|
HYDRATION INF 1ST HR
|
Facility
|
OP
|
$1,334.09
|
|
|
Service Code
|
HCPCS 96360
|
| Hospital Charge Code |
1600532
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$162.15 |
| Max. Negotiated Rate |
$802.00 |
| Rate for Payer: Aetna Commercial |
$400.23
|
| Rate for Payer: Aetna Medicare Advantage |
$400.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$340.19
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$340.19
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$162.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$340.19
|
| Rate for Payer: Cigna Commercial |
$506.53
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$173.43
|
| Rate for Payer: Oxford Commercial |
$707.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$200.11
|
| Rate for Payer: UnitedHealthcare Commercial |
$802.00
|
|
|
HYDRATION INF 1ST HR
|
Facility
|
IP
|
$1,334.09
|
|
|
Service Code
|
HCPCS 96360
|
| Hospital Charge Code |
73050901
|
|
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
|
OP
|
$1,334.09
|
|
|
Service Code
|
HCPCS 96360
|
| Hospital Charge Code |
2011454
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$162.15 |
| Max. Negotiated Rate |
$802.00 |
| Rate for Payer: Aetna Commercial |
$400.23
|
| Rate for Payer: Aetna Medicare Advantage |
$400.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$340.19
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$340.19
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$162.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$340.19
|
| Rate for Payer: Cigna Commercial |
$506.53
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$173.43
|
| Rate for Payer: Oxford Commercial |
$707.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$200.11
|
| Rate for Payer: UnitedHealthcare Commercial |
$802.00
|
|
|
HYDRATION INF 1ST HR
|
Facility
|
OP
|
$1,334.09
|
|
|
Service Code
|
HCPCS 96360
|
| Hospital Charge Code |
1500110
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$162.15 |
| Max. Negotiated Rate |
$802.00 |
| Rate for Payer: Aetna Commercial |
$400.23
|
| Rate for Payer: Aetna Medicare Advantage |
$400.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$340.19
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$340.19
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$162.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$340.19
|
| Rate for Payer: Cigna Commercial |
$506.53
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$173.43
|
| Rate for Payer: Oxford Commercial |
$707.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$200.11
|
| Rate for Payer: UnitedHealthcare Commercial |
$802.00
|
|
|
HYDRATION INF 1ST HR
|
Facility
|
IP
|
$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
|
OP
|
$2,800.00
|
|
|
Service Code
|
HCPCS 96360
|
| Hospital Charge Code |
100130
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$162.15 |
| Max. Negotiated Rate |
$840.00 |
| Rate for Payer: Aetna Commercial |
$840.00
|
| Rate for Payer: Aetna Medicare Advantage |
$840.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$714.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$714.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$162.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$714.00
|
| Rate for Payer: Cigna Commercial |
$506.53
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$364.00
|
| Rate for Payer: Oxford Commercial |
$707.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$420.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$802.00
|
|
|
HYDRATION INF 1ST HR
|
Facility
|
IP
|
$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
|
OP
|
$1,334.09
|
|
|
Service Code
|
HCPCS 96360
|
| Hospital Charge Code |
4501037
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$162.15 |
| Max. Negotiated Rate |
$802.00 |
| Rate for Payer: Aetna Commercial |
$400.23
|
| Rate for Payer: Aetna Medicare Advantage |
$400.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$340.19
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$340.19
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$162.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$340.19
|
| Rate for Payer: Cigna Commercial |
$506.53
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$173.43
|
| Rate for Payer: Oxford Commercial |
$707.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$200.11
|
| Rate for Payer: UnitedHealthcare Commercial |
$802.00
|
|
|
HYDRATION INF 1ST HR
|
Facility
|
OP
|
$2,800.00
|
|
|
Service Code
|
HCPCS 96360
|
| Hospital Charge Code |
321096360
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$162.15 |
| Max. Negotiated Rate |
$840.00 |
| Rate for Payer: Aetna Commercial |
$840.00
|
| Rate for Payer: Aetna Medicare Advantage |
$840.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$714.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$714.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$162.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$714.00
|
| Rate for Payer: Cigna Commercial |
$506.53
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$364.00
|
| Rate for Payer: Oxford Commercial |
$707.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$420.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$802.00
|
|
|
HYDRATION INF 1ST HR
|
Facility
|
IP
|
$2,800.00
|
|
|
Service Code
|
HCPCS 96360
|
| Hospital Charge Code |
93500007
|
|
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
|
IP
|
$1,334.09
|
|
|
Service Code
|
HCPCS 96360
|
| Hospital Charge Code |
2300910
|
|
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
|
IP
|
$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
|
OP
|
$1,334.09
|
|
|
Service Code
|
HCPCS 96360
|
| Hospital Charge Code |
1001170
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$162.15 |
| Max. Negotiated Rate |
$802.00 |
| Rate for Payer: Aetna Commercial |
$400.23
|
| Rate for Payer: Aetna Medicare Advantage |
$400.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$340.19
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$340.19
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$162.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$340.19
|
| Rate for Payer: Cigna Commercial |
$506.53
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$173.43
|
| Rate for Payer: Oxford Commercial |
$707.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$200.11
|
| Rate for Payer: UnitedHealthcare Commercial |
$802.00
|
|
|
HYDRATION INF 1ST HR
|
Facility
|
IP
|
$1,334.09
|
|
|
Service Code
|
HCPCS 96360
|
| Hospital Charge Code |
74308225
|
|
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
|
OP
|
$2,408.78
|
|
|
Service Code
|
HCPCS 96360
|
| Hospital Charge Code |
5700385
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$162.15 |
| Max. Negotiated Rate |
$722.63 |
| Rate for Payer: Aetna Commercial |
$722.63
|
| Rate for Payer: Aetna Medicare Advantage |
$722.63
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$614.24
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$614.24
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$162.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$614.24
|
| Rate for Payer: Cigna Commercial |
$506.53
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$313.14
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$361.32
|
|
|
HYDRATION INF 1ST HR
|
Facility
|
OP
|
$2,800.00
|
|
|
Service Code
|
HCPCS 96360
|
| Hospital Charge Code |
5700262
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$162.15 |
| Max. Negotiated Rate |
$840.00 |
| Rate for Payer: Aetna Commercial |
$840.00
|
| Rate for Payer: Aetna Medicare Advantage |
$840.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$714.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$714.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$162.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$714.00
|
| Rate for Payer: Cigna Commercial |
$506.53
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$364.00
|
| Rate for Payer: Oxford Commercial |
$707.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$420.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$802.00
|
|
|
HYDRATION INF 1ST HR
|
Facility
|
OP
|
$1,334.09
|
|
|
Service Code
|
HCPCS 96360
|
| Hospital Charge Code |
2400617
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$162.15 |
| Max. Negotiated Rate |
$802.00 |
| Rate for Payer: Aetna Commercial |
$400.23
|
| Rate for Payer: Aetna Medicare Advantage |
$400.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$340.19
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$340.19
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$162.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$340.19
|
| Rate for Payer: Cigna Commercial |
$506.53
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$173.43
|
| Rate for Payer: Oxford Commercial |
$707.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$200.11
|
| Rate for Payer: UnitedHealthcare Commercial |
$802.00
|
|
|
HYDRATION INF 1ST HR
|
Facility
|
OP
|
$1,334.09
|
|
|
Service Code
|
HCPCS 96360
|
| Hospital Charge Code |
2250416
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$162.15 |
| Max. Negotiated Rate |
$802.00 |
| Rate for Payer: Aetna Commercial |
$400.23
|
| Rate for Payer: Aetna Medicare Advantage |
$400.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$340.19
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$340.19
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$162.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$340.19
|
| Rate for Payer: Cigna Commercial |
$506.53
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$173.43
|
| Rate for Payer: Oxford Commercial |
$707.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$200.11
|
| Rate for Payer: UnitedHealthcare Commercial |
$802.00
|
|
|
HYDRATION INF 1ST HR
|
Facility
|
IP
|
$2,800.00
|
|
|
Service Code
|
HCPCS 96360
|
| Hospital Charge Code |
83653125
|
|
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
|
IP
|
$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
|
IP
|
$1,334.09
|
|
|
Service Code
|
HCPCS 96360
|
| Hospital Charge Code |
2400617
|
|
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
|
IP
|
$1,334.09
|
|
|
Service Code
|
HCPCS 96360
|
| Hospital Charge Code |
395096360
|
|
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
|
IP
|
$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
|
OP
|
$2,800.00
|
|
|
Service Code
|
HCPCS 96360
|
| Hospital Charge Code |
73190085
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$162.15 |
| Max. Negotiated Rate |
$840.00 |
| Rate for Payer: Aetna Commercial |
$840.00
|
| Rate for Payer: Aetna Medicare Advantage |
$840.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$714.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$714.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$162.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$714.00
|
| Rate for Payer: Cigna Commercial |
$506.53
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$364.00
|
| Rate for Payer: Oxford Commercial |
$707.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$420.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$802.00
|
|
|
HYDRATION INF 1ST HR
|
Facility
|
IP
|
$2,800.00
|
|
|
Service Code
|
HCPCS 96360
|
| Hospital Charge Code |
73190085
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$420.00 |
| Max. Negotiated Rate |
$420.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$420.00
|
|