|
FAMILY THERAPY W/O PT 50 MIN
|
Facility
|
OP
|
$1,094.00
|
|
|
Service Code
|
HCPCS 90846
|
| Hospital Charge Code |
4546752
|
|
Hospital Revenue Code
|
916
|
| Min. Negotiated Rate |
$26.37 |
| 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 |
$148.12
|
| 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 |
$328.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$164.10
|
| Rate for Payer: UnitedHealthcare Community & State |
$26.37
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$210.87
|
| Rate for Payer: Wellcare Medicare Advantage |
$210.87
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$28.99
|
|
|
FAMILY THERAPY W/OPT 50 MIN IO
|
Facility
|
IP
|
$1,094.00
|
|
|
Service Code
|
HCPCS 90846
|
| Hospital Charge Code |
4546745
|
|
Hospital Revenue Code
|
916
|
| Min. Negotiated Rate |
$164.10 |
| Max. Negotiated Rate |
$164.10 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$164.10
|
|
|
FAMILY THERAPY W/OPT 50 MIN IO
|
Facility
|
OP
|
$1,094.00
|
|
|
Service Code
|
HCPCS 90846
|
| Hospital Charge Code |
4546745
|
|
Hospital Revenue Code
|
916
|
| Min. Negotiated Rate |
$26.37 |
| 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 |
$148.12
|
| 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 |
$328.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$164.10
|
| Rate for Payer: UnitedHealthcare Community & State |
$26.37
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$210.87
|
| Rate for Payer: Wellcare Medicare Advantage |
$210.87
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$28.99
|
|
|
FAMILY THERAPY W PATIENT 50MIN
|
Facility
|
IP
|
$1,094.00
|
|
|
Service Code
|
HCPCS 90847
|
| Hospital Charge Code |
4546753
|
|
Hospital Revenue Code
|
916
|
| Min. Negotiated Rate |
$164.10 |
| Max. Negotiated Rate |
$164.10 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$164.10
|
|
|
FAMILY THERAPY W PATIENT 50MIN
|
Facility
|
OP
|
$1,094.00
|
|
|
Service Code
|
HCPCS 90847
|
| Hospital Charge Code |
4546753
|
|
Hospital Revenue Code
|
916
|
| Min. Negotiated Rate |
$26.37 |
| 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 |
$164.38
|
| 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 |
$328.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$164.10
|
| Rate for Payer: UnitedHealthcare Community & State |
$26.37
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$210.87
|
| Rate for Payer: Wellcare Medicare Advantage |
$210.87
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$113.84
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$28.99
|
|
|
FAMILY THERAPY W/PATIENT 50MIN
|
Facility
|
OP
|
$1,500.00
|
|
|
Service Code
|
HCPCS 90847
|
| Hospital Charge Code |
4546773
|
|
Hospital Revenue Code
|
916
|
| Min. Negotiated Rate |
$36.15 |
| 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 |
$164.38
|
| 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 |
$450.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$225.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$36.15
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$210.87
|
| Rate for Payer: Wellcare Medicare Advantage |
$210.87
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$113.84
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$39.75
|
|
|
FAMILY THERAPY W/PATIENT 50MIN
|
Facility
|
IP
|
$1,500.00
|
|
|
Service Code
|
HCPCS 90847
|
| Hospital Charge Code |
4546773
|
|
Hospital Revenue Code
|
916
|
| Min. Negotiated Rate |
$225.00 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$225.00
|
|
|
FAMILY THERAPY W PT 50 MIN IOP
|
Facility
|
OP
|
$1,094.00
|
|
|
Service Code
|
HCPCS 90847
|
| Hospital Charge Code |
4546746
|
|
Hospital Revenue Code
|
916
|
| Min. Negotiated Rate |
$26.37 |
| 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 |
$164.38
|
| 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 |
$328.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$164.10
|
| Rate for Payer: UnitedHealthcare Community & State |
$26.37
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$210.87
|
| Rate for Payer: Wellcare Medicare Advantage |
$210.87
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$113.84
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$28.99
|
|
|
FAMILY THERAPY W PT 50 MIN IOP
|
Facility
|
IP
|
$1,094.00
|
|
|
Service Code
|
HCPCS 90847
|
| Hospital Charge Code |
4546746
|
|
Hospital Revenue Code
|
916
|
| Min. Negotiated Rate |
$164.10 |
| Max. Negotiated Rate |
$164.10 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$164.10
|
|
|
FAMILY TX WO PATIENT 50 MIN
|
Facility
|
IP
|
$1,094.00
|
|
|
Service Code
|
HCPCS 90846
|
| Hospital Charge Code |
84509021
|
|
Hospital Revenue Code
|
916
|
| Min. Negotiated Rate |
$164.10 |
| Max. Negotiated Rate |
$164.10 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$164.10
|
|
|
FAMILY TX WO PATIENT 50 MIN
|
Facility
|
OP
|
$1,094.00
|
|
|
Service Code
|
HCPCS 90846
|
| Hospital Charge Code |
84509021
|
|
Hospital Revenue Code
|
916
|
| Min. Negotiated Rate |
$26.37 |
| 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 |
$148.12
|
| 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 |
$328.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$164.10
|
| Rate for Payer: UnitedHealthcare Community & State |
$26.37
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$210.87
|
| Rate for Payer: Wellcare Medicare Advantage |
$210.87
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$28.99
|
|
|
FAMILY TX WO PATIENT 50 MIN
|
Facility
|
OP
|
$1,094.00
|
|
|
Service Code
|
HCPCS 90846
|
| Hospital Charge Code |
87506005
|
|
Hospital Revenue Code
|
916
|
| Min. Negotiated Rate |
$26.37 |
| 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 |
$148.12
|
| 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 |
$328.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$164.10
|
| Rate for Payer: UnitedHealthcare Community & State |
$26.37
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$210.87
|
| Rate for Payer: Wellcare Medicare Advantage |
$210.87
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$28.99
|
|
|
FAMILY TX WO PATIENT 50 MIN
|
Facility
|
OP
|
$1,094.00
|
|
|
Service Code
|
HCPCS 90846
|
| Hospital Charge Code |
84511021
|
|
Hospital Revenue Code
|
916
|
| Min. Negotiated Rate |
$26.37 |
| 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 |
$148.12
|
| 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 |
$328.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$164.10
|
| Rate for Payer: UnitedHealthcare Community & State |
$26.37
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$210.87
|
| Rate for Payer: Wellcare Medicare Advantage |
$210.87
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$28.99
|
|
|
FAMILY TX WO PATIENT 50 MIN
|
Facility
|
IP
|
$1,094.00
|
|
|
Service Code
|
HCPCS 90846
|
| Hospital Charge Code |
84517021
|
|
Hospital Revenue Code
|
916
|
| Min. Negotiated Rate |
$164.10 |
| Max. Negotiated Rate |
$164.10 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$164.10
|
|
|
FAMILY TX WO PATIENT 50 MIN
|
Facility
|
IP
|
$1,094.00
|
|
|
Service Code
|
HCPCS 90846
|
| Hospital Charge Code |
84518021
|
|
Hospital Revenue Code
|
916
|
| Min. Negotiated Rate |
$164.10 |
| Max. Negotiated Rate |
$164.10 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$164.10
|
|
|
FAMILY TX WO PATIENT 50 MIN
|
Facility
|
IP
|
$1,094.00
|
|
|
Service Code
|
HCPCS 90846
|
| Hospital Charge Code |
87506005
|
|
Hospital Revenue Code
|
916
|
| Min. Negotiated Rate |
$164.10 |
| Max. Negotiated Rate |
$164.10 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$164.10
|
|
|
FAMILY TX WO PATIENT 50 MIN
|
Facility
|
IP
|
$640.00
|
|
|
Service Code
|
HCPCS 90846
|
| Hospital Charge Code |
87504055
|
|
Hospital Revenue Code
|
916
|
| Min. Negotiated Rate |
$96.00 |
| Max. Negotiated Rate |
$96.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$96.00
|
|
|
FAMILY TX WO PATIENT 50 MIN
|
Facility
|
OP
|
$1,094.00
|
|
|
Service Code
|
HCPCS 90846
|
| Hospital Charge Code |
84504055
|
|
Hospital Revenue Code
|
916
|
| Min. Negotiated Rate |
$26.37 |
| 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 |
$148.12
|
| 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 |
$328.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$164.10
|
| Rate for Payer: UnitedHealthcare Community & State |
$26.37
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$210.87
|
| Rate for Payer: Wellcare Medicare Advantage |
$210.87
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$28.99
|
|
|
FAMILY TX WO PATIENT 50 MIN
|
Facility
|
OP
|
$640.00
|
|
|
Service Code
|
HCPCS 90846
|
| Hospital Charge Code |
83246185
|
|
Hospital Revenue Code
|
916
|
| Min. Negotiated Rate |
$15.42 |
| 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 |
$148.12
|
| 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 |
$192.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$96.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$15.42
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$210.87
|
| Rate for Payer: Wellcare Medicare Advantage |
$210.87
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$16.96
|
|
|
FAMILY TX WO PATIENT 50 MIN
|
Facility
|
IP
|
$640.00
|
|
|
Service Code
|
HCPCS 90846
|
| Hospital Charge Code |
83246185
|
|
Hospital Revenue Code
|
916
|
| Min. Negotiated Rate |
$96.00 |
| Max. Negotiated Rate |
$96.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$96.00
|
|
|
FAMILY TX WO PATIENT 50 MIN
|
Facility
|
OP
|
$1,094.00
|
|
|
Service Code
|
HCPCS 90846
|
| Hospital Charge Code |
84517021
|
|
Hospital Revenue Code
|
916
|
| Min. Negotiated Rate |
$26.37 |
| 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 |
$148.12
|
| 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 |
$328.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$164.10
|
| Rate for Payer: UnitedHealthcare Community & State |
$26.37
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$210.87
|
| Rate for Payer: Wellcare Medicare Advantage |
$210.87
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$28.99
|
|
|
FAMILY TX WO PATIENT 50 MIN
|
Facility
|
IP
|
$1,094.00
|
|
|
Service Code
|
HCPCS 90846
|
| Hospital Charge Code |
84504055
|
|
Hospital Revenue Code
|
916
|
| Min. Negotiated Rate |
$164.10 |
| Max. Negotiated Rate |
$164.10 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$164.10
|
|
|
FAMILY TX WO PATIENT 50 MIN
|
Facility
|
OP
|
$640.00
|
|
|
Service Code
|
HCPCS 90846
|
| Hospital Charge Code |
87504055
|
|
Hospital Revenue Code
|
916
|
| Min. Negotiated Rate |
$15.42 |
| 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 |
$148.12
|
| 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 |
$192.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$96.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$15.42
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$210.87
|
| Rate for Payer: Wellcare Medicare Advantage |
$210.87
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$16.96
|
|
|
FAMILY TX WO PATIENT 50 MIN
|
Facility
|
OP
|
$1,047.00
|
|
|
Service Code
|
HCPCS 90846
|
| Hospital Charge Code |
84310100
|
|
Hospital Revenue Code
|
916
|
| Min. Negotiated Rate |
$25.23 |
| 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 |
$148.12
|
| 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 |
$314.10
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$157.05
|
| Rate for Payer: UnitedHealthcare Community & State |
$25.23
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$210.87
|
| Rate for Payer: Wellcare Medicare Advantage |
$210.87
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$27.75
|
|
|
FAMILY TX WO PATIENT 50 MIN
|
Facility
|
IP
|
$1,094.00
|
|
|
Service Code
|
HCPCS 90846
|
| Hospital Charge Code |
84511021
|
|
Hospital Revenue Code
|
916
|
| Min. Negotiated Rate |
$164.10 |
| Max. Negotiated Rate |
$164.10 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$164.10
|
|
