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All Charges

Charge

Type

Setting

Price

CRISIS PSYCHOTX MD 1ST HOUR

Facility

IP

$500.00

Service Code	HCPCS 90839
Hospital Charge Code	4535707
Hospital Revenue Code	914
Min. Negotiated Rate	$75.00
Max. Negotiated Rate	$75.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00

CRISIS PSYCHOTX MD 1ST HOUR

Facility

IP

$500.00

Service Code	HCPCS 90839
Hospital Charge Code	4818707
Hospital Revenue Code	914
Min. Negotiated Rate	$75.00
Max. Negotiated Rate	$75.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00

CRISIS PSYCHOTX MD 1ST HOUR

Facility

OP

$500.00

Service Code	HCPCS 90839
Hospital Charge Code	4824707
Hospital Revenue Code	914
Min. Negotiated Rate	$65.00
Max. Negotiated Rate	$422.69
Rate for Payer: Aetna Commercial	$150.00
Rate for Payer: Aetna Medicare Advantage	$150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$127.50
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	$127.50
Rate for Payer: Cigna Commercial	$422.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$65.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00

CRISIS PSYCHOTX MD 1ST HOUR

Facility

IP

$500.00

Service Code	HCPCS 90839
Hospital Charge Code	4832707
Hospital Revenue Code	914
Min. Negotiated Rate	$75.00
Max. Negotiated Rate	$75.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00

CRISIS PSYCHOTX MD EAADD 30MIN

Facility

IP

$275.00

Service Code	HCPCS 90840
Hospital Charge Code	4527708
Hospital Revenue Code	914
Min. Negotiated Rate	$41.25
Max. Negotiated Rate	$41.25
Rate for Payer: Qualcare PPO/HMO/WC	$41.25

CRISIS PSYCHOTX MD EAADD 30MIN

Facility

IP

$275.00

Service Code	HCPCS 90840
Hospital Charge Code	4818708
Hospital Revenue Code	914
Min. Negotiated Rate	$41.25
Max. Negotiated Rate	$41.25
Rate for Payer: Qualcare PPO/HMO/WC	$41.25

CRISIS PSYCHOTX MD EAADD 30MIN

Facility

OP

$275.00

Service Code	HCPCS 90840
Hospital Charge Code	4818708
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 PSYCHOTX MD EAADD 30MIN

Facility

OP

$275.00

Service Code	HCPCS 90840
Hospital Charge Code	4509708
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 PSYCHOTX MD EAADD 30MIN

Facility

OP

$275.00

Service Code	HCPCS 90840
Hospital Charge Code	4515708
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 PSYCHOTX MD EAADD 30MIN

Facility

IP

$275.00

Service Code	HCPCS 90840
Hospital Charge Code	4515708
Hospital Revenue Code	914
Min. Negotiated Rate	$41.25
Max. Negotiated Rate	$41.25
Rate for Payer: Qualcare PPO/HMO/WC	$41.25

CRISIS PSYCHOTX MD EAADD 30MIN

Facility

IP

$275.00

Service Code	HCPCS 90840
Hospital Charge Code	4546708
Hospital Revenue Code	914
Min. Negotiated Rate	$41.25
Max. Negotiated Rate	$41.25
Rate for Payer: Qualcare PPO/HMO/WC	$41.25

CRISIS PSYCHOTX MD EAADD 30MIN

Facility

IP

$275.00

Service Code	HCPCS 90840
Hospital Charge Code	4502708
Hospital Revenue Code	914
Min. Negotiated Rate	$41.25
Max. Negotiated Rate	$41.25
Rate for Payer: Qualcare PPO/HMO/WC	$41.25

CRISIS PSYCHOTX MD EAADD 30MIN

Facility

OP

$275.00

Service Code	HCPCS 90840
Hospital Charge Code	4822708
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 PSYCHOTX MD EAADD 30MIN

Facility

IP

$275.00

Service Code	HCPCS 90840
Hospital Charge Code	4504708
Hospital Revenue Code	914
Min. Negotiated Rate	$41.25
Max. Negotiated Rate	$41.25
Rate for Payer: Qualcare PPO/HMO/WC	$41.25

CRISIS PSYCHOTX MD EAADD 30MIN

Facility

OP

$275.00

Service Code	HCPCS 90840
Hospital Charge Code	4824708
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 PSYCHOTX MD EAADD 30MIN

Facility

IP

$275.00

Service Code	HCPCS 90840
Hospital Charge Code	4511708
Hospital Revenue Code	914
Min. Negotiated Rate	$41.25
Max. Negotiated Rate	$41.25
Rate for Payer: Qualcare PPO/HMO/WC	$41.25

CRISIS PSYCHOTX MD EAADD 30MIN

Facility

OP

$275.00

Service Code	HCPCS 90840
Hospital Charge Code	4518708
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 PSYCHOTX MD EAADD 30MIN

Facility

OP

$275.00

Service Code	HCPCS 90840
Hospital Charge Code	4832708
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 PSYCHOTX MD EAADD 30MIN

Facility

IP

$275.00

Service Code	HCPCS 90840
Hospital Charge Code	4518708
Hospital Revenue Code	914
Min. Negotiated Rate	$41.25
Max. Negotiated Rate	$41.25
Rate for Payer: Qualcare PPO/HMO/WC	$41.25

CRISIS PSYCHOTX MD EAADD 30MIN

Facility

IP

$275.00

Service Code	HCPCS 90840
Hospital Charge Code	4824708
Hospital Revenue Code	914
Min. Negotiated Rate	$41.25
Max. Negotiated Rate	$41.25
Rate for Payer: Qualcare PPO/HMO/WC	$41.25

CRISIS PSYCHOTX MD EAADD 30MIN

Facility

OP

$275.00

Service Code	HCPCS 90840
Hospital Charge Code	4504708
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 PSYCHOTX MD EAADD 30MIN

Facility

IP

$275.00

Service Code	HCPCS 90840
Hospital Charge Code	4517708
Hospital Revenue Code	914
Min. Negotiated Rate	$41.25
Max. Negotiated Rate	$41.25
Rate for Payer: Qualcare PPO/HMO/WC	$41.25

CRISIS PSYCHOTX MD EAADD 30MIN

Facility

IP

$275.00

Service Code	HCPCS 90840
Hospital Charge Code	4535708
Hospital Revenue Code	914
Min. Negotiated Rate	$41.25
Max. Negotiated Rate	$41.25
Rate for Payer: Qualcare PPO/HMO/WC	$41.25

CRISIS PSYCHOTX MD EAADD 30MIN

Facility

IP

$275.00

Service Code	HCPCS 90840
Hospital Charge Code	4509708
Hospital Revenue Code	914
Min. Negotiated Rate	$41.25
Max. Negotiated Rate	$41.25
Rate for Payer: Qualcare PPO/HMO/WC	$41.25

CRISIS PSYCHOTX MD EAADD 30MIN

Facility

OP

$275.00

Service Code	HCPCS 90840
Hospital Charge Code	4511708
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