|
RALTEGRAVIR 400MG TAB
|
Facility
|
OP
|
$161.40
|
|
|
Service Code
|
NDC 6022761
|
| Hospital Charge Code |
60630217
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.58 |
| Max. Negotiated Rate |
$80.70 |
| Rate for Payer: Aetna Commercial |
$61.33
|
| Rate for Payer: Aetna Medicare Advantage |
$48.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$41.16
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$41.16
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$41.16
|
| Rate for Payer: Cigna Commercial |
$80.70
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$41.96
|
| Rate for Payer: Oxford Commercial |
$32.28
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$24.21
|
| Rate for Payer: UnitedHealthcare Commercial |
$32.28
|
| Rate for Payer: UnitedHealthcare Community & State |
$5.10
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$4.58
|
|
|
RALTEGRAVIR 400MG TAB
|
Facility
|
IP
|
$161.40
|
|
|
Service Code
|
NDC 6022761
|
| Hospital Charge Code |
60630217
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$24.21 |
| Max. Negotiated Rate |
$24.21 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$24.21
|
|
|
RAM GUIDE 455MM
|
Facility
|
IP
|
$2,127.00
|
|
| Hospital Charge Code |
270673458
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$319.05 |
| Max. Negotiated Rate |
$319.05 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$319.05
|
|
|
RAM GUIDE 455MM
|
Facility
|
OP
|
$2,127.00
|
|
| Hospital Charge Code |
270673458
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$60.41 |
| Max. Negotiated Rate |
$1,063.50 |
| Rate for Payer: Aetna Commercial |
$808.26
|
| Rate for Payer: Aetna Medicare Advantage |
$638.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$542.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$542.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$542.38
|
| Rate for Payer: Cigna Commercial |
$1,063.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$553.02
|
| Rate for Payer: Oxford Commercial |
$425.40
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$319.05
|
| Rate for Payer: UnitedHealthcare Commercial |
$425.40
|
| Rate for Payer: UnitedHealthcare Community & State |
$67.21
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$60.41
|
|
|
RAMIPRIL 1.25 MG CAP
|
Facility
|
OP
|
$9.72
|
|
|
Service Code
|
NDC 16252057030
|
| Hospital Charge Code |
60627610
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.28 |
| Max. Negotiated Rate |
$4.86 |
| Rate for Payer: Aetna Commercial |
$3.69
|
| Rate for Payer: Aetna Medicare Advantage |
$2.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2.48
|
| Rate for Payer: Cigna Commercial |
$4.86
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2.53
|
| Rate for Payer: Oxford Commercial |
$1.94
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.46
|
| Rate for Payer: UnitedHealthcare Commercial |
$1.94
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.31
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.28
|
|
|
RAMIPRIL 1.25 MG CAP
|
Facility
|
IP
|
$9.72
|
|
|
Service Code
|
NDC 16252057030
|
| Hospital Charge Code |
60627610
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.46 |
| Max. Negotiated Rate |
$1.46 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.46
|
|
|
RAMIPRIL 2.5 MG CAP
|
Facility
|
IP
|
$13.00
|
|
|
Service Code
|
NDC 68084026601
|
| Hospital Charge Code |
60629223
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.95 |
| Max. Negotiated Rate |
$1.95 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.95
|
|
|
RAMIPRIL 2.5 MG CAP
|
Facility
|
OP
|
$13.00
|
|
|
Service Code
|
NDC 68084026601
|
| Hospital Charge Code |
60629223
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.37 |
| Max. Negotiated Rate |
$6.50 |
| Rate for Payer: Aetna Commercial |
$4.94
|
| Rate for Payer: Aetna Medicare Advantage |
$3.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3.31
|
| Rate for Payer: Cigna Commercial |
$6.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3.38
|
| Rate for Payer: Oxford Commercial |
$2.60
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.95
|
| Rate for Payer: UnitedHealthcare Commercial |
$2.60
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.41
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.37
|
|
|
RAMIPRIL 5 MG CAP
|
Facility
|
IP
|
$13.67
|
|
|
Service Code
|
NDC 68084026701
|
| Hospital Charge Code |
60629229
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.05 |
| Max. Negotiated Rate |
$2.05 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.05
|
|
|
RAMIPRIL 5 MG CAP
|
Facility
|
OP
|
$13.67
|
|
|
Service Code
|
NDC 68084026701
|
| Hospital Charge Code |
60629229
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.39 |
| Max. Negotiated Rate |
$6.83 |
| Rate for Payer: Aetna Commercial |
$5.19
|
| Rate for Payer: Aetna Medicare Advantage |
$4.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3.49
|
| Rate for Payer: Cigna Commercial |
$6.83
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3.55
|
| Rate for Payer: Oxford Commercial |
$2.73
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.05
|
| Rate for Payer: UnitedHealthcare Commercial |
$2.73
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.43
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.39
|
|
|
RANDOLPH CYCLODIALYIS CANNULA
|
Facility
|
OP
|
$139.75
|
|
| Hospital Charge Code |
270678870
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.97 |
| Max. Negotiated Rate |
$69.88 |
| Rate for Payer: Aetna Commercial |
$53.10
|
| Rate for Payer: Aetna Medicare Advantage |
$41.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$35.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$35.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$35.64
|
| Rate for Payer: Cigna Commercial |
$69.88
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$36.34
|
| Rate for Payer: Oxford Commercial |
$27.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$20.96
|
| Rate for Payer: UnitedHealthcare Commercial |
$27.95
|
| Rate for Payer: UnitedHealthcare Community & State |
$4.42
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$3.97
|
|
|
RANDOLPH CYCLODIALYIS CANNULA
|
Facility
|
IP
|
$139.75
|
|
| Hospital Charge Code |
270678870
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$20.96 |
| Max. Negotiated Rate |
$20.96 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$20.96
|
|
|
RANDOM URINE CHLORIDE
|
Facility
|
OP
|
$363.15
|
|
|
Service Code
|
HCPCS 82436
|
| Hospital Charge Code |
39900529
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.60 |
| Max. Negotiated Rate |
$181.57 |
| 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 |
$181.57
|
| 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 |
$94.42
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$54.47
|
| 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 |
$10.31
|
|
|
RANDOM URINE CHLORIDE
|
Facility
|
IP
|
$363.15
|
|
|
Service Code
|
HCPCS 82436
|
| Hospital Charge Code |
39900529
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$54.47 |
| Max. Negotiated Rate |
$54.47 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$54.47
|
|
|
RANDOM URINE MICROALBUMIN I
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 82043
|
| Hospital Charge Code |
39990129A
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$4.62 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$15.72
|
| Rate for Payer: Aetna Medicare Advantage |
$18.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$20.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$20.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$5.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$7.09
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$20.97
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$5.78
|
| Rate for Payer: Clover Medicare Advantage |
$5.49
|
| Rate for Payer: EmblemHealth Commercial |
$17.34
|
| Rate for Payer: Humana Medicare Advantage |
$5.95
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$5.78
|
| 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 |
$4.62
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$5.78
|
| Rate for Payer: Wellcare Medicare Advantage |
$5.78
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.08
|
|
|
RANDOM URINE MICROALBUMIN I
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 82043
|
| Hospital Charge Code |
39990129A
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
RANDOM URINE MICROALBUMIN II
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 82570
|
| Hospital Charge Code |
39990129B
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.14 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$14.09
|
| Rate for Payer: Aetna Medicare Advantage |
$16.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$18.79
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$18.79
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$5.18
|
| 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 |
$18.79
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$5.18
|
| Rate for Payer: Clover Medicare Advantage |
$4.92
|
| Rate for Payer: EmblemHealth Commercial |
$15.54
|
| Rate for Payer: Humana Medicare Advantage |
$5.34
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$5.18
|
| 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 |
$4.14
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$5.18
|
| Rate for Payer: Wellcare Medicare Advantage |
$5.18
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.08
|
|
|
RANDOM URINE MICROALBUMIN II
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 82570
|
| Hospital Charge Code |
39990129B
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
RANDOM URINE PROTEIN ELECTROPH
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 84166
|
| Hospital Charge Code |
39990065C
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.08 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$48.50
|
| Rate for Payer: Aetna Medicare Advantage |
$57.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$64.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$64.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$17.83
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$31.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$64.68
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$17.83
|
| Rate for Payer: Clover Medicare Advantage |
$16.94
|
| Rate for Payer: EmblemHealth Commercial |
$53.49
|
| Rate for Payer: Humana Medicare Advantage |
$18.36
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$17.83
|
| 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 |
$14.26
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$17.83
|
| Rate for Payer: Wellcare Medicare Advantage |
$17.83
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.08
|
|
|
RANDOM URINE PROTEIN ELECTROPH
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 84166
|
| Hospital Charge Code |
39990065C
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
RANDOM URINE PROTEIN ELECTROPH
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 84156
|
| Hospital Charge Code |
39990065B
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.94 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$9.98
|
| Rate for Payer: Aetna Medicare Advantage |
$11.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$13.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$13.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$3.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$4.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$13.31
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$3.67
|
| Rate for Payer: Clover Medicare Advantage |
$3.49
|
| Rate for Payer: EmblemHealth Commercial |
$11.01
|
| Rate for Payer: Humana Medicare Advantage |
$3.78
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$3.67
|
| 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 |
$2.94
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$3.67
|
| Rate for Payer: Wellcare Medicare Advantage |
$3.67
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.08
|
|
|
RANDOM URINE PROTEIN ELECTROPH
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 84156
|
| Hospital Charge Code |
39990065B
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
RANDOM URINE PROTEIN ELECTROPH
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 82570
|
| Hospital Charge Code |
39990065A
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
RANDOM URINE PROTEIN ELECTROPH
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 82570
|
| Hospital Charge Code |
39990065A
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.14 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$14.09
|
| Rate for Payer: Aetna Medicare Advantage |
$16.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$18.79
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$18.79
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$5.18
|
| 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 |
$18.79
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$5.18
|
| Rate for Payer: Clover Medicare Advantage |
$4.92
|
| Rate for Payer: EmblemHealth Commercial |
$15.54
|
| Rate for Payer: Humana Medicare Advantage |
$5.34
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$5.18
|
| 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 |
$4.14
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$5.18
|
| Rate for Payer: Wellcare Medicare Advantage |
$5.18
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.08
|
|
|
RANEXA 500MG TAB
|
Facility
|
OP
|
$37.05
|
|
|
Service Code
|
NDC 61958100301
|
| Hospital Charge Code |
60635580
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.05 |
| Max. Negotiated Rate |
$18.52 |
| Rate for Payer: Aetna Commercial |
$14.08
|
| Rate for Payer: Aetna Medicare Advantage |
$11.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$9.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$9.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$9.45
|
| Rate for Payer: Cigna Commercial |
$18.52
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$9.63
|
| Rate for Payer: Oxford Commercial |
$7.41
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$5.56
|
| Rate for Payer: UnitedHealthcare Commercial |
$7.41
|
| Rate for Payer: UnitedHealthcare Community & State |
$1.17
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.05
|
|
