|
VITAMIN B7 (BIOTIN)
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 84591
|
| Hospital Charge Code |
39900150
|
|
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 B7 (BIOTIN)
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 84591
|
| Hospital Charge Code |
39900150
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
VITAMIN C (ASCORBIC ACID)
|
Facility
|
OP
|
$231.00
|
|
|
Service Code
|
HCPCS 82180
|
| Hospital Charge Code |
38472695
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.94 |
| Max. Negotiated Rate |
$156.00 |
| Rate for Payer: Aetna Commercial |
$26.90
|
| Rate for Payer: Aetna Medicare Advantage |
$32.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$35.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$35.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$9.89
|
| 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 |
$35.88
|
| Rate for Payer: Cigna Commercial |
$115.50
|
| Rate for Payer: Cigna Medicare Advantage |
$9.89
|
| Rate for Payer: Clover Medicare Advantage |
$9.40
|
| Rate for Payer: EmblemHealth Commercial |
$29.67
|
| Rate for Payer: Humana Medicare Advantage |
$10.19
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$9.89
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$60.06
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$34.65
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$7.91
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$9.89
|
| Rate for Payer: Wellcare Medicare Advantage |
$9.89
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$6.56
|
|
|
VITAMIN C (ASCORBIC ACID)
|
Facility
|
IP
|
$231.00
|
|
|
Service Code
|
HCPCS 82180
|
| Hospital Charge Code |
38472695
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$34.65 |
| Max. Negotiated Rate |
$34.65 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$34.65
|
|
|
VITAMIN C,SERUM
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 82180
|
| Hospital Charge Code |
39900046
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
VITAMIN C,SERUM
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 82180
|
| Hospital Charge Code |
39900046
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.94 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$26.90
|
| Rate for Payer: Aetna Medicare Advantage |
$32.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$35.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$35.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$9.89
|
| 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 |
$35.88
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$9.89
|
| Rate for Payer: Clover Medicare Advantage |
$9.40
|
| Rate for Payer: EmblemHealth Commercial |
$29.67
|
| Rate for Payer: Humana Medicare Advantage |
$10.19
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$9.89
|
| 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 |
$7.91
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$9.89
|
| Rate for Payer: Wellcare Medicare Advantage |
$9.89
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.08
|
|
|
VITAMIN D 1,25 - DIHYDROXY
|
Facility
|
OP
|
$1,691.20
|
|
|
Service Code
|
HCPCS 82652
|
| Hospital Charge Code |
38472039
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$30.80 |
| Max. Negotiated Rate |
$845.60 |
| Rate for Payer: Aetna Commercial |
$104.72
|
| Rate for Payer: Aetna Medicare Advantage |
$124.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$139.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$139.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$38.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$90.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$139.66
|
| Rate for Payer: Cigna Commercial |
$845.60
|
| Rate for Payer: Cigna Medicare Advantage |
$38.50
|
| Rate for Payer: Clover Medicare Advantage |
$36.58
|
| Rate for Payer: EmblemHealth Commercial |
$115.50
|
| Rate for Payer: Humana Medicare Advantage |
$39.66
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$38.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$439.71
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$253.68
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$30.80
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$38.50
|
| Rate for Payer: Wellcare Medicare Advantage |
$38.50
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$48.03
|
|
|
VITAMIN D 1,25 - DIHYDROXY
|
Facility
|
IP
|
$1,691.20
|
|
|
Service Code
|
HCPCS 82652
|
| Hospital Charge Code |
38472039
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$253.68 |
| Max. Negotiated Rate |
$253.68 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$253.68
|
|
|
VITAMIN D 25 DI-HYDROXY
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 82652
|
| Hospital Charge Code |
39900329
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
VITAMIN D 25 DI-HYDROXY
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 82652
|
| Hospital Charge Code |
39900329
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.08 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$104.72
|
| Rate for Payer: Aetna Medicare Advantage |
$124.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$139.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$139.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$38.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$90.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$139.66
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$38.50
|
| Rate for Payer: Clover Medicare Advantage |
$36.58
|
| Rate for Payer: EmblemHealth Commercial |
$115.50
|
| Rate for Payer: Humana Medicare Advantage |
$39.66
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$38.50
|
| 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 |
$30.80
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$38.50
|
| Rate for Payer: Wellcare Medicare Advantage |
$38.50
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.08
|
|
|
Vitamin D, 25-Hydroxy
|
Facility
|
OP
|
$667.59
|
|
|
Service Code
|
HCPCS 82306
|
| Hospital Charge Code |
39888005
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.96 |
| Max. Negotiated Rate |
$333.80 |
| Rate for Payer: Aetna Commercial |
$80.51
|
| Rate for Payer: Aetna Medicare Advantage |
$95.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$107.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$107.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$29.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$49.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$107.37
|
| Rate for Payer: Cigna Commercial |
$333.80
|
| Rate for Payer: Cigna Medicare Advantage |
$29.60
|
| Rate for Payer: Clover Medicare Advantage |
$28.12
|
| Rate for Payer: EmblemHealth Commercial |
$88.80
|
| Rate for Payer: Humana Medicare Advantage |
$30.49
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$29.60
|
| 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 |
$23.68
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$29.60
|
| Rate for Payer: Wellcare Medicare Advantage |
$29.60
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$18.96
|
|
|
Vitamin D, 25-Hydroxy
|
Facility
|
IP
|
$667.59
|
|
|
Service Code
|
HCPCS 82306
|
| Hospital Charge Code |
39888005
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$100.14 |
| Max. Negotiated Rate |
$100.14 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$100.14
|
|
|
VITAMIN D, 25 HYDROXY
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 82306
|
| Hospital Charge Code |
39900050
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
VITAMIN D, 25 HYDROXY
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 82306
|
| Hospital Charge Code |
39900050
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.08 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$80.51
|
| Rate for Payer: Aetna Medicare Advantage |
$95.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$107.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$107.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$29.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$49.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$107.37
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$29.60
|
| Rate for Payer: Clover Medicare Advantage |
$28.12
|
| Rate for Payer: EmblemHealth Commercial |
$88.80
|
| Rate for Payer: Humana Medicare Advantage |
$30.49
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$29.60
|
| 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 |
$23.68
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$29.60
|
| Rate for Payer: Wellcare Medicare Advantage |
$29.60
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.08
|
|
|
VITAMIN D 25 - HYDROXY
|
Facility
|
IP
|
$618.80
|
|
|
Service Code
|
HCPCS 82306
|
| Hospital Charge Code |
38472040
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$92.82 |
| Max. Negotiated Rate |
$92.82 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$92.82
|
|
|
VITAMIN D 25 - HYDROXY
|
Facility
|
OP
|
$618.80
|
|
|
Service Code
|
HCPCS 82306
|
| Hospital Charge Code |
38472040
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.57 |
| Max. Negotiated Rate |
$309.40 |
| Rate for Payer: Aetna Commercial |
$80.51
|
| Rate for Payer: Aetna Medicare Advantage |
$95.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$107.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$107.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$29.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$49.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$107.37
|
| Rate for Payer: Cigna Commercial |
$309.40
|
| Rate for Payer: Cigna Medicare Advantage |
$29.60
|
| Rate for Payer: Clover Medicare Advantage |
$28.12
|
| Rate for Payer: EmblemHealth Commercial |
$88.80
|
| Rate for Payer: Humana Medicare Advantage |
$30.49
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$29.60
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$160.89
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$92.82
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$23.68
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$29.60
|
| Rate for Payer: Wellcare Medicare Advantage |
$29.60
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$17.57
|
|
|
VITAMIN D3 5000IU 125MCG TAB
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
NDC 7610017840
|
| Hospital Charge Code |
606390340
|
|
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 D3 5000IU 125MCG TAB
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
NDC 7610017840
|
| Hospital Charge Code |
606390340
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$0.60 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.60
|
|
|
VITAMIN D TAB 400 IU
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
NDC 43292055881
|
| Hospital Charge Code |
60628737
|
|
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 D TAB 400 IU
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
NDC 43292055881
|
| Hospital Charge Code |
60628737
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$0.60 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.60
|
|
|
VITAMIN E
|
Facility
|
IP
|
$236.00
|
|
|
Service Code
|
HCPCS 84446
|
| Hospital Charge Code |
38472701
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$35.40 |
| Max. Negotiated Rate |
$35.40 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$35.40
|
|
|
VITAMIN E
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 84446
|
| Hospital Charge Code |
39900143
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.08 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$38.57
|
| Rate for Payer: Aetna Medicare Advantage |
$45.94
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$51.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$51.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$14.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$34.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$51.44
|
| Rate for Payer: Cigna Commercial |
$195.00
|
| Rate for Payer: Cigna Medicare Advantage |
$14.18
|
| Rate for Payer: Clover Medicare Advantage |
$13.47
|
| Rate for Payer: EmblemHealth Commercial |
$42.54
|
| Rate for Payer: Humana Medicare Advantage |
$14.61
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$14.18
|
| 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 |
$11.34
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$14.18
|
| Rate for Payer: Wellcare Medicare Advantage |
$14.18
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.08
|
|
|
VITAMIN E
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 84446
|
| Hospital Charge Code |
39900143
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
VITAMIN E
|
Facility
|
OP
|
$236.00
|
|
|
Service Code
|
HCPCS 84446
|
| Hospital Charge Code |
38472701
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.70 |
| Max. Negotiated Rate |
$156.00 |
| Rate for Payer: Aetna Commercial |
$38.57
|
| Rate for Payer: Aetna Medicare Advantage |
$45.94
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$51.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$51.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$14.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$34.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$51.44
|
| Rate for Payer: Cigna Commercial |
$118.00
|
| Rate for Payer: Cigna Medicare Advantage |
$14.18
|
| Rate for Payer: Clover Medicare Advantage |
$13.47
|
| Rate for Payer: EmblemHealth Commercial |
$42.54
|
| Rate for Payer: Humana Medicare Advantage |
$14.61
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$14.18
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$61.36
|
| Rate for Payer: Oxford Commercial |
$156.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$35.40
|
| Rate for Payer: UnitedHealthcare Commercial |
$156.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$11.34
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$14.18
|
| Rate for Payer: Wellcare Medicare Advantage |
$14.18
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$6.70
|
|
|
VITAMIN E 100 IU SGL
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
NDC 904027060
|
| Hospital Charge Code |
6063943261
|
|
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
|
|
