|
CRISIS PSYCHOTHERAPY ADD30MINS
|
Facility
|
OP
|
$275.00
|
|
|
Service Code
|
HCPCS 90840
|
| Hospital Charge Code |
84511019
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$35.75 |
| Max. Negotiated Rate |
$82.50 |
| Rate for Payer: Aetna Commercial |
$82.50
|
| 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) PPO |
$70.12
|
| Rate for Payer: Cigna Commercial |
$66.85
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$35.75
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$41.25
|
|
|
CRISIS PSYCHOTHERAPY EACH ADD
|
Facility
|
OP
|
$275.00
|
|
|
Service Code
|
HCPCS 90840
|
| Hospital Charge Code |
4546778
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$35.75 |
| Max. Negotiated Rate |
$82.50 |
| Rate for Payer: Aetna Commercial |
$82.50
|
| 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) PPO |
$70.12
|
| Rate for Payer: Cigna Commercial |
$66.85
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$35.75
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$41.25
|
|
|
CRISIS PSYCHOTHERAPY EACH ADD
|
Facility
|
IP
|
$275.00
|
|
|
Service Code
|
HCPCS 90840
|
| Hospital Charge Code |
4546778
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$41.25 |
| Max. Negotiated Rate |
$41.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$41.25
|
|
|
CRISIS PSYCHOTHERAPY; FIRST 60
|
Facility
|
OP
|
$2,000.00
|
|
|
Service Code
|
HCPCS 90839
|
| Hospital Charge Code |
45467777
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$139.23 |
| Max. Negotiated Rate |
$600.00 |
| Rate for Payer: Aetna Commercial |
$600.00
|
| Rate for Payer: Aetna Medicare Advantage |
$600.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$510.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$510.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$139.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$510.00
|
| Rate for Payer: Cigna Commercial |
$422.69
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$260.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$300.00
|
|
|
CRISIS PSYCHOTHERAPY; FIRST 60
|
Facility
|
IP
|
$2,000.00
|
|
|
Service Code
|
HCPCS 90839
|
| Hospital Charge Code |
45467777
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$300.00 |
| Max. Negotiated Rate |
$300.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$300.00
|
|
|
CRISIS PSYCHOTHERAPY; FIRST 60
|
Facility
|
OP
|
$2,000.00
|
|
|
Service Code
|
HCPCS 90839
|
| Hospital Charge Code |
4546777
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$139.23 |
| Max. Negotiated Rate |
$600.00 |
| Rate for Payer: Aetna Commercial |
$600.00
|
| Rate for Payer: Aetna Medicare Advantage |
$600.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$510.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$510.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$139.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$510.00
|
| Rate for Payer: Cigna Commercial |
$422.69
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$260.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$300.00
|
|
|
CRISIS PSYCHOTHERAPY; FIRST 60
|
Facility
|
IP
|
$2,000.00
|
|
|
Service Code
|
HCPCS 90839
|
| Hospital Charge Code |
4546777
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$300.00 |
| Max. Negotiated Rate |
$300.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$300.00
|
|
|
CRISIS PSYCHOTX 1ST HOUR ADULT
|
Facility
|
OP
|
$2,000.00
|
|
|
Service Code
|
HCPCS 90839
|
| Hospital Charge Code |
4511510
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$139.23 |
| Max. Negotiated Rate |
$600.00 |
| Rate for Payer: Aetna Commercial |
$600.00
|
| Rate for Payer: Aetna Medicare Advantage |
$600.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$510.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$510.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$139.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$510.00
|
| Rate for Payer: Cigna Commercial |
$422.69
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$260.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$300.00
|
|
|
CRISIS PSYCHOTX 1ST HOUR ADULT
|
Facility
|
IP
|
$2,000.00
|
|
|
Service Code
|
HCPCS 90839
|
| Hospital Charge Code |
4535510
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$300.00 |
| Max. Negotiated Rate |
$300.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$300.00
|
|
|
CRISIS PSYCHOTX 1ST HOUR ADULT
|
Facility
|
IP
|
$2,000.00
|
|
|
Service Code
|
HCPCS 90839
|
| Hospital Charge Code |
4511510
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$300.00 |
| Max. Negotiated Rate |
$300.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$300.00
|
|
|
CRISIS PSYCHOTX 1ST HOUR ADULT
|
Facility
|
IP
|
$2,000.00
|
|
|
Service Code
|
HCPCS 90839
|
| Hospital Charge Code |
4504510
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$300.00 |
| Max. Negotiated Rate |
$300.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$300.00
|
|
|
CRISIS PSYCHOTX 1ST HOUR ADULT
|
Facility
|
IP
|
$2,000.00
|
|
|
Service Code
|
HCPCS 90839
|
| Hospital Charge Code |
4822510
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$300.00 |
| Max. Negotiated Rate |
$300.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$300.00
|
|
|
CRISIS PSYCHOTX 1ST HOUR ADULT
|
Facility
|
IP
|
$2,000.00
|
|
|
Service Code
|
HCPCS 90839
|
| Hospital Charge Code |
4824510
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$300.00 |
| Max. Negotiated Rate |
$300.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$300.00
|
|
|
CRISIS PSYCHOTX 1ST HOUR ADULT
|
Facility
|
IP
|
$2,000.00
|
|
|
Service Code
|
HCPCS 90839
|
| Hospital Charge Code |
4832510
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$300.00 |
| Max. Negotiated Rate |
$300.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$300.00
|
|
|
CRISIS PSYCHOTX 1ST HOUR ADULT
|
Facility
|
OP
|
$2,000.00
|
|
|
Service Code
|
HCPCS 90839
|
| Hospital Charge Code |
4822510
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$139.23 |
| Max. Negotiated Rate |
$600.00 |
| Rate for Payer: Aetna Commercial |
$600.00
|
| Rate for Payer: Aetna Medicare Advantage |
$600.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$510.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$510.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$139.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$510.00
|
| Rate for Payer: Cigna Commercial |
$422.69
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$260.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$300.00
|
|
|
CRISIS PSYCHOTX 1ST HOUR ADULT
|
Facility
|
OP
|
$2,000.00
|
|
|
Service Code
|
HCPCS 90839
|
| Hospital Charge Code |
4509510
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$139.23 |
| Max. Negotiated Rate |
$600.00 |
| Rate for Payer: Aetna Commercial |
$600.00
|
| Rate for Payer: Aetna Medicare Advantage |
$600.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$510.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$510.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$139.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$510.00
|
| Rate for Payer: Cigna Commercial |
$422.69
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$260.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$300.00
|
|
|
CRISIS PSYCHOTX 1ST HOUR ADULT
|
Facility
|
OP
|
$2,000.00
|
|
|
Service Code
|
HCPCS 90839
|
| Hospital Charge Code |
4502510
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$139.23 |
| Max. Negotiated Rate |
$600.00 |
| Rate for Payer: Aetna Commercial |
$600.00
|
| Rate for Payer: Aetna Medicare Advantage |
$600.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$510.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$510.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$139.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$510.00
|
| Rate for Payer: Cigna Commercial |
$422.69
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$260.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$300.00
|
|
|
CRISIS PSYCHOTX 1ST HOUR ADULT
|
Facility
|
IP
|
$2,000.00
|
|
|
Service Code
|
HCPCS 90839
|
| Hospital Charge Code |
4502510
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$300.00 |
| Max. Negotiated Rate |
$300.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$300.00
|
|
|
CRISIS PSYCHOTX 1ST HOUR ADULT
|
Facility
|
OP
|
$2,000.00
|
|
|
Service Code
|
HCPCS 90839
|
| Hospital Charge Code |
4535510
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$139.23 |
| Max. Negotiated Rate |
$600.00 |
| Rate for Payer: Aetna Commercial |
$600.00
|
| Rate for Payer: Aetna Medicare Advantage |
$600.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$510.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$510.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$139.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$510.00
|
| Rate for Payer: Cigna Commercial |
$422.69
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$260.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$300.00
|
|
|
CRISIS PSYCHOTX 1ST HOUR ADULT
|
Facility
|
IP
|
$2,000.00
|
|
|
Service Code
|
HCPCS 90839
|
| Hospital Charge Code |
4509510
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$300.00 |
| Max. Negotiated Rate |
$300.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$300.00
|
|
|
CRISIS PSYCHOTX 1ST HOUR ADULT
|
Facility
|
OP
|
$2,000.00
|
|
|
Service Code
|
HCPCS 90839
|
| Hospital Charge Code |
4832510
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$139.23 |
| Max. Negotiated Rate |
$600.00 |
| Rate for Payer: Aetna Commercial |
$600.00
|
| Rate for Payer: Aetna Medicare Advantage |
$600.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$510.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$510.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$139.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$510.00
|
| Rate for Payer: Cigna Commercial |
$422.69
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$260.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$300.00
|
|
|
CRISIS PSYCHOTX 1ST HOUR ADULT
|
Facility
|
OP
|
$2,000.00
|
|
|
Service Code
|
HCPCS 90839
|
| Hospital Charge Code |
4824510
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$139.23 |
| Max. Negotiated Rate |
$600.00 |
| Rate for Payer: Aetna Commercial |
$600.00
|
| Rate for Payer: Aetna Medicare Advantage |
$600.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$510.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$510.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$139.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$510.00
|
| Rate for Payer: Cigna Commercial |
$422.69
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$260.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$300.00
|
|
|
CRISIS PSYCHOTX 1ST HOUR ADULT
|
Facility
|
IP
|
$2,000.00
|
|
|
Service Code
|
HCPCS 90839
|
| Hospital Charge Code |
4818510
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$300.00 |
| Max. Negotiated Rate |
$300.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$300.00
|
|
|
CRISIS PSYCHOTX 1ST HOUR ADULT
|
Facility
|
OP
|
$2,000.00
|
|
|
Service Code
|
HCPCS 90839
|
| Hospital Charge Code |
4504510
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$139.23 |
| Max. Negotiated Rate |
$600.00 |
| Rate for Payer: Aetna Commercial |
$600.00
|
| Rate for Payer: Aetna Medicare Advantage |
$600.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$510.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$510.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$139.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$510.00
|
| Rate for Payer: Cigna Commercial |
$422.69
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$260.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$300.00
|
|
|
CRISIS PSYCHOTX 1ST HOUR ADULT
|
Facility
|
OP
|
$2,000.00
|
|
|
Service Code
|
HCPCS 90839
|
| Hospital Charge Code |
4818510
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$139.23 |
| Max. Negotiated Rate |
$600.00 |
| Rate for Payer: Aetna Commercial |
$600.00
|
| Rate for Payer: Aetna Medicare Advantage |
$600.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$510.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$510.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$139.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$510.00
|
| Rate for Payer: Cigna Commercial |
$422.69
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$260.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$300.00
|
|
