|
ROOM & BOARD SEMI2 DETOX
|
Facility
|
IP
|
$18,000.00
|
|
| Hospital Charge Code |
100920
|
|
Hospital Revenue Code
|
126
|
| Min. Negotiated Rate |
$2,700.00 |
| Max. Negotiated Rate |
$6,764.00 |
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$6,764.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,700.00
|
|
|
ROOM & BOARD SEMI2 PSYCH
|
Facility
|
IP
|
$18,000.00
|
|
| Hospital Charge Code |
100919
|
|
Hospital Revenue Code
|
124
|
| Min. Negotiated Rate |
$1,115.00 |
| Max. Negotiated Rate |
$3,360.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,115.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,360.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,700.00
|
|
|
ROOM & BOARD SEMI 5 TOWER
|
Facility
|
IP
|
$18,000.00
|
|
| Hospital Charge Code |
100904
|
|
Hospital Revenue Code
|
121
|
| Min. Negotiated Rate |
$2,312.00 |
| Max. Negotiated Rate |
$6,764.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,312.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$6,764.00
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$5,000.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,700.00
|
|
|
ROOM & BOARD SEMI 6 TOWER
|
Facility
|
IP
|
$18,000.00
|
|
| Hospital Charge Code |
100911
|
|
Hospital Revenue Code
|
121
|
| Min. Negotiated Rate |
$2,312.00 |
| Max. Negotiated Rate |
$6,764.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,312.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$6,764.00
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$5,000.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,700.00
|
|
|
ROOM & BOARD SEMI 7 TOWER
|
Facility
|
IP
|
$18,000.00
|
|
| Hospital Charge Code |
100914
|
|
Hospital Revenue Code
|
121
|
| Min. Negotiated Rate |
$2,312.00 |
| Max. Negotiated Rate |
$6,764.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,312.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$6,764.00
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$5,000.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,700.00
|
|
|
ROOM & BOARD SEMI 9E
|
Facility
|
IP
|
$18,000.00
|
|
| Hospital Charge Code |
100930
|
|
Hospital Revenue Code
|
121
|
| Min. Negotiated Rate |
$2,312.00 |
| Max. Negotiated Rate |
$6,764.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,312.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$6,764.00
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$5,000.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,700.00
|
|
|
ROOM & BOARD SEMI MTY
|
Facility
|
IP
|
$18,000.00
|
|
| Hospital Charge Code |
100936
|
|
Hospital Revenue Code
|
122
|
| Min. Negotiated Rate |
$2,312.00 |
| Max. Negotiated Rate |
$6,764.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,312.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$6,764.00
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$5,000.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,700.00
|
|
|
ROOM & BOARD STEPDOWN UNIT
|
Facility
|
IP
|
$18,000.00
|
|
| Hospital Charge Code |
100925
|
|
Hospital Revenue Code
|
206
|
| Min. Negotiated Rate |
$2,700.00 |
| Max. Negotiated Rate |
$8,116.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,755.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$8,116.00
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$5,000.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,700.00
|
|
|
ROOM & BOARD-TCU
|
Facility
|
IP
|
$18,000.00
|
|
| Hospital Charge Code |
101000
|
|
Hospital Revenue Code
|
120
|
| Min. Negotiated Rate |
$900.00 |
| Max. Negotiated Rate |
$6,764.00 |
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$6,764.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,700.00
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$900.00
|
|
|
ROOM & BOARD TCU PRIVATE
|
Facility
|
IP
|
$18,000.00
|
|
| Hospital Charge Code |
100821
|
|
Hospital Revenue Code
|
120
|
| Min. Negotiated Rate |
$900.00 |
| Max. Negotiated Rate |
$6,764.00 |
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$6,764.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,700.00
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$900.00
|
|
|
ROOM & BOARD TCU SEMI PRIVATE
|
Facility
|
IP
|
$18,000.00
|
|
| Hospital Charge Code |
100822
|
|
Hospital Revenue Code
|
120
|
| Min. Negotiated Rate |
$900.00 |
| Max. Negotiated Rate |
$6,764.00 |
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$6,764.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,700.00
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$900.00
|
|
|
ROOM & BOARD TELEMETRY
|
Facility
|
IP
|
$18,000.00
|
|
| Hospital Charge Code |
100091
|
|
Hospital Revenue Code
|
121
|
| Min. Negotiated Rate |
$2,312.00 |
| Max. Negotiated Rate |
$6,764.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,312.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$6,764.00
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$5,000.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,700.00
|
|
|
ROOM & BOARD-TELEMETRY
|
Facility
|
IP
|
$18,000.00
|
|
| Hospital Charge Code |
100980
|
|
Hospital Revenue Code
|
124
|
| Min. Negotiated Rate |
$1,115.00 |
| Max. Negotiated Rate |
$3,360.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,115.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,360.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,700.00
|
|
|
ROOM & BOARD-TELEMETRY
|
Facility
|
IP
|
$18,000.00
|
|
| Hospital Charge Code |
100992
|
|
Hospital Revenue Code
|
169
|
| Min. Negotiated Rate |
$2,700.00 |
| Max. Negotiated Rate |
$6,764.00 |
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$6,764.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,700.00
|
|
|
ROOM & BOARD-TELEMETRY
|
Facility
|
IP
|
$18,000.00
|
|
| Hospital Charge Code |
100988
|
|
Hospital Revenue Code
|
122
|
| Min. Negotiated Rate |
$2,312.00 |
| Max. Negotiated Rate |
$6,764.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,312.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$6,764.00
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$5,000.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,700.00
|
|
|
ROOM & BOARD-TELEMETRY
|
Facility
|
IP
|
$18,000.00
|
|
| Hospital Charge Code |
100986
|
|
Hospital Revenue Code
|
121
|
| Min. Negotiated Rate |
$2,312.00 |
| Max. Negotiated Rate |
$6,764.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,312.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$6,764.00
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$5,000.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,700.00
|
|
|
ROOM & BOARD-TELEMETRY
|
Facility
|
IP
|
$18,000.00
|
|
| Hospital Charge Code |
100991
|
|
Hospital Revenue Code
|
121
|
| Min. Negotiated Rate |
$2,312.00 |
| Max. Negotiated Rate |
$6,764.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,312.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$6,764.00
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$5,000.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,700.00
|
|
|
ROOM & BOARD-TELEMETRY
|
Facility
|
IP
|
$18,000.00
|
|
| Hospital Charge Code |
100983
|
|
Hospital Revenue Code
|
124
|
| Min. Negotiated Rate |
$1,115.00 |
| Max. Negotiated Rate |
$3,360.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,115.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,360.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,700.00
|
|
|
ROOM & BOARD-TELEMETRY
|
Facility
|
IP
|
$18,000.00
|
|
| Hospital Charge Code |
100987
|
|
Hospital Revenue Code
|
123
|
| Min. Negotiated Rate |
$2,312.00 |
| Max. Negotiated Rate |
$6,764.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,312.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$6,764.00
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$5,000.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,700.00
|
|
|
ROOM & BOARD-TELEMETRY
|
Facility
|
IP
|
$18,000.00
|
|
| Hospital Charge Code |
100972
|
|
Hospital Revenue Code
|
121
|
| Min. Negotiated Rate |
$2,312.00 |
| Max. Negotiated Rate |
$6,764.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,312.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$6,764.00
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$5,000.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,700.00
|
|
|
ROOM & BOARD-TELEMETRY
|
Facility
|
IP
|
$18,000.00
|
|
| Hospital Charge Code |
100993
|
|
Hospital Revenue Code
|
124
|
| Min. Negotiated Rate |
$1,115.00 |
| Max. Negotiated Rate |
$3,360.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,115.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,360.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,700.00
|
|
|
ROOM & BOARD-TELEMETRY
|
Facility
|
IP
|
$18,000.00
|
|
| Hospital Charge Code |
100982
|
|
Hospital Revenue Code
|
124
|
| Min. Negotiated Rate |
$1,115.00 |
| Max. Negotiated Rate |
$3,360.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,115.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,360.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,700.00
|
|
|
ROOM & BOARD-TELEMETRY
|
Facility
|
IP
|
$18,000.00
|
|
| Hospital Charge Code |
100989
|
|
Hospital Revenue Code
|
206
|
| Min. Negotiated Rate |
$2,700.00 |
| Max. Negotiated Rate |
$8,116.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,755.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$8,116.00
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$5,000.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,700.00
|
|
|
ROOM & BOARD-TELEMETRY
|
Facility
|
IP
|
$18,000.00
|
|
| Hospital Charge Code |
100973
|
|
Hospital Revenue Code
|
121
|
| Min. Negotiated Rate |
$2,312.00 |
| Max. Negotiated Rate |
$6,764.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,312.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$6,764.00
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$5,000.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,700.00
|
|
|
ROOM & BOARD-TELEMETRY
|
Facility
|
IP
|
$18,000.00
|
|
| Hospital Charge Code |
100985
|
|
Hospital Revenue Code
|
121
|
| Min. Negotiated Rate |
$2,312.00 |
| Max. Negotiated Rate |
$6,764.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,312.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$6,764.00
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$5,000.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,700.00
|
|