|
PSYCH-ED GROUP DISCHARGE PLAN
|
Facility
|
IP
|
$800.80
|
|
|
Service Code
|
HCPCS 90853
|
| Hospital Charge Code |
83246090
|
|
Hospital Revenue Code
|
915
|
| Min. Negotiated Rate |
$120.12 |
| Max. Negotiated Rate |
$120.12 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$120.12
|
|
|
PSYCH-ED GROUP DISCHARGE PLAN
|
Facility
|
OP
|
$800.80
|
|
|
Service Code
|
HCPCS 90853
|
| Hospital Charge Code |
83246090
|
|
Hospital Revenue Code
|
915
|
| Min. Negotiated Rate |
$27.48 |
| Max. Negotiated Rate |
$241.93 |
| Rate for Payer: Aetna Commercial |
$240.24
|
| Rate for Payer: Aetna Medicare Advantage |
$240.24
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$204.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$204.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$45.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$204.20
|
| Rate for Payer: Cigna Commercial |
$241.93
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$104.10
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$120.12
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$27.48
|
|
|
PSYCH-ED GROUP DISEASE GROUP
|
Facility
|
OP
|
$800.80
|
|
|
Service Code
|
HCPCS 90853
|
| Hospital Charge Code |
83246070
|
|
Hospital Revenue Code
|
915
|
| Min. Negotiated Rate |
$27.48 |
| Max. Negotiated Rate |
$241.93 |
| Rate for Payer: Aetna Commercial |
$240.24
|
| Rate for Payer: Aetna Medicare Advantage |
$240.24
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$204.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$204.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$45.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$204.20
|
| Rate for Payer: Cigna Commercial |
$241.93
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$104.10
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$120.12
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$27.48
|
|
|
PSYCH-ED GROUP DISEASE GROUP
|
Facility
|
IP
|
$800.80
|
|
|
Service Code
|
HCPCS 90853
|
| Hospital Charge Code |
83246070
|
|
Hospital Revenue Code
|
915
|
| Min. Negotiated Rate |
$120.12 |
| Max. Negotiated Rate |
$120.12 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$120.12
|
|
|
PSYCH-ED GROUP LEISURE AWARENE
|
Facility
|
IP
|
$800.80
|
|
| Hospital Charge Code |
24846080
|
|
Hospital Revenue Code
|
915
|
| Min. Negotiated Rate |
$120.12 |
| Max. Negotiated Rate |
$120.12 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$120.12
|
|
|
PSYCH-ED GROUP LEISURE AWARENE
|
Facility
|
IP
|
$800.80
|
|
|
Service Code
|
HCPCS 90853
|
| Hospital Charge Code |
83246080
|
|
Hospital Revenue Code
|
915
|
| Min. Negotiated Rate |
$120.12 |
| Max. Negotiated Rate |
$120.12 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$120.12
|
|
|
PSYCH-ED GROUP LEISURE AWARENE
|
Facility
|
OP
|
$800.80
|
|
|
Service Code
|
HCPCS 90853
|
| Hospital Charge Code |
83246080
|
|
Hospital Revenue Code
|
915
|
| Min. Negotiated Rate |
$27.48 |
| Max. Negotiated Rate |
$241.93 |
| Rate for Payer: Aetna Commercial |
$240.24
|
| Rate for Payer: Aetna Medicare Advantage |
$240.24
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$204.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$204.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$45.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$204.20
|
| Rate for Payer: Cigna Commercial |
$241.93
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$104.10
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$120.12
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$27.48
|
|
|
PSYCH-ED GROUP LEISURE AWARENE
|
Facility
|
IP
|
$800.80
|
|
| Hospital Charge Code |
24746080
|
|
Hospital Revenue Code
|
915
|
| Min. Negotiated Rate |
$120.12 |
| Max. Negotiated Rate |
$120.12 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$120.12
|
|
|
PSYCH-ED GROUP LEISURE AWARENE
|
Facility
|
OP
|
$800.80
|
|
| Hospital Charge Code |
24746080
|
|
Hospital Revenue Code
|
915
|
| Min. Negotiated Rate |
$104.10 |
| Max. Negotiated Rate |
$400.40 |
| Rate for Payer: Aetna Commercial |
$240.24
|
| Rate for Payer: Aetna Medicare Advantage |
$240.24
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$204.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$204.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$204.20
|
| Rate for Payer: Cigna Commercial |
$400.40
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$104.10
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$120.12
|
|
|
PSYCH-ED GROUP LEISURE AWARENE
|
Facility
|
OP
|
$800.80
|
|
| Hospital Charge Code |
24846080
|
|
Hospital Revenue Code
|
915
|
| Min. Negotiated Rate |
$104.10 |
| Max. Negotiated Rate |
$400.40 |
| Rate for Payer: Aetna Commercial |
$240.24
|
| Rate for Payer: Aetna Medicare Advantage |
$240.24
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$204.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$204.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$204.20
|
| Rate for Payer: Cigna Commercial |
$400.40
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$104.10
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$120.12
|
|
|
PSYCH-ED GROUP MEDICATION
|
Facility
|
IP
|
$800.80
|
|
|
Service Code
|
HCPCS 90853
|
| Hospital Charge Code |
83246030
|
|
Hospital Revenue Code
|
915
|
| Min. Negotiated Rate |
$120.12 |
| Max. Negotiated Rate |
$120.12 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$120.12
|
|
|
PSYCH-ED GROUP MEDICATION
|
Facility
|
OP
|
$800.80
|
|
|
Service Code
|
HCPCS 90853
|
| Hospital Charge Code |
83246030
|
|
Hospital Revenue Code
|
915
|
| Min. Negotiated Rate |
$27.48 |
| Max. Negotiated Rate |
$241.93 |
| Rate for Payer: Aetna Commercial |
$240.24
|
| Rate for Payer: Aetna Medicare Advantage |
$240.24
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$204.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$204.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$45.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$204.20
|
| Rate for Payer: Cigna Commercial |
$241.93
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$104.10
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$120.12
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$27.48
|
|
|
PSYCH-ED GROUP RELAXATION GROU
|
Facility
|
OP
|
$800.80
|
|
| Hospital Charge Code |
24846095
|
|
Hospital Revenue Code
|
915
|
| Min. Negotiated Rate |
$104.10 |
| Max. Negotiated Rate |
$400.40 |
| Rate for Payer: Aetna Commercial |
$240.24
|
| Rate for Payer: Aetna Medicare Advantage |
$240.24
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$204.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$204.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$204.20
|
| Rate for Payer: Cigna Commercial |
$400.40
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$104.10
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$120.12
|
|
|
PSYCH-ED GROUP RELAXATION GROU
|
Facility
|
IP
|
$800.80
|
|
| Hospital Charge Code |
24746095
|
|
Hospital Revenue Code
|
915
|
| Min. Negotiated Rate |
$120.12 |
| Max. Negotiated Rate |
$120.12 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$120.12
|
|
|
PSYCH-ED GROUP RELAXATION GROU
|
Facility
|
IP
|
$800.80
|
|
| Hospital Charge Code |
24846095
|
|
Hospital Revenue Code
|
915
|
| Min. Negotiated Rate |
$120.12 |
| Max. Negotiated Rate |
$120.12 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$120.12
|
|
|
PSYCH-ED GROUP RELAXATION GROU
|
Facility
|
OP
|
$800.80
|
|
|
Service Code
|
HCPCS 90853
|
| Hospital Charge Code |
83246095
|
|
Hospital Revenue Code
|
915
|
| Min. Negotiated Rate |
$27.48 |
| Max. Negotiated Rate |
$241.93 |
| Rate for Payer: Aetna Commercial |
$240.24
|
| Rate for Payer: Aetna Medicare Advantage |
$240.24
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$204.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$204.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$45.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$204.20
|
| Rate for Payer: Cigna Commercial |
$241.93
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$104.10
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$120.12
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$27.48
|
|
|
PSYCH-ED GROUP RELAXATION GROU
|
Facility
|
IP
|
$800.80
|
|
|
Service Code
|
HCPCS 90853
|
| Hospital Charge Code |
83246095
|
|
Hospital Revenue Code
|
915
|
| Min. Negotiated Rate |
$120.12 |
| Max. Negotiated Rate |
$120.12 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$120.12
|
|
|
PSYCH-ED GROUP RELAXATION GROU
|
Facility
|
OP
|
$800.80
|
|
| Hospital Charge Code |
24746095
|
|
Hospital Revenue Code
|
915
|
| Min. Negotiated Rate |
$104.10 |
| Max. Negotiated Rate |
$400.40 |
| Rate for Payer: Aetna Commercial |
$240.24
|
| Rate for Payer: Aetna Medicare Advantage |
$240.24
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$204.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$204.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$204.20
|
| Rate for Payer: Cigna Commercial |
$400.40
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$104.10
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$120.12
|
|
|
PSYCH-ED GROUP SELF ESTEEM
|
Facility
|
OP
|
$800.80
|
|
|
Service Code
|
HCPCS 90853
|
| Hospital Charge Code |
83246040
|
|
Hospital Revenue Code
|
915
|
| Min. Negotiated Rate |
$27.48 |
| Max. Negotiated Rate |
$241.93 |
| Rate for Payer: Aetna Commercial |
$240.24
|
| Rate for Payer: Aetna Medicare Advantage |
$240.24
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$204.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$204.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$45.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$204.20
|
| Rate for Payer: Cigna Commercial |
$241.93
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$104.10
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$120.12
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$27.48
|
|
|
PSYCH-ED GROUP SELF ESTEEM
|
Facility
|
IP
|
$800.80
|
|
|
Service Code
|
HCPCS 90853
|
| Hospital Charge Code |
83246040
|
|
Hospital Revenue Code
|
915
|
| Min. Negotiated Rate |
$120.12 |
| Max. Negotiated Rate |
$120.12 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$120.12
|
|
|
PSYCH-ED GROUP SLEEP/DISCOMFOR
|
Facility
|
IP
|
$800.80
|
|
|
Service Code
|
HCPCS 90853
|
| Hospital Charge Code |
83246075
|
|
Hospital Revenue Code
|
915
|
| Min. Negotiated Rate |
$120.12 |
| Max. Negotiated Rate |
$120.12 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$120.12
|
|
|
PSYCH-ED GROUP SLEEP/DISCOMFOR
|
Facility
|
OP
|
$800.80
|
|
|
Service Code
|
HCPCS 90853
|
| Hospital Charge Code |
83246075
|
|
Hospital Revenue Code
|
915
|
| Min. Negotiated Rate |
$27.48 |
| Max. Negotiated Rate |
$241.93 |
| Rate for Payer: Aetna Commercial |
$240.24
|
| Rate for Payer: Aetna Medicare Advantage |
$240.24
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$204.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$204.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$45.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$204.20
|
| Rate for Payer: Cigna Commercial |
$241.93
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$104.10
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$120.12
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$27.48
|
|
|
PSYCH-ED GROUP STRESS/COPING
|
Facility
|
OP
|
$800.80
|
|
|
Service Code
|
HCPCS 90853
|
| Hospital Charge Code |
83246055
|
|
Hospital Revenue Code
|
915
|
| Min. Negotiated Rate |
$27.48 |
| Max. Negotiated Rate |
$241.93 |
| Rate for Payer: Aetna Commercial |
$240.24
|
| Rate for Payer: Aetna Medicare Advantage |
$240.24
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$204.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$204.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$45.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$204.20
|
| Rate for Payer: Cigna Commercial |
$241.93
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$104.10
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$120.12
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$27.48
|
|
|
PSYCH-ED GROUP STRESS/COPING
|
Facility
|
IP
|
$800.80
|
|
|
Service Code
|
HCPCS 90853
|
| Hospital Charge Code |
83246055
|
|
Hospital Revenue Code
|
915
|
| Min. Negotiated Rate |
$120.12 |
| Max. Negotiated Rate |
$120.12 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$120.12
|
|
|
PSYCH-ED WRAP UP GROUP
|
Facility
|
OP
|
$800.80
|
|
|
Service Code
|
HCPCS 90853
|
| Hospital Charge Code |
83246065
|
|
Hospital Revenue Code
|
915
|
| Min. Negotiated Rate |
$27.48 |
| Max. Negotiated Rate |
$241.93 |
| Rate for Payer: Aetna Commercial |
$240.24
|
| Rate for Payer: Aetna Medicare Advantage |
$240.24
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$204.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$204.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$45.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$204.20
|
| Rate for Payer: Cigna Commercial |
$241.93
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$104.10
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$120.12
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$27.48
|
|
