|
HYDRATION INF EA ADDL HR
|
Facility
|
OP
|
$331.87
|
|
|
Service Code
|
HCPCS 96361
|
| Hospital Charge Code |
1500111
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$8.00 |
| Max. Negotiated Rate |
$919.00 |
| Rate for Payer: Aetna Commercial |
$151.31
|
| Rate for Payer: Aetna Medicare Advantage |
$180.24
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$200.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$200.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$55.63
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$112.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$200.81
|
| Rate for Payer: Cigna Commercial |
$111.50
|
| Rate for Payer: Cigna Medicare Advantage |
$55.63
|
| Rate for Payer: Clover Medicare Advantage |
$52.85
|
| Rate for Payer: EmblemHealth Commercial |
$166.89
|
| Rate for Payer: Humana Medicare Advantage |
$57.30
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$55.63
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$99.56
|
| Rate for Payer: Oxford Commercial |
$707.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$49.78
|
| Rate for Payer: UnitedHealthcare Commercial |
$919.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$8.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$55.63
|
| Rate for Payer: Wellcare Medicare Advantage |
$55.63
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$8.79
|
|
|
HYDRATION INF EA ADDL HR
|
Facility
|
OP
|
$331.87
|
|
|
Service Code
|
HCPCS 96361
|
| Hospital Charge Code |
73190091
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$8.00 |
| Max. Negotiated Rate |
$919.00 |
| Rate for Payer: Aetna Commercial |
$151.31
|
| Rate for Payer: Aetna Medicare Advantage |
$180.24
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$200.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$200.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$55.63
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$112.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$200.81
|
| Rate for Payer: Cigna Commercial |
$111.50
|
| Rate for Payer: Cigna Medicare Advantage |
$55.63
|
| Rate for Payer: Clover Medicare Advantage |
$52.85
|
| Rate for Payer: EmblemHealth Commercial |
$166.89
|
| Rate for Payer: Humana Medicare Advantage |
$57.30
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$55.63
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$99.56
|
| Rate for Payer: Oxford Commercial |
$707.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$49.78
|
| Rate for Payer: UnitedHealthcare Commercial |
$919.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$8.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$55.63
|
| Rate for Payer: Wellcare Medicare Advantage |
$55.63
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$8.79
|
|
|
HYDRATION INF EA ADDL HR
|
Facility
|
IP
|
$331.87
|
|
|
Service Code
|
HCPCS 96361
|
| Hospital Charge Code |
100136
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$49.78 |
| Max. Negotiated Rate |
$49.78 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$49.78
|
|
|
HYDRATION INF EA ADDL HR
|
Facility
|
OP
|
$598.74
|
|
|
Service Code
|
HCPCS 96361
|
| Hospital Charge Code |
5700388
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$15.87 |
| Max. Negotiated Rate |
$850.00 |
| Rate for Payer: Aetna Commercial |
$151.31
|
| Rate for Payer: Aetna Medicare Advantage |
$180.24
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$200.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$200.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$55.63
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$112.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$200.81
|
| Rate for Payer: Cigna Commercial |
$111.50
|
| Rate for Payer: Cigna Medicare Advantage |
$55.63
|
| Rate for Payer: Clover Medicare Advantage |
$52.85
|
| Rate for Payer: EmblemHealth Commercial |
$166.89
|
| Rate for Payer: Humana Medicare Advantage |
$57.30
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$55.63
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$179.62
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$850.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$89.81
|
| Rate for Payer: UnitedHealthcare Community & State |
$140.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$55.63
|
| Rate for Payer: Wellcare Medicare Advantage |
$55.63
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$15.87
|
|
|
HYDRATION INF EA ADDL HR
|
Facility
|
IP
|
$331.87
|
|
|
Service Code
|
HCPCS 96361
|
| Hospital Charge Code |
1001171
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$49.78 |
| Max. Negotiated Rate |
$49.78 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$49.78
|
|
|
HYDRATION INF EA ADDL HR
|
Facility
|
OP
|
$331.87
|
|
|
Service Code
|
HCPCS 96361
|
| Hospital Charge Code |
100139
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$8.00 |
| Max. Negotiated Rate |
$919.00 |
| Rate for Payer: Aetna Commercial |
$151.31
|
| Rate for Payer: Aetna Medicare Advantage |
$180.24
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$200.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$200.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$55.63
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$112.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$200.81
|
| Rate for Payer: Cigna Commercial |
$111.50
|
| Rate for Payer: Cigna Medicare Advantage |
$55.63
|
| Rate for Payer: Clover Medicare Advantage |
$52.85
|
| Rate for Payer: EmblemHealth Commercial |
$166.89
|
| Rate for Payer: Humana Medicare Advantage |
$57.30
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$55.63
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$99.56
|
| Rate for Payer: Oxford Commercial |
$707.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$49.78
|
| Rate for Payer: UnitedHealthcare Commercial |
$919.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$8.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$55.63
|
| Rate for Payer: Wellcare Medicare Advantage |
$55.63
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$8.79
|
|
|
HYDRATION INF EA ADDL HR
|
Facility
|
OP
|
$331.87
|
|
|
Service Code
|
HCPCS 96361
|
| Hospital Charge Code |
3401140
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$8.00 |
| Max. Negotiated Rate |
$919.00 |
| Rate for Payer: Aetna Commercial |
$151.31
|
| Rate for Payer: Aetna Medicare Advantage |
$180.24
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$200.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$200.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$55.63
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$112.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$200.81
|
| Rate for Payer: Cigna Commercial |
$111.50
|
| Rate for Payer: Cigna Medicare Advantage |
$55.63
|
| Rate for Payer: Clover Medicare Advantage |
$52.85
|
| Rate for Payer: EmblemHealth Commercial |
$166.89
|
| Rate for Payer: Humana Medicare Advantage |
$57.30
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$55.63
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$99.56
|
| Rate for Payer: Oxford Commercial |
$707.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$49.78
|
| Rate for Payer: UnitedHealthcare Commercial |
$919.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$8.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$55.63
|
| Rate for Payer: Wellcare Medicare Advantage |
$55.63
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$8.79
|
|
|
HYDRATION INF EA ADDL HR
|
Facility
|
IP
|
$331.87
|
|
|
Service Code
|
HCPCS 96361
|
| Hospital Charge Code |
100139
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$49.78 |
| Max. Negotiated Rate |
$49.78 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$49.78
|
|
|
HYDRATION INF EA ADDL HR
|
Facility
|
OP
|
$331.87
|
|
|
Service Code
|
HCPCS 96361
|
| Hospital Charge Code |
5100785
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$8.00 |
| Max. Negotiated Rate |
$919.00 |
| Rate for Payer: Aetna Commercial |
$151.31
|
| Rate for Payer: Aetna Medicare Advantage |
$180.24
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$200.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$200.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$55.63
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$112.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$200.81
|
| Rate for Payer: Cigna Commercial |
$111.50
|
| Rate for Payer: Cigna Medicare Advantage |
$55.63
|
| Rate for Payer: Clover Medicare Advantage |
$52.85
|
| Rate for Payer: EmblemHealth Commercial |
$166.89
|
| Rate for Payer: Humana Medicare Advantage |
$57.30
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$55.63
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$99.56
|
| Rate for Payer: Oxford Commercial |
$707.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$49.78
|
| Rate for Payer: UnitedHealthcare Commercial |
$919.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$8.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$55.63
|
| Rate for Payer: Wellcare Medicare Advantage |
$55.63
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$8.79
|
|
|
HYDRATION INF EA ADDL HR
|
Facility
|
OP
|
$331.87
|
|
|
Service Code
|
HCPCS 96361
|
| Hospital Charge Code |
411096361
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$8.00 |
| Max. Negotiated Rate |
$919.00 |
| Rate for Payer: Aetna Commercial |
$151.31
|
| Rate for Payer: Aetna Medicare Advantage |
$180.24
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$200.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$200.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$55.63
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$112.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$200.81
|
| Rate for Payer: Cigna Commercial |
$111.50
|
| Rate for Payer: Cigna Medicare Advantage |
$55.63
|
| Rate for Payer: Clover Medicare Advantage |
$52.85
|
| Rate for Payer: EmblemHealth Commercial |
$166.89
|
| Rate for Payer: Humana Medicare Advantage |
$57.30
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$55.63
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$99.56
|
| Rate for Payer: Oxford Commercial |
$707.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$49.78
|
| Rate for Payer: UnitedHealthcare Commercial |
$919.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$8.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$55.63
|
| Rate for Payer: Wellcare Medicare Advantage |
$55.63
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$8.79
|
|
|
HYDRATION INF EA ADDL HR
|
Facility
|
IP
|
$331.87
|
|
|
Service Code
|
HCPCS 96361
|
| Hospital Charge Code |
411096361
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$49.78 |
| Max. Negotiated Rate |
$49.78 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$49.78
|
|
|
HYDRATION INF EA ADDL HR
|
Facility
|
OP
|
$331.87
|
|
|
Service Code
|
HCPCS 96361
|
| Hospital Charge Code |
100138
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$8.00 |
| Max. Negotiated Rate |
$919.00 |
| Rate for Payer: Aetna Commercial |
$151.31
|
| Rate for Payer: Aetna Medicare Advantage |
$180.24
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$200.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$200.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$55.63
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$112.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$200.81
|
| Rate for Payer: Cigna Commercial |
$111.50
|
| Rate for Payer: Cigna Medicare Advantage |
$55.63
|
| Rate for Payer: Clover Medicare Advantage |
$52.85
|
| Rate for Payer: EmblemHealth Commercial |
$166.89
|
| Rate for Payer: Humana Medicare Advantage |
$57.30
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$55.63
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$99.56
|
| Rate for Payer: Oxford Commercial |
$707.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$49.78
|
| Rate for Payer: UnitedHealthcare Commercial |
$919.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$8.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$55.63
|
| Rate for Payer: Wellcare Medicare Advantage |
$55.63
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$8.79
|
|
|
HYDRATION INF EA ADDL HR
|
Facility
|
OP
|
$331.87
|
|
|
Service Code
|
HCPCS 96361
|
| Hospital Charge Code |
3401125
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$8.00 |
| Max. Negotiated Rate |
$919.00 |
| Rate for Payer: Aetna Commercial |
$151.31
|
| Rate for Payer: Aetna Medicare Advantage |
$180.24
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$200.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$200.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$55.63
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$112.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$200.81
|
| Rate for Payer: Cigna Commercial |
$111.50
|
| Rate for Payer: Cigna Medicare Advantage |
$55.63
|
| Rate for Payer: Clover Medicare Advantage |
$52.85
|
| Rate for Payer: EmblemHealth Commercial |
$166.89
|
| Rate for Payer: Humana Medicare Advantage |
$57.30
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$55.63
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$99.56
|
| Rate for Payer: Oxford Commercial |
$707.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$49.78
|
| Rate for Payer: UnitedHealthcare Commercial |
$919.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$8.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$55.63
|
| Rate for Payer: Wellcare Medicare Advantage |
$55.63
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$8.79
|
|
|
HYDRATION INF EA ADDL HR
|
Facility
|
IP
|
$331.87
|
|
|
Service Code
|
HCPCS 96361
|
| Hospital Charge Code |
93500013
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$49.78 |
| Max. Negotiated Rate |
$49.78 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$49.78
|
|
|
HYDRATION INF EA ADDL HR
|
Facility
|
IP
|
$331.87
|
|
|
Service Code
|
HCPCS 96361
|
| Hospital Charge Code |
5100785
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$49.78 |
| Max. Negotiated Rate |
$49.78 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$49.78
|
|
|
HYDRATION INF EA ADDL HR
|
Facility
|
IP
|
$331.87
|
|
|
Service Code
|
HCPCS 96361
|
| Hospital Charge Code |
93500015
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$49.78 |
| Max. Negotiated Rate |
$49.78 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$49.78
|
|
|
HYDRATION INF EA ADDL HR
|
Facility
|
IP
|
$331.87
|
|
|
Service Code
|
HCPCS 96361
|
| Hospital Charge Code |
2300911
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$49.78 |
| Max. Negotiated Rate |
$49.78 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$49.78
|
|
|
HYDRATION INF EA ADDL HR
|
Facility
|
OP
|
$331.87
|
|
|
Service Code
|
HCPCS 96361
|
| Hospital Charge Code |
93500013
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$8.00 |
| Max. Negotiated Rate |
$919.00 |
| Rate for Payer: Aetna Commercial |
$151.31
|
| Rate for Payer: Aetna Medicare Advantage |
$180.24
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$200.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$200.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$55.63
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$112.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$200.81
|
| Rate for Payer: Cigna Commercial |
$111.50
|
| Rate for Payer: Cigna Medicare Advantage |
$55.63
|
| Rate for Payer: Clover Medicare Advantage |
$52.85
|
| Rate for Payer: EmblemHealth Commercial |
$166.89
|
| Rate for Payer: Humana Medicare Advantage |
$57.30
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$55.63
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$99.56
|
| Rate for Payer: Oxford Commercial |
$707.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$49.78
|
| Rate for Payer: UnitedHealthcare Commercial |
$919.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$8.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$55.63
|
| Rate for Payer: Wellcare Medicare Advantage |
$55.63
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$8.79
|
|
|
HYDRATION INF EA ADDL HR
|
Facility
|
OP
|
$331.87
|
|
|
Service Code
|
HCPCS 96361
|
| Hospital Charge Code |
2400618
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$8.00 |
| Max. Negotiated Rate |
$919.00 |
| Rate for Payer: Aetna Commercial |
$151.31
|
| Rate for Payer: Aetna Medicare Advantage |
$180.24
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$200.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$200.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$55.63
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$112.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$200.81
|
| Rate for Payer: Cigna Commercial |
$111.50
|
| Rate for Payer: Cigna Medicare Advantage |
$55.63
|
| Rate for Payer: Clover Medicare Advantage |
$52.85
|
| Rate for Payer: EmblemHealth Commercial |
$166.89
|
| Rate for Payer: Humana Medicare Advantage |
$57.30
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$55.63
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$99.56
|
| Rate for Payer: Oxford Commercial |
$707.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$49.78
|
| Rate for Payer: UnitedHealthcare Commercial |
$919.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$8.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$55.63
|
| Rate for Payer: Wellcare Medicare Advantage |
$55.63
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$8.79
|
|
|
HYDRATION INF EA ADDL HR
|
Facility
|
OP
|
$331.87
|
|
|
Service Code
|
HCPCS 96361
|
| Hospital Charge Code |
8200520
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$8.00 |
| Max. Negotiated Rate |
$919.00 |
| Rate for Payer: Aetna Commercial |
$151.31
|
| Rate for Payer: Aetna Medicare Advantage |
$180.24
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$200.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$200.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$55.63
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$112.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$200.81
|
| Rate for Payer: Cigna Commercial |
$111.50
|
| Rate for Payer: Cigna Medicare Advantage |
$55.63
|
| Rate for Payer: Clover Medicare Advantage |
$52.85
|
| Rate for Payer: EmblemHealth Commercial |
$166.89
|
| Rate for Payer: Humana Medicare Advantage |
$57.30
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$55.63
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$99.56
|
| Rate for Payer: Oxford Commercial |
$707.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$49.78
|
| Rate for Payer: UnitedHealthcare Commercial |
$919.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$8.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$55.63
|
| Rate for Payer: Wellcare Medicare Advantage |
$55.63
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$8.79
|
|
|
HYDRATION INF EA ADDL HR
|
Facility
|
OP
|
$331.87
|
|
|
Service Code
|
HCPCS 96361
|
| Hospital Charge Code |
2011455
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$8.00 |
| Max. Negotiated Rate |
$919.00 |
| Rate for Payer: Aetna Commercial |
$151.31
|
| Rate for Payer: Aetna Medicare Advantage |
$180.24
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$200.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$200.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$55.63
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$112.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$200.81
|
| Rate for Payer: Cigna Commercial |
$111.50
|
| Rate for Payer: Cigna Medicare Advantage |
$55.63
|
| Rate for Payer: Clover Medicare Advantage |
$52.85
|
| Rate for Payer: EmblemHealth Commercial |
$166.89
|
| Rate for Payer: Humana Medicare Advantage |
$57.30
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$55.63
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$99.56
|
| Rate for Payer: Oxford Commercial |
$707.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$49.78
|
| Rate for Payer: UnitedHealthcare Commercial |
$919.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$8.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$55.63
|
| Rate for Payer: Wellcare Medicare Advantage |
$55.63
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$8.79
|
|
|
HYDRATION INF EA ADDL HR
|
Facility
|
OP
|
$331.87
|
|
|
Service Code
|
HCPCS 96361
|
| Hospital Charge Code |
100136
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$8.00 |
| Max. Negotiated Rate |
$919.00 |
| Rate for Payer: Aetna Commercial |
$151.31
|
| Rate for Payer: Aetna Medicare Advantage |
$180.24
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$200.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$200.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$55.63
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$112.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$200.81
|
| Rate for Payer: Cigna Commercial |
$111.50
|
| Rate for Payer: Cigna Medicare Advantage |
$55.63
|
| Rate for Payer: Clover Medicare Advantage |
$52.85
|
| Rate for Payer: EmblemHealth Commercial |
$166.89
|
| Rate for Payer: Humana Medicare Advantage |
$57.30
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$55.63
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$99.56
|
| Rate for Payer: Oxford Commercial |
$707.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$49.78
|
| Rate for Payer: UnitedHealthcare Commercial |
$919.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$8.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$55.63
|
| Rate for Payer: Wellcare Medicare Advantage |
$55.63
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$8.79
|
|
|
HYDRATION INF EA ADDL HR
|
Facility
|
IP
|
$331.87
|
|
|
Service Code
|
HCPCS 96361
|
| Hospital Charge Code |
5700263
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$49.78 |
| Max. Negotiated Rate |
$49.78 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$49.78
|
|
|
HYDRATION INF EA ADDL HR
|
Facility
|
IP
|
$331.87
|
|
|
Service Code
|
HCPCS 96361
|
| Hospital Charge Code |
3401140
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$49.78 |
| Max. Negotiated Rate |
$49.78 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$49.78
|
|
|
HYDRATION INF EA ADDL HR
|
Facility
|
IP
|
$331.87
|
|
|
Service Code
|
HCPCS 96361
|
| Hospital Charge Code |
100138
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$49.78 |
| Max. Negotiated Rate |
$49.78 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$49.78
|
|
