|
RECOV EA ADD 30 MIN (NON-PACU)
|
Facility
|
OP
|
$400.00
|
|
| Hospital Charge Code |
41101005
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$52.00 |
| Max. Negotiated Rate |
$200.00 |
| Rate for Payer: Aetna Commercial |
$120.00
|
| Rate for Payer: Aetna Medicare Advantage |
$120.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$102.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$102.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$102.00
|
| Rate for Payer: Cigna Commercial |
$200.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$52.00
|
| Rate for Payer: Oxford Commercial |
$200.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$60.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$200.00
|
|
|
RECOV EA ADD 30 MIN (NON-PACU)
|
Facility
|
OP
|
$400.00
|
|
| Hospital Charge Code |
1001189
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$52.00 |
| Max. Negotiated Rate |
$200.00 |
| Rate for Payer: Aetna Commercial |
$120.00
|
| Rate for Payer: Aetna Medicare Advantage |
$120.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$102.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$102.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$102.00
|
| Rate for Payer: Cigna Commercial |
$200.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$52.00
|
| Rate for Payer: Oxford Commercial |
$200.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$60.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$200.00
|
|
|
RECOV EA ADD 30 MIN (NON-PACU)
|
Facility
|
IP
|
$400.00
|
|
| Hospital Charge Code |
1001189
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$60.00 |
| Max. Negotiated Rate |
$60.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$60.00
|
|
|
RECOVERY: 106-120 MINS
|
Facility
|
OP
|
$2,205.00
|
|
| Hospital Charge Code |
93500109
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$286.65 |
| Max. Negotiated Rate |
$1,102.50 |
| Rate for Payer: Aetna Commercial |
$661.50
|
| Rate for Payer: Aetna Medicare Advantage |
$661.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$562.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$562.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$562.27
|
| Rate for Payer: Cigna Commercial |
$1,102.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$286.65
|
| Rate for Payer: Oxford Commercial |
$1,102.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$330.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,102.50
|
|
|
RECOVERY: 106-120 MINS
|
Facility
|
IP
|
$2,205.00
|
|
| Hospital Charge Code |
93500109
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$330.75 |
| Max. Negotiated Rate |
$330.75 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$330.75
|
|
|
RECOVERY: 1-15 MINS
|
Facility
|
OP
|
$276.00
|
|
| Hospital Charge Code |
93500111
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$35.88 |
| Max. Negotiated Rate |
$138.00 |
| Rate for Payer: Aetna Commercial |
$82.80
|
| Rate for Payer: Aetna Medicare Advantage |
$82.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$70.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$70.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$70.38
|
| Rate for Payer: Cigna Commercial |
$138.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$35.88
|
| Rate for Payer: Oxford Commercial |
$138.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$41.40
|
| Rate for Payer: UnitedHealthcare Commercial |
$138.00
|
|
|
RECOVERY: 1-15 MINS
|
Facility
|
IP
|
$276.00
|
|
| Hospital Charge Code |
93500111
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$41.40 |
| Max. Negotiated Rate |
$41.40 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$41.40
|
|
|
RECOVERY: 121-135 MINS
|
Facility
|
IP
|
$2,418.00
|
|
| Hospital Charge Code |
93500113
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$362.70 |
| Max. Negotiated Rate |
$362.70 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$362.70
|
|
|
RECOVERY: 121-135 MINS
|
Facility
|
OP
|
$2,418.00
|
|
| Hospital Charge Code |
93500113
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$314.34 |
| Max. Negotiated Rate |
$1,209.00 |
| Rate for Payer: Aetna Commercial |
$725.40
|
| Rate for Payer: Aetna Medicare Advantage |
$725.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$616.59
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$616.59
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$616.59
|
| Rate for Payer: Cigna Commercial |
$1,209.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$314.34
|
| Rate for Payer: Oxford Commercial |
$1,209.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$362.70
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,209.00
|
|
|
RECOVERY: 136-150 MINS
|
Facility
|
IP
|
$2,756.00
|
|
| Hospital Charge Code |
93500115
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$413.40 |
| Max. Negotiated Rate |
$413.40 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$413.40
|
|
|
RECOVERY: 136-150 MINS
|
Facility
|
OP
|
$2,756.00
|
|
| Hospital Charge Code |
93500115
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$358.28 |
| Max. Negotiated Rate |
$1,378.00 |
| Rate for Payer: Aetna Commercial |
$826.80
|
| Rate for Payer: Aetna Medicare Advantage |
$826.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$702.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$702.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$702.78
|
| Rate for Payer: Cigna Commercial |
$1,378.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$358.28
|
| Rate for Payer: Oxford Commercial |
$1,378.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$413.40
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,378.00
|
|
|
RECOVERY: 151-165 MINS
|
Facility
|
IP
|
$3,032.00
|
|
| Hospital Charge Code |
93500117
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$454.80 |
| Max. Negotiated Rate |
$454.80 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$454.80
|
|
|
RECOVERY: 151-165 MINS
|
Facility
|
OP
|
$3,032.00
|
|
| Hospital Charge Code |
93500117
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$394.16 |
| Max. Negotiated Rate |
$1,516.00 |
| Rate for Payer: Aetna Commercial |
$909.60
|
| Rate for Payer: Aetna Medicare Advantage |
$909.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$773.16
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$773.16
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$773.16
|
| Rate for Payer: Cigna Commercial |
$1,516.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$394.16
|
| Rate for Payer: Oxford Commercial |
$1,516.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$454.80
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,516.00
|
|
|
RECOVERY: 16-30 MINS
|
Facility
|
OP
|
$551.00
|
|
| Hospital Charge Code |
93500119
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$71.63 |
| Max. Negotiated Rate |
$275.50 |
| Rate for Payer: Aetna Commercial |
$165.30
|
| Rate for Payer: Aetna Medicare Advantage |
$165.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$140.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$140.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$140.50
|
| Rate for Payer: Cigna Commercial |
$275.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$71.63
|
| Rate for Payer: Oxford Commercial |
$275.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$82.65
|
| Rate for Payer: UnitedHealthcare Commercial |
$275.50
|
|
|
RECOVERY: 16-30 MINS
|
Facility
|
IP
|
$551.00
|
|
| Hospital Charge Code |
93500119
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$82.65 |
| Max. Negotiated Rate |
$82.65 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$82.65
|
|
|
RECOVERY: 166-180 MINS
|
Facility
|
OP
|
$3,308.00
|
|
| Hospital Charge Code |
93500121
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$430.04 |
| Max. Negotiated Rate |
$1,654.00 |
| Rate for Payer: Aetna Commercial |
$992.40
|
| Rate for Payer: Aetna Medicare Advantage |
$992.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$843.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$843.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$843.54
|
| Rate for Payer: Cigna Commercial |
$1,654.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$430.04
|
| Rate for Payer: Oxford Commercial |
$1,654.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$496.20
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,654.00
|
|
|
RECOVERY: 166-180 MINS
|
Facility
|
IP
|
$3,308.00
|
|
| Hospital Charge Code |
93500121
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$496.20 |
| Max. Negotiated Rate |
$496.20 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$496.20
|
|
|
RECOVERY: 31-45 MINS
|
Facility
|
OP
|
$827.00
|
|
| Hospital Charge Code |
93500123
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$107.51 |
| Max. Negotiated Rate |
$413.50 |
| Rate for Payer: Aetna Commercial |
$248.10
|
| Rate for Payer: Aetna Medicare Advantage |
$248.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$210.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$210.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$210.88
|
| Rate for Payer: Cigna Commercial |
$413.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$107.51
|
| Rate for Payer: Oxford Commercial |
$413.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$124.05
|
| Rate for Payer: UnitedHealthcare Commercial |
$413.50
|
|
|
RECOVERY: 31-45 MINS
|
Facility
|
IP
|
$827.00
|
|
| Hospital Charge Code |
93500123
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$124.05 |
| Max. Negotiated Rate |
$124.05 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$124.05
|
|
|
RECOVERY: 46-60 MINS
|
Facility
|
OP
|
$1,103.00
|
|
| Hospital Charge Code |
93500125
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$143.39 |
| Max. Negotiated Rate |
$551.50 |
| Rate for Payer: Aetna Commercial |
$330.90
|
| Rate for Payer: Aetna Medicare Advantage |
$330.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$281.26
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$281.26
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$281.26
|
| Rate for Payer: Cigna Commercial |
$551.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$143.39
|
| Rate for Payer: Oxford Commercial |
$551.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$165.45
|
| Rate for Payer: UnitedHealthcare Commercial |
$551.50
|
|
|
RECOVERY: 46-60 MINS
|
Facility
|
IP
|
$1,103.00
|
|
| Hospital Charge Code |
93500125
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$165.45 |
| Max. Negotiated Rate |
$165.45 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$165.45
|
|
|
RECOVERY: 61-75 MINS
|
Facility
|
OP
|
$1,379.00
|
|
| Hospital Charge Code |
93500127
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$179.27 |
| Max. Negotiated Rate |
$689.50 |
| Rate for Payer: Aetna Commercial |
$413.70
|
| Rate for Payer: Aetna Medicare Advantage |
$413.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$351.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$351.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$351.64
|
| Rate for Payer: Cigna Commercial |
$689.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$179.27
|
| Rate for Payer: Oxford Commercial |
$689.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$206.85
|
| Rate for Payer: UnitedHealthcare Commercial |
$689.50
|
|
|
RECOVERY: 61-75 MINS
|
Facility
|
IP
|
$1,379.00
|
|
| Hospital Charge Code |
93500127
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$206.85 |
| Max. Negotiated Rate |
$206.85 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$206.85
|
|
|
RECOVERY: 76-90 MINS
|
Facility
|
OP
|
$1,654.00
|
|
| Hospital Charge Code |
93500129
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$215.02 |
| Max. Negotiated Rate |
$827.00 |
| Rate for Payer: Aetna Commercial |
$496.20
|
| Rate for Payer: Aetna Medicare Advantage |
$496.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$421.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$421.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$421.77
|
| Rate for Payer: Cigna Commercial |
$827.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$215.02
|
| Rate for Payer: Oxford Commercial |
$827.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$248.10
|
| Rate for Payer: UnitedHealthcare Commercial |
$827.00
|
|
|
RECOVERY: 76-90 MINS
|
Facility
|
IP
|
$1,654.00
|
|
| Hospital Charge Code |
93500129
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$248.10 |
| Max. Negotiated Rate |
$248.10 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$248.10
|
|