|
IND PSYCHOTX W E&M MD 45 MIN
|
Facility
|
OP
|
$425.00
|
|
|
Service Code
|
HCPCS 90836
|
| Hospital Charge Code |
4824705
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$55.25 |
| Max. Negotiated Rate |
$147.87 |
| Rate for Payer: Aetna Commercial |
$127.50
|
| Rate for Payer: Aetna Medicare Advantage |
$127.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$108.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$108.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$147.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$108.38
|
| Rate for Payer: Cigna Commercial |
$89.20
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$55.25
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$63.75
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$94.46
|
|
|
IND PSYCHOTX W E&M MD 45 MIN
|
Facility
|
IP
|
$425.00
|
|
|
Service Code
|
HCPCS 90836
|
| Hospital Charge Code |
4824705
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$63.75 |
| Max. Negotiated Rate |
$63.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$63.75
|
|
|
IND PSYCHOTX W E&M MD 45 MIN
|
Facility
|
IP
|
$425.00
|
|
|
Service Code
|
HCPCS 90836
|
| Hospital Charge Code |
4832705
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$63.75 |
| Max. Negotiated Rate |
$63.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$63.75
|
|
|
IND PSYCHOTX W E&M MD 45 MIN
|
Facility
|
IP
|
$425.00
|
|
|
Service Code
|
HCPCS 90836
|
| Hospital Charge Code |
4535705
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$63.75 |
| Max. Negotiated Rate |
$63.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$63.75
|
|
|
IND PSYCHOTX W E&M MD 45 MIN
|
Facility
|
OP
|
$425.00
|
|
|
Service Code
|
HCPCS 90836
|
| Hospital Charge Code |
4518705
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$55.25 |
| Max. Negotiated Rate |
$147.87 |
| Rate for Payer: Aetna Commercial |
$127.50
|
| Rate for Payer: Aetna Medicare Advantage |
$127.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$108.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$108.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$147.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$108.38
|
| Rate for Payer: Cigna Commercial |
$89.20
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$55.25
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$63.75
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$94.46
|
|
|
IND PSYCHOTX W E&M MD 45 MIN
|
Facility
|
OP
|
$425.00
|
|
|
Service Code
|
HCPCS 90836
|
| Hospital Charge Code |
4546705
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$55.25 |
| Max. Negotiated Rate |
$147.87 |
| Rate for Payer: Aetna Commercial |
$127.50
|
| Rate for Payer: Aetna Medicare Advantage |
$127.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$108.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$108.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$147.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$108.38
|
| Rate for Payer: Cigna Commercial |
$89.20
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$55.25
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$63.75
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$94.46
|
|
|
IND PSYCHOTX W E&M MD 45 MIN
|
Facility
|
IP
|
$425.00
|
|
|
Service Code
|
HCPCS 90836
|
| Hospital Charge Code |
4822705
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$63.75 |
| Max. Negotiated Rate |
$63.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$63.75
|
|
|
IND PSYCHOTX W E&M MD 45 MIN
|
Facility
|
IP
|
$425.00
|
|
|
Service Code
|
HCPCS 90836
|
| Hospital Charge Code |
4517705
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$63.75 |
| Max. Negotiated Rate |
$63.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$63.75
|
|
|
IND PSYCHOTX W E&M MD 45 MIN
|
Facility
|
OP
|
$425.00
|
|
|
Service Code
|
HCPCS 90836
|
| Hospital Charge Code |
4822705
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$55.25 |
| Max. Negotiated Rate |
$147.87 |
| Rate for Payer: Aetna Commercial |
$127.50
|
| Rate for Payer: Aetna Medicare Advantage |
$127.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$108.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$108.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$147.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$108.38
|
| Rate for Payer: Cigna Commercial |
$89.20
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$55.25
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$63.75
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$94.46
|
|
|
IND PSYCHOTX W E&M MD 45 MIN
|
Facility
|
OP
|
$425.00
|
|
|
Service Code
|
HCPCS 90836
|
| Hospital Charge Code |
4832705
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$55.25 |
| Max. Negotiated Rate |
$147.87 |
| Rate for Payer: Aetna Commercial |
$127.50
|
| Rate for Payer: Aetna Medicare Advantage |
$127.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$108.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$108.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$147.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$108.38
|
| Rate for Payer: Cigna Commercial |
$89.20
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$55.25
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$63.75
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$94.46
|
|
|
IND PSYCHOTX W E&M MD 45 MIN
|
Facility
|
IP
|
$425.00
|
|
|
Service Code
|
HCPCS 90836
|
| Hospital Charge Code |
4546705
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$63.75 |
| Max. Negotiated Rate |
$63.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$63.75
|
|
|
IND PSYTX MD ADULT/30MIN MCAID
|
Facility
|
OP
|
$750.00
|
|
|
Service Code
|
HCPCS 90832
|
| Hospital Charge Code |
4822602
|
|
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 PSYTX MD ADULT/30MIN MCAID
|
Facility
|
IP
|
$750.00
|
|
|
Service Code
|
HCPCS 90832
|
| Hospital Charge Code |
4504602
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$112.50 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$112.50
|
|
|
IND PSYTX MD ADULT/30MIN MCAID
|
Facility
|
OP
|
$750.00
|
|
|
Service Code
|
HCPCS 90832
|
| Hospital Charge Code |
4504602
|
|
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 PSYTX MD ADULT/30MIN MCAID
|
Facility
|
OP
|
$750.00
|
|
|
Service Code
|
HCPCS 90832
|
| Hospital Charge Code |
4832602
|
|
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 PSYTX MD ADULT/30MIN MCAID
|
Facility
|
IP
|
$750.00
|
|
|
Service Code
|
HCPCS 90832
|
| Hospital Charge Code |
4502602
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$112.50 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$112.50
|
|
|
IND PSYTX MD ADULT/30MIN MCAID
|
Facility
|
IP
|
$750.00
|
|
|
Service Code
|
HCPCS 90832
|
| Hospital Charge Code |
4822602
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$112.50 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$112.50
|
|
|
IND PSYTX MD ADULT/30MIN MCAID
|
Facility
|
IP
|
$750.00
|
|
|
Service Code
|
HCPCS 90832
|
| Hospital Charge Code |
4832602
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$112.50 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$112.50
|
|
|
IND PSYTX MD ADULT/30MIN MCAID
|
Facility
|
IP
|
$750.00
|
|
|
Service Code
|
HCPCS 90832
|
| Hospital Charge Code |
4535602
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$112.50 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$112.50
|
|
|
IND PSYTX MD ADULT/30MIN MCAID
|
Facility
|
OP
|
$750.00
|
|
|
Service Code
|
HCPCS 90832
|
| Hospital Charge Code |
4818602
|
|
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 PSYTX MD ADULT/30MIN MCAID
|
Facility
|
IP
|
$750.00
|
|
|
Service Code
|
HCPCS 90832
|
| Hospital Charge Code |
4511602
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$112.50 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$112.50
|
|
|
IND PSYTX MD ADULT/30MIN MCAID
|
Facility
|
IP
|
$750.00
|
|
|
Service Code
|
HCPCS 90832
|
| Hospital Charge Code |
4818602
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$112.50 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$112.50
|
|
|
IND PSYTX MD ADULT/30MIN MCAID
|
Facility
|
OP
|
$750.00
|
|
|
Service Code
|
HCPCS 90832
|
| Hospital Charge Code |
4535602
|
|
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 PSYTX MD ADULT/30MIN MCAID
|
Facility
|
OP
|
$750.00
|
|
|
Service Code
|
HCPCS 90832
|
| Hospital Charge Code |
4502602
|
|
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 PSYTX MD ADULT/30MIN MCAID
|
Facility
|
OP
|
$750.00
|
|
|
Service Code
|
HCPCS 90832
|
| Hospital Charge Code |
4511602
|
|
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
|
|
