|
ROOM & BOARD 2A - PRIVATE
|
Facility
|
IP
|
$18,000.00
|
|
| Hospital Charge Code |
100017
|
|
Hospital Revenue Code
|
110
|
| 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 2E PRIVATE
|
Facility
|
IP
|
$18,000.00
|
|
| Hospital Charge Code |
100941
|
|
Hospital Revenue Code
|
111
|
| 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 2E SEMI
|
Facility
|
IP
|
$18,000.00
|
|
| Hospital Charge Code |
100940
|
|
Hospital Revenue Code
|
121
|
| Min. Negotiated Rate |
$2,086.00 |
| Max. Negotiated Rate |
$6,764.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,086.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$6,764.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,700.00
|
|
|
ROOM & BOARD 2R
|
Facility
|
IP
|
$18,000.00
|
|
| Hospital Charge Code |
100024
|
|
Hospital Revenue Code
|
121
|
| Min. Negotiated Rate |
$2,086.00 |
| Max. Negotiated Rate |
$6,764.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,086.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$6,764.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,700.00
|
|
|
ROOM & BOARD 3R
|
Facility
|
IP
|
$18,000.00
|
|
| Hospital Charge Code |
100057
|
|
Hospital Revenue Code
|
121
|
| Min. Negotiated Rate |
$2,086.00 |
| Max. Negotiated Rate |
$6,764.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,086.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$6,764.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,700.00
|
|
|
ROOM & BOARD 3R - PRIVATE
|
Facility
|
IP
|
$18,000.00
|
|
| Hospital Charge Code |
100058
|
|
Hospital Revenue Code
|
141
|
| 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 3 SEMI TOWER
|
Facility
|
IP
|
$18,000.00
|
|
| Hospital Charge Code |
100901
|
|
Hospital Revenue Code
|
121
|
| Min. Negotiated Rate |
$2,086.00 |
| Max. Negotiated Rate |
$6,764.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,086.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$6,764.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,700.00
|
|
|
ROOM & BOARD 4NORTH-PRIVATE
|
Facility
|
IP
|
$18,000.00
|
|
| Hospital Charge Code |
100810
|
|
Hospital Revenue Code
|
121
|
| Min. Negotiated Rate |
$2,086.00 |
| Max. Negotiated Rate |
$6,764.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,086.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$6,764.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,700.00
|
|
|
ROOM & BOARD 4R
|
Facility
|
IP
|
$18,000.00
|
|
| Hospital Charge Code |
100065
|
|
Hospital Revenue Code
|
121
|
| Min. Negotiated Rate |
$2,086.00 |
| Max. Negotiated Rate |
$6,764.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,086.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$6,764.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,700.00
|
|
|
ROOM & BOARD 4R - PRIVATE
|
Facility
|
IP
|
$18,000.00
|
|
| Hospital Charge Code |
100066
|
|
Hospital Revenue Code
|
141
|
| 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 5R
|
Facility
|
IP
|
$18,000.00
|
|
| Hospital Charge Code |
100073
|
|
Hospital Revenue Code
|
121
|
| Min. Negotiated Rate |
$2,086.00 |
| Max. Negotiated Rate |
$6,764.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,086.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$6,764.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,700.00
|
|
|
ROOM & BOARD 5R - PRIVATE
|
Facility
|
IP
|
$18,000.00
|
|
| Hospital Charge Code |
100074
|
|
Hospital Revenue Code
|
141
|
| 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 5R - PRIVATE
|
Facility
|
IP
|
$18,000.00
|
|
| Hospital Charge Code |
1000074
|
|
Hospital Revenue Code
|
111
|
| 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 6SO-ISOLATION
|
Facility
|
IP
|
$18,000.00
|
|
| Hospital Charge Code |
100808
|
|
Hospital Revenue Code
|
164
|
| 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 6SO-PRIVATE
|
Facility
|
IP
|
$18,000.00
|
|
| Hospital Charge Code |
100805
|
|
Hospital Revenue Code
|
111
|
| 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 6SO-SEMI PRIVATE
|
Facility
|
IP
|
$18,000.00
|
|
| Hospital Charge Code |
100806
|
|
Hospital Revenue Code
|
121
|
| Min. Negotiated Rate |
$2,086.00 |
| Max. Negotiated Rate |
$6,764.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,086.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$6,764.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,700.00
|
|
|
ROOM & BOARD CCIS - ISOLATION
|
Facility
|
IP
|
$18,000.00
|
|
| Hospital Charge Code |
100803
|
|
Hospital Revenue Code
|
164
|
| 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 CCU
|
Facility
|
IP
|
$20,000.00
|
|
| Hospital Charge Code |
100149
|
|
Hospital Revenue Code
|
219
|
| Min. Negotiated Rate |
$2,670.00 |
| Max. Negotiated Rate |
$3,000.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,670.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,000.00
|
|
|
ROOM & BOARD CRITICAL CAR 9E
|
Facility
|
IP
|
$18,000.00
|
|
| Hospital Charge Code |
100931
|
|
Hospital Revenue Code
|
211
|
| Min. Negotiated Rate |
$2,670.00 |
| Max. Negotiated Rate |
$2,700.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,670.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,700.00
|
|
|
ROOM & BOARD ENDOSCOPY
|
Facility
|
OP
|
$2,236.00
|
|
| Hospital Charge Code |
100156
|
|
Hospital Revenue Code
|
499
|
| Min. Negotiated Rate |
$290.68 |
| Max. Negotiated Rate |
$1,118.00 |
| Rate for Payer: Aetna Commercial |
$670.80
|
| Rate for Payer: Aetna Medicare Advantage |
$670.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$570.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$570.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$570.18
|
| Rate for Payer: Cigna Commercial |
$1,118.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$290.68
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$335.40
|
|
|
ROOM & BOARD ENDOSCOPY
|
Facility
|
IP
|
$2,236.00
|
|
| Hospital Charge Code |
100156
|
|
Hospital Revenue Code
|
499
|
| Min. Negotiated Rate |
$335.40 |
| Max. Negotiated Rate |
$335.40 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$335.40
|
|
|
ROOM & BOARD ER
|
Facility
|
IP
|
$18,000.00
|
|
| Hospital Charge Code |
100131
|
|
Hospital Revenue Code
|
121
|
| Min. Negotiated Rate |
$2,086.00 |
| Max. Negotiated Rate |
$6,764.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,086.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$6,764.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,700.00
|
|
|
ROOM & BOARD ERH-SEMI PRIVATE
|
Facility
|
IP
|
$18,000.00
|
|
| Hospital Charge Code |
100804
|
|
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 ICU
|
Facility
|
IP
|
$20,000.00
|
|
| Hospital Charge Code |
100962
|
|
Hospital Revenue Code
|
200
|
| Min. Negotiated Rate |
$2,670.00 |
| Max. Negotiated Rate |
$8,793.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,670.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$8,793.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,000.00
|
|
|
ROOM & BOARD ICU
|
Facility
|
IP
|
$20,000.00
|
|
| Hospital Charge Code |
100123
|
|
Hospital Revenue Code
|
209
|
| Min. Negotiated Rate |
$2,670.00 |
| Max. Negotiated Rate |
$8,793.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,670.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$8,793.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,000.00
|
|