|
CRE WG 12-15MM/180
|
Facility
|
IP
|
$1,067.35
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
270680629
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$160.10 |
| Max. Negotiated Rate |
$258.30 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$213.47
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$258.30
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$234.82
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$160.10
|
|
|
CRE WG 15-18MM/180/5.5F/G 5843
|
Facility
|
IP
|
$1,089.15
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
270619660
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$163.37 |
| Max. Negotiated Rate |
$263.57 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$217.83
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$263.57
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$239.61
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$163.37
|
|
|
CRE WG 15-18MM/180/5.5F/G 5843
|
Facility
|
OP
|
$1,089.15
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
270619660
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$26.25 |
| Max. Negotiated Rate |
$544.58 |
| Rate for Payer: Aetna Commercial |
$413.88
|
| Rate for Payer: Aetna Medicare Advantage |
$326.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$277.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$277.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$217.83
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$277.73
|
| Rate for Payer: Cigna Commercial |
$544.58
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$263.57
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$239.61
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$163.37
|
| Rate for Payer: UnitedHealthcare Community & State |
$26.25
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$28.86
|
|
|
CRICOTHYROTOMY EMERGENCY
|
Facility
|
IP
|
$746.00
|
|
| Hospital Charge Code |
270332334
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$111.90 |
| Max. Negotiated Rate |
$111.90 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$111.90
|
|
|
CRICOTHYROTOMY EMERGENCY
|
Facility
|
OP
|
$746.00
|
|
| Hospital Charge Code |
270332334
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$17.98 |
| Max. Negotiated Rate |
$373.00 |
| Rate for Payer: Aetna Commercial |
$283.48
|
| Rate for Payer: Aetna Medicare Advantage |
$223.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$190.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$190.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$190.23
|
| Rate for Payer: Cigna Commercial |
$373.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$223.80
|
| Rate for Payer: Oxford Commercial |
$149.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$111.90
|
| Rate for Payer: UnitedHealthcare Commercial |
$149.20
|
| Rate for Payer: UnitedHealthcare Community & State |
$17.98
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$19.77
|
|
|
CRISIS ADULT/30MIN MEDICAID
|
Facility
|
IP
|
$1,000.00
|
|
|
Service Code
|
HCPCS 90839
|
| Hospital Charge Code |
4822604
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$150.00 |
| Max. Negotiated Rate |
$150.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$150.00
|
|
|
CRISIS ADULT/30MIN MEDICAID
|
Facility
|
OP
|
$1,000.00
|
|
|
Service Code
|
HCPCS 90839
|
| Hospital Charge Code |
4535604
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$24.10 |
| Max. Negotiated Rate |
$761.18 |
| Rate for Payer: Aetna Commercial |
$573.57
|
| Rate for Payer: Aetna Medicare Advantage |
$683.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$761.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$761.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$210.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$120.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$761.18
|
| Rate for Payer: Cigna Commercial |
$422.69
|
| Rate for Payer: Cigna Medicare Advantage |
$210.87
|
| Rate for Payer: Clover Medicare Advantage |
$200.33
|
| Rate for Payer: EmblemHealth Commercial |
$632.61
|
| Rate for Payer: Humana Medicare Advantage |
$217.20
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$210.87
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$300.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$150.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$24.10
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$210.87
|
| Rate for Payer: Wellcare Medicare Advantage |
$210.87
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$26.50
|
|
|
CRISIS ADULT/30MIN MEDICAID
|
Facility
|
OP
|
$1,000.00
|
|
|
Service Code
|
HCPCS 90839
|
| Hospital Charge Code |
4822604
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$24.10 |
| Max. Negotiated Rate |
$761.18 |
| Rate for Payer: Aetna Commercial |
$573.57
|
| Rate for Payer: Aetna Medicare Advantage |
$683.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$761.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$761.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$210.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$120.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$761.18
|
| Rate for Payer: Cigna Commercial |
$422.69
|
| Rate for Payer: Cigna Medicare Advantage |
$210.87
|
| Rate for Payer: Clover Medicare Advantage |
$200.33
|
| Rate for Payer: EmblemHealth Commercial |
$632.61
|
| Rate for Payer: Humana Medicare Advantage |
$217.20
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$210.87
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$300.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$150.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$24.10
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$210.87
|
| Rate for Payer: Wellcare Medicare Advantage |
$210.87
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$26.50
|
|
|
CRISIS ADULT/30MIN MEDICAID
|
Facility
|
OP
|
$1,000.00
|
|
|
Service Code
|
HCPCS 90839
|
| Hospital Charge Code |
4832604
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$24.10 |
| Max. Negotiated Rate |
$761.18 |
| Rate for Payer: Aetna Commercial |
$573.57
|
| Rate for Payer: Aetna Medicare Advantage |
$683.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$761.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$761.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$210.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$120.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$761.18
|
| Rate for Payer: Cigna Commercial |
$422.69
|
| Rate for Payer: Cigna Medicare Advantage |
$210.87
|
| Rate for Payer: Clover Medicare Advantage |
$200.33
|
| Rate for Payer: EmblemHealth Commercial |
$632.61
|
| Rate for Payer: Humana Medicare Advantage |
$217.20
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$210.87
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$300.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$150.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$24.10
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$210.87
|
| Rate for Payer: Wellcare Medicare Advantage |
$210.87
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$26.50
|
|
|
CRISIS ADULT/30MIN MEDICAID
|
Facility
|
IP
|
$1,000.00
|
|
|
Service Code
|
HCPCS 90839
|
| Hospital Charge Code |
4832604
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$150.00 |
| Max. Negotiated Rate |
$150.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$150.00
|
|
|
CRISIS ADULT/30MIN MEDICAID
|
Facility
|
IP
|
$1,000.00
|
|
|
Service Code
|
HCPCS 90839
|
| Hospital Charge Code |
4535604
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$150.00 |
| Max. Negotiated Rate |
$150.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$150.00
|
|
|
CRISIS ADULT/30MIN MEDICAID
|
Facility
|
IP
|
$1,000.00
|
|
|
Service Code
|
HCPCS 90839
|
| Hospital Charge Code |
4504604
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$150.00 |
| Max. Negotiated Rate |
$150.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$150.00
|
|
|
CRISIS ADULT/30MIN MEDICAID
|
Facility
|
IP
|
$1,000.00
|
|
|
Service Code
|
HCPCS 90839
|
| Hospital Charge Code |
4818604
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$150.00 |
| Max. Negotiated Rate |
$150.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$150.00
|
|
|
CRISIS ADULT/30MIN MEDICAID
|
Facility
|
OP
|
$1,000.00
|
|
|
Service Code
|
HCPCS 90839
|
| Hospital Charge Code |
4818604
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$24.10 |
| Max. Negotiated Rate |
$761.18 |
| Rate for Payer: Aetna Commercial |
$573.57
|
| Rate for Payer: Aetna Medicare Advantage |
$683.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$761.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$761.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$210.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$120.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$761.18
|
| Rate for Payer: Cigna Commercial |
$422.69
|
| Rate for Payer: Cigna Medicare Advantage |
$210.87
|
| Rate for Payer: Clover Medicare Advantage |
$200.33
|
| Rate for Payer: EmblemHealth Commercial |
$632.61
|
| Rate for Payer: Humana Medicare Advantage |
$217.20
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$210.87
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$300.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$150.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$24.10
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$210.87
|
| Rate for Payer: Wellcare Medicare Advantage |
$210.87
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$26.50
|
|
|
CRISIS ADULT/30MIN MEDICAID
|
Facility
|
IP
|
$1,000.00
|
|
|
Service Code
|
HCPCS 90839
|
| Hospital Charge Code |
4502604
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$150.00 |
| Max. Negotiated Rate |
$150.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$150.00
|
|
|
CRISIS ADULT/30MIN MEDICAID
|
Facility
|
OP
|
$1,000.00
|
|
|
Service Code
|
HCPCS 90839
|
| Hospital Charge Code |
4511604
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$24.10 |
| Max. Negotiated Rate |
$761.18 |
| Rate for Payer: Aetna Commercial |
$573.57
|
| Rate for Payer: Aetna Medicare Advantage |
$683.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$761.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$761.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$210.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$120.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$761.18
|
| Rate for Payer: Cigna Commercial |
$422.69
|
| Rate for Payer: Cigna Medicare Advantage |
$210.87
|
| Rate for Payer: Clover Medicare Advantage |
$200.33
|
| Rate for Payer: EmblemHealth Commercial |
$632.61
|
| Rate for Payer: Humana Medicare Advantage |
$217.20
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$210.87
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$300.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$150.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$24.10
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$210.87
|
| Rate for Payer: Wellcare Medicare Advantage |
$210.87
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$26.50
|
|
|
CRISIS ADULT/30MIN MEDICAID
|
Facility
|
OP
|
$1,000.00
|
|
|
Service Code
|
HCPCS 90839
|
| Hospital Charge Code |
4502604
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$24.10 |
| Max. Negotiated Rate |
$761.18 |
| Rate for Payer: Aetna Commercial |
$573.57
|
| Rate for Payer: Aetna Medicare Advantage |
$683.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$761.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$761.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$210.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$120.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$761.18
|
| Rate for Payer: Cigna Commercial |
$422.69
|
| Rate for Payer: Cigna Medicare Advantage |
$210.87
|
| Rate for Payer: Clover Medicare Advantage |
$200.33
|
| Rate for Payer: EmblemHealth Commercial |
$632.61
|
| Rate for Payer: Humana Medicare Advantage |
$217.20
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$210.87
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$300.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$150.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$24.10
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$210.87
|
| Rate for Payer: Wellcare Medicare Advantage |
$210.87
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$26.50
|
|
|
CRISIS ADULT/30MIN MEDICAID
|
Facility
|
IP
|
$1,000.00
|
|
|
Service Code
|
HCPCS 90839
|
| Hospital Charge Code |
4511604
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$150.00 |
| Max. Negotiated Rate |
$150.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$150.00
|
|
|
CRISIS ADULT/30MIN MEDICAID
|
Facility
|
OP
|
$1,000.00
|
|
|
Service Code
|
HCPCS 90839
|
| Hospital Charge Code |
4504604
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$24.10 |
| Max. Negotiated Rate |
$761.18 |
| Rate for Payer: Aetna Commercial |
$573.57
|
| Rate for Payer: Aetna Medicare Advantage |
$683.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$761.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$761.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$210.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$120.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$761.18
|
| Rate for Payer: Cigna Commercial |
$422.69
|
| Rate for Payer: Cigna Medicare Advantage |
$210.87
|
| Rate for Payer: Clover Medicare Advantage |
$200.33
|
| Rate for Payer: EmblemHealth Commercial |
$632.61
|
| Rate for Payer: Humana Medicare Advantage |
$217.20
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$210.87
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$300.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$150.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$24.10
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$210.87
|
| Rate for Payer: Wellcare Medicare Advantage |
$210.87
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$26.50
|
|
|
CRISIS CHILD/30MIN MEDICAID
|
Facility
|
OP
|
$1,000.00
|
|
|
Service Code
|
HCPCS 90839
|
| Hospital Charge Code |
4546613
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$24.10 |
| Max. Negotiated Rate |
$761.18 |
| Rate for Payer: Aetna Commercial |
$573.57
|
| Rate for Payer: Aetna Medicare Advantage |
$683.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$761.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$761.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$210.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$120.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$761.18
|
| Rate for Payer: Cigna Commercial |
$422.69
|
| Rate for Payer: Cigna Medicare Advantage |
$210.87
|
| Rate for Payer: Clover Medicare Advantage |
$200.33
|
| Rate for Payer: EmblemHealth Commercial |
$632.61
|
| Rate for Payer: Humana Medicare Advantage |
$217.20
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$210.87
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$300.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$150.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$24.10
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$210.87
|
| Rate for Payer: Wellcare Medicare Advantage |
$210.87
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$26.50
|
|
|
CRISIS CHILD/30MIN MEDICAID
|
Facility
|
IP
|
$1,000.00
|
|
|
Service Code
|
HCPCS 90839
|
| Hospital Charge Code |
4824613
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$150.00 |
| Max. Negotiated Rate |
$150.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$150.00
|
|
|
CRISIS CHILD/30MIN MEDICAID
|
Facility
|
OP
|
$1,000.00
|
|
|
Service Code
|
HCPCS 90839
|
| Hospital Charge Code |
4824613
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$24.10 |
| Max. Negotiated Rate |
$761.18 |
| Rate for Payer: Aetna Commercial |
$573.57
|
| Rate for Payer: Aetna Medicare Advantage |
$683.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$761.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$761.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$210.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$120.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$761.18
|
| Rate for Payer: Cigna Commercial |
$422.69
|
| Rate for Payer: Cigna Medicare Advantage |
$210.87
|
| Rate for Payer: Clover Medicare Advantage |
$200.33
|
| Rate for Payer: EmblemHealth Commercial |
$632.61
|
| Rate for Payer: Humana Medicare Advantage |
$217.20
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$210.87
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$300.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$150.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$24.10
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$210.87
|
| Rate for Payer: Wellcare Medicare Advantage |
$210.87
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$26.50
|
|
|
CRISIS CHILD/30MIN MEDICAID
|
Facility
|
OP
|
$1,000.00
|
|
|
Service Code
|
HCPCS 90839
|
| Hospital Charge Code |
4504613
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$24.10 |
| Max. Negotiated Rate |
$761.18 |
| Rate for Payer: Aetna Commercial |
$573.57
|
| Rate for Payer: Aetna Medicare Advantage |
$683.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$761.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$761.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$210.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$120.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$761.18
|
| Rate for Payer: Cigna Commercial |
$422.69
|
| Rate for Payer: Cigna Medicare Advantage |
$210.87
|
| Rate for Payer: Clover Medicare Advantage |
$200.33
|
| Rate for Payer: EmblemHealth Commercial |
$632.61
|
| Rate for Payer: Humana Medicare Advantage |
$217.20
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$210.87
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$300.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$150.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$24.10
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$210.87
|
| Rate for Payer: Wellcare Medicare Advantage |
$210.87
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$26.50
|
|
|
CRISIS CHILD/30MIN MEDICAID
|
Facility
|
IP
|
$1,000.00
|
|
|
Service Code
|
HCPCS 90839
|
| Hospital Charge Code |
4504613
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$150.00 |
| Max. Negotiated Rate |
$150.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$150.00
|
|
|
CRISIS CHILD/30MIN MEDICAID
|
Facility
|
OP
|
$1,000.00
|
|
|
Service Code
|
HCPCS 90839
|
| Hospital Charge Code |
4535613
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$24.10 |
| Max. Negotiated Rate |
$761.18 |
| Rate for Payer: Aetna Commercial |
$573.57
|
| Rate for Payer: Aetna Medicare Advantage |
$683.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$761.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$761.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$210.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$120.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$761.18
|
| Rate for Payer: Cigna Commercial |
$422.69
|
| Rate for Payer: Cigna Medicare Advantage |
$210.87
|
| Rate for Payer: Clover Medicare Advantage |
$200.33
|
| Rate for Payer: EmblemHealth Commercial |
$632.61
|
| Rate for Payer: Humana Medicare Advantage |
$217.20
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$210.87
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$300.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$150.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$24.10
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$210.87
|
| Rate for Payer: Wellcare Medicare Advantage |
$210.87
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$26.50
|
|
