|
VITAMIN B12
|
Facility
|
OP
|
$380.80
|
|
|
Service Code
|
HCPCS 82607
|
| Hospital Charge Code |
38472692
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.81 |
| Max. Negotiated Rate |
$190.40 |
| Rate for Payer: Aetna Commercial |
$41.02
|
| Rate for Payer: Aetna Medicare Advantage |
$48.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$54.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$54.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$15.08
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$24.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$54.70
|
| Rate for Payer: Cigna Commercial |
$190.40
|
| Rate for Payer: Cigna Medicare Advantage |
$15.08
|
| Rate for Payer: Clover Medicare Advantage |
$14.33
|
| Rate for Payer: EmblemHealth Commercial |
$45.24
|
| Rate for Payer: Humana Medicare Advantage |
$15.53
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$15.08
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$99.01
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$57.12
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$12.06
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$15.08
|
| Rate for Payer: Wellcare Medicare Advantage |
$15.08
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$10.81
|
|
|
VITAMIN B12
|
Facility
|
IP
|
$667.59
|
|
|
Service Code
|
HCPCS 82607
|
| Hospital Charge Code |
39888002
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$100.14 |
| Max. Negotiated Rate |
$100.14 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$100.14
|
|
|
VITAMIN B12
|
Facility
|
OP
|
$667.59
|
|
|
Service Code
|
HCPCS 82607
|
| Hospital Charge Code |
39888002
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.06 |
| Max. Negotiated Rate |
$333.80 |
| Rate for Payer: Aetna Commercial |
$41.02
|
| Rate for Payer: Aetna Medicare Advantage |
$48.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$54.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$54.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$15.08
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$24.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$54.70
|
| Rate for Payer: Cigna Commercial |
$333.80
|
| Rate for Payer: Cigna Medicare Advantage |
$15.08
|
| Rate for Payer: Clover Medicare Advantage |
$14.33
|
| Rate for Payer: EmblemHealth Commercial |
$45.24
|
| Rate for Payer: Humana Medicare Advantage |
$15.53
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$15.08
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$173.57
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$100.14
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$12.06
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$15.08
|
| Rate for Payer: Wellcare Medicare Advantage |
$15.08
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$18.96
|
|
|
VITAMIN B12 250MG TABLET
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
NDC 50268085315
|
| Hospital Charge Code |
606390158
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$0.60 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.60
|
|
|
VITAMIN B12 250MG TABLET
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
NDC 50268085315
|
| Hospital Charge Code |
606390158
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$2.00 |
| Rate for Payer: Aetna Commercial |
$1.52
|
| Rate for Payer: Aetna Medicare Advantage |
$1.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1.02
|
| Rate for Payer: Cigna Commercial |
$2.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1.04
|
| Rate for Payer: Oxford Commercial |
$0.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.60
|
| Rate for Payer: UnitedHealthcare Commercial |
$0.80
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.13
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.11
|
|
|
VITAMIN B12 BINDING CAPAC
|
Facility
|
OP
|
$98.40
|
|
|
Service Code
|
HCPCS 82608
|
| Hospital Charge Code |
39900070
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.79 |
| Max. Negotiated Rate |
$156.00 |
| Rate for Payer: Aetna Commercial |
$38.95
|
| Rate for Payer: Aetna Medicare Advantage |
$46.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$51.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$51.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$14.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$24.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$51.95
|
| Rate for Payer: Cigna Commercial |
$49.20
|
| Rate for Payer: Cigna Medicare Advantage |
$14.32
|
| Rate for Payer: Clover Medicare Advantage |
$13.60
|
| Rate for Payer: EmblemHealth Commercial |
$42.96
|
| Rate for Payer: Humana Medicare Advantage |
$14.75
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$14.32
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$25.58
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$14.76
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$11.46
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$14.32
|
| Rate for Payer: Wellcare Medicare Advantage |
$14.32
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.79
|
|
|
VITAMIN B12 BINDING CAPAC
|
Facility
|
IP
|
$98.40
|
|
|
Service Code
|
HCPCS 82608
|
| Hospital Charge Code |
39900070
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.76 |
| Max. Negotiated Rate |
$14.76 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$14.76
|
|
|
VITAMIN B12,SERUM
|
Facility
|
OP
|
$103.60
|
|
|
Service Code
|
HCPCS 82607
|
| Hospital Charge Code |
39900069
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.94 |
| Max. Negotiated Rate |
$156.00 |
| Rate for Payer: Aetna Commercial |
$41.02
|
| Rate for Payer: Aetna Medicare Advantage |
$48.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$54.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$54.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$15.08
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$24.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$54.70
|
| Rate for Payer: Cigna Commercial |
$51.80
|
| Rate for Payer: Cigna Medicare Advantage |
$15.08
|
| Rate for Payer: Clover Medicare Advantage |
$14.33
|
| Rate for Payer: EmblemHealth Commercial |
$45.24
|
| Rate for Payer: Humana Medicare Advantage |
$15.53
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$15.08
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$26.94
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$15.54
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$12.06
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$15.08
|
| Rate for Payer: Wellcare Medicare Advantage |
$15.08
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.94
|
|
|
VITAMIN B12,SERUM
|
Facility
|
IP
|
$103.60
|
|
|
Service Code
|
HCPCS 82607
|
| Hospital Charge Code |
39900069
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.54 |
| Max. Negotiated Rate |
$15.54 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$15.54
|
|
|
VITAMIN B1 (ERYTHROCYTE TRANSK
|
Facility
|
OP
|
$588.00
|
|
|
Service Code
|
HCPCS 84425
|
| Hospital Charge Code |
38472683
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.70 |
| Max. Negotiated Rate |
$294.00 |
| Rate for Payer: Aetna Commercial |
$57.75
|
| Rate for Payer: Aetna Medicare Advantage |
$68.79
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$77.01
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$77.01
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$21.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$52.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$77.01
|
| Rate for Payer: Cigna Commercial |
$294.00
|
| Rate for Payer: Cigna Medicare Advantage |
$21.23
|
| Rate for Payer: Clover Medicare Advantage |
$20.17
|
| Rate for Payer: EmblemHealth Commercial |
$63.69
|
| Rate for Payer: Humana Medicare Advantage |
$21.87
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$21.23
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$152.88
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$88.20
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$16.98
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$21.23
|
| Rate for Payer: Wellcare Medicare Advantage |
$21.23
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$16.70
|
|
|
VITAMIN B1 (ERYTHROCYTE TRANSK
|
Facility
|
IP
|
$588.00
|
|
|
Service Code
|
HCPCS 84425
|
| Hospital Charge Code |
38472683
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$88.20 |
| Max. Negotiated Rate |
$88.20 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$88.20
|
|
|
VITAMIN B1 (THIAMINE), B
|
Facility
|
OP
|
$667.59
|
|
|
Service Code
|
HCPCS 84425
|
| Hospital Charge Code |
39900138
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.98 |
| Max. Negotiated Rate |
$333.80 |
| Rate for Payer: Aetna Commercial |
$57.75
|
| Rate for Payer: Aetna Medicare Advantage |
$68.79
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$77.01
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$77.01
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$21.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$52.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$77.01
|
| Rate for Payer: Cigna Commercial |
$333.80
|
| Rate for Payer: Cigna Medicare Advantage |
$21.23
|
| Rate for Payer: Clover Medicare Advantage |
$20.17
|
| Rate for Payer: EmblemHealth Commercial |
$63.69
|
| Rate for Payer: Humana Medicare Advantage |
$21.87
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$21.23
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$173.57
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$100.14
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$16.98
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$21.23
|
| Rate for Payer: Wellcare Medicare Advantage |
$21.23
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$18.96
|
|
|
VITAMIN B1 (THIAMINE), B
|
Facility
|
IP
|
$667.59
|
|
|
Service Code
|
HCPCS 84425
|
| Hospital Charge Code |
39900138
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$100.14 |
| Max. Negotiated Rate |
$100.14 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$100.14
|
|
|
VITAMIN B2 (ERYTHROCYTE GLUT.R
|
Facility
|
OP
|
$304.00
|
|
|
Service Code
|
HCPCS 84252
|
| Hospital Charge Code |
38472686
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.63 |
| Max. Negotiated Rate |
$156.00 |
| Rate for Payer: Aetna Commercial |
$55.05
|
| Rate for Payer: Aetna Medicare Advantage |
$65.58
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$73.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$73.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$20.24
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$54.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$73.42
|
| Rate for Payer: Cigna Commercial |
$152.00
|
| Rate for Payer: Cigna Medicare Advantage |
$20.24
|
| Rate for Payer: Clover Medicare Advantage |
$19.23
|
| Rate for Payer: EmblemHealth Commercial |
$60.72
|
| Rate for Payer: Humana Medicare Advantage |
$20.85
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$20.24
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$79.04
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$45.60
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$16.19
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$20.24
|
| Rate for Payer: Wellcare Medicare Advantage |
$20.24
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$8.63
|
|
|
VITAMIN B2 (ERYTHROCYTE GLUT.R
|
Facility
|
IP
|
$304.00
|
|
|
Service Code
|
HCPCS 84252
|
| Hospital Charge Code |
38472686
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$45.60 |
| Max. Negotiated Rate |
$45.60 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$45.60
|
|
|
VITAMIN B2,PLASMA
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 84252
|
| Hospital Charge Code |
39900129
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
VITAMIN B2,PLASMA
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 84252
|
| Hospital Charge Code |
39900129
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.08 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$55.05
|
| Rate for Payer: Aetna Medicare Advantage |
$65.58
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$73.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$73.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$20.24
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$54.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$73.42
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$20.24
|
| Rate for Payer: Clover Medicare Advantage |
$19.23
|
| Rate for Payer: EmblemHealth Commercial |
$60.72
|
| Rate for Payer: Humana Medicare Advantage |
$20.85
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$20.24
|
| 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 |
$16.19
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$20.24
|
| Rate for Payer: Wellcare Medicare Advantage |
$20.24
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.08
|
|
|
VITAMIN B3
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 84591
|
| Hospital Charge Code |
39900518
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
VITAMIN B3
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 84591
|
| Hospital Charge Code |
39900518
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.84 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$46.40
|
| Rate for Payer: Aetna Medicare Advantage |
$55.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$61.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$61.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$17.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$10.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$61.89
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$17.06
|
| Rate for Payer: Clover Medicare Advantage |
$16.21
|
| Rate for Payer: EmblemHealth Commercial |
$51.18
|
| Rate for Payer: Humana Medicare Advantage |
$17.57
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$17.06
|
| 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 |
$13.65
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$17.06
|
| Rate for Payer: Wellcare Medicare Advantage |
$17.06
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.08
|
|
|
VITAMIN B5 (PANTOTHENC AC)
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 84591
|
| Hospital Charge Code |
39708040
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
VITAMIN B5 (PANTOTHENC AC)
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 84591
|
| Hospital Charge Code |
39708040
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$10.84 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$46.40
|
| Rate for Payer: Aetna Medicare Advantage |
$55.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$61.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$61.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$17.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$10.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$61.89
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$17.06
|
| Rate for Payer: Clover Medicare Advantage |
$16.21
|
| Rate for Payer: EmblemHealth Commercial |
$51.18
|
| Rate for Payer: Humana Medicare Advantage |
$17.57
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$17.06
|
| 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 |
$13.65
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$17.06
|
| Rate for Payer: Wellcare Medicare Advantage |
$17.06
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.08
|
|
|
VITAMIN B6,PLASMA
|
Facility
|
OP
|
$193.10
|
|
|
Service Code
|
HCPCS 84207
|
| Hospital Charge Code |
39900126
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.48 |
| Max. Negotiated Rate |
$24,078.00 |
| Rate for Payer: Aetna Commercial |
$76.43
|
| Rate for Payer: Aetna Medicare Advantage |
$91.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$101.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$101.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$28.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$66.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$101.93
|
| Rate for Payer: Cigna Commercial |
$96.55
|
| Rate for Payer: Cigna Medicare Advantage |
$28.10
|
| Rate for Payer: Clover Medicare Advantage |
$26.70
|
| Rate for Payer: EmblemHealth Commercial |
$84.30
|
| Rate for Payer: Humana Medicare Advantage |
$28.94
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$28.10
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$50.21
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$28.96
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$22.48
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$28.10
|
| Rate for Payer: Wellcare Medicare Advantage |
$28.10
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$24,078.00
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$5.48
|
|
|
VITAMIN B6,PLASMA
|
Facility
|
IP
|
$193.10
|
|
|
Service Code
|
HCPCS 84207
|
| Hospital Charge Code |
39900126
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$28.96 |
| Max. Negotiated Rate |
$28.96 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$28.96
|
|
|
VITAMIN B6 (PYRIDOXAL PHOSPHAT
|
Facility
|
OP
|
$514.00
|
|
|
Service Code
|
HCPCS 84207
|
| Hospital Charge Code |
38472689
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.60 |
| Max. Negotiated Rate |
$24,078.00 |
| Rate for Payer: Aetna Commercial |
$76.43
|
| Rate for Payer: Aetna Medicare Advantage |
$91.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$101.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$101.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$28.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$66.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$101.93
|
| Rate for Payer: Cigna Commercial |
$257.00
|
| Rate for Payer: Cigna Medicare Advantage |
$28.10
|
| Rate for Payer: Clover Medicare Advantage |
$26.70
|
| Rate for Payer: EmblemHealth Commercial |
$84.30
|
| Rate for Payer: Humana Medicare Advantage |
$28.94
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$28.10
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$133.64
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$77.10
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$22.48
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$28.10
|
| Rate for Payer: Wellcare Medicare Advantage |
$28.10
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$24,078.00
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$14.60
|
|
|
VITAMIN B6 (PYRIDOXAL PHOSPHAT
|
Facility
|
IP
|
$514.00
|
|
|
Service Code
|
HCPCS 84207
|
| Hospital Charge Code |
38472689
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$77.10 |
| Max. Negotiated Rate |
$77.10 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$77.10
|
|
