|
IND PSYCHOTX NONMD 30MIN ADULT
|
Facility
|
IP
|
$750.00
|
|
|
Service Code
|
HCPCS 90832
|
| Hospital Charge Code |
4818504
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$112.50 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$112.50
|
|
|
IND PSYCHOTX NONMD 30MIN ADULT
|
Facility
|
OP
|
$750.00
|
|
|
Service Code
|
HCPCS 90832
|
| Hospital Charge Code |
4504504
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$71.39 |
| Max. Negotiated Rate |
$422.69 |
| Rate for Payer: Aetna Commercial |
$225.00
|
| 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 |
$132.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$191.25
|
| Rate for Payer: Cigna Commercial |
$422.69
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$97.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$112.50
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$71.39
|
|
|
IND PSYCHOTX NONMD 30MIN ADULT
|
Facility
|
OP
|
$750.00
|
|
|
Service Code
|
HCPCS 90832
|
| Hospital Charge Code |
4535504
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$71.39 |
| Max. Negotiated Rate |
$422.69 |
| Rate for Payer: Aetna Commercial |
$225.00
|
| 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 |
$132.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$191.25
|
| Rate for Payer: Cigna Commercial |
$422.69
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$97.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$112.50
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$71.39
|
|
|
IND PSYCHOTX NONMD 30MIN ADULT
|
Facility
|
IP
|
$750.00
|
|
|
Service Code
|
HCPCS 90832
|
| Hospital Charge Code |
4535504
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$112.50 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$112.50
|
|
|
IND PSYCHOTX NONMD 30MIN ADULT
|
Facility
|
OP
|
$750.00
|
|
|
Service Code
|
HCPCS 90832
|
| Hospital Charge Code |
4509504
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$71.39 |
| Max. Negotiated Rate |
$422.69 |
| Rate for Payer: Aetna Commercial |
$225.00
|
| 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 |
$132.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$191.25
|
| Rate for Payer: Cigna Commercial |
$422.69
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$97.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$112.50
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$71.39
|
|
|
IND PSYCHOTX NONMD 30MIN ADULT
|
Facility
|
IP
|
$750.00
|
|
|
Service Code
|
HCPCS 90832
|
| Hospital Charge Code |
4832504
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$112.50 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$112.50
|
|
|
IND PSYCHOTX NONMD 30MIN ADULT
|
Facility
|
IP
|
$750.00
|
|
|
Service Code
|
HCPCS 90832
|
| Hospital Charge Code |
4502504
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$112.50 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$112.50
|
|
|
IND PSYCHOTX NONMD 30MIN ADULT
|
Facility
|
IP
|
$750.00
|
|
|
Service Code
|
HCPCS 90832
|
| Hospital Charge Code |
4509504
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$112.50 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$112.50
|
|
|
IND PSYCHOTX NONMD 30MIN ADULT
|
Facility
|
OP
|
$750.00
|
|
|
Service Code
|
HCPCS 90832
|
| Hospital Charge Code |
4511504
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$71.39 |
| Max. Negotiated Rate |
$422.69 |
| Rate for Payer: Aetna Commercial |
$225.00
|
| 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 |
$132.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$191.25
|
| Rate for Payer: Cigna Commercial |
$422.69
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$97.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$112.50
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$71.39
|
|
|
IND PSYCHOTX NONMD 30MIN ADULT
|
Facility
|
IP
|
$750.00
|
|
|
Service Code
|
HCPCS 90832
|
| Hospital Charge Code |
4504504
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$112.50 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$112.50
|
|
|
IND PSYCHOTX NONMD 30MIN ADULT
|
Facility
|
IP
|
$750.00
|
|
|
Service Code
|
HCPCS 90832
|
| Hospital Charge Code |
4511504
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$112.50 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$112.50
|
|
|
IND PSYCHOTX NONMD 30MIN ADULT
|
Facility
|
IP
|
$750.00
|
|
|
Service Code
|
HCPCS 90832
|
| Hospital Charge Code |
4822504
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$112.50 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$112.50
|
|
|
IND PSYCHOTX NONMD 30MIN ADULT
|
Facility
|
OP
|
$750.00
|
|
|
Service Code
|
HCPCS 90832
|
| Hospital Charge Code |
4818504
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$71.39 |
| Max. Negotiated Rate |
$422.69 |
| Rate for Payer: Aetna Commercial |
$225.00
|
| 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 |
$132.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$191.25
|
| Rate for Payer: Cigna Commercial |
$422.69
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$97.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$112.50
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$71.39
|
|
|
IND PSYCHOTX NONMD 30MIN ADULT
|
Facility
|
OP
|
$750.00
|
|
|
Service Code
|
HCPCS 90832
|
| Hospital Charge Code |
4502504
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$71.39 |
| Max. Negotiated Rate |
$422.69 |
| Rate for Payer: Aetna Commercial |
$225.00
|
| 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 |
$132.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$191.25
|
| Rate for Payer: Cigna Commercial |
$422.69
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$97.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$112.50
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$71.39
|
|
|
IND PSYCHOTX NONMD 30MIN ADULT
|
Facility
|
OP
|
$750.00
|
|
|
Service Code
|
HCPCS 90832
|
| Hospital Charge Code |
4822504
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$71.39 |
| Max. Negotiated Rate |
$422.69 |
| Rate for Payer: Aetna Commercial |
$225.00
|
| 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 |
$132.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$191.25
|
| Rate for Payer: Cigna Commercial |
$422.69
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$97.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$112.50
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$71.39
|
|
|
IND PSYCHOTX NONMD 30MIN ADULT
|
Facility
|
OP
|
$750.00
|
|
|
Service Code
|
HCPCS 90832
|
| Hospital Charge Code |
4832504
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$71.39 |
| Max. Negotiated Rate |
$422.69 |
| Rate for Payer: Aetna Commercial |
$225.00
|
| 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 |
$132.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$191.25
|
| Rate for Payer: Cigna Commercial |
$422.69
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$97.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$112.50
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$71.39
|
|
|
IND PSYCHOTX NONMD 30MIN CHILD
|
Facility
|
IP
|
$750.00
|
|
|
Service Code
|
HCPCS 90832
|
| Hospital Charge Code |
4510505
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$112.50 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$112.50
|
|
|
IND PSYCHOTX NONMD 30MIN CHILD
|
Facility
|
IP
|
$750.00
|
|
|
Service Code
|
HCPCS 90832
|
| Hospital Charge Code |
4527505
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$112.50 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$112.50
|
|
|
IND PSYCHOTX NONMD 30MIN CHILD
|
Facility
|
OP
|
$750.00
|
|
|
Service Code
|
HCPCS 90832
|
| Hospital Charge Code |
4824505
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$71.39 |
| Max. Negotiated Rate |
$422.69 |
| Rate for Payer: Aetna Commercial |
$225.00
|
| 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 |
$132.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$191.25
|
| Rate for Payer: Cigna Commercial |
$422.69
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$97.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$112.50
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$71.39
|
|
|
IND PSYCHOTX NONMD 30MIN CHILD
|
Facility
|
OP
|
$750.00
|
|
|
Service Code
|
HCPCS 90832
|
| Hospital Charge Code |
4510505
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$71.39 |
| Max. Negotiated Rate |
$422.69 |
| Rate for Payer: Aetna Commercial |
$225.00
|
| 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 |
$132.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$191.25
|
| Rate for Payer: Cigna Commercial |
$422.69
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$97.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$112.50
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$71.39
|
|
|
IND PSYCHOTX NONMD 30MIN CHILD
|
Facility
|
OP
|
$750.00
|
|
|
Service Code
|
HCPCS 90832
|
| Hospital Charge Code |
4517505
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$71.39 |
| Max. Negotiated Rate |
$422.69 |
| Rate for Payer: Aetna Commercial |
$225.00
|
| 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 |
$132.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$191.25
|
| Rate for Payer: Cigna Commercial |
$422.69
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$97.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$112.50
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$71.39
|
|
|
IND PSYCHOTX NONMD 30MIN CHILD
|
Facility
|
IP
|
$750.00
|
|
|
Service Code
|
HCPCS 90832
|
| Hospital Charge Code |
4517505
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$112.50 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$112.50
|
|
|
IND PSYCHOTX NONMD 30MIN CHILD
|
Facility
|
IP
|
$750.00
|
|
|
Service Code
|
HCPCS 90832
|
| Hospital Charge Code |
4511505
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$112.50 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$112.50
|
|
|
IND PSYCHOTX NONMD 30MIN CHILD
|
Facility
|
OP
|
$750.00
|
|
|
Service Code
|
HCPCS 90832
|
| Hospital Charge Code |
4515505
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$71.39 |
| Max. Negotiated Rate |
$422.69 |
| Rate for Payer: Aetna Commercial |
$225.00
|
| 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 |
$132.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$191.25
|
| Rate for Payer: Cigna Commercial |
$422.69
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$97.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$112.50
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$71.39
|
|
|
IND PSYCHOTX NONMD 30MIN CHILD
|
Facility
|
IP
|
$750.00
|
|
|
Service Code
|
HCPCS 90832
|
| Hospital Charge Code |
4822505
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$112.50 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$112.50
|
|