|
PSYCH DIAG EVAL MD
|
Facility
|
IP
|
$6,800.00
|
|
|
Service Code
|
HCPCS 90792
|
| Hospital Charge Code |
4517700
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$1,020.00 |
| Max. Negotiated Rate |
$1,020.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,020.00
|
|
|
PSYCH DIAG EVAL MD
|
Facility
|
IP
|
$6,800.00
|
|
|
Service Code
|
HCPCS 90792
|
| Hospital Charge Code |
4832700
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$1,020.00 |
| Max. Negotiated Rate |
$1,020.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,020.00
|
|
|
PSYCH DIAG EVAL NON MD ADULT
|
Facility
|
IP
|
$6,800.00
|
|
|
Service Code
|
HCPCS 90791
|
| Hospital Charge Code |
4818502
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$1,020.00 |
| Max. Negotiated Rate |
$1,020.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,020.00
|
|
|
PSYCH DIAG EVAL NON MD ADULT
|
Facility
|
IP
|
$6,800.00
|
|
|
Service Code
|
HCPCS 90791
|
| Hospital Charge Code |
4822502
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$1,020.00 |
| Max. Negotiated Rate |
$1,020.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,020.00
|
|
|
PSYCH DIAG EVAL NON MD ADULT
|
Facility
|
IP
|
$6,800.00
|
|
|
Service Code
|
HCPCS 90791
|
| Hospital Charge Code |
4504502
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$1,020.00 |
| Max. Negotiated Rate |
$1,020.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,020.00
|
|
|
PSYCH DIAG EVAL NON MD ADULT
|
Facility
|
OP
|
$6,800.00
|
|
|
Service Code
|
HCPCS 90791
|
| Hospital Charge Code |
4504502
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$171.99 |
| Max. Negotiated Rate |
$3,080.00 |
| Rate for Payer: Aetna Commercial |
$573.57
|
| Rate for Payer: Aetna Medicare Advantage |
$683.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$764.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$764.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$210.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$246.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$764.93
|
| Rate for Payer: Cigna Commercial |
$422.69
|
| Rate for Payer: Cigna Medicare Advantage |
$210.87
|
| Rate for Payer: Clover Medicare Advantage |
$200.33
|
| Rate for Payer: EmblemHealth Commercial |
$632.61
|
| Rate for Payer: Humana Medicare Advantage |
$217.20
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$210.87
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,768.00
|
| Rate for Payer: Oxford Commercial |
$2,715.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,020.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$3,080.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$214.88
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$210.87
|
| Rate for Payer: Wellcare Medicare Advantage |
$210.87
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$171.99
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$193.12
|
|
|
PSYCH DIAG EVAL NON MD ADULT
|
Facility
|
OP
|
$6,800.00
|
|
|
Service Code
|
HCPCS 90791
|
| Hospital Charge Code |
4822502
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$171.99 |
| Max. Negotiated Rate |
$3,080.00 |
| Rate for Payer: Aetna Commercial |
$573.57
|
| Rate for Payer: Aetna Medicare Advantage |
$683.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$764.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$764.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$210.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$246.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$764.93
|
| Rate for Payer: Cigna Commercial |
$422.69
|
| Rate for Payer: Cigna Medicare Advantage |
$210.87
|
| Rate for Payer: Clover Medicare Advantage |
$200.33
|
| Rate for Payer: EmblemHealth Commercial |
$632.61
|
| Rate for Payer: Humana Medicare Advantage |
$217.20
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$210.87
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,768.00
|
| Rate for Payer: Oxford Commercial |
$2,715.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,020.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$3,080.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$214.88
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$210.87
|
| Rate for Payer: Wellcare Medicare Advantage |
$210.87
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$171.99
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$193.12
|
|
|
PSYCH DIAG EVAL NON MD ADULT
|
Facility
|
OP
|
$6,800.00
|
|
|
Service Code
|
HCPCS 90791
|
| Hospital Charge Code |
4818502
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$171.99 |
| Max. Negotiated Rate |
$3,080.00 |
| Rate for Payer: Aetna Commercial |
$573.57
|
| Rate for Payer: Aetna Medicare Advantage |
$683.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$764.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$764.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$210.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$246.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$764.93
|
| Rate for Payer: Cigna Commercial |
$422.69
|
| Rate for Payer: Cigna Medicare Advantage |
$210.87
|
| Rate for Payer: Clover Medicare Advantage |
$200.33
|
| Rate for Payer: EmblemHealth Commercial |
$632.61
|
| Rate for Payer: Humana Medicare Advantage |
$217.20
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$210.87
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,768.00
|
| Rate for Payer: Oxford Commercial |
$2,715.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,020.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$3,080.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$214.88
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$210.87
|
| Rate for Payer: Wellcare Medicare Advantage |
$210.87
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$171.99
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$193.12
|
|
|
PSYCH DIAG EVAL NON MD ADULT
|
Facility
|
IP
|
$6,800.00
|
|
|
Service Code
|
HCPCS 90791
|
| Hospital Charge Code |
4511502
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$1,020.00 |
| Max. Negotiated Rate |
$1,020.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,020.00
|
|
|
PSYCH DIAG EVAL NON MD ADULT
|
Facility
|
OP
|
$6,800.00
|
|
|
Service Code
|
HCPCS 90791
|
| Hospital Charge Code |
4511502
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$171.99 |
| Max. Negotiated Rate |
$3,080.00 |
| Rate for Payer: Aetna Commercial |
$573.57
|
| Rate for Payer: Aetna Medicare Advantage |
$683.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$764.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$764.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$210.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$246.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$764.93
|
| Rate for Payer: Cigna Commercial |
$422.69
|
| Rate for Payer: Cigna Medicare Advantage |
$210.87
|
| Rate for Payer: Clover Medicare Advantage |
$200.33
|
| Rate for Payer: EmblemHealth Commercial |
$632.61
|
| Rate for Payer: Humana Medicare Advantage |
$217.20
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$210.87
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,768.00
|
| Rate for Payer: Oxford Commercial |
$2,715.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,020.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$3,080.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$214.88
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$210.87
|
| Rate for Payer: Wellcare Medicare Advantage |
$210.87
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$171.99
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$193.12
|
|
|
PSYCH DIAG EVAL NON MD ADULT
|
Facility
|
IP
|
$6,800.00
|
|
|
Service Code
|
HCPCS 90791
|
| Hospital Charge Code |
4535502
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$1,020.00 |
| Max. Negotiated Rate |
$1,020.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,020.00
|
|
|
PSYCH DIAG EVAL NON MD ADULT
|
Facility
|
IP
|
$6,800.00
|
|
|
Service Code
|
HCPCS 90791
|
| Hospital Charge Code |
4832502
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$1,020.00 |
| Max. Negotiated Rate |
$1,020.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,020.00
|
|
|
PSYCH DIAG EVAL NON MD ADULT
|
Facility
|
IP
|
$6,800.00
|
|
|
Service Code
|
HCPCS 90791
|
| Hospital Charge Code |
4512502
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$1,020.00 |
| Max. Negotiated Rate |
$1,020.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,020.00
|
|
|
PSYCH DIAG EVAL NON MD ADULT
|
Facility
|
OP
|
$6,800.00
|
|
|
Service Code
|
HCPCS 90791
|
| Hospital Charge Code |
4535502
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$171.99 |
| Max. Negotiated Rate |
$3,080.00 |
| Rate for Payer: Aetna Commercial |
$573.57
|
| Rate for Payer: Aetna Medicare Advantage |
$683.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$764.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$764.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$210.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$246.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$764.93
|
| Rate for Payer: Cigna Commercial |
$422.69
|
| Rate for Payer: Cigna Medicare Advantage |
$210.87
|
| Rate for Payer: Clover Medicare Advantage |
$200.33
|
| Rate for Payer: EmblemHealth Commercial |
$632.61
|
| Rate for Payer: Humana Medicare Advantage |
$217.20
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$210.87
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,768.00
|
| Rate for Payer: Oxford Commercial |
$2,715.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,020.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$3,080.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$214.88
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$210.87
|
| Rate for Payer: Wellcare Medicare Advantage |
$210.87
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$171.99
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$193.12
|
|
|
PSYCH DIAG EVAL NON MD ADULT
|
Facility
|
OP
|
$6,800.00
|
|
|
Service Code
|
HCPCS 90791
|
| Hospital Charge Code |
4832502
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$171.99 |
| Max. Negotiated Rate |
$3,080.00 |
| Rate for Payer: Aetna Commercial |
$573.57
|
| Rate for Payer: Aetna Medicare Advantage |
$683.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$764.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$764.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$210.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$246.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$764.93
|
| Rate for Payer: Cigna Commercial |
$422.69
|
| Rate for Payer: Cigna Medicare Advantage |
$210.87
|
| Rate for Payer: Clover Medicare Advantage |
$200.33
|
| Rate for Payer: EmblemHealth Commercial |
$632.61
|
| Rate for Payer: Humana Medicare Advantage |
$217.20
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$210.87
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,768.00
|
| Rate for Payer: Oxford Commercial |
$2,715.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,020.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$3,080.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$214.88
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$210.87
|
| Rate for Payer: Wellcare Medicare Advantage |
$210.87
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$171.99
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$193.12
|
|
|
PSYCH DIAG EVAL NON MD ADULT
|
Facility
|
OP
|
$6,800.00
|
|
|
Service Code
|
HCPCS 90791
|
| Hospital Charge Code |
4512502
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$171.99 |
| Max. Negotiated Rate |
$3,080.00 |
| Rate for Payer: Aetna Commercial |
$573.57
|
| Rate for Payer: Aetna Medicare Advantage |
$683.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$764.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$764.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$210.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$246.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$764.93
|
| Rate for Payer: Cigna Commercial |
$422.69
|
| Rate for Payer: Cigna Medicare Advantage |
$210.87
|
| Rate for Payer: Clover Medicare Advantage |
$200.33
|
| Rate for Payer: EmblemHealth Commercial |
$632.61
|
| Rate for Payer: Humana Medicare Advantage |
$217.20
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$210.87
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,768.00
|
| Rate for Payer: Oxford Commercial |
$2,715.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,020.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$3,080.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$214.88
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$210.87
|
| Rate for Payer: Wellcare Medicare Advantage |
$210.87
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$171.99
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$193.12
|
|
|
PSYCH DIAG EVAL NON MD ADULT
|
Facility
|
IP
|
$6,800.00
|
|
|
Service Code
|
HCPCS 90791
|
| Hospital Charge Code |
4509502
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$1,020.00 |
| Max. Negotiated Rate |
$1,020.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,020.00
|
|
|
PSYCH DIAG EVAL NON MD ADULT
|
Facility
|
IP
|
$6,800.00
|
|
|
Service Code
|
HCPCS 90791
|
| Hospital Charge Code |
4502502
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$1,020.00 |
| Max. Negotiated Rate |
$1,020.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,020.00
|
|
|
PSYCH DIAG EVAL NON MD ADULT
|
Facility
|
OP
|
$6,800.00
|
|
|
Service Code
|
HCPCS 90791
|
| Hospital Charge Code |
4509502
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$171.99 |
| Max. Negotiated Rate |
$3,080.00 |
| Rate for Payer: Aetna Commercial |
$573.57
|
| Rate for Payer: Aetna Medicare Advantage |
$683.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$764.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$764.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$210.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$246.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$764.93
|
| Rate for Payer: Cigna Commercial |
$422.69
|
| Rate for Payer: Cigna Medicare Advantage |
$210.87
|
| Rate for Payer: Clover Medicare Advantage |
$200.33
|
| Rate for Payer: EmblemHealth Commercial |
$632.61
|
| Rate for Payer: Humana Medicare Advantage |
$217.20
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$210.87
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,768.00
|
| Rate for Payer: Oxford Commercial |
$2,715.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,020.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$3,080.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$214.88
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$210.87
|
| Rate for Payer: Wellcare Medicare Advantage |
$210.87
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$171.99
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$193.12
|
|
|
PSYCH DIAG EVAL NON MD ADULT
|
Facility
|
OP
|
$6,800.00
|
|
|
Service Code
|
HCPCS 90791
|
| Hospital Charge Code |
4502502
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$171.99 |
| Max. Negotiated Rate |
$3,080.00 |
| Rate for Payer: Aetna Commercial |
$573.57
|
| Rate for Payer: Aetna Medicare Advantage |
$683.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$764.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$764.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$210.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$246.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$764.93
|
| Rate for Payer: Cigna Commercial |
$422.69
|
| Rate for Payer: Cigna Medicare Advantage |
$210.87
|
| Rate for Payer: Clover Medicare Advantage |
$200.33
|
| Rate for Payer: EmblemHealth Commercial |
$632.61
|
| Rate for Payer: Humana Medicare Advantage |
$217.20
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$210.87
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,768.00
|
| Rate for Payer: Oxford Commercial |
$2,715.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,020.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$3,080.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$214.88
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$210.87
|
| Rate for Payer: Wellcare Medicare Advantage |
$210.87
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$171.99
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$193.12
|
|
|
PSYCH DIAG EVAL NON MD CHILD
|
Facility
|
IP
|
$6,800.00
|
|
|
Service Code
|
HCPCS 90791
|
| Hospital Charge Code |
4509503
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$1,020.00 |
| Max. Negotiated Rate |
$1,020.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,020.00
|
|
|
PSYCH DIAG EVAL NON MD CHILD
|
Facility
|
IP
|
$6,800.00
|
|
|
Service Code
|
HCPCS 90791
|
| Hospital Charge Code |
4510503
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$1,020.00 |
| Max. Negotiated Rate |
$1,020.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,020.00
|
|
|
PSYCH DIAG EVAL NON MD CHILD
|
Facility
|
OP
|
$6,800.00
|
|
|
Service Code
|
HCPCS 90791
|
| Hospital Charge Code |
4546503
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$171.99 |
| Max. Negotiated Rate |
$3,080.00 |
| Rate for Payer: Aetna Commercial |
$573.57
|
| Rate for Payer: Aetna Medicare Advantage |
$683.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$764.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$764.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$210.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$246.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$764.93
|
| Rate for Payer: Cigna Commercial |
$422.69
|
| Rate for Payer: Cigna Medicare Advantage |
$210.87
|
| Rate for Payer: Clover Medicare Advantage |
$200.33
|
| Rate for Payer: EmblemHealth Commercial |
$632.61
|
| Rate for Payer: Humana Medicare Advantage |
$217.20
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$210.87
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,768.00
|
| Rate for Payer: Oxford Commercial |
$2,715.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,020.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$3,080.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$214.88
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$210.87
|
| Rate for Payer: Wellcare Medicare Advantage |
$210.87
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$171.99
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$193.12
|
|
|
PSYCH DIAG EVAL NON MD CHILD
|
Facility
|
OP
|
$6,800.00
|
|
|
Service Code
|
HCPCS 90791
|
| Hospital Charge Code |
4527503
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$171.99 |
| Max. Negotiated Rate |
$3,080.00 |
| Rate for Payer: Aetna Commercial |
$573.57
|
| Rate for Payer: Aetna Medicare Advantage |
$683.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$764.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$764.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$210.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$246.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$764.93
|
| Rate for Payer: Cigna Commercial |
$422.69
|
| Rate for Payer: Cigna Medicare Advantage |
$210.87
|
| Rate for Payer: Clover Medicare Advantage |
$200.33
|
| Rate for Payer: EmblemHealth Commercial |
$632.61
|
| Rate for Payer: Humana Medicare Advantage |
$217.20
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$210.87
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,768.00
|
| Rate for Payer: Oxford Commercial |
$2,715.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,020.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$3,080.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$214.88
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$210.87
|
| Rate for Payer: Wellcare Medicare Advantage |
$210.87
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$171.99
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$193.12
|
|
|
PSYCH DIAG EVAL NON MD CHILD
|
Facility
|
OP
|
$6,800.00
|
|
|
Service Code
|
HCPCS 90791
|
| Hospital Charge Code |
4518503
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$171.99 |
| Max. Negotiated Rate |
$3,080.00 |
| Rate for Payer: Aetna Commercial |
$573.57
|
| Rate for Payer: Aetna Medicare Advantage |
$683.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$764.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$764.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$210.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$246.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$764.93
|
| Rate for Payer: Cigna Commercial |
$422.69
|
| Rate for Payer: Cigna Medicare Advantage |
$210.87
|
| Rate for Payer: Clover Medicare Advantage |
$200.33
|
| Rate for Payer: EmblemHealth Commercial |
$632.61
|
| Rate for Payer: Humana Medicare Advantage |
$217.20
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$210.87
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,768.00
|
| Rate for Payer: Oxford Commercial |
$2,715.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,020.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$3,080.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$214.88
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$210.87
|
| Rate for Payer: Wellcare Medicare Advantage |
$210.87
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$171.99
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$193.12
|
|
