|
TUBE ENDOTRACHEAL 5MM
|
Facility
|
OP
|
$72.00
|
|
| Hospital Charge Code |
270331091
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.36 |
| Max. Negotiated Rate |
$36.00 |
| Rate for Payer: Aetna Commercial |
$21.60
|
| Rate for Payer: Aetna Medicare Advantage |
$21.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$18.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$18.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$18.36
|
| Rate for Payer: Cigna Commercial |
$36.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$9.36
|
| Rate for Payer: Oxford Commercial |
$36.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$10.80
|
| Rate for Payer: UnitedHealthcare Commercial |
$36.00
|
|
|
TUBE ENDOTRACHEAL 5MM
|
Facility
|
IP
|
$72.00
|
|
| Hospital Charge Code |
270331091
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.80 |
| Max. Negotiated Rate |
$10.80 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$10.80
|
|
|
TUBE ENDOTRACHEAL 6.0mm
|
Facility
|
OP
|
$111.80
|
|
| Hospital Charge Code |
270649823
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.53 |
| Max. Negotiated Rate |
$55.90 |
| Rate for Payer: Aetna Commercial |
$33.54
|
| Rate for Payer: Aetna Medicare Advantage |
$33.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$28.51
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$28.51
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$28.51
|
| Rate for Payer: Cigna Commercial |
$55.90
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$14.53
|
| Rate for Payer: Oxford Commercial |
$55.90
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$16.77
|
| Rate for Payer: UnitedHealthcare Commercial |
$55.90
|
|
|
TUBE ENDOTRACHEAL 6.0mm
|
Facility
|
IP
|
$111.80
|
|
| Hospital Charge Code |
270649823
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.77 |
| Max. Negotiated Rate |
$16.77 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$16.77
|
|
|
TUBE ENDOTRACHEAL 6.5MM
|
Facility
|
OP
|
$48.00
|
|
| Hospital Charge Code |
270331312
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.24 |
| Max. Negotiated Rate |
$24.00 |
| Rate for Payer: Aetna Commercial |
$14.40
|
| Rate for Payer: Aetna Medicare Advantage |
$14.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$12.24
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$12.24
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$12.24
|
| Rate for Payer: Cigna Commercial |
$24.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$6.24
|
| Rate for Payer: Oxford Commercial |
$24.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$7.20
|
| Rate for Payer: UnitedHealthcare Commercial |
$24.00
|
|
|
TUBE ENDOTRACHEAL 6.5MM
|
Facility
|
IP
|
$48.00
|
|
| Hospital Charge Code |
270331312
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.20 |
| Max. Negotiated Rate |
$7.20 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$7.20
|
|
|
TUBE ENDOTRACHEAL 6.5MM
|
Facility
|
OP
|
$11.18
|
|
| Hospital Charge Code |
270649932
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.45 |
| Max. Negotiated Rate |
$5.59 |
| Rate for Payer: Aetna Commercial |
$3.35
|
| Rate for Payer: Aetna Medicare Advantage |
$3.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2.85
|
| Rate for Payer: Cigna Commercial |
$5.59
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1.45
|
| Rate for Payer: Oxford Commercial |
$5.59
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.68
|
| Rate for Payer: UnitedHealthcare Commercial |
$5.59
|
|
|
TUBE ENDOTRACHEAL 6.5MM
|
Facility
|
IP
|
$11.18
|
|
| Hospital Charge Code |
270649932
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.68 |
| Max. Negotiated Rate |
$1.68 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.68
|
|
|
TUBE ENDOTRACHEAL 7.0mm
|
Facility
|
IP
|
$7.23
|
|
| Hospital Charge Code |
270649824
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.08 |
| Max. Negotiated Rate |
$1.08 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.08
|
|
|
TUBE ENDOTRACHEAL 7.0mm
|
Facility
|
OP
|
$7.23
|
|
| Hospital Charge Code |
270649824
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.94 |
| Max. Negotiated Rate |
$3.62 |
| Rate for Payer: Aetna Commercial |
$2.17
|
| Rate for Payer: Aetna Medicare Advantage |
$2.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1.84
|
| Rate for Payer: Cigna Commercial |
$3.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$0.94
|
| Rate for Payer: Oxford Commercial |
$3.62
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.08
|
| Rate for Payer: UnitedHealthcare Commercial |
$3.62
|
|
|
TUBE ENDOTRACHEAL 7.0mm CUFFED
|
Facility
|
OP
|
$89.69
|
|
| Hospital Charge Code |
270655733
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$11.66 |
| Max. Negotiated Rate |
$44.84 |
| Rate for Payer: Aetna Commercial |
$26.91
|
| Rate for Payer: Aetna Medicare Advantage |
$26.91
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$22.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$22.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$22.87
|
| Rate for Payer: Cigna Commercial |
$44.84
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$11.66
|
| Rate for Payer: Oxford Commercial |
$44.84
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$13.45
|
| Rate for Payer: UnitedHealthcare Commercial |
$44.84
|
|
|
TUBE ENDOTRACHEAL 7.0mm CUFFED
|
Facility
|
IP
|
$89.69
|
|
| Hospital Charge Code |
270655733
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$13.45 |
| Max. Negotiated Rate |
$13.45 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$13.45
|
|
|
TUBE ENDOTRACHEAL 7.5mm
|
Facility
|
IP
|
$7.23
|
|
| Hospital Charge Code |
270649825
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.08 |
| Max. Negotiated Rate |
$1.08 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.08
|
|
|
TUBE ENDOTRACHEAL 7.5mm
|
Facility
|
OP
|
$7.23
|
|
| Hospital Charge Code |
270649825
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.94 |
| Max. Negotiated Rate |
$3.62 |
| Rate for Payer: Aetna Commercial |
$2.17
|
| Rate for Payer: Aetna Medicare Advantage |
$2.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1.84
|
| Rate for Payer: Cigna Commercial |
$3.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$0.94
|
| Rate for Payer: Oxford Commercial |
$3.62
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.08
|
| Rate for Payer: UnitedHealthcare Commercial |
$3.62
|
|
|
TUBE ENDOTRACHEAL 7.5mm CUFFED
|
Facility
|
IP
|
$99.54
|
|
| Hospital Charge Code |
270655737
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$14.93 |
| Max. Negotiated Rate |
$14.93 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$14.93
|
|
|
TUBE ENDOTRACHEAL 7.5mm CUFFED
|
Facility
|
OP
|
$99.54
|
|
| Hospital Charge Code |
270655737
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$12.94 |
| Max. Negotiated Rate |
$49.77 |
| Rate for Payer: Aetna Commercial |
$29.86
|
| Rate for Payer: Aetna Medicare Advantage |
$29.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$25.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$25.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$25.38
|
| Rate for Payer: Cigna Commercial |
$49.77
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$12.94
|
| Rate for Payer: Oxford Commercial |
$49.77
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$14.93
|
| Rate for Payer: UnitedHealthcare Commercial |
$49.77
|
|
|
TUBE ENDOTRACHEAL 7MM
|
Facility
|
IP
|
$72.00
|
|
| Hospital Charge Code |
270331092
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.80 |
| Max. Negotiated Rate |
$10.80 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$10.80
|
|
|
TUBE ENDOTRACHEAL 7MM
|
Facility
|
OP
|
$72.00
|
|
| Hospital Charge Code |
270331092
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.36 |
| Max. Negotiated Rate |
$36.00 |
| Rate for Payer: Aetna Commercial |
$21.60
|
| Rate for Payer: Aetna Medicare Advantage |
$21.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$18.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$18.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$18.36
|
| Rate for Payer: Cigna Commercial |
$36.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$9.36
|
| Rate for Payer: Oxford Commercial |
$36.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$10.80
|
| Rate for Payer: UnitedHealthcare Commercial |
$36.00
|
|
|
TUBE ENDOTRACHEAL 8.0mm
|
Facility
|
OP
|
$7.23
|
|
| Hospital Charge Code |
270649827
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.94 |
| Max. Negotiated Rate |
$3.62 |
| Rate for Payer: Aetna Commercial |
$2.17
|
| Rate for Payer: Aetna Medicare Advantage |
$2.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1.84
|
| Rate for Payer: Cigna Commercial |
$3.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$0.94
|
| Rate for Payer: Oxford Commercial |
$3.62
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.08
|
| Rate for Payer: UnitedHealthcare Commercial |
$3.62
|
|
|
TUBE ENDOTRACHEAL 8.0mm
|
Facility
|
IP
|
$7.23
|
|
| Hospital Charge Code |
270649827
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.08 |
| Max. Negotiated Rate |
$1.08 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.08
|
|
|
TUBE ENDOTRACHEAL 8.5MM
|
Facility
|
IP
|
$689.00
|
|
| Hospital Charge Code |
270332466
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$103.35 |
| Max. Negotiated Rate |
$103.35 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$103.35
|
|
|
TUBE ENDOTRACHEAL 8.5MM
|
Facility
|
OP
|
$7.02
|
|
| Hospital Charge Code |
270649828
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.91 |
| Max. Negotiated Rate |
$3.51 |
| Rate for Payer: Aetna Commercial |
$2.11
|
| Rate for Payer: Aetna Medicare Advantage |
$2.11
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1.79
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1.79
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1.79
|
| Rate for Payer: Cigna Commercial |
$3.51
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$0.91
|
| Rate for Payer: Oxford Commercial |
$3.51
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.05
|
| Rate for Payer: UnitedHealthcare Commercial |
$3.51
|
|
|
TUBE ENDOTRACHEAL 8.5MM
|
Facility
|
OP
|
$689.00
|
|
| Hospital Charge Code |
270332466
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$89.57 |
| Max. Negotiated Rate |
$344.50 |
| Rate for Payer: Aetna Commercial |
$206.70
|
| Rate for Payer: Aetna Medicare Advantage |
$206.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$175.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$175.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$175.69
|
| Rate for Payer: Cigna Commercial |
$344.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$89.57
|
| Rate for Payer: Oxford Commercial |
$344.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$103.35
|
| Rate for Payer: UnitedHealthcare Commercial |
$344.50
|
|
|
TUBE ENDOTRACHEAL 8.5MM
|
Facility
|
IP
|
$7.02
|
|
| Hospital Charge Code |
270649828
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.05 |
| Max. Negotiated Rate |
$1.05 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.05
|
|
|
TUBE ENDOTRACHEAL 8.5MM 34FR
|
Facility
|
OP
|
$71.00
|
|
| Hospital Charge Code |
270330898
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.23 |
| Max. Negotiated Rate |
$35.50 |
| Rate for Payer: Aetna Commercial |
$21.30
|
| Rate for Payer: Aetna Medicare Advantage |
$21.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$18.11
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$18.11
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$18.11
|
| Rate for Payer: Cigna Commercial |
$35.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$9.23
|
| Rate for Payer: Oxford Commercial |
$35.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$10.65
|
| Rate for Payer: UnitedHealthcare Commercial |
$35.50
|
|