|
ROOM & BOARD-TELEMETRY
|
Facility
|
IP
|
$18,000.00
|
|
| Hospital Charge Code |
100985
|
|
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-TELEMETRY
|
Facility
|
IP
|
$18,000.00
|
|
| Hospital Charge Code |
100986
|
|
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-TELEMETRY
|
Facility
|
IP
|
$18,000.00
|
|
| Hospital Charge Code |
100981
|
|
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 TELEMETRY 9E
|
Facility
|
IP
|
$18,000.00
|
|
| Hospital Charge Code |
100932
|
|
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 TELM 3 TOWER
|
Facility
|
IP
|
$18,000.00
|
|
| Hospital Charge Code |
100903
|
|
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 TELM 5 TOWER
|
Facility
|
IP
|
$18,000.00
|
|
| Hospital Charge Code |
100906
|
|
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 TELM 6 TOWER
|
Facility
|
IP
|
$18,000.00
|
|
| Hospital Charge Code |
100913
|
|
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 TELM 7 TOWER
|
Facility
|
IP
|
$18,000.00
|
|
| Hospital Charge Code |
100916
|
|
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 TELM 9P
|
Facility
|
IP
|
$18,000.00
|
|
| Hospital Charge Code |
100928
|
|
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 TELM ICU2
|
Facility
|
IP
|
$20,000.00
|
|
| Hospital Charge Code |
100924
|
|
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 |
$3,000.00
|
|
|
ROOM & BOARD TRCU
|
Facility
|
IP
|
$18,000.00
|
|
| Hospital Charge Code |
100075
|
|
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
|
|
|
ROOM DETOX PRIVATE
|
Facility
|
IP
|
$18,500.00
|
|
| Hospital Charge Code |
100937
|
|
Hospital Revenue Code
|
116
|
| Min. Negotiated Rate |
$2,775.00 |
| 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 |
$2,775.00
|
|
|
ROOM DETOX SEMI PRIVATE
|
Facility
|
IP
|
$18,000.00
|
|
| Hospital Charge Code |
100938
|
|
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 TEMP INJECTATE SYSTEM
|
Facility
|
IP
|
$108.60
|
|
| Hospital Charge Code |
270676374
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.29 |
| Max. Negotiated Rate |
$16.29 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$16.29
|
|
|
ROOM TEMP INJECTATE SYSTEM
|
Facility
|
OP
|
$108.60
|
|
| Hospital Charge Code |
270676374
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.12 |
| Max. Negotiated Rate |
$54.30 |
| Rate for Payer: Aetna Commercial |
$32.58
|
| Rate for Payer: Aetna Medicare Advantage |
$32.58
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$27.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$27.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$27.69
|
| Rate for Payer: Cigna Commercial |
$54.30
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$14.12
|
| Rate for Payer: Oxford Commercial |
$54.30
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$16.29
|
| Rate for Payer: UnitedHealthcare Commercial |
$54.30
|
|
|
ROOT MARKING HOOK MENISCAL
|
Facility
|
IP
|
$3,475.00
|
|
| Hospital Charge Code |
270688312
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$521.25 |
| Max. Negotiated Rate |
$521.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$521.25
|
|
|
ROOT MARKING HOOK MENISCAL
|
Facility
|
OP
|
$3,475.00
|
|
| Hospital Charge Code |
270688312
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$451.75 |
| Max. Negotiated Rate |
$1,737.50 |
| Rate for Payer: Aetna Commercial |
$1,042.50
|
| Rate for Payer: Aetna Medicare Advantage |
$1,042.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$886.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$886.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$886.12
|
| Rate for Payer: Cigna Commercial |
$1,737.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$451.75
|
| Rate for Payer: Oxford Commercial |
$1,737.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$521.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,737.50
|
|
|
ROPINIROLE 1MG TAB
|
Facility
|
IP
|
$9.55
|
|
| Hospital Charge Code |
60629855
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.43 |
| Max. Negotiated Rate |
$1.43 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.43
|
|
|
ROPINIROLE 1MG TAB
|
Facility
|
OP
|
$9.55
|
|
| Hospital Charge Code |
60629855
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.24 |
| Max. Negotiated Rate |
$4.78 |
| Rate for Payer: Aetna Commercial |
$2.87
|
| Rate for Payer: Aetna Medicare Advantage |
$2.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2.44
|
| Rate for Payer: Cigna Commercial |
$4.78
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1.24
|
| Rate for Payer: Oxford Commercial |
$4.78
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.43
|
| Rate for Payer: UnitedHealthcare Commercial |
$4.78
|
|
|
ROPINIROLE HCL 0.5MG TAB
|
Facility
|
IP
|
$7.28
|
|
| Hospital Charge Code |
606350918
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.09 |
| Max. Negotiated Rate |
$1.09 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.09
|
|
|
ROPINIROLE HCL 0.5MG TAB
|
Facility
|
OP
|
$7.28
|
|
| Hospital Charge Code |
606350918
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.95 |
| Max. Negotiated Rate |
$3.64 |
| Rate for Payer: Aetna Commercial |
$2.18
|
| Rate for Payer: Aetna Medicare Advantage |
$2.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1.86
|
| Rate for Payer: Cigna Commercial |
$3.64
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$0.95
|
| Rate for Payer: Oxford Commercial |
$3.64
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.09
|
| Rate for Payer: UnitedHealthcare Commercial |
$3.64
|
|
|
ROPIVACAINE 0.2% 20ML 2MG/ML
|
Facility
|
IP
|
$46.90
|
|
|
Service Code
|
HCPCS J2795
|
| Hospital Charge Code |
606390514
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.04 |
| Max. Negotiated Rate |
$11.35 |
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$11.35
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$7.04
|
|
|
ROPIVACAINE 0.2% 20ML 2MG/ML
|
Facility
|
OP
|
$46.90
|
|
|
Service Code
|
HCPCS J2795
|
| Hospital Charge Code |
606390514
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$14.07 |
| Rate for Payer: Aetna Commercial |
$14.07
|
| Rate for Payer: Aetna Medicare Advantage |
$14.07
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$11.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$11.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$11.96
|
| Rate for Payer: Cigna Commercial |
$0.05
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$11.35
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$7.04
|
|
|
ROPIVACAINE 0.2% SOL
|
Facility
|
OP
|
$231.25
|
|
| Hospital Charge Code |
60628971
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$30.06 |
| Max. Negotiated Rate |
$115.62 |
| Rate for Payer: Aetna Commercial |
$69.38
|
| Rate for Payer: Aetna Medicare Advantage |
$69.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$58.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$58.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$58.97
|
| Rate for Payer: Cigna Commercial |
$115.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$30.06
|
| Rate for Payer: Oxford Commercial |
$115.62
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$34.69
|
| Rate for Payer: UnitedHealthcare Commercial |
$115.62
|
|
|
ROPIVACAINE 0.2% SOL
|
Facility
|
IP
|
$231.25
|
|
| Hospital Charge Code |
60628971
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$34.69 |
| Max. Negotiated Rate |
$34.69 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$34.69
|
|