|
SUCTION 1000ccEVAC CON.1614-05
|
Facility
|
OP
|
$58.00
|
|
| Hospital Charge Code |
2963569
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.24 |
| Max. Negotiated Rate |
$232.00 |
| Rate for Payer: Aetna Commercial |
$52.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$49.88
|
| Rate for Payer: Aetna Managed Medicare |
$16.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$37.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$29.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$27.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$30.74
|
| Rate for Payer: Cash Price |
$17.40
|
| Rate for Payer: Cigna Commercial |
$53.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$32.46
|
| Rate for Payer: Health EOS Commercial |
$51.62
|
| Rate for Payer: HFN Commercial |
$53.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$43.50
|
| Rate for Payer: Multiplan Commercial |
$46.40
|
| Rate for Payer: NAPHCARE Commercial |
$34.80
|
| Rate for Payer: Preferred Network Access Commercial |
$53.36
|
| Rate for Payer: Quartz Beloit One Network |
$28.42
|
| Rate for Payer: Quartz Commercial |
$37.70
|
| Rate for Payer: Quartz Medicare Advantage |
$34.80
|
| Rate for Payer: The Alliance Commercial |
$232.00
|
| Rate for Payer: WEA Trust Commercial |
$31.90
|
| Rate for Payer: WPS Commercial |
$42.96
|
|
|
SUCTION & AUXILLARY TUBING
|
Facility
|
OP
|
$2,451.00
|
|
| Hospital Charge Code |
2972989
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$686.28 |
| Max. Negotiated Rate |
$9,804.00 |
| Rate for Payer: Aetna Commercial |
$2,205.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,107.86
|
| Rate for Payer: Aetna Managed Medicare |
$686.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,593.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,225.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,176.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,299.03
|
| Rate for Payer: Cash Price |
$735.30
|
| Rate for Payer: Cigna Commercial |
$2,254.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,371.58
|
| Rate for Payer: Health EOS Commercial |
$2,181.39
|
| Rate for Payer: HFN Commercial |
$2,254.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,838.25
|
| Rate for Payer: Multiplan Commercial |
$1,960.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,470.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,254.92
|
| Rate for Payer: Quartz Beloit One Network |
$1,200.99
|
| Rate for Payer: Quartz Commercial |
$1,593.15
|
| Rate for Payer: Quartz Medicare Advantage |
$1,470.60
|
| Rate for Payer: The Alliance Commercial |
$9,804.00
|
| Rate for Payer: WEA Trust Commercial |
$1,348.05
|
| Rate for Payer: WPS Commercial |
$1,815.46
|
|
|
SUCTION & AUXILLARY TUBING
|
Facility
|
IP
|
$2,451.00
|
|
| Hospital Charge Code |
2972989
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,200.99 |
| Max. Negotiated Rate |
$2,254.92 |
| Rate for Payer: Aetna Commercial |
$2,205.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,107.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,299.03
|
| Rate for Payer: Cash Price |
$735.30
|
| Rate for Payer: Cigna Commercial |
$2,254.92
|
| Rate for Payer: Health EOS Commercial |
$2,181.39
|
| Rate for Payer: HFN Commercial |
$2,254.92
|
| Rate for Payer: Multiplan Commercial |
$1,960.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,470.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,254.92
|
| Rate for Payer: Quartz Beloit One Network |
$1,200.99
|
| Rate for Payer: Quartz Commercial |
$1,470.60
|
| Rate for Payer: WEA Trust Commercial |
$1,348.05
|
| Rate for Payer: WPS Commercial |
$1,815.46
|
|
|
SUCTION CANISTER/CRASH CART 1200ML GREEN COVER FLOAT VALVE 484410
|
Facility
|
OP
|
$80.00
|
|
| Hospital Charge Code |
2963105
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$22.40 |
| Max. Negotiated Rate |
$320.00 |
| Rate for Payer: Aetna Commercial |
$72.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$68.80
|
| Rate for Payer: Aetna Managed Medicare |
$22.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$52.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$40.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$38.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$42.40
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cigna Commercial |
$73.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$44.77
|
| Rate for Payer: Health EOS Commercial |
$71.20
|
| Rate for Payer: HFN Commercial |
$73.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$60.00
|
| Rate for Payer: Multiplan Commercial |
$64.00
|
| Rate for Payer: NAPHCARE Commercial |
$48.00
|
| Rate for Payer: Preferred Network Access Commercial |
$73.60
|
| Rate for Payer: Quartz Beloit One Network |
$39.20
|
| Rate for Payer: Quartz Commercial |
$52.00
|
| Rate for Payer: Quartz Medicare Advantage |
$48.00
|
| Rate for Payer: The Alliance Commercial |
$320.00
|
| Rate for Payer: WEA Trust Commercial |
$44.00
|
| Rate for Payer: WPS Commercial |
$59.26
|
|
|
SUCTION CANISTER/CRASH CART 1200ML GREEN COVER FLOAT VALVE 484410
|
Facility
|
IP
|
$80.00
|
|
| Hospital Charge Code |
2963105
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$39.20 |
| Max. Negotiated Rate |
$73.60 |
| Rate for Payer: Aetna Commercial |
$72.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$68.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$42.40
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cigna Commercial |
$73.60
|
| Rate for Payer: Health EOS Commercial |
$71.20
|
| Rate for Payer: HFN Commercial |
$73.60
|
| Rate for Payer: Multiplan Commercial |
$64.00
|
| Rate for Payer: NAPHCARE Commercial |
$48.00
|
| Rate for Payer: Preferred Network Access Commercial |
$73.60
|
| Rate for Payer: Quartz Beloit One Network |
$39.20
|
| Rate for Payer: Quartz Commercial |
$48.00
|
| Rate for Payer: WEA Trust Commercial |
$44.00
|
| Rate for Payer: WPS Commercial |
$59.26
|
|
|
Suction Cannister
|
Facility
|
IP
|
$6.00
|
|
| Hospital Charge Code |
3040352
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$2.94 |
| Max. Negotiated Rate |
$5.52 |
| Rate for Payer: Aetna Commercial |
$5.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3.18
|
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Cigna Commercial |
$5.52
|
| Rate for Payer: Health EOS Commercial |
$5.34
|
| Rate for Payer: HFN Commercial |
$5.52
|
| Rate for Payer: Multiplan Commercial |
$4.80
|
| Rate for Payer: NAPHCARE Commercial |
$3.60
|
| Rate for Payer: Preferred Network Access Commercial |
$5.52
|
| Rate for Payer: Quartz Beloit One Network |
$2.94
|
| Rate for Payer: Quartz Commercial |
$3.60
|
| Rate for Payer: WEA Trust Commercial |
$3.30
|
| Rate for Payer: WPS Commercial |
$4.44
|
|
|
Suction Cannister
|
Facility
|
OP
|
$6.00
|
|
| Hospital Charge Code |
3040352
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.68 |
| Max. Negotiated Rate |
$24.00 |
| Rate for Payer: Aetna Commercial |
$5.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5.16
|
| Rate for Payer: Aetna Managed Medicare |
$1.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3.18
|
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Cigna Commercial |
$5.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3.36
|
| Rate for Payer: Health EOS Commercial |
$5.34
|
| Rate for Payer: HFN Commercial |
$5.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4.50
|
| Rate for Payer: Multiplan Commercial |
$4.80
|
| Rate for Payer: NAPHCARE Commercial |
$3.60
|
| Rate for Payer: Preferred Network Access Commercial |
$5.52
|
| Rate for Payer: Quartz Beloit One Network |
$2.94
|
| Rate for Payer: Quartz Commercial |
$3.90
|
| Rate for Payer: Quartz Medicare Advantage |
$3.60
|
| Rate for Payer: The Alliance Commercial |
$24.00
|
| Rate for Payer: WEA Trust Commercial |
$3.30
|
| Rate for Payer: WPS Commercial |
$4.44
|
|
|
SUCTION/CAUTERY 13FR BIPOLAR DISPOSABLE
|
Facility
|
OP
|
$915.00
|
|
| Hospital Charge Code |
2964132
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$256.20 |
| Max. Negotiated Rate |
$3,660.00 |
| Rate for Payer: Aetna Commercial |
$823.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$786.90
|
| Rate for Payer: Aetna Managed Medicare |
$256.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$594.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$457.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$439.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$484.95
|
| Rate for Payer: Cash Price |
$274.50
|
| Rate for Payer: Cigna Commercial |
$841.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$512.03
|
| Rate for Payer: Health EOS Commercial |
$814.35
|
| Rate for Payer: HFN Commercial |
$841.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$686.25
|
| Rate for Payer: Multiplan Commercial |
$732.00
|
| Rate for Payer: NAPHCARE Commercial |
$549.00
|
| Rate for Payer: Preferred Network Access Commercial |
$841.80
|
| Rate for Payer: Quartz Beloit One Network |
$448.35
|
| Rate for Payer: Quartz Commercial |
$594.75
|
| Rate for Payer: Quartz Medicare Advantage |
$549.00
|
| Rate for Payer: The Alliance Commercial |
$3,660.00
|
| Rate for Payer: WEA Trust Commercial |
$503.25
|
| Rate for Payer: WPS Commercial |
$677.74
|
|
|
SUCTION/CAUTERY 13FR BIPOLAR DISPOSABLE
|
Facility
|
IP
|
$915.00
|
|
| Hospital Charge Code |
2964132
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$448.35 |
| Max. Negotiated Rate |
$841.80 |
| Rate for Payer: Aetna Commercial |
$823.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$786.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$484.95
|
| Rate for Payer: Cash Price |
$274.50
|
| Rate for Payer: Cigna Commercial |
$841.80
|
| Rate for Payer: Health EOS Commercial |
$814.35
|
| Rate for Payer: HFN Commercial |
$841.80
|
| Rate for Payer: Multiplan Commercial |
$732.00
|
| Rate for Payer: NAPHCARE Commercial |
$549.00
|
| Rate for Payer: Preferred Network Access Commercial |
$841.80
|
| Rate for Payer: Quartz Beloit One Network |
$448.35
|
| Rate for Payer: Quartz Commercial |
$549.00
|
| Rate for Payer: WEA Trust Commercial |
$503.25
|
| Rate for Payer: WPS Commercial |
$677.74
|
|
|
SUCTION CHEST DRAIN OASIS SINGLE 3600-100
|
Facility
|
OP
|
$598.00
|
|
|
Service Code
|
HCPCS A7041
|
| Hospital Charge Code |
3323497
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$167.44 |
| Max. Negotiated Rate |
$2,392.00 |
| Rate for Payer: Aetna Commercial |
$538.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$514.28
|
| Rate for Payer: Aetna Managed Medicare |
$167.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$388.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$299.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$287.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$316.94
|
| Rate for Payer: Cash Price |
$179.40
|
| Rate for Payer: Cigna Commercial |
$550.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$334.64
|
| Rate for Payer: Health EOS Commercial |
$532.22
|
| Rate for Payer: HFN Commercial |
$550.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$448.50
|
| Rate for Payer: Multiplan Commercial |
$478.40
|
| Rate for Payer: NAPHCARE Commercial |
$358.80
|
| Rate for Payer: Preferred Network Access Commercial |
$550.16
|
| Rate for Payer: Quartz Beloit One Network |
$293.02
|
| Rate for Payer: Quartz Commercial |
$388.70
|
| Rate for Payer: Quartz Medicare Advantage |
$358.80
|
| Rate for Payer: The Alliance Commercial |
$2,392.00
|
| Rate for Payer: WEA Trust Commercial |
$328.90
|
| Rate for Payer: WPS Commercial |
$442.94
|
|
|
SUCTION CHEST DRAIN OASIS SINGLE 3600-100
|
Facility
|
IP
|
$598.00
|
|
|
Service Code
|
HCPCS A7041
|
| Hospital Charge Code |
3323497
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$293.02 |
| Max. Negotiated Rate |
$550.16 |
| Rate for Payer: Aetna Commercial |
$538.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$514.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$316.94
|
| Rate for Payer: Cash Price |
$179.40
|
| Rate for Payer: Cigna Commercial |
$550.16
|
| Rate for Payer: Health EOS Commercial |
$532.22
|
| Rate for Payer: HFN Commercial |
$550.16
|
| Rate for Payer: Multiplan Commercial |
$478.40
|
| Rate for Payer: NAPHCARE Commercial |
$358.80
|
| Rate for Payer: Preferred Network Access Commercial |
$550.16
|
| Rate for Payer: Quartz Beloit One Network |
$293.02
|
| Rate for Payer: Quartz Commercial |
$358.80
|
| Rate for Payer: WEA Trust Commercial |
$328.90
|
| Rate for Payer: WPS Commercial |
$442.94
|
|
|
SUCTION COAGULATOR VALLEYLAB FOOT CONTOLLED 10FR/CH 6 IN E2505-10FR
|
Facility
|
IP
|
$246.00
|
|
| Hospital Charge Code |
2963101
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$120.54 |
| Max. Negotiated Rate |
$226.32 |
| Rate for Payer: Aetna Commercial |
$221.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$211.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$130.38
|
| Rate for Payer: Cash Price |
$73.80
|
| Rate for Payer: Cigna Commercial |
$226.32
|
| Rate for Payer: Health EOS Commercial |
$218.94
|
| Rate for Payer: HFN Commercial |
$226.32
|
| Rate for Payer: Multiplan Commercial |
$196.80
|
| Rate for Payer: NAPHCARE Commercial |
$147.60
|
| Rate for Payer: Preferred Network Access Commercial |
$226.32
|
| Rate for Payer: Quartz Beloit One Network |
$120.54
|
| Rate for Payer: Quartz Commercial |
$147.60
|
| Rate for Payer: WEA Trust Commercial |
$135.30
|
| Rate for Payer: WPS Commercial |
$182.21
|
|
|
SUCTION COAGULATOR VALLEYLAB FOOT CONTOLLED 10FR/CH 6 IN E2505-10FR
|
Facility
|
OP
|
$246.00
|
|
| Hospital Charge Code |
2963101
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$68.88 |
| Max. Negotiated Rate |
$984.00 |
| Rate for Payer: Aetna Commercial |
$221.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$211.56
|
| Rate for Payer: Aetna Managed Medicare |
$68.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$159.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$123.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$118.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$130.38
|
| Rate for Payer: Cash Price |
$73.80
|
| Rate for Payer: Cigna Commercial |
$226.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$137.66
|
| Rate for Payer: Health EOS Commercial |
$218.94
|
| Rate for Payer: HFN Commercial |
$226.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$184.50
|
| Rate for Payer: Multiplan Commercial |
$196.80
|
| Rate for Payer: NAPHCARE Commercial |
$147.60
|
| Rate for Payer: Preferred Network Access Commercial |
$226.32
|
| Rate for Payer: Quartz Beloit One Network |
$120.54
|
| Rate for Payer: Quartz Commercial |
$159.90
|
| Rate for Payer: Quartz Medicare Advantage |
$147.60
|
| Rate for Payer: The Alliance Commercial |
$984.00
|
| Rate for Payer: WEA Trust Commercial |
$135.30
|
| Rate for Payer: WPS Commercial |
$182.21
|
|
|
SUCTION DEVICE BIO-VAC BX00711513
|
Facility
|
OP
|
$1,727.00
|
|
| Hospital Charge Code |
2973628
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$483.56 |
| Max. Negotiated Rate |
$6,908.00 |
| Rate for Payer: Aetna Commercial |
$1,554.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,485.22
|
| Rate for Payer: Aetna Managed Medicare |
$483.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,122.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$863.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$828.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$915.31
|
| Rate for Payer: Cash Price |
$518.10
|
| Rate for Payer: Cigna Commercial |
$1,588.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$966.43
|
| Rate for Payer: Health EOS Commercial |
$1,537.03
|
| Rate for Payer: HFN Commercial |
$1,588.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,295.25
|
| Rate for Payer: Multiplan Commercial |
$1,381.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,036.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,588.84
|
| Rate for Payer: Quartz Beloit One Network |
$846.23
|
| Rate for Payer: Quartz Commercial |
$1,122.55
|
| Rate for Payer: Quartz Medicare Advantage |
$1,036.20
|
| Rate for Payer: The Alliance Commercial |
$6,908.00
|
| Rate for Payer: WEA Trust Commercial |
$949.85
|
| Rate for Payer: WPS Commercial |
$1,279.19
|
|
|
SUCTION DEVICE BIO-VAC BX00711513
|
Facility
|
IP
|
$1,727.00
|
|
| Hospital Charge Code |
2973628
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$846.23 |
| Max. Negotiated Rate |
$1,588.84 |
| Rate for Payer: Aetna Commercial |
$1,554.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,485.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$915.31
|
| Rate for Payer: Cash Price |
$518.10
|
| Rate for Payer: Cigna Commercial |
$1,588.84
|
| Rate for Payer: Health EOS Commercial |
$1,537.03
|
| Rate for Payer: HFN Commercial |
$1,588.84
|
| Rate for Payer: Multiplan Commercial |
$1,381.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,036.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,588.84
|
| Rate for Payer: Quartz Beloit One Network |
$846.23
|
| Rate for Payer: Quartz Commercial |
$1,036.20
|
| Rate for Payer: WEA Trust Commercial |
$949.85
|
| Rate for Payer: WPS Commercial |
$1,279.19
|
|
|
SUCTION DLP CARDIAC MALLEABLE 10050
|
Facility
|
OP
|
$348.00
|
|
| Hospital Charge Code |
4088497
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$97.44 |
| Max. Negotiated Rate |
$1,392.00 |
| Rate for Payer: Aetna Commercial |
$313.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$299.28
|
| Rate for Payer: Aetna Managed Medicare |
$97.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$226.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$174.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$167.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$184.44
|
| Rate for Payer: Cash Price |
$104.40
|
| Rate for Payer: Cigna Commercial |
$320.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$194.74
|
| Rate for Payer: Health EOS Commercial |
$309.72
|
| Rate for Payer: HFN Commercial |
$320.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$261.00
|
| Rate for Payer: Multiplan Commercial |
$278.40
|
| Rate for Payer: NAPHCARE Commercial |
$208.80
|
| Rate for Payer: Preferred Network Access Commercial |
$320.16
|
| Rate for Payer: Quartz Beloit One Network |
$170.52
|
| Rate for Payer: Quartz Commercial |
$226.20
|
| Rate for Payer: Quartz Medicare Advantage |
$208.80
|
| Rate for Payer: The Alliance Commercial |
$1,392.00
|
| Rate for Payer: WEA Trust Commercial |
$191.40
|
| Rate for Payer: WPS Commercial |
$257.76
|
|
|
SUCTION DLP CARDIAC MALLEABLE 10050
|
Facility
|
IP
|
$348.00
|
|
| Hospital Charge Code |
4088497
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$170.52 |
| Max. Negotiated Rate |
$320.16 |
| Rate for Payer: Aetna Commercial |
$313.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$299.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$184.44
|
| Rate for Payer: Cash Price |
$104.40
|
| Rate for Payer: Cigna Commercial |
$320.16
|
| Rate for Payer: Health EOS Commercial |
$309.72
|
| Rate for Payer: HFN Commercial |
$320.16
|
| Rate for Payer: Multiplan Commercial |
$278.40
|
| Rate for Payer: NAPHCARE Commercial |
$208.80
|
| Rate for Payer: Preferred Network Access Commercial |
$320.16
|
| Rate for Payer: Quartz Beloit One Network |
$170.52
|
| Rate for Payer: Quartz Commercial |
$208.80
|
| Rate for Payer: WEA Trust Commercial |
$191.40
|
| Rate for Payer: WPS Commercial |
$257.76
|
|
|
SUCTION HEMOVAC 100cc 0070740
|
Facility
|
OP
|
$162.00
|
|
| Hospital Charge Code |
2963314
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$45.36 |
| Max. Negotiated Rate |
$648.00 |
| Rate for Payer: Aetna Commercial |
$145.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$139.32
|
| Rate for Payer: Aetna Managed Medicare |
$45.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$105.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$81.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$77.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$85.86
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Cigna Commercial |
$149.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$90.66
|
| Rate for Payer: Health EOS Commercial |
$144.18
|
| Rate for Payer: HFN Commercial |
$149.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$121.50
|
| Rate for Payer: Multiplan Commercial |
$129.60
|
| Rate for Payer: NAPHCARE Commercial |
$97.20
|
| Rate for Payer: Preferred Network Access Commercial |
$149.04
|
| Rate for Payer: Quartz Beloit One Network |
$79.38
|
| Rate for Payer: Quartz Commercial |
$105.30
|
| Rate for Payer: Quartz Medicare Advantage |
$97.20
|
| Rate for Payer: The Alliance Commercial |
$648.00
|
| Rate for Payer: WEA Trust Commercial |
$89.10
|
| Rate for Payer: WPS Commercial |
$119.99
|
|
|
SUCTION HEMOVAC 100cc 0070740
|
Facility
|
IP
|
$162.00
|
|
| Hospital Charge Code |
2963314
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$79.38 |
| Max. Negotiated Rate |
$149.04 |
| Rate for Payer: Aetna Commercial |
$145.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$139.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$85.86
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Cigna Commercial |
$149.04
|
| Rate for Payer: Health EOS Commercial |
$144.18
|
| Rate for Payer: HFN Commercial |
$149.04
|
| Rate for Payer: Multiplan Commercial |
$129.60
|
| Rate for Payer: NAPHCARE Commercial |
$97.20
|
| Rate for Payer: Preferred Network Access Commercial |
$149.04
|
| Rate for Payer: Quartz Beloit One Network |
$79.38
|
| Rate for Payer: Quartz Commercial |
$97.20
|
| Rate for Payer: WEA Trust Commercial |
$89.10
|
| Rate for Payer: WPS Commercial |
$119.99
|
|
|
SUCTION HEMOVAC 400cc EVACUATOR 0043650
|
Facility
|
IP
|
$192.00
|
|
| Hospital Charge Code |
2963425
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$94.08 |
| Max. Negotiated Rate |
$176.64 |
| Rate for Payer: Aetna Commercial |
$172.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$165.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$101.76
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cigna Commercial |
$176.64
|
| Rate for Payer: Health EOS Commercial |
$170.88
|
| Rate for Payer: HFN Commercial |
$176.64
|
| Rate for Payer: Multiplan Commercial |
$153.60
|
| Rate for Payer: NAPHCARE Commercial |
$115.20
|
| Rate for Payer: Preferred Network Access Commercial |
$176.64
|
| Rate for Payer: Quartz Beloit One Network |
$94.08
|
| Rate for Payer: Quartz Commercial |
$115.20
|
| Rate for Payer: WEA Trust Commercial |
$105.60
|
| Rate for Payer: WPS Commercial |
$142.21
|
|
|
SUCTION HEMOVAC 400cc EVACUATOR 0043650
|
Facility
|
OP
|
$192.00
|
|
| Hospital Charge Code |
2963425
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$53.76 |
| Max. Negotiated Rate |
$768.00 |
| Rate for Payer: Aetna Commercial |
$172.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$165.12
|
| Rate for Payer: Aetna Managed Medicare |
$53.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$124.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$96.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$92.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$101.76
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cigna Commercial |
$176.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$107.44
|
| Rate for Payer: Health EOS Commercial |
$170.88
|
| Rate for Payer: HFN Commercial |
$176.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$144.00
|
| Rate for Payer: Multiplan Commercial |
$153.60
|
| Rate for Payer: NAPHCARE Commercial |
$115.20
|
| Rate for Payer: Preferred Network Access Commercial |
$176.64
|
| Rate for Payer: Quartz Beloit One Network |
$94.08
|
| Rate for Payer: Quartz Commercial |
$124.80
|
| Rate for Payer: Quartz Medicare Advantage |
$115.20
|
| Rate for Payer: The Alliance Commercial |
$768.00
|
| Rate for Payer: WEA Trust Commercial |
$105.60
|
| Rate for Payer: WPS Commercial |
$142.21
|
|
|
SUCTION MUCAS TRAP 8FR
|
Facility
|
OP
|
$168.00
|
|
| Hospital Charge Code |
2963346
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$47.04 |
| Max. Negotiated Rate |
$672.00 |
| Rate for Payer: Aetna Commercial |
$151.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$144.48
|
| Rate for Payer: Aetna Managed Medicare |
$47.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$109.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$84.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$80.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$89.04
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cigna Commercial |
$154.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$94.01
|
| Rate for Payer: Health EOS Commercial |
$149.52
|
| Rate for Payer: HFN Commercial |
$154.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$126.00
|
| Rate for Payer: Multiplan Commercial |
$134.40
|
| Rate for Payer: NAPHCARE Commercial |
$100.80
|
| Rate for Payer: Preferred Network Access Commercial |
$154.56
|
| Rate for Payer: Quartz Beloit One Network |
$82.32
|
| Rate for Payer: Quartz Commercial |
$109.20
|
| Rate for Payer: Quartz Medicare Advantage |
$100.80
|
| Rate for Payer: The Alliance Commercial |
$672.00
|
| Rate for Payer: WEA Trust Commercial |
$92.40
|
| Rate for Payer: WPS Commercial |
$124.44
|
|
|
SUCTION MUCAS TRAP 8FR
|
Facility
|
IP
|
$168.00
|
|
| Hospital Charge Code |
2963346
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$82.32 |
| Max. Negotiated Rate |
$154.56 |
| Rate for Payer: Aetna Commercial |
$151.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$144.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$89.04
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cigna Commercial |
$154.56
|
| Rate for Payer: Health EOS Commercial |
$149.52
|
| Rate for Payer: HFN Commercial |
$154.56
|
| Rate for Payer: Multiplan Commercial |
$134.40
|
| Rate for Payer: NAPHCARE Commercial |
$100.80
|
| Rate for Payer: Preferred Network Access Commercial |
$154.56
|
| Rate for Payer: Quartz Beloit One Network |
$82.32
|
| Rate for Payer: Quartz Commercial |
$100.80
|
| Rate for Payer: WEA Trust Commercial |
$92.40
|
| Rate for Payer: WPS Commercial |
$124.44
|
|
|
SUCTION POOLE LATEX FREE 8888509703
|
Facility
|
OP
|
$59.00
|
|
| Hospital Charge Code |
2963382
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.52 |
| Max. Negotiated Rate |
$236.00 |
| Rate for Payer: Aetna Commercial |
$53.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$50.74
|
| Rate for Payer: Aetna Managed Medicare |
$16.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$38.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$29.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$28.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$31.27
|
| Rate for Payer: Cash Price |
$17.70
|
| Rate for Payer: Cigna Commercial |
$54.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$33.02
|
| Rate for Payer: Health EOS Commercial |
$52.51
|
| Rate for Payer: HFN Commercial |
$54.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$44.25
|
| Rate for Payer: Multiplan Commercial |
$47.20
|
| Rate for Payer: NAPHCARE Commercial |
$35.40
|
| Rate for Payer: Preferred Network Access Commercial |
$54.28
|
| Rate for Payer: Quartz Beloit One Network |
$28.91
|
| Rate for Payer: Quartz Commercial |
$38.35
|
| Rate for Payer: Quartz Medicare Advantage |
$35.40
|
| Rate for Payer: The Alliance Commercial |
$236.00
|
| Rate for Payer: WEA Trust Commercial |
$32.45
|
| Rate for Payer: WPS Commercial |
$43.70
|
|
|
SUCTION POOLE LATEX FREE 8888509703
|
Facility
|
IP
|
$59.00
|
|
| Hospital Charge Code |
2963382
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$28.91 |
| Max. Negotiated Rate |
$54.28 |
| Rate for Payer: Aetna Commercial |
$53.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$50.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$31.27
|
| Rate for Payer: Cash Price |
$17.70
|
| Rate for Payer: Cigna Commercial |
$54.28
|
| Rate for Payer: Health EOS Commercial |
$52.51
|
| Rate for Payer: HFN Commercial |
$54.28
|
| Rate for Payer: Multiplan Commercial |
$47.20
|
| Rate for Payer: NAPHCARE Commercial |
$35.40
|
| Rate for Payer: Preferred Network Access Commercial |
$54.28
|
| Rate for Payer: Quartz Beloit One Network |
$28.91
|
| Rate for Payer: Quartz Commercial |
$35.40
|
| Rate for Payer: WEA Trust Commercial |
$32.45
|
| Rate for Payer: WPS Commercial |
$43.70
|
|
