|
ROOM & BOARD ICU
|
Facility
|
IP
|
$20,000.00
|
|
| Hospital Charge Code |
100923
|
|
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 |
100995
|
|
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-4N
|
Facility
|
IP
|
$20,000.00
|
|
| Hospital Charge Code |
100819
|
|
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-MEDICAL
|
Facility
|
IP
|
$20,000.00
|
|
| Hospital Charge Code |
100817
|
|
Hospital Revenue Code
|
202
|
| 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 IMCU
|
Facility
|
IP
|
$18,000.00
|
|
| Hospital Charge Code |
100172
|
|
Hospital Revenue Code
|
206
|
| Min. Negotiated Rate |
$2,274.00 |
| Max. Negotiated Rate |
$8,116.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,274.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$8,116.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,700.00
|
|
|
ROOM & BOARD L&D
|
Facility
|
IP
|
$25,000.00
|
|
| Hospital Charge Code |
100929
|
|
Hospital Revenue Code
|
122
|
| 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 |
$3,750.00
|
|
|
ROOM & BOARD MED/SURG
|
Facility
|
IP
|
$18,000.00
|
|
| Hospital Charge Code |
100095
|
|
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-MED SURG
|
Facility
|
IP
|
$18,000.00
|
|
| Hospital Charge Code |
100096
|
|
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-MED SURG
|
Facility
|
IP
|
$18,000.00
|
|
| Hospital Charge Code |
100999
|
|
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-MED SURG
|
Facility
|
IP
|
$18,000.00
|
|
| Hospital Charge Code |
100997
|
|
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-MED SURG
|
Facility
|
IP
|
$18,000.00
|
|
| Hospital Charge Code |
100998
|
|
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-MED SURG
|
Facility
|
IP
|
$18,000.00
|
|
| Hospital Charge Code |
100996
|
|
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 MED/SURG 9P
|
Facility
|
IP
|
$18,000.00
|
|
| Hospital Charge Code |
100927
|
|
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-MED SURG PRIVATE
|
Facility
|
IP
|
$18,000.00
|
|
| Hospital Charge Code |
100969
|
|
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 M/S
|
Facility
|
IP
|
$18,000.00
|
|
| Hospital Charge Code |
100015
|
|
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-M/S SEMIPRIVATE
|
Facility
|
IP
|
$18,000.00
|
|
| Hospital Charge Code |
100970
|
|
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 MTY
|
Facility
|
IP
|
$14,500.00
|
|
| Hospital Charge Code |
100921
|
|
Hospital Revenue Code
|
122
|
| 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 |
$2,175.00
|
|
|
ROOM & BOARD NURSERY
|
Facility
|
IP
|
$2,400.00
|
|
| Hospital Charge Code |
100115
|
|
Hospital Revenue Code
|
171
|
| Min. Negotiated Rate |
$360.00 |
| Max. Negotiated Rate |
$2,435.00 |
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,435.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$360.00
|
|
|
ROOM & BOARD NURSERY A
|
Facility
|
IP
|
$18,000.00
|
|
| Hospital Charge Code |
100922
|
|
Hospital Revenue Code
|
171
|
| Min. Negotiated Rate |
$2,435.00 |
| Max. Negotiated Rate |
$2,700.00 |
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,435.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,700.00
|
|
|
ROOM & BOARD NURSERY LEVEL 1
|
Facility
|
IP
|
$18,000.00
|
|
| Hospital Charge Code |
100814
|
|
Hospital Revenue Code
|
171
|
| Min. Negotiated Rate |
$2,435.00 |
| Max. Negotiated Rate |
$2,700.00 |
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,435.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,700.00
|
|
|
ROOM & BOARD OB
|
Facility
|
IP
|
$25,000.00
|
|
| Hospital Charge Code |
100816
|
|
Hospital Revenue Code
|
122
|
| 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 |
$3,750.00
|
|
|
ROOM & BOARD OB
|
Facility
|
IP
|
$2,875.00
|
|
| Hospital Charge Code |
100107
|
|
Hospital Revenue Code
|
122
|
| Min. Negotiated Rate |
$431.25 |
| 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 |
$431.25
|
|
|
ROOM & BOARD OB - PRIVATE
|
Facility
|
IP
|
$2,950.00
|
|
| Hospital Charge Code |
100108
|
|
Hospital Revenue Code
|
142
|
| Min. Negotiated Rate |
$442.50 |
| 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 |
$442.50
|
|
|
ROOM & BOARD OB - PRIVATE
|
Facility
|
IP
|
$2,650.00
|
|
| Hospital Charge Code |
100109
|
|
Hospital Revenue Code
|
110
|
| Min. Negotiated Rate |
$397.50 |
| 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 |
$397.50
|
|
|
ROOM & BOARD ONCOL
|
Facility
|
IP
|
$1,427.25
|
|
| Hospital Charge Code |
100164
|
|
Hospital Revenue Code
|
127
|
| Min. Negotiated Rate |
$214.09 |
| 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 |
$214.09
|
|