|
INTERACT COMPLEX MD (ADD ON CO
|
Facility
|
IP
|
$275.00
|
|
|
Service Code
|
HCPCS 90785
|
| Hospital Charge Code |
4515709
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$41.25 |
| Max. Negotiated Rate |
$41.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$41.25
|
|
|
INTERACT COMPLEX MD (ADD ON CO
|
Facility
|
OP
|
$275.00
|
|
|
Service Code
|
HCPCS 90785
|
| Hospital Charge Code |
4535709
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$5.20 |
| Max. Negotiated Rate |
$137.50 |
| Rate for Payer: Aetna Commercial |
$104.50
|
| Rate for Payer: Aetna Medicare Advantage |
$82.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$70.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$70.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$5.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$70.12
|
| Rate for Payer: Cigna Commercial |
$137.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$82.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$41.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$6.63
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$7.29
|
|
|
INTERACT COMPLEX MD (ADD ON CO
|
Facility
|
IP
|
$275.00
|
|
|
Service Code
|
HCPCS 90785
|
| Hospital Charge Code |
4535709
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$41.25 |
| Max. Negotiated Rate |
$41.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$41.25
|
|
|
INTERACT COMPLEX MD (ADD ON CO
|
Facility
|
IP
|
$275.00
|
|
|
Service Code
|
HCPCS 90785
|
| Hospital Charge Code |
4832709
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$41.25 |
| Max. Negotiated Rate |
$41.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$41.25
|
|
|
INTERACT COMPLEX MD (ADD ON CO
|
Facility
|
OP
|
$275.00
|
|
|
Service Code
|
HCPCS 90785
|
| Hospital Charge Code |
4515709
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$5.20 |
| Max. Negotiated Rate |
$137.50 |
| Rate for Payer: Aetna Commercial |
$104.50
|
| Rate for Payer: Aetna Medicare Advantage |
$82.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$70.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$70.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$5.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$70.12
|
| Rate for Payer: Cigna Commercial |
$137.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$82.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$41.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$6.63
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$7.29
|
|
|
INTERACT COMPLEX MD (ADD ON CO
|
Facility
|
IP
|
$275.00
|
|
|
Service Code
|
HCPCS 90785
|
| Hospital Charge Code |
4502709
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$41.25 |
| Max. Negotiated Rate |
$41.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$41.25
|
|
|
INTERACT COMPLEX MD (ADD ON CO
|
Facility
|
IP
|
$275.00
|
|
|
Service Code
|
HCPCS 90785
|
| Hospital Charge Code |
4518709
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$41.25 |
| Max. Negotiated Rate |
$41.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$41.25
|
|
|
INTERACT COMPLEX MD (ADD ON CO
|
Facility
|
OP
|
$275.00
|
|
|
Service Code
|
HCPCS 90785
|
| Hospital Charge Code |
4832709
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$5.20 |
| Max. Negotiated Rate |
$137.50 |
| Rate for Payer: Aetna Commercial |
$104.50
|
| Rate for Payer: Aetna Medicare Advantage |
$82.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$70.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$70.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$5.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$70.12
|
| Rate for Payer: Cigna Commercial |
$137.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$82.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$41.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$6.63
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$7.29
|
|
|
INTERACT COMPLEX MD (ADD ON CO
|
Facility
|
OP
|
$275.00
|
|
|
Service Code
|
HCPCS 90785
|
| Hospital Charge Code |
4518709
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$5.20 |
| Max. Negotiated Rate |
$137.50 |
| Rate for Payer: Aetna Commercial |
$104.50
|
| Rate for Payer: Aetna Medicare Advantage |
$82.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$70.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$70.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$5.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$70.12
|
| Rate for Payer: Cigna Commercial |
$137.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$82.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$41.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$6.63
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$7.29
|
|
|
INTERACT COMPLEX MD (ADD ON CO
|
Facility
|
IP
|
$275.00
|
|
|
Service Code
|
HCPCS 90785
|
| Hospital Charge Code |
4527709
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$41.25 |
| Max. Negotiated Rate |
$41.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$41.25
|
|
|
INTERACT COMPLEX NON MD ADULT
|
Facility
|
IP
|
$750.00
|
|
|
Service Code
|
HCPCS 90785
|
| Hospital Charge Code |
4535500
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$112.50 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$112.50
|
|
|
INTERACT COMPLEX NON MD ADULT
|
Facility
|
OP
|
$750.00
|
|
|
Service Code
|
HCPCS 90785
|
| Hospital Charge Code |
4535500
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$5.20 |
| Max. Negotiated Rate |
$375.00 |
| Rate for Payer: Aetna Commercial |
$285.00
|
| Rate for Payer: Aetna Medicare Advantage |
$225.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$191.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$191.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$5.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$191.25
|
| Rate for Payer: Cigna Commercial |
$375.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$225.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$112.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$18.07
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$19.88
|
|
|
INTERACT COMPLEX NON MD ADULT
|
Facility
|
IP
|
$750.00
|
|
|
Service Code
|
HCPCS 90785
|
| Hospital Charge Code |
4822500
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$112.50 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$112.50
|
|
|
INTERACT COMPLEX NON MD ADULT
|
Facility
|
IP
|
$750.00
|
|
|
Service Code
|
HCPCS 90785
|
| Hospital Charge Code |
4832500
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$112.50 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$112.50
|
|
|
INTERACT COMPLEX NON MD ADULT
|
Facility
|
OP
|
$750.00
|
|
|
Service Code
|
HCPCS 90785
|
| Hospital Charge Code |
4818500
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$5.20 |
| Max. Negotiated Rate |
$375.00 |
| Rate for Payer: Aetna Commercial |
$285.00
|
| Rate for Payer: Aetna Medicare Advantage |
$225.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$191.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$191.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$5.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$191.25
|
| Rate for Payer: Cigna Commercial |
$375.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$225.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$112.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$18.07
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$19.88
|
|
|
INTERACT COMPLEX NON MD ADULT
|
Facility
|
IP
|
$750.00
|
|
|
Service Code
|
HCPCS 90785
|
| Hospital Charge Code |
4502500
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$112.50 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$112.50
|
|
|
INTERACT COMPLEX NON MD ADULT
|
Facility
|
IP
|
$750.00
|
|
|
Service Code
|
HCPCS 90785
|
| Hospital Charge Code |
4818500
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$112.50 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$112.50
|
|
|
INTERACT COMPLEX NON MD ADULT
|
Facility
|
OP
|
$750.00
|
|
|
Service Code
|
HCPCS 90785
|
| Hospital Charge Code |
4502500
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$5.20 |
| Max. Negotiated Rate |
$375.00 |
| Rate for Payer: Aetna Commercial |
$285.00
|
| Rate for Payer: Aetna Medicare Advantage |
$225.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$191.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$191.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$5.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$191.25
|
| Rate for Payer: Cigna Commercial |
$375.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$225.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$112.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$18.07
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$19.88
|
|
|
INTERACT COMPLEX NON MD ADULT
|
Facility
|
IP
|
$750.00
|
|
|
Service Code
|
HCPCS 90785
|
| Hospital Charge Code |
4511500
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$112.50 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$112.50
|
|
|
INTERACT COMPLEX NON MD ADULT
|
Facility
|
IP
|
$750.00
|
|
|
Service Code
|
HCPCS 90785
|
| Hospital Charge Code |
4509500
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$112.50 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$112.50
|
|
|
INTERACT COMPLEX NON MD ADULT
|
Facility
|
OP
|
$750.00
|
|
|
Service Code
|
HCPCS 90785
|
| Hospital Charge Code |
4511500
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$5.20 |
| Max. Negotiated Rate |
$375.00 |
| Rate for Payer: Aetna Commercial |
$285.00
|
| Rate for Payer: Aetna Medicare Advantage |
$225.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$191.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$191.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$5.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$191.25
|
| Rate for Payer: Cigna Commercial |
$375.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$225.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$112.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$18.07
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$19.88
|
|
|
INTERACT COMPLEX NON MD ADULT
|
Facility
|
OP
|
$750.00
|
|
|
Service Code
|
HCPCS 90785
|
| Hospital Charge Code |
4509500
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$5.20 |
| Max. Negotiated Rate |
$375.00 |
| Rate for Payer: Aetna Commercial |
$285.00
|
| Rate for Payer: Aetna Medicare Advantage |
$225.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$191.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$191.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$5.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$191.25
|
| Rate for Payer: Cigna Commercial |
$375.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$225.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$112.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$18.07
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$19.88
|
|
|
INTERACT COMPLEX NON MD ADULT
|
Facility
|
IP
|
$750.00
|
|
|
Service Code
|
HCPCS 90785
|
| Hospital Charge Code |
4504500
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$112.50 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$112.50
|
|
|
INTERACT COMPLEX NON MD ADULT
|
Facility
|
OP
|
$750.00
|
|
|
Service Code
|
HCPCS 90785
|
| Hospital Charge Code |
4822500
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$5.20 |
| Max. Negotiated Rate |
$375.00 |
| Rate for Payer: Aetna Commercial |
$285.00
|
| Rate for Payer: Aetna Medicare Advantage |
$225.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$191.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$191.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$5.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$191.25
|
| Rate for Payer: Cigna Commercial |
$375.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$225.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$112.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$18.07
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$19.88
|
|
|
INTERACT COMPLEX NON MD ADULT
|
Facility
|
OP
|
$750.00
|
|
|
Service Code
|
HCPCS 90785
|
| Hospital Charge Code |
4832500
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$5.20 |
| Max. Negotiated Rate |
$375.00 |
| Rate for Payer: Aetna Commercial |
$285.00
|
| Rate for Payer: Aetna Medicare Advantage |
$225.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$191.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$191.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$5.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$191.25
|
| Rate for Payer: Cigna Commercial |
$375.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$225.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$112.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$18.07
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$19.88
|
|