|
TUBE ENDOTRACH 7.0MM
|
Facility
|
OP
|
$7.95
|
|
| Hospital Charge Code |
270070150
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.23 |
| Max. Negotiated Rate |
$3.98 |
| Rate for Payer: Aetna Commercial |
$3.02
|
| 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 |
$2.07
|
| Rate for Payer: Oxford Commercial |
$1.59
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.19
|
| Rate for Payer: UnitedHealthcare Commercial |
$1.59
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.25
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.23
|
|
|
TUBE ENDOTRACH 7.5MM
|
Facility
|
OP
|
$8.18
|
|
| Hospital Charge Code |
270070155
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.23 |
| Max. Negotiated Rate |
$4.09 |
| Rate for Payer: Aetna Commercial |
$3.11
|
| 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 |
$2.13
|
| Rate for Payer: Oxford Commercial |
$1.64
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.23
|
| Rate for Payer: UnitedHealthcare Commercial |
$1.64
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.26
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.23
|
|
|
TUBE ENDOTRACH 7.5MM
|
Facility
|
IP
|
$8.18
|
|
| Hospital Charge Code |
270070155
|
|
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 8.0MM
|
Facility
|
OP
|
$8.18
|
|
| Hospital Charge Code |
270070160
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.23 |
| Max. Negotiated Rate |
$4.09 |
| Rate for Payer: Aetna Commercial |
$3.11
|
| 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 |
$2.13
|
| Rate for Payer: Oxford Commercial |
$1.64
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.23
|
| Rate for Payer: UnitedHealthcare Commercial |
$1.64
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.26
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.23
|
|
|
TUBE ENDOTRACH 8.0MM
|
Facility
|
IP
|
$8.18
|
|
| Hospital Charge Code |
270070160
|
|
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 8.5MM
|
Facility
|
OP
|
$8.18
|
|
| Hospital Charge Code |
270070165
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.23 |
| Max. Negotiated Rate |
$4.09 |
| Rate for Payer: Aetna Commercial |
$3.11
|
| 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 |
$2.13
|
| Rate for Payer: Oxford Commercial |
$1.64
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.23
|
| Rate for Payer: UnitedHealthcare Commercial |
$1.64
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.26
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.23
|
|
|
TUBE ENDOTRACH 8.5MM
|
Facility
|
IP
|
$8.18
|
|
| Hospital Charge Code |
270070165
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.23 |
| Max. Negotiated Rate |
$1.23 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.23
|
|
|
TUBE ENDOTRACHEAL 10MM
|
Facility
|
OP
|
$72.00
|
|
| Hospital Charge Code |
270331095
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.04 |
| Max. Negotiated Rate |
$36.00 |
| Rate for Payer: Aetna Commercial |
$27.36
|
| 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 |
$18.72
|
| Rate for Payer: Oxford Commercial |
$14.40
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$10.80
|
| Rate for Payer: UnitedHealthcare Commercial |
$14.40
|
| Rate for Payer: UnitedHealthcare Community & State |
$2.28
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.04
|
|
|
TUBE ENDOTRACHEAL 10MM
|
Facility
|
IP
|
$72.00
|
|
| Hospital Charge Code |
270331095
|
|
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 4.0mm
|
Facility
|
IP
|
$7.18
|
|
| Hospital Charge Code |
270649830
|
|
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 4.0mm
|
Facility
|
OP
|
$7.18
|
|
| Hospital Charge Code |
270649830
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$3.59 |
| Rate for Payer: Aetna Commercial |
$2.73
|
| Rate for Payer: Aetna Medicare Advantage |
$2.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1.83
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1.83
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1.83
|
| Rate for Payer: Cigna Commercial |
$3.59
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1.87
|
| Rate for Payer: Oxford Commercial |
$1.44
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.08
|
| Rate for Payer: UnitedHealthcare Commercial |
$1.44
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.23
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.20
|
|
|
TUBE ENDOTRACHEAL 4.5mm
|
Facility
|
OP
|
$7.02
|
|
| Hospital Charge Code |
270650107
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$3.51 |
| Rate for Payer: Aetna Commercial |
$2.67
|
| 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 |
$1.83
|
| Rate for Payer: Oxford Commercial |
$1.40
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.05
|
| Rate for Payer: UnitedHealthcare Commercial |
$1.40
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.22
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.20
|
|
|
TUBE ENDOTRACHEAL 4.5mm
|
Facility
|
IP
|
$7.02
|
|
| Hospital Charge Code |
270650107
|
|
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 5.0mm
|
Facility
|
OP
|
$11.18
|
|
| Hospital Charge Code |
270650108
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$5.59 |
| Rate for Payer: Aetna Commercial |
$4.25
|
| 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 |
$2.91
|
| Rate for Payer: Oxford Commercial |
$2.24
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.68
|
| Rate for Payer: UnitedHealthcare Commercial |
$2.24
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.35
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.32
|
|
|
TUBE ENDOTRACHEAL 5.0mm
|
Facility
|
IP
|
$11.18
|
|
| Hospital Charge Code |
270650108
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.68 |
| Max. Negotiated Rate |
$1.68 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.68
|
|
|
TUBE ENDOTRACHEAL 5.5mm
|
Facility
|
OP
|
$16.46
|
|
| Hospital Charge Code |
270650109
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.47 |
| Max. Negotiated Rate |
$8.23 |
| Rate for Payer: Aetna Commercial |
$6.25
|
| Rate for Payer: Aetna Medicare Advantage |
$4.94
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4.20
|
| Rate for Payer: Cigna Commercial |
$8.23
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4.28
|
| Rate for Payer: Oxford Commercial |
$3.29
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.47
|
| Rate for Payer: UnitedHealthcare Commercial |
$3.29
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.52
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.47
|
|
|
TUBE ENDOTRACHEAL 5.5mm
|
Facility
|
IP
|
$16.46
|
|
| Hospital Charge Code |
270650109
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.47 |
| Max. Negotiated Rate |
$2.47 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.47
|
|
|
TUBE ENDOTRACHEAL 5MM
|
Facility
|
OP
|
$72.00
|
|
| Hospital Charge Code |
270331091
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.04 |
| Max. Negotiated Rate |
$36.00 |
| Rate for Payer: Aetna Commercial |
$27.36
|
| 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 |
$18.72
|
| Rate for Payer: Oxford Commercial |
$14.40
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$10.80
|
| Rate for Payer: UnitedHealthcare Commercial |
$14.40
|
| Rate for Payer: UnitedHealthcare Community & State |
$2.28
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.04
|
|
|
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
|
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 6.0mm
|
Facility
|
OP
|
$111.80
|
|
| Hospital Charge Code |
270649823
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.18 |
| Max. Negotiated Rate |
$55.90 |
| Rate for Payer: Aetna Commercial |
$42.48
|
| 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 |
$29.07
|
| Rate for Payer: Oxford Commercial |
$22.36
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$16.77
|
| Rate for Payer: UnitedHealthcare Commercial |
$22.36
|
| Rate for Payer: UnitedHealthcare Community & State |
$3.53
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$3.18
|
|
|
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 6.5MM
|
Facility
|
OP
|
$11.18
|
|
| Hospital Charge Code |
270649932
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$5.59 |
| Rate for Payer: Aetna Commercial |
$4.25
|
| 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 |
$2.91
|
| Rate for Payer: Oxford Commercial |
$2.24
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.68
|
| Rate for Payer: UnitedHealthcare Commercial |
$2.24
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.35
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.32
|
|
|
TUBE ENDOTRACHEAL 6.5MM
|
Facility
|
OP
|
$48.00
|
|
| Hospital Charge Code |
270331312
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.36 |
| Max. Negotiated Rate |
$24.00 |
| Rate for Payer: Aetna Commercial |
$18.24
|
| 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 |
$12.48
|
| Rate for Payer: Oxford Commercial |
$9.60
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$7.20
|
| Rate for Payer: UnitedHealthcare Commercial |
$9.60
|
| Rate for Payer: UnitedHealthcare Community & State |
$1.52
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.36
|
|
|
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
|
|