|
PSYDX EVAL NONMD CHILD CAID
|
Facility
|
OP
|
$6,800.00
|
|
|
Service Code
|
HCPCS 90791
|
| Hospital Charge Code |
4822630
|
|
Hospital Revenue Code
|
918
|
| 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
|
|
|
PSYDX EVAL NONMD CHILD CAID
|
Facility
|
OP
|
$6,800.00
|
|
|
Service Code
|
HCPCS 90791
|
| Hospital Charge Code |
4824609
|
|
Hospital Revenue Code
|
918
|
| 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
|
|
|
PSYDX EVAL NONMD CHILD CAID
|
Facility
|
IP
|
$6,800.00
|
|
|
Service Code
|
HCPCS 90791
|
| Hospital Charge Code |
4511609
|
|
Hospital Revenue Code
|
918
|
| Min. Negotiated Rate |
$1,020.00 |
| Max. Negotiated Rate |
$1,020.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,020.00
|
|
|
PSYDX EVAL NONMD CHILD CAID
|
Facility
|
OP
|
$6,800.00
|
|
|
Service Code
|
HCPCS 90791
|
| Hospital Charge Code |
4511609
|
|
Hospital Revenue Code
|
918
|
| 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
|
|
|
PSYDX EVAL NONMD CHILD CAID
|
Facility
|
OP
|
$6,800.00
|
|
|
Service Code
|
HCPCS 90791
|
| Hospital Charge Code |
4527609
|
|
Hospital Revenue Code
|
918
|
| 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
|
|
|
PSYDX EVAL NONMD CHILD CAID
|
Facility
|
IP
|
$6,800.00
|
|
|
Service Code
|
HCPCS 90791
|
| Hospital Charge Code |
4504609
|
|
Hospital Revenue Code
|
918
|
| Min. Negotiated Rate |
$1,020.00 |
| Max. Negotiated Rate |
$1,020.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,020.00
|
|
|
PSYDX EVAL NONMD CHILD CAID
|
Facility
|
IP
|
$6,800.00
|
|
|
Service Code
|
HCPCS 90791
|
| Hospital Charge Code |
4824630
|
|
Hospital Revenue Code
|
918
|
| Min. Negotiated Rate |
$1,020.00 |
| Max. Negotiated Rate |
$1,020.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,020.00
|
|
|
PSYDX EVAL NONMD CHILD CAID
|
Facility
|
IP
|
$6,800.00
|
|
|
Service Code
|
HCPCS 90791
|
| Hospital Charge Code |
4527609
|
|
Hospital Revenue Code
|
918
|
| Min. Negotiated Rate |
$1,020.00 |
| Max. Negotiated Rate |
$1,020.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,020.00
|
|
|
PSYDX EVAL NONMD CHILD CAID
|
Facility
|
OP
|
$6,800.00
|
|
|
Service Code
|
HCPCS 90791
|
| Hospital Charge Code |
4515609
|
|
Hospital Revenue Code
|
918
|
| 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
|
|
|
PSYDX EVAL NONMD CHILD CAID
|
Facility
|
IP
|
$6,800.00
|
|
|
Service Code
|
HCPCS 90791
|
| Hospital Charge Code |
4517609
|
|
Hospital Revenue Code
|
918
|
| Min. Negotiated Rate |
$1,020.00 |
| Max. Negotiated Rate |
$1,020.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,020.00
|
|
|
PSYDX EVAL NONMD CHILD CAID
|
Facility
|
OP
|
$6,800.00
|
|
|
Service Code
|
HCPCS 90791
|
| Hospital Charge Code |
4510630
|
|
Hospital Revenue Code
|
918
|
| 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
|
|
|
PSYDX EVAL NONMD CHILD CAID
|
Facility
|
IP
|
$6,800.00
|
|
|
Service Code
|
HCPCS 90791
|
| Hospital Charge Code |
4510630
|
|
Hospital Revenue Code
|
918
|
| Min. Negotiated Rate |
$1,020.00 |
| Max. Negotiated Rate |
$1,020.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,020.00
|
|
|
PSYDX EVAL NONMD CHILD CAID
|
Facility
|
OP
|
$6,800.00
|
|
|
Service Code
|
HCPCS 90791
|
| Hospital Charge Code |
4517609
|
|
Hospital Revenue Code
|
918
|
| 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
|
|
|
PSYDX EVAL NONMD CHILD CAID
|
Facility
|
IP
|
$6,800.00
|
|
|
Service Code
|
HCPCS 90791
|
| Hospital Charge Code |
4509630
|
|
Hospital Revenue Code
|
918
|
| Min. Negotiated Rate |
$1,020.00 |
| Max. Negotiated Rate |
$1,020.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,020.00
|
|
|
PSYDX EVAL NONMD CHILD CAID
|
Facility
|
IP
|
$6,800.00
|
|
|
Service Code
|
HCPCS 90791
|
| Hospital Charge Code |
4832609
|
|
Hospital Revenue Code
|
918
|
| Min. Negotiated Rate |
$1,020.00 |
| Max. Negotiated Rate |
$1,020.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,020.00
|
|
|
PSYDX EVAL NONMD CHILD CAID
|
Facility
|
IP
|
$6,800.00
|
|
|
Service Code
|
HCPCS 90791
|
| Hospital Charge Code |
4822630
|
|
Hospital Revenue Code
|
918
|
| Min. Negotiated Rate |
$1,020.00 |
| Max. Negotiated Rate |
$1,020.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,020.00
|
|
|
PSYDX EVAL NONMD CHILD CAID
|
Facility
|
OP
|
$6,800.00
|
|
|
Service Code
|
HCPCS 90791
|
| Hospital Charge Code |
4832609
|
|
Hospital Revenue Code
|
918
|
| 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
|
|
|
PSYDX EVAL NONMD CHILD CAID
|
Facility
|
IP
|
$6,800.00
|
|
|
Service Code
|
HCPCS 90791
|
| Hospital Charge Code |
4518609
|
|
Hospital Revenue Code
|
918
|
| Min. Negotiated Rate |
$1,020.00 |
| Max. Negotiated Rate |
$1,020.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,020.00
|
|
|
PSYDX EVAL NONMD CHILD CAID
|
Facility
|
OP
|
$6,800.00
|
|
|
Service Code
|
HCPCS 90791
|
| Hospital Charge Code |
4518609
|
|
Hospital Revenue Code
|
918
|
| 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
|
|
|
PSYDX EVAL NONMD CHILD CAID
|
Facility
|
OP
|
$6,800.00
|
|
|
Service Code
|
HCPCS 90791
|
| Hospital Charge Code |
4509630
|
|
Hospital Revenue Code
|
918
|
| 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
|
|
|
PSY-ED GR MEDS REINFORCEM
|
Facility
|
IP
|
$800.80
|
|
|
Service Code
|
HCPCS 90853
|
| Hospital Charge Code |
83246115
|
|
Hospital Revenue Code
|
915
|
| Min. Negotiated Rate |
$120.12 |
| Max. Negotiated Rate |
$120.12 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$120.12
|
|
|
PSY-ED GR MEDS REINFORCEM
|
Facility
|
OP
|
$800.80
|
|
|
Service Code
|
HCPCS 90853
|
| Hospital Charge Code |
83246115
|
|
Hospital Revenue Code
|
915
|
| Min. Negotiated Rate |
$22.74 |
| Max. Negotiated Rate |
$437.80 |
| Rate for Payer: Aetna Commercial |
$328.28
|
| Rate for Payer: Aetna Medicare Advantage |
$391.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$437.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$437.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$120.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$36.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$437.80
|
| Rate for Payer: Cigna Commercial |
$241.93
|
| Rate for Payer: Cigna Medicare Advantage |
$120.69
|
| Rate for Payer: Clover Medicare Advantage |
$114.66
|
| Rate for Payer: EmblemHealth Commercial |
$362.07
|
| Rate for Payer: Humana Medicare Advantage |
$124.31
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$120.69
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$208.21
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$120.12
|
| Rate for Payer: UnitedHealthcare Community & State |
$25.31
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$120.69
|
| Rate for Payer: Wellcare Medicare Advantage |
$120.69
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$27.48
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$22.74
|
|
|
PSYLLIUM 3.5 G PACKET
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
NDC 38485080855
|
| Hospital Charge Code |
60628136
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$2.00 |
| Rate for Payer: Aetna Commercial |
$1.52
|
| Rate for Payer: Aetna Medicare Advantage |
$1.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1.02
|
| Rate for Payer: Cigna Commercial |
$2.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1.04
|
| Rate for Payer: Oxford Commercial |
$0.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.60
|
| Rate for Payer: UnitedHealthcare Commercial |
$0.80
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.13
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.11
|
|
|
PSYLLIUM 3.5 G PACKET
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
NDC 38485080855
|
| Hospital Charge Code |
60628136
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$0.60 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.60
|
|
|
PT ADD WALKER TO CAST
|
Facility
|
IP
|
$468.75
|
|
|
Service Code
|
HCPCS 29440GP
|
| Hospital Charge Code |
422529440
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$70.31 |
| Max. Negotiated Rate |
$70.31 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$70.31
|
|
