|
CANNULA NASAL OPTIFLOW MED
|
Facility
|
IP
|
$2,054.05
|
|
| Hospital Charge Code |
270651737
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$308.11 |
| Max. Negotiated Rate |
$308.11 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$308.11
|
|
|
CANNULA NASAL PEDIATRIC
|
Facility
|
OP
|
$5.49
|
|
| Hospital Charge Code |
270655445
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.71 |
| Max. Negotiated Rate |
$2.75 |
| Rate for Payer: Aetna Commercial |
$1.65
|
| Rate for Payer: Aetna Medicare Advantage |
$1.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1.40
|
| Rate for Payer: Cigna Commercial |
$2.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$0.71
|
| Rate for Payer: Oxford Commercial |
$2.75
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.82
|
| Rate for Payer: UnitedHealthcare Commercial |
$2.75
|
|
|
CANNULA NASAL PEDIATRIC
|
Facility
|
IP
|
$13.65
|
|
| Hospital Charge Code |
270613157
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.05 |
| Max. Negotiated Rate |
$2.05 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.05
|
|
|
CANNULA NASAL PEDIATRIC
|
Facility
|
IP
|
$5.49
|
|
| Hospital Charge Code |
270655445
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.82 |
| Max. Negotiated Rate |
$0.82 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.82
|
|
|
CANNULA NASAL PEDIATRIC
|
Facility
|
OP
|
$13.65
|
|
| Hospital Charge Code |
270613157
|
|
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
|
|
|
CANNULA NEONATAL
|
Facility
|
OP
|
$9.74
|
|
| Hospital Charge Code |
270635033
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.27 |
| Max. Negotiated Rate |
$4.87 |
| Rate for Payer: Aetna Commercial |
$2.92
|
| Rate for Payer: Aetna Medicare Advantage |
$2.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2.48
|
| Rate for Payer: Cigna Commercial |
$4.87
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1.27
|
| Rate for Payer: Oxford Commercial |
$4.87
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.46
|
| Rate for Payer: UnitedHealthcare Commercial |
$4.87
|
|
|
CANNULA NEONATAL
|
Facility
|
IP
|
$9.74
|
|
| Hospital Charge Code |
270635033
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.46 |
| Max. Negotiated Rate |
$1.46 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.46
|
|
|
CANNULA NEOSOFT PREMATURE
|
Facility
|
IP
|
$67.50
|
|
| Hospital Charge Code |
270689833
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.12 |
| Max. Negotiated Rate |
$10.12 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$10.12
|
|
|
CANNULA NEOSOFT PREMATURE
|
Facility
|
OP
|
$67.50
|
|
| Hospital Charge Code |
270689833
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.78 |
| Max. Negotiated Rate |
$33.75 |
| Rate for Payer: Aetna Commercial |
$20.25
|
| Rate for Payer: Aetna Medicare Advantage |
$20.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$17.21
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$17.21
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$17.21
|
| Rate for Payer: Cigna Commercial |
$33.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$8.78
|
| Rate for Payer: Oxford Commercial |
$33.75
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$10.12
|
| Rate for Payer: UnitedHealthcare Commercial |
$33.75
|
|
|
CANNULA OPTI FEM ART 18FR
|
Facility
|
OP
|
$1,230.00
|
|
| Hospital Charge Code |
2703110V
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$159.90 |
| Max. Negotiated Rate |
$615.00 |
| Rate for Payer: Aetna Commercial |
$369.00
|
| Rate for Payer: Aetna Medicare Advantage |
$369.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$313.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$313.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$313.65
|
| Rate for Payer: Cigna Commercial |
$615.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$159.90
|
| Rate for Payer: Oxford Commercial |
$615.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$184.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$615.00
|
|
|
CANNULA OPTI FEM ART 18FR
|
Facility
|
IP
|
$1,230.00
|
|
| Hospital Charge Code |
2703110V
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$184.50 |
| Max. Negotiated Rate |
$184.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$184.50
|
|
|
CANNULA OPTI FEM ART 20FR
|
Facility
|
OP
|
$1,230.00
|
|
| Hospital Charge Code |
2703110U
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$159.90 |
| Max. Negotiated Rate |
$615.00 |
| Rate for Payer: Aetna Commercial |
$369.00
|
| Rate for Payer: Aetna Medicare Advantage |
$369.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$313.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$313.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$313.65
|
| Rate for Payer: Cigna Commercial |
$615.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$159.90
|
| Rate for Payer: Oxford Commercial |
$615.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$184.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$615.00
|
|
|
CANNULA OPTI FEM ART 20FR
|
Facility
|
IP
|
$1,230.00
|
|
| Hospital Charge Code |
2703110U
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$184.50 |
| Max. Negotiated Rate |
$184.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$184.50
|
|
|
CANNULA OPTIFLOW+ MED
|
Facility
|
IP
|
$106.90
|
|
| Hospital Charge Code |
270676372
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.04 |
| Max. Negotiated Rate |
$16.04 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$16.04
|
|
|
CANNULA OPTIFLOW+ MED
|
Facility
|
OP
|
$106.90
|
|
| Hospital Charge Code |
270676372
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.90 |
| Max. Negotiated Rate |
$53.45 |
| Rate for Payer: Aetna Commercial |
$32.07
|
| Rate for Payer: Aetna Medicare Advantage |
$32.07
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$27.26
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$27.26
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$27.26
|
| Rate for Payer: Cigna Commercial |
$53.45
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$13.90
|
| Rate for Payer: Oxford Commercial |
$53.45
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$16.04
|
| Rate for Payer: UnitedHealthcare Commercial |
$53.45
|
|
|
CANNULA OXYGEN NASAL HIGH FLOW
|
Facility
|
IP
|
$142.43
|
|
| Hospital Charge Code |
270674877
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.36 |
| Max. Negotiated Rate |
$21.36 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$21.36
|
|
|
CANNULA OXYGEN NASAL HIGH FLOW
|
Facility
|
OP
|
$142.43
|
|
| Hospital Charge Code |
270674877
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$18.52 |
| Max. Negotiated Rate |
$71.22 |
| Rate for Payer: Aetna Commercial |
$42.73
|
| Rate for Payer: Aetna Medicare Advantage |
$42.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$36.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$36.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$36.32
|
| Rate for Payer: Cigna Commercial |
$71.22
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$18.52
|
| Rate for Payer: Oxford Commercial |
$71.22
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$21.36
|
| Rate for Payer: UnitedHealthcare Commercial |
$71.22
|
|
|
CANNULA OXYGEN NASAL LOW FLOW
|
Facility
|
IP
|
$23.00
|
|
| Hospital Charge Code |
270674878
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.45 |
| Max. Negotiated Rate |
$3.45 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$3.45
|
|
|
CANNULA OXYGEN NASAL LOW FLOW
|
Facility
|
OP
|
$23.00
|
|
| Hospital Charge Code |
270674878
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$11.50 |
| Rate for Payer: Aetna Commercial |
$6.90
|
| Rate for Payer: Aetna Medicare Advantage |
$6.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$5.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$5.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$5.87
|
| Rate for Payer: Cigna Commercial |
$11.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2.99
|
| Rate for Payer: Oxford Commercial |
$11.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3.45
|
| Rate for Payer: UnitedHealthcare Commercial |
$11.50
|
|
|
CANNULA PASSPORT 8MMx3CM BU
|
Facility
|
IP
|
$230.00
|
|
| Hospital Charge Code |
270665942
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$34.50 |
| Max. Negotiated Rate |
$34.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$34.50
|
|
|
CANNULA PASSPORT 8MMx3CM BU
|
Facility
|
OP
|
$230.00
|
|
| Hospital Charge Code |
270665942
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$29.90 |
| Max. Negotiated Rate |
$115.00 |
| Rate for Payer: Aetna Commercial |
$69.00
|
| Rate for Payer: Aetna Medicare Advantage |
$69.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$58.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$58.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$58.65
|
| Rate for Payer: Cigna Commercial |
$115.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$29.90
|
| Rate for Payer: Oxford Commercial |
$115.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$34.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$115.00
|
|
|
CANNULA PASSPORT BUTTON
|
Facility
|
OP
|
$160.00
|
|
| Hospital Charge Code |
270660885
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$20.80 |
| Max. Negotiated Rate |
$80.00 |
| Rate for Payer: Aetna Commercial |
$48.00
|
| Rate for Payer: Aetna Medicare Advantage |
$48.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$40.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$40.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$40.80
|
| Rate for Payer: Cigna Commercial |
$80.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$20.80
|
| Rate for Payer: Oxford Commercial |
$80.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$24.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$80.00
|
|
|
CANNULA PASSPORT BUTTON
|
Facility
|
IP
|
$160.00
|
|
| Hospital Charge Code |
270660885
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$24.00 |
| Max. Negotiated Rate |
$24.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$24.00
|
|
|
CANNULA PASSPORT BUTTON 30 MM
|
Facility
|
IP
|
$300.00
|
|
| Hospital Charge Code |
270688469
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$45.00 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$45.00
|
|
|
CANNULA PASSPORT BUTTON 30 MM
|
Facility
|
OP
|
$300.00
|
|
| Hospital Charge Code |
270688469
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$39.00 |
| Max. Negotiated Rate |
$150.00 |
| Rate for Payer: Aetna Commercial |
$90.00
|
| Rate for Payer: Aetna Medicare Advantage |
$90.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$76.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$76.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$76.50
|
| Rate for Payer: Cigna Commercial |
$150.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$39.00
|
| Rate for Payer: Oxford Commercial |
$150.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$45.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$150.00
|
|