Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

HYDRATION INF 1ST HR

Facility

$2,408.78

Service Code	HCPCS 96360
Hospital Charge Code	5700385
Hospital Revenue Code	450
Min. Negotiated Rate	$63.83
Max. Negotiated Rate	$912.17
Rate for Payer: Aetna Commercial	$687.34
Rate for Payer: Aetna Medicare Advantage	$818.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$912.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$912.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$252.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$272.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$912.17
Rate for Payer: Cigna Commercial	$506.53
Rate for Payer: Cigna Medicare Advantage	$252.70
Rate for Payer: Clover Medicare Advantage	$240.06
Rate for Payer: EmblemHealth Commercial	$758.10
Rate for Payer: Humana Medicare Advantage	$260.28
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$252.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$722.63
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$850.00
Rate for Payer: Qualcare PPO/HMO/WC	$361.32
Rate for Payer: UnitedHealthcare Community & State	$140.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$252.70
Rate for Payer: Wellcare Medicare Advantage	$252.70
Rate for Payer: Wellpoint Medicaid Managed Care	$63.83

HYDRATION INF 1ST HR

Facility

$1,334.09

Service Code	HCPCS 96360
Hospital Charge Code	1600532
Hospital Revenue Code	260
Min. Negotiated Rate	$32.15
Max. Negotiated Rate	$919.00
Rate for Payer: Aetna Commercial	$687.34
Rate for Payer: Aetna Medicare Advantage	$818.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$912.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$912.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$252.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$272.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$912.17
Rate for Payer: Cigna Commercial	$506.53
Rate for Payer: Cigna Medicare Advantage	$252.70
Rate for Payer: Clover Medicare Advantage	$240.06
Rate for Payer: EmblemHealth Commercial	$758.10
Rate for Payer: Humana Medicare Advantage	$260.28
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$252.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$400.23
Rate for Payer: Oxford Commercial	$707.00
Rate for Payer: Qualcare PPO/HMO/WC	$200.11
Rate for Payer: UnitedHealthcare Commercial	$919.00
Rate for Payer: UnitedHealthcare Community & State	$32.15
Rate for Payer: UnitedHealthcare Medicare Advantage	$252.70
Rate for Payer: Wellcare Medicare Advantage	$252.70
Rate for Payer: Wellpoint Medicaid Managed Care	$35.35

HYDRATION INF 1ST HR

Facility

$2,408.78

Service Code	HCPCS 96360
Hospital Charge Code	5700385
Hospital Revenue Code	450
Min. Negotiated Rate	$361.32
Max. Negotiated Rate	$361.32
Rate for Payer: Qualcare PPO/HMO/WC	$361.32

HYDRATION INF 1ST HR

Facility

$2,800.00

Service Code	HCPCS 96360
Hospital Charge Code	83653125
Hospital Revenue Code	260
Min. Negotiated Rate	$67.48
Max. Negotiated Rate	$919.00
Rate for Payer: Aetna Commercial	$687.34
Rate for Payer: Aetna Medicare Advantage	$818.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$912.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$912.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$252.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$272.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$912.17
Rate for Payer: Cigna Commercial	$506.53
Rate for Payer: Cigna Medicare Advantage	$252.70
Rate for Payer: Clover Medicare Advantage	$240.06
Rate for Payer: EmblemHealth Commercial	$758.10
Rate for Payer: Humana Medicare Advantage	$260.28
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$252.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$840.00
Rate for Payer: Oxford Commercial	$707.00
Rate for Payer: Qualcare PPO/HMO/WC	$420.00
Rate for Payer: UnitedHealthcare Commercial	$919.00
Rate for Payer: UnitedHealthcare Community & State	$67.48
Rate for Payer: UnitedHealthcare Medicare Advantage	$252.70
Rate for Payer: Wellcare Medicare Advantage	$252.70
Rate for Payer: Wellpoint Medicaid Managed Care	$74.20

HYDRATION INF 1ST HR

Facility

$1,334.09

Service Code	HCPCS 96360
Hospital Charge Code	1600532
Hospital Revenue Code	260
Min. Negotiated Rate	$200.11
Max. Negotiated Rate	$200.11
Rate for Payer: Qualcare PPO/HMO/WC	$200.11

HYDRATION INF 1ST HR

Facility

$1,326.52

Service Code	HCPCS 96360
Hospital Charge Code	3409015
Hospital Revenue Code	260
Min. Negotiated Rate	$198.98
Max. Negotiated Rate	$198.98
Rate for Payer: Qualcare PPO/HMO/WC	$198.98

HYDRATION INF 1ST HR

Facility

$1,334.09

Service Code	HCPCS 96360
Hospital Charge Code	73237019
Hospital Revenue Code	260
Min. Negotiated Rate	$200.11
Max. Negotiated Rate	$200.11
Rate for Payer: Qualcare PPO/HMO/WC	$200.11

HYDRATION INF 1ST HR

Facility

$2,800.00

Service Code	HCPCS 96360
Hospital Charge Code	100130
Hospital Revenue Code	260
Min. Negotiated Rate	$420.00
Max. Negotiated Rate	$420.00
Rate for Payer: Qualcare PPO/HMO/WC	$420.00

HYDRATION INF 1ST HR

Facility

$1,334.09

Service Code	HCPCS 96360
Hospital Charge Code	74308225
Hospital Revenue Code	260
Min. Negotiated Rate	$32.15
Max. Negotiated Rate	$919.00
Rate for Payer: Aetna Commercial	$687.34
Rate for Payer: Aetna Medicare Advantage	$818.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$912.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$912.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$252.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$272.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$912.17
Rate for Payer: Cigna Commercial	$506.53
Rate for Payer: Cigna Medicare Advantage	$252.70
Rate for Payer: Clover Medicare Advantage	$240.06
Rate for Payer: EmblemHealth Commercial	$758.10
Rate for Payer: Humana Medicare Advantage	$260.28
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$252.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$400.23
Rate for Payer: Oxford Commercial	$707.00
Rate for Payer: Qualcare PPO/HMO/WC	$200.11
Rate for Payer: UnitedHealthcare Commercial	$919.00
Rate for Payer: UnitedHealthcare Community & State	$32.15
Rate for Payer: UnitedHealthcare Medicare Advantage	$252.70
Rate for Payer: Wellcare Medicare Advantage	$252.70
Rate for Payer: Wellpoint Medicaid Managed Care	$35.35

HYDRATION INF 1ST HR

Facility

$1,334.09

Service Code	HCPCS 96360
Hospital Charge Code	2300910
Hospital Revenue Code	260
Min. Negotiated Rate	$32.15
Max. Negotiated Rate	$919.00
Rate for Payer: Aetna Commercial	$687.34
Rate for Payer: Aetna Medicare Advantage	$818.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$912.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$912.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$252.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$272.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$912.17
Rate for Payer: Cigna Commercial	$506.53
Rate for Payer: Cigna Medicare Advantage	$252.70
Rate for Payer: Clover Medicare Advantage	$240.06
Rate for Payer: EmblemHealth Commercial	$758.10
Rate for Payer: Humana Medicare Advantage	$260.28
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$252.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$400.23
Rate for Payer: Oxford Commercial	$707.00
Rate for Payer: Qualcare PPO/HMO/WC	$200.11
Rate for Payer: UnitedHealthcare Commercial	$919.00
Rate for Payer: UnitedHealthcare Community & State	$32.15
Rate for Payer: UnitedHealthcare Medicare Advantage	$252.70
Rate for Payer: Wellcare Medicare Advantage	$252.70
Rate for Payer: Wellpoint Medicaid Managed Care	$35.35

HYDRATION INF 1ST HR

Facility

$1,334.09

Service Code	HCPCS 96360
Hospital Charge Code	2250416
Hospital Revenue Code	260
Min. Negotiated Rate	$32.15
Max. Negotiated Rate	$919.00
Rate for Payer: Aetna Commercial	$687.34
Rate for Payer: Aetna Medicare Advantage	$818.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$912.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$912.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$252.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$272.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$912.17
Rate for Payer: Cigna Commercial	$506.53
Rate for Payer: Cigna Medicare Advantage	$252.70
Rate for Payer: Clover Medicare Advantage	$240.06
Rate for Payer: EmblemHealth Commercial	$758.10
Rate for Payer: Humana Medicare Advantage	$260.28
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$252.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$400.23
Rate for Payer: Oxford Commercial	$707.00
Rate for Payer: Qualcare PPO/HMO/WC	$200.11
Rate for Payer: UnitedHealthcare Commercial	$919.00
Rate for Payer: UnitedHealthcare Community & State	$32.15
Rate for Payer: UnitedHealthcare Medicare Advantage	$252.70
Rate for Payer: Wellcare Medicare Advantage	$252.70
Rate for Payer: Wellpoint Medicaid Managed Care	$35.35

HYDRATION INF 1ST HR

Facility

$1,334.09

Service Code	HCPCS 96360
Hospital Charge Code	2250416
Hospital Revenue Code	260
Min. Negotiated Rate	$200.11
Max. Negotiated Rate	$200.11
Rate for Payer: Qualcare PPO/HMO/WC	$200.11

HYDRATION INF 1ST HR

Facility

$2,800.00

Service Code	HCPCS 96360
Hospital Charge Code	411096360
Hospital Revenue Code	260
Min. Negotiated Rate	$67.48
Max. Negotiated Rate	$919.00
Rate for Payer: Aetna Commercial	$687.34
Rate for Payer: Aetna Medicare Advantage	$818.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$912.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$912.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$252.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$272.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$912.17
Rate for Payer: Cigna Commercial	$506.53
Rate for Payer: Cigna Medicare Advantage	$252.70
Rate for Payer: Clover Medicare Advantage	$240.06
Rate for Payer: EmblemHealth Commercial	$758.10
Rate for Payer: Humana Medicare Advantage	$260.28
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$252.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$840.00
Rate for Payer: Oxford Commercial	$707.00
Rate for Payer: Qualcare PPO/HMO/WC	$420.00
Rate for Payer: UnitedHealthcare Commercial	$919.00
Rate for Payer: UnitedHealthcare Community & State	$67.48
Rate for Payer: UnitedHealthcare Medicare Advantage	$252.70
Rate for Payer: Wellcare Medicare Advantage	$252.70
Rate for Payer: Wellpoint Medicaid Managed Care	$74.20

HYDRATION INF 1ST HR

Facility

$2,800.00

Service Code	HCPCS 96360
Hospital Charge Code	411096360
Hospital Revenue Code	260
Min. Negotiated Rate	$420.00
Max. Negotiated Rate	$420.00
Rate for Payer: Qualcare PPO/HMO/WC	$420.00

HYDRATION INF 1ST HR

Facility

$2,800.00

Service Code	HCPCS 96360
Hospital Charge Code	321096360
Hospital Revenue Code	260
Min. Negotiated Rate	$420.00
Max. Negotiated Rate	$420.00
Rate for Payer: Qualcare PPO/HMO/WC	$420.00

HYDRATION INF 1ST HR

Facility

$1,334.09

Service Code	HCPCS 96360
Hospital Charge Code	1500110
Hospital Revenue Code	260
Min. Negotiated Rate	$200.11
Max. Negotiated Rate	$200.11
Rate for Payer: Qualcare PPO/HMO/WC	$200.11

HYDRATION INF 1ST HR

Facility

$2,800.00

Service Code	HCPCS 96360
Hospital Charge Code	5700262
Hospital Revenue Code	260
Min. Negotiated Rate	$420.00
Max. Negotiated Rate	$420.00
Rate for Payer: Qualcare PPO/HMO/WC	$420.00

HYDRATION INF 1ST HR

Facility

$1,334.09

Service Code	HCPCS 96360
Hospital Charge Code	8200519
Hospital Revenue Code	260
Min. Negotiated Rate	$200.11
Max. Negotiated Rate	$200.11
Rate for Payer: Qualcare PPO/HMO/WC	$200.11

HYDRATION INF 1ST HR

Facility

$1,334.09

Service Code	HCPCS 96360
Hospital Charge Code	8200519
Hospital Revenue Code	260
Min. Negotiated Rate	$32.15
Max. Negotiated Rate	$919.00
Rate for Payer: Aetna Commercial	$687.34
Rate for Payer: Aetna Medicare Advantage	$818.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$912.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$912.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$252.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$272.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$912.17
Rate for Payer: Cigna Commercial	$506.53
Rate for Payer: Cigna Medicare Advantage	$252.70
Rate for Payer: Clover Medicare Advantage	$240.06
Rate for Payer: EmblemHealth Commercial	$758.10
Rate for Payer: Humana Medicare Advantage	$260.28
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$252.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$400.23
Rate for Payer: Oxford Commercial	$707.00
Rate for Payer: Qualcare PPO/HMO/WC	$200.11
Rate for Payer: UnitedHealthcare Commercial	$919.00
Rate for Payer: UnitedHealthcare Community & State	$32.15
Rate for Payer: UnitedHealthcare Medicare Advantage	$252.70
Rate for Payer: Wellcare Medicare Advantage	$252.70
Rate for Payer: Wellpoint Medicaid Managed Care	$35.35

HYDRATION INF 1ST HR

Facility

$1,334.09

Service Code	HCPCS 96360
Hospital Charge Code	395096360
Hospital Revenue Code	260
Min. Negotiated Rate	$32.15
Max. Negotiated Rate	$919.00
Rate for Payer: Aetna Commercial	$687.34
Rate for Payer: Aetna Medicare Advantage	$818.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$912.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$912.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$252.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$272.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$912.17
Rate for Payer: Cigna Commercial	$506.53
Rate for Payer: Cigna Medicare Advantage	$252.70
Rate for Payer: Clover Medicare Advantage	$240.06
Rate for Payer: EmblemHealth Commercial	$758.10
Rate for Payer: Humana Medicare Advantage	$260.28
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$252.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$400.23
Rate for Payer: Oxford Commercial	$707.00
Rate for Payer: Qualcare PPO/HMO/WC	$200.11
Rate for Payer: UnitedHealthcare Commercial	$919.00
Rate for Payer: UnitedHealthcare Community & State	$32.15
Rate for Payer: UnitedHealthcare Medicare Advantage	$252.70
Rate for Payer: Wellcare Medicare Advantage	$252.70
Rate for Payer: Wellpoint Medicaid Managed Care	$35.35

HYDRATION INF 1ST HR

Facility

$1,334.09

Service Code	HCPCS 96360
Hospital Charge Code	73237019
Hospital Revenue Code	260
Min. Negotiated Rate	$32.15
Max. Negotiated Rate	$919.00
Rate for Payer: Aetna Commercial	$687.34
Rate for Payer: Aetna Medicare Advantage	$818.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$912.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$912.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$252.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$272.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$912.17
Rate for Payer: Cigna Commercial	$506.53
Rate for Payer: Cigna Medicare Advantage	$252.70
Rate for Payer: Clover Medicare Advantage	$240.06
Rate for Payer: EmblemHealth Commercial	$758.10
Rate for Payer: Humana Medicare Advantage	$260.28
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$252.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$400.23
Rate for Payer: Oxford Commercial	$707.00
Rate for Payer: Qualcare PPO/HMO/WC	$200.11
Rate for Payer: UnitedHealthcare Commercial	$919.00
Rate for Payer: UnitedHealthcare Community & State	$32.15
Rate for Payer: UnitedHealthcare Medicare Advantage	$252.70
Rate for Payer: Wellcare Medicare Advantage	$252.70
Rate for Payer: Wellpoint Medicaid Managed Care	$35.35

HYDRATION INF 1ST HR

Facility

$1,334.09

Service Code	HCPCS 96360
Hospital Charge Code	2011454
Hospital Revenue Code	260
Min. Negotiated Rate	$200.11
Max. Negotiated Rate	$200.11
Rate for Payer: Qualcare PPO/HMO/WC	$200.11

HYDRATION INF 1ST HR

Facility

$1,334.09

Service Code	HCPCS 96360
Hospital Charge Code	3401110
Hospital Revenue Code	260
Min. Negotiated Rate	$32.15
Max. Negotiated Rate	$919.00
Rate for Payer: Aetna Commercial	$687.34
Rate for Payer: Aetna Medicare Advantage	$818.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$912.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$912.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$252.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$272.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$912.17
Rate for Payer: Cigna Commercial	$506.53
Rate for Payer: Cigna Medicare Advantage	$252.70
Rate for Payer: Clover Medicare Advantage	$240.06
Rate for Payer: EmblemHealth Commercial	$758.10
Rate for Payer: Humana Medicare Advantage	$260.28
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$252.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$400.23
Rate for Payer: Oxford Commercial	$707.00
Rate for Payer: Qualcare PPO/HMO/WC	$200.11
Rate for Payer: UnitedHealthcare Commercial	$919.00
Rate for Payer: UnitedHealthcare Community & State	$32.15
Rate for Payer: UnitedHealthcare Medicare Advantage	$252.70
Rate for Payer: Wellcare Medicare Advantage	$252.70
Rate for Payer: Wellpoint Medicaid Managed Care	$35.35

HYDRATION INF 1ST HR

Facility

$1,334.09

Service Code	HCPCS 96360
Hospital Charge Code	2400617
Hospital Revenue Code	260
Min. Negotiated Rate	$32.15
Max. Negotiated Rate	$919.00
Rate for Payer: Aetna Commercial	$687.34
Rate for Payer: Aetna Medicare Advantage	$818.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$912.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$912.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$252.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$272.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$912.17
Rate for Payer: Cigna Commercial	$506.53
Rate for Payer: Cigna Medicare Advantage	$252.70
Rate for Payer: Clover Medicare Advantage	$240.06
Rate for Payer: EmblemHealth Commercial	$758.10
Rate for Payer: Humana Medicare Advantage	$260.28
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$252.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$400.23
Rate for Payer: Oxford Commercial	$707.00
Rate for Payer: Qualcare PPO/HMO/WC	$200.11
Rate for Payer: UnitedHealthcare Commercial	$919.00
Rate for Payer: UnitedHealthcare Community & State	$32.15
Rate for Payer: UnitedHealthcare Medicare Advantage	$252.70
Rate for Payer: Wellcare Medicare Advantage	$252.70
Rate for Payer: Wellpoint Medicaid Managed Care	$35.35

HYDRATION INF 1ST HR

Facility

$1,334.09

Service Code	HCPCS 96360
Hospital Charge Code	3401110
Hospital Revenue Code	260
Min. Negotiated Rate	$200.11
Max. Negotiated Rate	$200.11
Rate for Payer: Qualcare PPO/HMO/WC	$200.11

Know your out-of-pocket cost for care.

All Charges