|
ROOM & BOARD PEDS
|
Facility
|
IP
|
$18,000.00
|
|
| Hospital Charge Code |
100099
|
|
Hospital Revenue Code
|
123
|
| 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 PEDS
|
Facility
|
IP
|
$18,000.00
|
|
| Hospital Charge Code |
100907
|
|
Hospital Revenue Code
|
123
|
| 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 PEDS - PRIVATE
|
Facility
|
IP
|
$18,000.00
|
|
| Hospital Charge Code |
100100
|
|
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 PRI 3 TOWER
|
Facility
|
IP
|
$18,000.00
|
|
| Hospital Charge Code |
100902
|
|
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 PRI 4 TOWER
|
Facility
|
IP
|
$18,000.00
|
|
| Hospital Charge Code |
100909
|
|
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 PRI 5 TOWER
|
Facility
|
IP
|
$18,000.00
|
|
| Hospital Charge Code |
100905
|
|
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 PRI 6 TOWER
|
Facility
|
IP
|
$18,000.00
|
|
| Hospital Charge Code |
100912
|
|
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 PRI 7 TOWER
|
Facility
|
IP
|
$18,000.00
|
|
| Hospital Charge Code |
100915
|
|
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 PRI DETOX
|
Facility
|
IP
|
$18,000.00
|
|
| Hospital Charge Code |
100918
|
|
Hospital Revenue Code
|
116
|
| 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 PRI MED 4 TOWER
|
Facility
|
IP
|
$18,000.00
|
|
| Hospital Charge Code |
100908
|
|
Hospital Revenue Code
|
113
|
| 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 PRI MEDJUS 9E
|
Facility
|
IP
|
$18,000.00
|
|
| Hospital Charge Code |
100933
|
|
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 PRI MTY
|
Facility
|
IP
|
$18,000.00
|
|
| Hospital Charge Code |
100935
|
|
Hospital Revenue Code
|
112
|
| 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 PRI PEDS 2 EAST
|
Facility
|
IP
|
$18,000.00
|
|
| Hospital Charge Code |
100910
|
|
Hospital Revenue Code
|
113
|
| 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 PRI PSYCH
|
Facility
|
IP
|
$18,000.00
|
|
| Hospital Charge Code |
100917
|
|
Hospital Revenue Code
|
114
|
| Min. Negotiated Rate |
$1,109.00 |
| Max. Negotiated Rate |
$3,360.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,109.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,360.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,700.00
|
|
|
ROOM & BOARD PSYCH
|
Facility
|
IP
|
$18,000.00
|
|
| Hospital Charge Code |
100081
|
|
Hospital Revenue Code
|
124
|
| Min. Negotiated Rate |
$1,109.00 |
| Max. Negotiated Rate |
$3,360.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,109.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,360.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,700.00
|
|
|
ROOM & BOARD SDA
|
Facility
|
IP
|
$18,000.00
|
|
| Hospital Charge Code |
100926
|
|
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 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 |
$1,109.00 |
| Max. Negotiated Rate |
$3,360.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,109.00
|
| 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 |
$2,086.00 |
| 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 SEMI 6 TOWER
|
Facility
|
IP
|
$18,000.00
|
|
| Hospital Charge Code |
100911
|
|
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 SEMI 7 TOWER
|
Facility
|
IP
|
$18,000.00
|
|
| Hospital Charge Code |
100914
|
|
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 SEMI 9E
|
Facility
|
IP
|
$18,000.00
|
|
| Hospital Charge Code |
100930
|
|
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 SEMI MTY
|
Facility
|
IP
|
$18,000.00
|
|
| Hospital Charge Code |
100936
|
|
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 |
$2,700.00
|
|
|
ROOM & BOARD STEPDOWN UNIT
|
Facility
|
IP
|
$18,000.00
|
|
| Hospital Charge Code |
100925
|
|
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-TCU
|
Facility
|
IP
|
$18,000.00
|
|
| Hospital Charge Code |
101000
|
|
Hospital Revenue Code
|
120
|
| 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
|
|