|
RECOVERY: 91-105 MINS
|
Facility
|
IP
|
$1,930.00
|
|
| Hospital Charge Code |
93500131
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$289.50 |
| Max. Negotiated Rate |
$289.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$289.50
|
|
|
RECOVERY: 91-105 MINS
|
Facility
|
OP
|
$1,930.00
|
|
| Hospital Charge Code |
93500131
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$250.90 |
| Max. Negotiated Rate |
$965.00 |
| Rate for Payer: Aetna Commercial |
$579.00
|
| Rate for Payer: Aetna Medicare Advantage |
$579.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$492.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$492.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$492.15
|
| Rate for Payer: Cigna Commercial |
$965.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$250.90
|
| Rate for Payer: Oxford Commercial |
$965.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$289.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$965.00
|
|
|
RECOVERY ADDITIONAL 1/2 HOUR
|
Facility
|
IP
|
$551.50
|
|
| Hospital Charge Code |
93500176
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$82.72 |
| Max. Negotiated Rate |
$82.72 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$82.72
|
|
|
RECOVERY ADDITIONAL 1/2 HOUR
|
Facility
|
OP
|
$551.50
|
|
| Hospital Charge Code |
93500176
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$71.69 |
| Max. Negotiated Rate |
$275.75 |
| Rate for Payer: Aetna Commercial |
$165.45
|
| Rate for Payer: Aetna Medicare Advantage |
$165.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$140.63
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$140.63
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$140.63
|
| Rate for Payer: Cigna Commercial |
$275.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$71.69
|
| Rate for Payer: Oxford Commercial |
$275.75
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$82.72
|
| Rate for Payer: UnitedHealthcare Commercial |
$275.75
|
|
|
RECOVERY ADDITIONAL 1 HR
|
Facility
|
IP
|
$1,103.00
|
|
| Hospital Charge Code |
93500174
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$165.45 |
| Max. Negotiated Rate |
$165.45 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$165.45
|
|
|
RECOVERY ADDITIONAL 1 HR
|
Facility
|
OP
|
$1,103.00
|
|
| Hospital Charge Code |
93500174
|
|
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 EXTEND/HR AFTER 3
|
Facility
|
IP
|
$664.00
|
|
| Hospital Charge Code |
73190156
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$99.60 |
| Max. Negotiated Rate |
$99.60 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$99.60
|
|
|
RECOVERY EXTEND/HR AFTER 3
|
Facility
|
OP
|
$664.00
|
|
| Hospital Charge Code |
73190156
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$86.32 |
| Max. Negotiated Rate |
$332.00 |
| Rate for Payer: Aetna Commercial |
$199.20
|
| Rate for Payer: Aetna Medicare Advantage |
$199.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$169.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$169.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$169.32
|
| Rate for Payer: Cigna Commercial |
$332.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$86.32
|
| Rate for Payer: Oxford Commercial |
$332.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$99.60
|
| Rate for Payer: UnitedHealthcare Commercial |
$332.00
|
|
|
RECOVERY FILTER SYSTEM RF310F
|
Facility
|
IP
|
$6,975.00
|
|
| Hospital Charge Code |
270635339
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,046.25 |
| Max. Negotiated Rate |
$1,046.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,046.25
|
|
|
RECOVERY FILTER SYSTEM RF310F
|
Facility
|
OP
|
$6,975.00
|
|
| Hospital Charge Code |
270635339
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$906.75 |
| Max. Negotiated Rate |
$3,487.50 |
| Rate for Payer: Aetna Commercial |
$2,092.50
|
| Rate for Payer: Aetna Medicare Advantage |
$2,092.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,778.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,778.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,778.62
|
| Rate for Payer: Cigna Commercial |
$3,487.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$906.75
|
| Rate for Payer: Oxford Commercial |
$3,487.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,046.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$3,487.50
|
|
|
RECOVERY INITIAL HOUR
|
Facility
|
IP
|
$1,103.00
|
|
| Hospital Charge Code |
93500172
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$165.45 |
| Max. Negotiated Rate |
$165.45 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$165.45
|
|
|
RECOVERY INITIAL HOUR
|
Facility
|
OP
|
$1,103.00
|
|
| Hospital Charge Code |
93500172
|
|
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 REMOVAL SYSTEM
|
Facility
|
OP
|
$4,350.00
|
|
| Hospital Charge Code |
270676335
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$565.50 |
| Max. Negotiated Rate |
$2,175.00 |
| Rate for Payer: Aetna Commercial |
$1,305.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,305.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,109.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,109.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,109.25
|
| Rate for Payer: Cigna Commercial |
$2,175.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$565.50
|
| Rate for Payer: Oxford Commercial |
$2,175.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$652.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,175.00
|
|
|
RECOVERY REMOVAL SYSTEM
|
Facility
|
IP
|
$4,350.00
|
|
| Hospital Charge Code |
270676335
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$652.50 |
| Max. Negotiated Rate |
$652.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$652.50
|
|
|
RECOVERY UP TO 1 HR (NON-PACU)
|
Facility
|
IP
|
$800.00
|
|
| Hospital Charge Code |
1001188
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$120.00 |
| Max. Negotiated Rate |
$120.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$120.00
|
|
|
RECOVERY UP TO 1 HR (NON-PACU)
|
Facility
|
IP
|
$800.00
|
|
| Hospital Charge Code |
41101000
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$120.00 |
| Max. Negotiated Rate |
$120.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$120.00
|
|
|
RECOVERY UP TO 1 HR (NON-PACU)
|
Facility
|
OP
|
$800.00
|
|
| Hospital Charge Code |
1001188
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$104.00 |
| Max. Negotiated Rate |
$400.00 |
| Rate for Payer: Aetna Commercial |
$240.00
|
| Rate for Payer: Aetna Medicare Advantage |
$240.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$204.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$204.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$204.00
|
| Rate for Payer: Cigna Commercial |
$400.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$104.00
|
| Rate for Payer: Oxford Commercial |
$400.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$120.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$400.00
|
|
|
RECOVERY UP TO 1 HR (NON-PACU)
|
Facility
|
OP
|
$800.00
|
|
| Hospital Charge Code |
41101000
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$104.00 |
| Max. Negotiated Rate |
$400.00 |
| Rate for Payer: Aetna Commercial |
$240.00
|
| Rate for Payer: Aetna Medicare Advantage |
$240.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$204.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$204.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$204.00
|
| Rate for Payer: Cigna Commercial |
$400.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$104.00
|
| Rate for Payer: Oxford Commercial |
$400.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$120.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$400.00
|
|
|
RECOV ROOM 1 1/2 TO 2 HRS
|
Facility
|
OP
|
$4,797.91
|
|
| Hospital Charge Code |
1500040
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$623.73 |
| Max. Negotiated Rate |
$2,398.95 |
| Rate for Payer: Aetna Commercial |
$1,439.37
|
| Rate for Payer: Aetna Medicare Advantage |
$1,439.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,223.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,223.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,223.47
|
| Rate for Payer: Cigna Commercial |
$2,398.95
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$623.73
|
| Rate for Payer: Oxford Commercial |
$2,398.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$719.69
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,398.95
|
|
|
RECOV ROOM 1 1/2 TO 2 HRS
|
Facility
|
IP
|
$4,797.91
|
|
| Hospital Charge Code |
1500040
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$719.69 |
| Max. Negotiated Rate |
$719.69 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$719.69
|
|
|
RECOV ROOM 1 HOUR
|
Facility
|
IP
|
$2,423.40
|
|
| Hospital Charge Code |
41101010
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$363.51 |
| Max. Negotiated Rate |
$363.51 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$363.51
|
|
|
RECOV ROOM 1 HOUR
|
Facility
|
IP
|
$3,198.55
|
|
| Hospital Charge Code |
1500024
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$479.78 |
| Max. Negotiated Rate |
$479.78 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$479.78
|
|
|
RECOV ROOM 1 HOUR
|
Facility
|
OP
|
$3,198.55
|
|
| Hospital Charge Code |
1500024
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$415.81 |
| Max. Negotiated Rate |
$1,599.28 |
| Rate for Payer: Aetna Commercial |
$959.57
|
| Rate for Payer: Aetna Medicare Advantage |
$959.57
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$815.63
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$815.63
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$815.63
|
| Rate for Payer: Cigna Commercial |
$1,599.28
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$415.81
|
| Rate for Payer: Oxford Commercial |
$1,599.28
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$479.78
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,599.28
|
|
|
RECOV ROOM 1 HOUR
|
Facility
|
OP
|
$2,423.40
|
|
| Hospital Charge Code |
41101010
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$315.04 |
| Max. Negotiated Rate |
$1,211.70 |
| Rate for Payer: Aetna Commercial |
$727.02
|
| Rate for Payer: Aetna Medicare Advantage |
$727.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$617.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$617.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$617.97
|
| Rate for Payer: Cigna Commercial |
$1,211.70
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$315.04
|
| Rate for Payer: Oxford Commercial |
$1,211.70
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$363.51
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,211.70
|
|
|
RECOV ROOM < 1 HR
|
Facility
|
OP
|
$2,398.87
|
|
| Hospital Charge Code |
1500020
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$311.85 |
| Max. Negotiated Rate |
$1,199.43 |
| Rate for Payer: Aetna Commercial |
$719.66
|
| Rate for Payer: Aetna Medicare Advantage |
$719.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$611.71
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$611.71
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$611.71
|
| Rate for Payer: Cigna Commercial |
$1,199.43
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$311.85
|
| Rate for Payer: Oxford Commercial |
$1,199.43
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$359.83
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,199.43
|
|