|
TUBE ENDO CUFFED 8.5mm
|
Facility
|
IP
|
$8.63
|
|
| Hospital Charge Code |
270649293
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.29 |
| Max. Negotiated Rate |
$1.29 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.29
|
|
|
TUBE ENDO CUFFED 8.5mm
|
Facility
|
OP
|
$8.63
|
|
| Hospital Charge Code |
270649293
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.12 |
| Max. Negotiated Rate |
$4.32 |
| Rate for Payer: Aetna Commercial |
$2.59
|
| Rate for Payer: Aetna Medicare Advantage |
$2.59
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2.20
|
| Rate for Payer: Cigna Commercial |
$4.32
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1.12
|
| Rate for Payer: Oxford Commercial |
$4.32
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.29
|
| Rate for Payer: UnitedHealthcare Commercial |
$4.32
|
|
|
TUBE ENDO CUFFED 9.0mm
|
Facility
|
IP
|
$8.63
|
|
| Hospital Charge Code |
270649294
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.29 |
| Max. Negotiated Rate |
$1.29 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.29
|
|
|
TUBE ENDO CUFFED 9.0mm
|
Facility
|
OP
|
$8.63
|
|
| Hospital Charge Code |
270649294
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.12 |
| Max. Negotiated Rate |
$4.32 |
| Rate for Payer: Aetna Commercial |
$2.59
|
| Rate for Payer: Aetna Medicare Advantage |
$2.59
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2.20
|
| Rate for Payer: Cigna Commercial |
$4.32
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1.12
|
| Rate for Payer: Oxford Commercial |
$4.32
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.29
|
| Rate for Payer: UnitedHealthcare Commercial |
$4.32
|
|
|
TUBE ENDO CUFFED 9.5mm
|
Facility
|
IP
|
$8.63
|
|
| Hospital Charge Code |
270649295
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.29 |
| Max. Negotiated Rate |
$1.29 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.29
|
|
|
TUBE ENDO CUFFED 9.5mm
|
Facility
|
OP
|
$8.63
|
|
| Hospital Charge Code |
270649295
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.12 |
| Max. Negotiated Rate |
$4.32 |
| Rate for Payer: Aetna Commercial |
$2.59
|
| Rate for Payer: Aetna Medicare Advantage |
$2.59
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2.20
|
| Rate for Payer: Cigna Commercial |
$4.32
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1.12
|
| Rate for Payer: Oxford Commercial |
$4.32
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.29
|
| Rate for Payer: UnitedHealthcare Commercial |
$4.32
|
|
|
TUBE ENDOTRACH 2.0MM
|
Facility
|
OP
|
$13.65
|
|
| Hospital Charge Code |
270070110
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.77 |
| Max. Negotiated Rate |
$6.83 |
| Rate for Payer: Aetna Commercial |
$4.09
|
| Rate for Payer: Aetna Medicare Advantage |
$4.09
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3.48
|
| Rate for Payer: Cigna Commercial |
$6.83
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1.77
|
| Rate for Payer: Oxford Commercial |
$6.83
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.05
|
| Rate for Payer: UnitedHealthcare Commercial |
$6.83
|
|
|
TUBE ENDOTRACH 2.0MM
|
Facility
|
IP
|
$13.65
|
|
| Hospital Charge Code |
270070110
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.05 |
| Max. Negotiated Rate |
$2.05 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.05
|
|
|
TUBE ENDOTRACH 2.5MM
|
Facility
|
OP
|
$18.45
|
|
| Hospital Charge Code |
270070111
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.40 |
| Max. Negotiated Rate |
$9.22 |
| Rate for Payer: Aetna Commercial |
$5.54
|
| Rate for Payer: Aetna Medicare Advantage |
$5.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4.70
|
| Rate for Payer: Cigna Commercial |
$9.22
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2.40
|
| Rate for Payer: Oxford Commercial |
$9.22
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.77
|
| Rate for Payer: UnitedHealthcare Commercial |
$9.22
|
|
|
TUBE ENDOTRACH 2.5MM
|
Facility
|
IP
|
$18.45
|
|
| Hospital Charge Code |
270070111
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.77 |
| Max. Negotiated Rate |
$2.77 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.77
|
|
|
TUBE ENDOTRACH 3.5MM
|
Facility
|
OP
|
$5.43
|
|
| Hospital Charge Code |
270070115
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.71 |
| Max. Negotiated Rate |
$2.71 |
| Rate for Payer: Aetna Commercial |
$1.63
|
| Rate for Payer: Aetna Medicare Advantage |
$1.63
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1.38
|
| Rate for Payer: Cigna Commercial |
$2.71
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$0.71
|
| Rate for Payer: Oxford Commercial |
$2.71
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.81
|
| Rate for Payer: UnitedHealthcare Commercial |
$2.71
|
|
|
TUBE ENDOTRACH 3.5MM
|
Facility
|
IP
|
$5.43
|
|
| Hospital Charge Code |
270070115
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.81 |
| Max. Negotiated Rate |
$0.81 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.81
|
|
|
TUBE ENDOTRACH 4.0MM
|
Facility
|
IP
|
$12.01
|
|
| Hospital Charge Code |
270070120
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$1.80 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.80
|
|
|
TUBE ENDOTRACH 4.0MM
|
Facility
|
OP
|
$12.01
|
|
| Hospital Charge Code |
270070120
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.56 |
| Max. Negotiated Rate |
$6.00 |
| Rate for Payer: Aetna Commercial |
$3.60
|
| Rate for Payer: Aetna Medicare Advantage |
$3.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3.06
|
| Rate for Payer: Cigna Commercial |
$6.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1.56
|
| Rate for Payer: Oxford Commercial |
$6.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.80
|
| Rate for Payer: UnitedHealthcare Commercial |
$6.00
|
|
|
TUBE ENDOTRACH 4.5MM
|
Facility
|
OP
|
$13.65
|
|
| Hospital Charge Code |
270070125
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.77 |
| Max. Negotiated Rate |
$6.83 |
| Rate for Payer: Aetna Commercial |
$4.09
|
| Rate for Payer: Aetna Medicare Advantage |
$4.09
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3.48
|
| Rate for Payer: Cigna Commercial |
$6.83
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1.77
|
| Rate for Payer: Oxford Commercial |
$6.83
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.05
|
| Rate for Payer: UnitedHealthcare Commercial |
$6.83
|
|
|
TUBE ENDOTRACH 4.5MM
|
Facility
|
IP
|
$13.65
|
|
| Hospital Charge Code |
270070125
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.05 |
| Max. Negotiated Rate |
$2.05 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.05
|
|
|
TUBE ENDOTRACH 5.0MM
|
Facility
|
OP
|
$22.45
|
|
| Hospital Charge Code |
270070130
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.92 |
| Max. Negotiated Rate |
$11.22 |
| Rate for Payer: Aetna Commercial |
$6.74
|
| Rate for Payer: Aetna Medicare Advantage |
$6.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$5.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$5.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$5.72
|
| Rate for Payer: Cigna Commercial |
$11.22
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2.92
|
| Rate for Payer: Oxford Commercial |
$11.22
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3.37
|
| Rate for Payer: UnitedHealthcare Commercial |
$11.22
|
|
|
TUBE ENDOTRACH 5.0MM
|
Facility
|
IP
|
$22.45
|
|
| Hospital Charge Code |
270070130
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.37 |
| Max. Negotiated Rate |
$3.37 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$3.37
|
|
|
TUBE ENDOTRACH 5.5MM
|
Facility
|
OP
|
$8.10
|
|
| Hospital Charge Code |
270070135
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.05 |
| Max. Negotiated Rate |
$4.05 |
| Rate for Payer: Aetna Commercial |
$2.43
|
| Rate for Payer: Aetna Medicare Advantage |
$2.43
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2.07
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2.07
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2.07
|
| Rate for Payer: Cigna Commercial |
$4.05
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1.05
|
| Rate for Payer: Oxford Commercial |
$4.05
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.22
|
| Rate for Payer: UnitedHealthcare Commercial |
$4.05
|
|
|
TUBE ENDOTRACH 5.5MM
|
Facility
|
IP
|
$8.10
|
|
| Hospital Charge Code |
270070135
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.22 |
| Max. Negotiated Rate |
$1.22 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.22
|
|
|
TUBE ENDOTRACH 6.0MM
|
Facility
|
OP
|
$8.10
|
|
| Hospital Charge Code |
270070140
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.05 |
| Max. Negotiated Rate |
$4.05 |
| Rate for Payer: Aetna Commercial |
$2.43
|
| Rate for Payer: Aetna Medicare Advantage |
$2.43
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2.07
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2.07
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2.07
|
| Rate for Payer: Cigna Commercial |
$4.05
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1.05
|
| Rate for Payer: Oxford Commercial |
$4.05
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.22
|
| Rate for Payer: UnitedHealthcare Commercial |
$4.05
|
|
|
TUBE ENDOTRACH 6.0MM
|
Facility
|
IP
|
$8.10
|
|
| Hospital Charge Code |
270070140
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.22 |
| Max. Negotiated Rate |
$1.22 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.22
|
|
|
TUBE ENDOTRACH 6.5MM
|
Facility
|
IP
|
$8.18
|
|
| Hospital Charge Code |
270070145
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.23 |
| Max. Negotiated Rate |
$1.23 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.23
|
|
|
TUBE ENDOTRACH 6.5MM
|
Facility
|
OP
|
$8.18
|
|
| Hospital Charge Code |
270070145
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.06 |
| Max. Negotiated Rate |
$4.09 |
| Rate for Payer: Aetna Commercial |
$2.45
|
| Rate for Payer: Aetna Medicare Advantage |
$2.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2.09
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2.09
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2.09
|
| Rate for Payer: Cigna Commercial |
$4.09
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1.06
|
| Rate for Payer: Oxford Commercial |
$4.09
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.23
|
| Rate for Payer: UnitedHealthcare Commercial |
$4.09
|
|
|
TUBE ENDOTRACH 7.0MM
|
Facility
|
OP
|
$7.95
|
|
| Hospital Charge Code |
270070150
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.03 |
| Max. Negotiated Rate |
$3.98 |
| Rate for Payer: Aetna Commercial |
$2.38
|
| Rate for Payer: Aetna Medicare Advantage |
$2.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2.03
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2.03
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2.03
|
| Rate for Payer: Cigna Commercial |
$3.98
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1.03
|
| Rate for Payer: Oxford Commercial |
$3.98
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.19
|
| Rate for Payer: UnitedHealthcare Commercial |
$3.98
|
|