|
INF THERAPEUTIC EA ADDL HR
|
Facility
|
IP
|
$412.88
|
|
|
Service Code
|
HCPCS 96366
|
| Hospital Charge Code |
73237022
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$61.93 |
| Max. Negotiated Rate |
$61.93 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$61.93
|
|
|
INF THERAPEUTIC EA ADDL HR
|
Facility
|
OP
|
$412.88
|
|
|
Service Code
|
HCPCS 96366
|
| Hospital Charge Code |
100118
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$11.73 |
| Max. Negotiated Rate |
$1,235.00 |
| 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 |
$201.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$201.80
|
| 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 |
$13.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$201.80
|
| 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 |
$107.35
|
| Rate for Payer: Oxford Commercial |
$1,092.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$61.93
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,235.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$13.05
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$55.63
|
| Rate for Payer: Wellcare Medicare Advantage |
$55.63
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.73
|
|
|
INF THERAPEUTIC EA ADDL HR
|
Facility
|
OP
|
$412.88
|
|
|
Service Code
|
HCPCS 96366
|
| Hospital Charge Code |
3401060
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$11.73 |
| Max. Negotiated Rate |
$1,235.00 |
| 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 |
$201.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$201.80
|
| 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 |
$13.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$201.80
|
| 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 |
$107.35
|
| Rate for Payer: Oxford Commercial |
$1,092.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$61.93
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,235.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$13.05
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$55.63
|
| Rate for Payer: Wellcare Medicare Advantage |
$55.63
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.73
|
|
|
INF THERAPEUTIC EA ADDL HR
|
Facility
|
OP
|
$412.88
|
|
|
Service Code
|
HCPCS 96366
|
| Hospital Charge Code |
5100783
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$11.73 |
| Max. Negotiated Rate |
$1,235.00 |
| 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 |
$201.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$201.80
|
| 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 |
$13.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$201.80
|
| 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 |
$107.35
|
| Rate for Payer: Oxford Commercial |
$1,092.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$61.93
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,235.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$13.05
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$55.63
|
| Rate for Payer: Wellcare Medicare Advantage |
$55.63
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.73
|
|
|
INF THERAPEUTIC EA ADDL HR
|
Facility
|
IP
|
$412.88
|
|
|
Service Code
|
HCPCS 96366
|
| Hospital Charge Code |
270339104
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$61.93 |
| Max. Negotiated Rate |
$61.93 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$61.93
|
|
|
INF THERAPEUTIC EA ADDL HR
|
Facility
|
IP
|
$412.88
|
|
|
Service Code
|
HCPCS 96366
|
| Hospital Charge Code |
5100783
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$61.93 |
| Max. Negotiated Rate |
$61.93 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$61.93
|
|
|
INF THERAPEUTIC EA ADDL HR
|
Facility
|
IP
|
$331.87
|
|
|
Service Code
|
HCPCS 96366
|
| Hospital Charge Code |
485096366
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$49.78 |
| Max. Negotiated Rate |
$49.78 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$49.78
|
|
|
INF THERAPEUTIC EA ADDL HR
|
Facility
|
OP
|
$412.88
|
|
|
Service Code
|
HCPCS 96366
|
| Hospital Charge Code |
411096366
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$11.73 |
| Max. Negotiated Rate |
$1,235.00 |
| 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 |
$201.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$201.80
|
| 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 |
$13.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$201.80
|
| 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 |
$107.35
|
| Rate for Payer: Oxford Commercial |
$1,092.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$61.93
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,235.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$13.05
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$55.63
|
| Rate for Payer: Wellcare Medicare Advantage |
$55.63
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.73
|
|
|
INF THERAPEUTIC EA ADDL HR
|
Facility
|
IP
|
$412.88
|
|
|
Service Code
|
HCPCS 96366
|
| Hospital Charge Code |
100126
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$61.93 |
| Max. Negotiated Rate |
$61.93 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$61.93
|
|
|
INF THERAPEUTIC EA ADDL HR
|
Facility
|
OP
|
$221.80
|
|
|
Service Code
|
HCPCS 96366
|
| Hospital Charge Code |
5700261
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$6.30 |
| Max. Negotiated Rate |
$1,235.00 |
| 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 |
$201.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$201.80
|
| 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 |
$13.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$201.80
|
| 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 |
$57.67
|
| Rate for Payer: Oxford Commercial |
$1,092.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$33.27
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,235.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$7.01
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$55.63
|
| Rate for Payer: Wellcare Medicare Advantage |
$55.63
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$6.30
|
|
|
INF THERAPEUTIC EA ADDL HR
|
Facility
|
OP
|
$331.87
|
|
|
Service Code
|
HCPCS 96366
|
| Hospital Charge Code |
485096366
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$9.43 |
| Max. Negotiated Rate |
$1,235.00 |
| 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 |
$201.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$201.80
|
| 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 |
$13.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$201.80
|
| 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 |
$86.29
|
| Rate for Payer: Oxford Commercial |
$1,092.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$49.78
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,235.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$10.49
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$55.63
|
| Rate for Payer: Wellcare Medicare Advantage |
$55.63
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$9.43
|
|
|
INF THERAPEUTIC EA ADDL HR
|
Facility
|
OP
|
$412.88
|
|
|
Service Code
|
HCPCS 96366
|
| Hospital Charge Code |
100121
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$11.73 |
| Max. Negotiated Rate |
$1,235.00 |
| 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 |
$201.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$201.80
|
| 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 |
$13.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$201.80
|
| 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 |
$107.35
|
| Rate for Payer: Oxford Commercial |
$1,092.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$61.93
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,235.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$13.05
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$55.63
|
| Rate for Payer: Wellcare Medicare Advantage |
$55.63
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.73
|
|
|
INF THERAPEUTIC EA ADDL HR
|
Facility
|
IP
|
$412.88
|
|
|
Service Code
|
HCPCS 96366
|
| Hospital Charge Code |
2301096
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$61.93 |
| Max. Negotiated Rate |
$61.93 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$61.93
|
|
|
INF THERAPEUTIC EA ADDL HR
|
Facility
|
OP
|
$412.88
|
|
|
Service Code
|
HCPCS 96366
|
| Hospital Charge Code |
270339104
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$11.73 |
| Max. Negotiated Rate |
$1,235.00 |
| 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 |
$201.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$201.80
|
| 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 |
$13.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$201.80
|
| 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 |
$107.35
|
| Rate for Payer: Oxford Commercial |
$1,092.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$61.93
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,235.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$13.05
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$55.63
|
| Rate for Payer: Wellcare Medicare Advantage |
$55.63
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.73
|
|
|
INF THERAPEUTIC EA ADDL HR
|
Facility
|
IP
|
$221.80
|
|
|
Service Code
|
HCPCS 96366
|
| Hospital Charge Code |
5700261
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$33.27 |
| Max. Negotiated Rate |
$33.27 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$33.27
|
|
|
INF THERAPEUTIC EA ADDL HR
|
Facility
|
IP
|
$412.88
|
|
|
Service Code
|
HCPCS 96366
|
| Hospital Charge Code |
411096366
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$61.93 |
| Max. Negotiated Rate |
$61.93 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$61.93
|
|
|
INF THERAPEUTIC EA ADDL HR
|
Facility
|
IP
|
$412.88
|
|
|
Service Code
|
HCPCS 96366
|
| Hospital Charge Code |
3401031
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$61.93 |
| Max. Negotiated Rate |
$61.93 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$61.93
|
|
|
INF THERAPEUTIC EA ADDL HR
|
Facility
|
OP
|
$412.88
|
|
|
Service Code
|
HCPCS 96366
|
| Hospital Charge Code |
1600531
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$11.73 |
| Max. Negotiated Rate |
$1,235.00 |
| 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 |
$201.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$201.80
|
| 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 |
$13.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$201.80
|
| 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 |
$107.35
|
| Rate for Payer: Oxford Commercial |
$1,092.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$61.93
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,235.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$13.05
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$55.63
|
| Rate for Payer: Wellcare Medicare Advantage |
$55.63
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.73
|
|
|
INF THERAPEUTIC EA ADDL HR
|
Facility
|
IP
|
$412.88
|
|
|
Service Code
|
HCPCS 96366
|
| Hospital Charge Code |
1600531
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$61.93 |
| Max. Negotiated Rate |
$61.93 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$61.93
|
|
|
INF THERAPEUTIC EA ADDL HR
|
Facility
|
IP
|
$412.88
|
|
|
Service Code
|
HCPCS 96366
|
| Hospital Charge Code |
73050920
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$61.93 |
| Max. Negotiated Rate |
$61.93 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$61.93
|
|
|
INF THERAPEUTIC EA ADDL HR
|
Facility
|
IP
|
$412.88
|
|
|
Service Code
|
HCPCS 96366
|
| Hospital Charge Code |
73190097
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$61.93 |
| Max. Negotiated Rate |
$61.93 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$61.93
|
|
|
INF THERAPEUTIC EA ADDL HR
|
Facility
|
IP
|
$412.88
|
|
|
Service Code
|
HCPCS 96366
|
| Hospital Charge Code |
1500109
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$61.93 |
| Max. Negotiated Rate |
$61.93 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$61.93
|
|
|
INF THERAPEUTIC EA ADDL HR
|
Facility
|
IP
|
$412.88
|
|
|
Service Code
|
HCPCS 96366
|
| Hospital Charge Code |
3401029
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$61.93 |
| Max. Negotiated Rate |
$61.93 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$61.93
|
|
|
INF THERAPEUTIC EA ADDL HR
|
Facility
|
IP
|
$412.88
|
|
|
Service Code
|
HCPCS 96366
|
| Hospital Charge Code |
100119
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$61.93 |
| Max. Negotiated Rate |
$61.93 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$61.93
|
|
|
INF THERAPEUTIC EA ADDL HR
|
Facility
|
OP
|
$412.88
|
|
|
Service Code
|
HCPCS 96366
|
| Hospital Charge Code |
100126
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$11.73 |
| Max. Negotiated Rate |
$1,235.00 |
| 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 |
$201.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$201.80
|
| 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 |
$13.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$201.80
|
| 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 |
$107.35
|
| Rate for Payer: Oxford Commercial |
$1,092.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$61.93
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,235.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$13.05
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$55.63
|
| Rate for Payer: Wellcare Medicare Advantage |
$55.63
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.73
|
|
