6,754.93
|
| Rate for Payer: Aetna Medicare Advantage |
$8,046.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$9,008.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$9,008.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$2,483.43
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,536.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$9,008.64
|
| Rate for Payer: Cigna Commercial |
$4,978.04
|
| Rate for Payer: Cigna Medicare Advantage |
$2,483.43
|
| Rate for Payer: Clover Medicare Advantage |
$2,359.26
|
| Rate for Payer: EmblemHealth Commercial |
$7,450.29
|
| Rate for Payer: Humana Medicare Advantage |
$2,557.93
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$2,483.43
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,136.18
|
| Rate for Payer: Oxford Commercial |
$7,525.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,809.34
|
| Rate for Payer: UnitedHealthcare Commercial |
$8,192.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$381.17
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$2,483.43
|
| Rate for Payer: Wellcare Medicare Advantage |
$2,483.43
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$342.57
|
|
|
LYSIS PENIL CIRCUMIC LESION
|
Facility
|
IP
|
$12,062.25
|
|
|
Service Code
|
HCPCS 54162
|
| Hospital Charge Code |
1600000583
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,809.34 |
| Max. Negotiated Rate |
$1,809.34 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,809.34
|
|
|
LYSOZYME (MURAMIDASE)
|
Facility
|
OP
|
$280.00
|
|
|
Service Code
|
HCPCS 85549
|
| Hospital Charge Code |
38473055
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$7.95 |
| Max. Negotiated Rate |
$156.00 |
| Rate for Payer: Aetna Commercial |
$51.00
|
| Rate for Payer: Aetna Medicare Advantage |
$60.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$68.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$68.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$18.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$46.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$68.02
|
| Rate for Payer: Cigna Commercial |
$140.00
|
| Rate for Payer: Cigna Medicare Advantage |
$18.75
|
| Rate for Payer: Clover Medicare Advantage |
$17.81
|
| Rate for Payer: EmblemHealth Commercial |
$56.25
|
| Rate for Payer: Humana Medicare Advantage |
$19.31
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$18.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$72.80
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$42.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$15.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$18.75
|
| Rate for Payer: Wellcare Medicare Advantage |
$18.75
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$7.95
|
|
|
LYSOZYME (MURAMIDASE)
|
Facility
|
IP
|
$280.00
|
|
|
Service Code
|
HCPCS 85549
|
| Hospital Charge Code |
38473055
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$42.00 |
| Max. Negotiated Rate |
$42.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$42.00
|
|
|
LYSOZYME,SERUM
|
Facility
|
OP
|
$128.90
|
|
|
Service Code
|
HCPCS 85549
|
| Hospital Charge Code |
39900176
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$3.66 |
| Max. Negotiated Rate |
$156.00 |
| Rate for Payer: Aetna Commercial |
$51.00
|
| Rate for Payer: Aetna Medicare Advantage |
$60.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$68.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$68.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$18.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$46.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$68.02
|
| Rate for Payer: Cigna Commercial |
$64.45
|
| Rate for Payer: Cigna Medicare Advantage |
$18.75
|
| Rate for Payer: Clover Medicare Advantage |
$17.81
|
| Rate for Payer: EmblemHealth Commercial |
$56.25
|
| Rate for Payer: Humana Medicare Advantage |
$19.31
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$18.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$33.51
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$19.34
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$15.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$18.75
|
| Rate for Payer: Wellcare Medicare Advantage |
$18.75
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$3.66
|
|
|
LYSOZYME,SERUM
|
Facility
|
IP
|
$128.90
|
|
|
Service Code
|
HCPCS 85549
|
| Hospital Charge Code |
39900176
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$19.34 |
| Max. Negotiated Rate |
$19.34 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$19.34
|
|
|
LYTES 1
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 82438
|
| Hospital Charge Code |
39708030A
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
LYTES 1
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 82438
|
| Hospital Charge Code |
39708030A
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$13.60
|
| Rate for Payer: Aetna Medicare Advantage |
$16.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$18.14
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$18.14
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$5.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$5.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$18.14
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$5.00
|
| Rate for Payer: Clover Medicare Advantage |
$4.75
|
| Rate for Payer: EmblemHealth Commercial |
$15.00
|
| Rate for Payer: Humana Medicare Advantage |
$5.15
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$5.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$101.40
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$4.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$5.00
|
| Rate for Payer: Wellcare Medicare Advantage |
$5.00
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.08
|
|
|
LYTES 2
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 84302
|
| Hospital Charge Code |
366884302
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.89 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$13.22
|
| Rate for Payer: Aetna Medicare Advantage |
$15.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$17.63
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$17.63
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$4.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$4.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$17.63
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$4.86
|
| Rate for Payer: Clover Medicare Advantage |
$4.62
|
| Rate for Payer: EmblemHealth Commercial |
$14.58
|
| Rate for Payer: Humana Medicare Advantage |
$5.01
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$4.86
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$101.40
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$3.89
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$4.86
|
| Rate for Payer: Wellcare Medicare Advantage |
$4.86
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.08
|
|
|
LYTES 2
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 84302
|
| Hospital Charge Code |
366884302
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
LYTES 2
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 84302
|
| Hospital Charge Code |
39708030B
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
LYTES 2
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 84302
|
| Hospital Charge Code |
39708030B
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.89 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$13.22
|
| Rate for Payer: Aetna Medicare Advantage |
$15.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$17.63
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$17.63
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$4.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$4.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$17.63
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$4.86
|
| Rate for Payer: Clover Medicare Advantage |
$4.62
|
| Rate for Payer: EmblemHealth Commercial |
$14.58
|
| Rate for Payer: Humana Medicare Advantage |
$5.01
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$4.86
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$101.40
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$3.89
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$4.86
|
| Rate for Payer: Wellcare Medicare Advantage |
$4.86
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.08
|
|
|
LYTES 24H SODIUM
|
Facility
|
OP
|
$517.00
|
|
|
Service Code
|
HCPCS 82340
|
| Hospital Charge Code |
38479473
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.82 |
| Max. Negotiated Rate |
$258.50 |
| Rate for Payer: Aetna Commercial |
$16.40
|
| Rate for Payer: Aetna Medicare Advantage |
$19.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$21.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$21.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$6.03
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$5.94
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$21.87
|
| Rate for Payer: Cigna Commercial |
$258.50
|
| Rate for Payer: Cigna Medicare Advantage |
$6.03
|
| Rate for Payer: Clover Medicare Advantage |
$5.73
|
| Rate for Payer: EmblemHealth Commercial |
$18.09
|
| Rate for Payer: Humana Medicare Advantage |
$6.21
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$6.03
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$134.42
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$77.55
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$4.82
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$6.03
|
| Rate for Payer: Wellcare Medicare Advantage |
$6.03
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$14.68
|
|
|
LYTES 24H SODIUM
|
Facility
|
IP
|
$517.00
|
|
|
Service Code
|
HCPCS 82340
|
| Hospital Charge Code |
38479473
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$77.55 |
| Max. Negotiated Rate |
$77.55 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$77.55
|
|
|
LYTES 3
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 84311
|
| Hospital Charge Code |
39708030C
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.48 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$22.03
|
| Rate for Payer: Aetna Medicare Advantage |
$26.24
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$29.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$29.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$8.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$6.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$29.38
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$8.10
|
| Rate for Payer: Clover Medicare Advantage |
$7.70
|
| Rate for Payer: EmblemHealth Commercial |
$24.30
|
| Rate for Payer: Humana Medicare Advantage |
$8.34
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$8.10
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$101.40
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$6.48
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$8.10
|
| Rate for Payer: Wellcare Medicare Advantage |
$8.10
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.08
|
|
|
LYTES 3
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 84311
|
| Hospital Charge Code |
39708030C
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
LYTES CHLORIDE
|
Facility
|
OP
|
$107.00
|
|
|
Service Code
|
HCPCS 82436
|
| Hospital Charge Code |
38479475
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.04 |
| Max. Negotiated Rate |
$156.00 |
| Rate for Payer: Aetna Commercial |
$15.64
|
| Rate for Payer: Aetna Medicare Advantage |
$18.63
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$20.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$20.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$5.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$4.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$20.86
|
| Rate for Payer: Cigna Commercial |
$53.50
|
| Rate for Payer: Cigna Medicare Advantage |
$5.75
|
| Rate for Payer: Clover Medicare Advantage |
$5.46
|
| Rate for Payer: EmblemHealth Commercial |
$17.25
|
| Rate for Payer: Humana Medicare Advantage |
$5.92
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$5.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$27.82
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$16.05
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$4.60
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$5.75
|
| Rate for Payer: Wellcare Medicare Advantage |
$5.75
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$3.04
|
|
|
LYTES CHLORIDE
|
Facility
|
IP
|
$107.00
|
|
|
Service Code
|
HCPCS 82436
|
| Hospital Charge Code |
38479475
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.05 |
| Max. Negotiated Rate |
$16.05 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$16.05
|
|
|
LYTES POTASIUM
|
Facility
|
OP
|
$119.00
|
|
|
Service Code
|
HCPCS 84133
|
| Hospital Charge Code |
38479474
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.38 |
| Max. Negotiated Rate |
$156.00 |
| Rate for Payer: Aetna Commercial |
$12.87
|
| Rate for Payer: Aetna Medicare Advantage |
$15.33
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$17.16
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$17.16
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$4.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$6.43
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$17.16
|
| Rate for Payer: Cigna Commercial |
$59.50
|
| Rate for Payer: Cigna Medicare Advantage |
$4.73
|
| Rate for Payer: Clover Medicare Advantage |
$4.49
|
| Rate for Payer: EmblemHealth Commercial |
$14.19
|
| Rate for Payer: Humana Medicare Advantage |
$4.87
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$4.73
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$30.94
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$17.85
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$3.78
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$4.73
|
| Rate for Payer: Wellcare Medicare Advantage |
$4.73
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$3.38
|
|
|
LYTES POTASIUM
|
Facility
|
IP
|
$119.00
|
|
|
Service Code
|
HCPCS 84133
|
| Hospital Charge Code |
38479474
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.85 |
| Max. Negotiated Rate |
$17.85 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$17.85
|
|
|
LYTU CHLORIDE URINE
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 82436
|
| Hospital Charge Code |
3036012C
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.60 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$15.64
|
| Rate for Payer: Aetna Medicare Advantage |
$18.63
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$20.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$20.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$5.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$4.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$20.86
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$5.75
|
| Rate for Payer: Clover Medicare Advantage |
$5.46
|
| Rate for Payer: EmblemHealth Commercial |
$17.25
|
| Rate for Payer: Humana Medicare Advantage |
$5.92
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$5.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$101.40
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$4.60
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$5.75
|
| Rate for Payer: Wellcare Medicare Advantage |
$5.75
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.08
|
|
|
LYTU CHLORIDE URINE
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 82436
|
| Hospital Charge Code |
3036012C
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
LYTU POTASSIUM SERUM PLSMA WB
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 84132
|
| Hospital Charge Code |
3036012B
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
LYTU POTASSIUM SERUM PLSMA WB
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 84132
|
| Hospital Charge Code |
3036012B
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.81 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$12.95
|
| Rate for Payer: Aetna Medicare Advantage |
$15.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$17.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$17.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$4.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$6.43
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$17.27
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$4.76
|
| Rate for Payer: Clover Medicare Advantage |
$4.52
|
| Rate for Payer: EmblemHealth Commercial |
$14.28
|
| Rate for Payer: Humana Medicare Advantage |
$4.90
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$4.76
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$101.40
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$3.81
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$4.76
|
| Rate for Payer: Wellcare Medicare Advantage |
$4.76
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.08
|
|
