Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

CRISIS PSYCHOTX 1ST HOUR CHILD

Facility

OP

$2,000.00

Service Code	HCPCS 90839
Hospital Charge Code	4527511
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 CHILD

Facility

IP

$2,000.00

Service Code	HCPCS 90839
Hospital Charge Code	4517511
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 CHILD

Facility

IP

$2,000.00

Service Code	HCPCS 90839
Hospital Charge Code	4546511
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 EAADD 30MIN AD

Facility

OP

$1,000.00

Service Code	HCPCS 90840
Hospital Charge Code	4504512
Hospital Revenue Code	914
Min. Negotiated Rate	$66.85
Max. Negotiated Rate	$300.00
Rate for Payer: Aetna Commercial	$300.00
Rate for Payer: Aetna Medicare Advantage	$300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$255.00
Rate for Payer: Cigna Commercial	$66.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$130.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00

CRISIS PSYCHOTX EAADD 30MIN AD

Facility

IP

$1,000.00

Service Code	HCPCS 90840
Hospital Charge Code	4824512
Hospital Revenue Code	914
Min. Negotiated Rate	$150.00
Max. Negotiated Rate	$150.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00

CRISIS PSYCHOTX EAADD 30MIN AD

Facility

IP

$1,000.00

Service Code	HCPCS 90840
Hospital Charge Code	4509512
Hospital Revenue Code	914
Min. Negotiated Rate	$150.00
Max. Negotiated Rate	$150.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00

CRISIS PSYCHOTX EAADD 30MIN AD

Facility

OP

$1,000.00

Service Code	HCPCS 90840
Hospital Charge Code	4832512
Hospital Revenue Code	914
Min. Negotiated Rate	$66.85
Max. Negotiated Rate	$300.00
Rate for Payer: Aetna Commercial	$300.00
Rate for Payer: Aetna Medicare Advantage	$300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$255.00
Rate for Payer: Cigna Commercial	$66.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$130.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00

CRISIS PSYCHOTX EAADD 30MIN AD

Facility

IP

$1,000.00

Service Code	HCPCS 90840
Hospital Charge Code	4502512
Hospital Revenue Code	914
Min. Negotiated Rate	$150.00
Max. Negotiated Rate	$150.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00

CRISIS PSYCHOTX EAADD 30MIN AD

Facility

IP

$1,000.00

Service Code	HCPCS 90840
Hospital Charge Code	4504512
Hospital Revenue Code	914
Min. Negotiated Rate	$150.00
Max. Negotiated Rate	$150.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00

CRISIS PSYCHOTX EAADD 30MIN AD

Facility

OP

$1,000.00

Service Code	HCPCS 90840
Hospital Charge Code	4502512
Hospital Revenue Code	914
Min. Negotiated Rate	$66.85
Max. Negotiated Rate	$300.00
Rate for Payer: Aetna Commercial	$300.00
Rate for Payer: Aetna Medicare Advantage	$300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$255.00
Rate for Payer: Cigna Commercial	$66.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$130.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00

CRISIS PSYCHOTX EAADD 30MIN AD

Facility

IP

$1,000.00

Service Code	HCPCS 90840
Hospital Charge Code	4822512
Hospital Revenue Code	914
Min. Negotiated Rate	$150.00
Max. Negotiated Rate	$150.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00

CRISIS PSYCHOTX EAADD 30MIN AD

Facility

IP

$1,000.00

Service Code	HCPCS 90840
Hospital Charge Code	4511512
Hospital Revenue Code	914
Min. Negotiated Rate	$150.00
Max. Negotiated Rate	$150.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00

CRISIS PSYCHOTX EAADD 30MIN AD

Facility

OP

$1,000.00

Service Code	HCPCS 90840
Hospital Charge Code	4818512
Hospital Revenue Code	914
Min. Negotiated Rate	$66.85
Max. Negotiated Rate	$300.00
Rate for Payer: Aetna Commercial	$300.00
Rate for Payer: Aetna Medicare Advantage	$300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$255.00
Rate for Payer: Cigna Commercial	$66.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$130.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00

CRISIS PSYCHOTX EAADD 30MIN AD

Facility

OP

$1,000.00

Service Code	HCPCS 90840
Hospital Charge Code	4535512
Hospital Revenue Code	914
Min. Negotiated Rate	$66.85
Max. Negotiated Rate	$300.00
Rate for Payer: Aetna Commercial	$300.00
Rate for Payer: Aetna Medicare Advantage	$300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$255.00
Rate for Payer: Cigna Commercial	$66.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$130.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00

CRISIS PSYCHOTX EAADD 30MIN AD

Facility

IP

$1,000.00

Service Code	HCPCS 90840
Hospital Charge Code	4535512
Hospital Revenue Code	914
Min. Negotiated Rate	$150.00
Max. Negotiated Rate	$150.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00

CRISIS PSYCHOTX EAADD 30MIN AD

Facility

IP

$1,000.00

Service Code	HCPCS 90840
Hospital Charge Code	4818512
Hospital Revenue Code	914
Min. Negotiated Rate	$150.00
Max. Negotiated Rate	$150.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00

CRISIS PSYCHOTX EAADD 30MIN AD

Facility

OP

$1,000.00

Service Code	HCPCS 90840
Hospital Charge Code	4824512
Hospital Revenue Code	914
Min. Negotiated Rate	$66.85
Max. Negotiated Rate	$300.00
Rate for Payer: Aetna Commercial	$300.00
Rate for Payer: Aetna Medicare Advantage	$300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$255.00
Rate for Payer: Cigna Commercial	$66.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$130.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00

CRISIS PSYCHOTX EAADD 30MIN AD

Facility

OP

$1,000.00

Service Code	HCPCS 90840
Hospital Charge Code	4511512
Hospital Revenue Code	914
Min. Negotiated Rate	$66.85
Max. Negotiated Rate	$300.00
Rate for Payer: Aetna Commercial	$300.00
Rate for Payer: Aetna Medicare Advantage	$300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$255.00
Rate for Payer: Cigna Commercial	$66.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$130.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00

CRISIS PSYCHOTX EAADD 30MIN AD

Facility

OP

$1,000.00

Service Code	HCPCS 90840
Hospital Charge Code	4822512
Hospital Revenue Code	914
Min. Negotiated Rate	$66.85
Max. Negotiated Rate	$300.00
Rate for Payer: Aetna Commercial	$300.00
Rate for Payer: Aetna Medicare Advantage	$300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$255.00
Rate for Payer: Cigna Commercial	$66.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$130.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00

CRISIS PSYCHOTX EAADD 30MIN AD

Facility

IP

$1,000.00

Service Code	HCPCS 90840
Hospital Charge Code	4832512
Hospital Revenue Code	914
Min. Negotiated Rate	$150.00
Max. Negotiated Rate	$150.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00

CRISIS PSYCHOTX EAADD 30MIN AD

Facility

OP

$1,000.00

Service Code	HCPCS 90840
Hospital Charge Code	4509512
Hospital Revenue Code	914
Min. Negotiated Rate	$66.85
Max. Negotiated Rate	$300.00
Rate for Payer: Aetna Commercial	$300.00
Rate for Payer: Aetna Medicare Advantage	$300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$255.00
Rate for Payer: Cigna Commercial	$66.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$130.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00

CRISIS PSYCHOTX EAADD 30MIN CH

Facility

IP

$1,000.00

Service Code	HCPCS 90840
Hospital Charge Code	4535513
Hospital Revenue Code	914
Min. Negotiated Rate	$150.00
Max. Negotiated Rate	$150.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00

CRISIS PSYCHOTX EAADD 30MIN CH

Facility

OP

$1,000.00

Service Code	HCPCS 90840
Hospital Charge Code	4818513
Hospital Revenue Code	914
Min. Negotiated Rate	$66.85
Max. Negotiated Rate	$300.00
Rate for Payer: Aetna Commercial	$300.00
Rate for Payer: Aetna Medicare Advantage	$300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$255.00
Rate for Payer: Cigna Commercial	$66.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$130.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00

CRISIS PSYCHOTX EAADD 30MIN CH

Facility

IP

$1,000.00

Service Code	HCPCS 90840
Hospital Charge Code	4509513
Hospital Revenue Code	914
Min. Negotiated Rate	$150.00
Max. Negotiated Rate	$150.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00

CRISIS PSYCHOTX EAADD 30MIN CH

Facility

OP

$1,000.00

Service Code	HCPCS 90840
Hospital Charge Code	4824513
Hospital Revenue Code	914
Min. Negotiated Rate	$66.85
Max. Negotiated Rate	$300.00
Rate for Payer: Aetna Commercial	$300.00
Rate for Payer: Aetna Medicare Advantage	$300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$255.00
Rate for Payer: Cigna Commercial	$66.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$130.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00