|
IND PSYCHOTX NONMD 45MIN ADULT
|
Facility
|
IP
|
$1,500.00
|
|
|
Service Code
|
HCPCS 90834
|
| Hospital Charge Code |
4822506
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$225.00 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$225.00
|
|
|
IND PSYCHOTX NONMD 45MIN ADULT
|
Facility
|
OP
|
$1,500.00
|
|
|
Service Code
|
HCPCS 90834
|
| Hospital Charge Code |
4822506
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$94.46 |
| Max. Negotiated Rate |
$450.00 |
| Rate for Payer: Aetna Commercial |
$450.00
|
| Rate for Payer: Aetna Medicare Advantage |
$450.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$382.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$382.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$150.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$382.50
|
| Rate for Payer: Cigna Commercial |
$422.69
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$195.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$225.00
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$94.46
|
|
|
IND PSYCHOTX NONMD 45MIN ADULT
|
Facility
|
IP
|
$1,500.00
|
|
|
Service Code
|
HCPCS 90834
|
| Hospital Charge Code |
4509506
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$225.00 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$225.00
|
|
|
IND PSYCHOTX NONMD 45MIN ADULT
|
Facility
|
IP
|
$1,500.00
|
|
|
Service Code
|
HCPCS 90834
|
| Hospital Charge Code |
4502506
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$225.00 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$225.00
|
|
|
IND PSYCHOTX NONMD 45MIN ADULT
|
Facility
|
OP
|
$1,500.00
|
|
|
Service Code
|
HCPCS 90834
|
| Hospital Charge Code |
4504506
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$94.46 |
| Max. Negotiated Rate |
$450.00 |
| Rate for Payer: Aetna Commercial |
$450.00
|
| Rate for Payer: Aetna Medicare Advantage |
$450.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$382.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$382.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$150.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$382.50
|
| Rate for Payer: Cigna Commercial |
$422.69
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$195.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$225.00
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$94.46
|
|
|
IND PSYCHOTX NONMD 45MIN ADULT
|
Facility
|
OP
|
$1,500.00
|
|
|
Service Code
|
HCPCS 90834
|
| Hospital Charge Code |
4511506
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$94.46 |
| Max. Negotiated Rate |
$450.00 |
| Rate for Payer: Aetna Commercial |
$450.00
|
| Rate for Payer: Aetna Medicare Advantage |
$450.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$382.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$382.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$150.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$382.50
|
| Rate for Payer: Cigna Commercial |
$422.69
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$195.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$225.00
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$94.46
|
|
|
IND PSYCHOTX NONMD 45MIN ADULT
|
Facility
|
OP
|
$1,500.00
|
|
|
Service Code
|
HCPCS 90834
|
| Hospital Charge Code |
4509506
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$94.46 |
| Max. Negotiated Rate |
$450.00 |
| Rate for Payer: Aetna Commercial |
$450.00
|
| Rate for Payer: Aetna Medicare Advantage |
$450.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$382.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$382.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$150.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$382.50
|
| Rate for Payer: Cigna Commercial |
$422.69
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$195.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$225.00
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$94.46
|
|
|
IND PSYCHOTX NONMD 45MIN ADULT
|
Facility
|
IP
|
$1,500.00
|
|
|
Service Code
|
HCPCS 90834
|
| Hospital Charge Code |
4535506
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$225.00 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$225.00
|
|
|
IND PSYCHOTX NONMD 45MIN CHILD
|
Facility
|
IP
|
$1,500.00
|
|
|
Service Code
|
HCPCS 90834
|
| Hospital Charge Code |
4535507
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$225.00 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$225.00
|
|
|
IND PSYCHOTX NONMD 45MIN CHILD
|
Facility
|
IP
|
$1,500.00
|
|
|
Service Code
|
HCPCS 90834
|
| Hospital Charge Code |
4510507
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$225.00 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$225.00
|
|
|
IND PSYCHOTX NONMD 45MIN CHILD
|
Facility
|
OP
|
$1,500.00
|
|
|
Service Code
|
HCPCS 90834
|
| Hospital Charge Code |
4824507
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$94.46 |
| Max. Negotiated Rate |
$450.00 |
| Rate for Payer: Aetna Commercial |
$450.00
|
| Rate for Payer: Aetna Medicare Advantage |
$450.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$382.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$382.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$150.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$382.50
|
| Rate for Payer: Cigna Commercial |
$422.69
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$195.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$225.00
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$94.46
|
|
|
IND PSYCHOTX NONMD 45MIN CHILD
|
Facility
|
OP
|
$1,500.00
|
|
|
Service Code
|
HCPCS 90834
|
| Hospital Charge Code |
4510507
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$94.46 |
| Max. Negotiated Rate |
$450.00 |
| Rate for Payer: Aetna Commercial |
$450.00
|
| Rate for Payer: Aetna Medicare Advantage |
$450.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$382.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$382.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$150.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$382.50
|
| Rate for Payer: Cigna Commercial |
$422.69
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$195.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$225.00
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$94.46
|
|
|
IND PSYCHOTX NONMD 45MIN CHILD
|
Facility
|
IP
|
$1,500.00
|
|
|
Service Code
|
HCPCS 90834
|
| Hospital Charge Code |
4832507
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$225.00 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$225.00
|
|
|
IND PSYCHOTX NONMD 45MIN CHILD
|
Facility
|
OP
|
$1,500.00
|
|
|
Service Code
|
HCPCS 90834
|
| Hospital Charge Code |
4518507
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$94.46 |
| Max. Negotiated Rate |
$450.00 |
| Rate for Payer: Aetna Commercial |
$450.00
|
| Rate for Payer: Aetna Medicare Advantage |
$450.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$382.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$382.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$150.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$382.50
|
| Rate for Payer: Cigna Commercial |
$422.69
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$195.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$225.00
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$94.46
|
|
|
IND PSYCHOTX NONMD 45MIN CHILD
|
Facility
|
IP
|
$1,500.00
|
|
|
Service Code
|
HCPCS 90834
|
| Hospital Charge Code |
4515507
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$225.00 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$225.00
|
|
|
IND PSYCHOTX NONMD 45MIN CHILD
|
Facility
|
OP
|
$1,500.00
|
|
|
Service Code
|
HCPCS 90834
|
| Hospital Charge Code |
4515507
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$94.46 |
| Max. Negotiated Rate |
$450.00 |
| Rate for Payer: Aetna Commercial |
$450.00
|
| Rate for Payer: Aetna Medicare Advantage |
$450.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$382.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$382.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$150.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$382.50
|
| Rate for Payer: Cigna Commercial |
$422.69
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$195.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$225.00
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$94.46
|
|
|
IND PSYCHOTX NONMD 45MIN CHILD
|
Facility
|
OP
|
$1,500.00
|
|
|
Service Code
|
HCPCS 90834
|
| Hospital Charge Code |
4832507
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$94.46 |
| Max. Negotiated Rate |
$450.00 |
| Rate for Payer: Aetna Commercial |
$450.00
|
| Rate for Payer: Aetna Medicare Advantage |
$450.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$382.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$382.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$150.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$382.50
|
| Rate for Payer: Cigna Commercial |
$422.69
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$195.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$225.00
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$94.46
|
|
|
IND PSYCHOTX NONMD 45MIN CHILD
|
Facility
|
OP
|
$1,500.00
|
|
|
Service Code
|
HCPCS 90834
|
| Hospital Charge Code |
4546507
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$94.46 |
| Max. Negotiated Rate |
$450.00 |
| Rate for Payer: Aetna Commercial |
$450.00
|
| Rate for Payer: Aetna Medicare Advantage |
$450.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$382.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$382.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$150.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$382.50
|
| Rate for Payer: Cigna Commercial |
$422.69
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$195.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$225.00
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$94.46
|
|
|
IND PSYCHOTX NONMD 45MIN CHILD
|
Facility
|
OP
|
$1,500.00
|
|
|
Service Code
|
HCPCS 90834
|
| Hospital Charge Code |
4504507
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$94.46 |
| Max. Negotiated Rate |
$450.00 |
| Rate for Payer: Aetna Commercial |
$450.00
|
| Rate for Payer: Aetna Medicare Advantage |
$450.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$382.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$382.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$150.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$382.50
|
| Rate for Payer: Cigna Commercial |
$422.69
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$195.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$225.00
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$94.46
|
|
|
IND PSYCHOTX NONMD 45MIN CHILD
|
Facility
|
IP
|
$1,500.00
|
|
|
Service Code
|
HCPCS 90834
|
| Hospital Charge Code |
4546507
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$225.00 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$225.00
|
|
|
IND PSYCHOTX NONMD 45MIN CHILD
|
Facility
|
IP
|
$1,500.00
|
|
|
Service Code
|
HCPCS 90834
|
| Hospital Charge Code |
4509507
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$225.00 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$225.00
|
|
|
IND PSYCHOTX NONMD 45MIN CHILD
|
Facility
|
OP
|
$1,500.00
|
|
|
Service Code
|
HCPCS 90834
|
| Hospital Charge Code |
4535507
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$94.46 |
| Max. Negotiated Rate |
$450.00 |
| Rate for Payer: Aetna Commercial |
$450.00
|
| Rate for Payer: Aetna Medicare Advantage |
$450.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$382.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$382.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$150.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$382.50
|
| Rate for Payer: Cigna Commercial |
$422.69
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$195.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$225.00
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$94.46
|
|
|
IND PSYCHOTX NONMD 45MIN CHILD
|
Facility
|
OP
|
$1,500.00
|
|
|
Service Code
|
HCPCS 90834
|
| Hospital Charge Code |
4822507
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$94.46 |
| Max. Negotiated Rate |
$450.00 |
| Rate for Payer: Aetna Commercial |
$450.00
|
| Rate for Payer: Aetna Medicare Advantage |
$450.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$382.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$382.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$150.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$382.50
|
| Rate for Payer: Cigna Commercial |
$422.69
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$195.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$225.00
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$94.46
|
|
|
IND PSYCHOTX NONMD 45MIN CHILD
|
Facility
|
OP
|
$1,500.00
|
|
|
Service Code
|
HCPCS 90834
|
| Hospital Charge Code |
4511507
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$94.46 |
| Max. Negotiated Rate |
$450.00 |
| Rate for Payer: Aetna Commercial |
$450.00
|
| Rate for Payer: Aetna Medicare Advantage |
$450.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$382.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$382.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$150.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$382.50
|
| Rate for Payer: Cigna Commercial |
$422.69
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$195.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$225.00
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$94.46
|
|
|
IND PSYCHOTX NONMD 45MIN CHILD
|
Facility
|
IP
|
$1,500.00
|
|
|
Service Code
|
HCPCS 90834
|
| Hospital Charge Code |
4824507
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$225.00 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$225.00
|
|