|
IND PSYCHOTX W E&M MD 45 MIN
|
Facility
|
OP
|
$425.00
|
|
|
Service Code
|
HCPCS 90836
|
| Hospital Charge Code |
4504705
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$12.07 |
| Max. Negotiated Rate |
$212.50 |
| Rate for Payer: Aetna Commercial |
$161.50
|
| 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 |
$118.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$108.38
|
| Rate for Payer: Cigna Commercial |
$212.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$110.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$63.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$13.43
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$94.46
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$12.07
|
|
|
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 |
$12.07 |
| Max. Negotiated Rate |
$212.50 |
| Rate for Payer: Aetna Commercial |
$161.50
|
| 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 |
$118.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$108.38
|
| Rate for Payer: Cigna Commercial |
$212.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$110.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$63.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$13.43
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$94.46
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$12.07
|
|
|
IND PSYCHOTX W E&M MD 45 MIN
|
Facility
|
OP
|
$425.00
|
|
|
Service Code
|
HCPCS 90836
|
| Hospital Charge Code |
4818705
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$12.07 |
| Max. Negotiated Rate |
$212.50 |
| Rate for Payer: Aetna Commercial |
$161.50
|
| 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 |
$118.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$108.38
|
| Rate for Payer: Cigna Commercial |
$212.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$110.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$63.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$13.43
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$94.46
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$12.07
|
|
|
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 |
$12.07 |
| Max. Negotiated Rate |
$212.50 |
| Rate for Payer: Aetna Commercial |
$161.50
|
| 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 |
$118.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$108.38
|
| Rate for Payer: Cigna Commercial |
$212.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$110.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$63.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$13.43
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$94.46
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$12.07
|
|
|
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
|
OP
|
$425.00
|
|
|
Service Code
|
HCPCS 90836
|
| Hospital Charge Code |
4824705
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$12.07 |
| Max. Negotiated Rate |
$212.50 |
| Rate for Payer: Aetna Commercial |
$161.50
|
| 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 |
$118.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$108.38
|
| Rate for Payer: Cigna Commercial |
$212.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$110.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$63.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$13.43
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$94.46
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$12.07
|
|
|
IND PSYCHOTX W E&M MD 45 MIN
|
Facility
|
OP
|
$425.00
|
|
|
Service Code
|
HCPCS 90836
|
| Hospital Charge Code |
4535705
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$12.07 |
| Max. Negotiated Rate |
$212.50 |
| Rate for Payer: Aetna Commercial |
$161.50
|
| 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 |
$118.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$108.38
|
| Rate for Payer: Cigna Commercial |
$212.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$110.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$63.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$13.43
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$94.46
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$12.07
|
|
|
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 |
4510705
|
|
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 |
$12.07 |
| Max. Negotiated Rate |
$212.50 |
| Rate for Payer: Aetna Commercial |
$161.50
|
| 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 |
$118.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$108.38
|
| Rate for Payer: Cigna Commercial |
$212.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$110.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$63.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$13.43
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$94.46
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$12.07
|
|
|
IND PSYCHOTX W E&M MD 45 MIN
|
Facility
|
OP
|
$425.00
|
|
|
Service Code
|
HCPCS 90836
|
| Hospital Charge Code |
4517705
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$12.07 |
| Max. Negotiated Rate |
$212.50 |
| Rate for Payer: Aetna Commercial |
$161.50
|
| 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 |
$118.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$108.38
|
| Rate for Payer: Cigna Commercial |
$212.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$110.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$63.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$13.43
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$94.46
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$12.07
|
|
|
IND PSYCHOTX W E&M MD 45 MIN
|
Facility
|
IP
|
$425.00
|
|
|
Service Code
|
HCPCS 90836
|
| Hospital Charge Code |
4527705
|
|
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 |
4504705
|
|
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 |
4515705
|
|
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
|
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 |
4509705
|
|
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 |
4818705
|
|
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 |
4502705
|
|
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 |
4515705
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$12.07 |
| Max. Negotiated Rate |
$212.50 |
| Rate for Payer: Aetna Commercial |
$161.50
|
| 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 |
$118.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$108.38
|
| Rate for Payer: Cigna Commercial |
$212.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$110.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$63.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$13.43
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$94.46
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$12.07
|
|
|
IND PSYCHOTX W E&M MD 45 MIN
|
Facility
|
OP
|
$425.00
|
|
|
Service Code
|
HCPCS 90836
|
| Hospital Charge Code |
4510705
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$12.07 |
| Max. Negotiated Rate |
$212.50 |
| Rate for Payer: Aetna Commercial |
$161.50
|
| 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 |
$118.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$108.38
|
| Rate for Payer: Cigna Commercial |
$212.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$110.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$63.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$13.43
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$94.46
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$12.07
|
|
|
IND PSYCHOTX W E&M MD 45 MIN
|
Facility
|
OP
|
$425.00
|
|
|
Service Code
|
HCPCS 90836
|
| Hospital Charge Code |
4502705
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$12.07 |
| Max. Negotiated Rate |
$212.50 |
| Rate for Payer: Aetna Commercial |
$161.50
|
| 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 |
$118.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$108.38
|
| Rate for Payer: Cigna Commercial |
$212.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$110.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$63.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$13.43
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$94.46
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$12.07
|
|
|
IND PSYCHOTX W E&M MD 45 MIN
|
Facility
|
IP
|
$425.00
|
|
|
Service Code
|
HCPCS 90836
|
| Hospital Charge Code |
4518705
|
|
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 |
4511705
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$12.07 |
| Max. Negotiated Rate |
$212.50 |
| Rate for Payer: Aetna Commercial |
$161.50
|
| 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 |
$118.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$108.38
|
| Rate for Payer: Cigna Commercial |
$212.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$110.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$63.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$13.43
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$94.46
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$12.07
|
|
|
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
|
|