|
successful insertion pacing Swan-Ganz catheter - PA Line Procedure Result
|
Facility
|
OP
|
$532.00
|
|
| Hospital Charge Code |
3025927
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$154.92 |
| Max. Negotiated Rate |
$509.02 |
| Rate for Payer: Aetna Commercial |
$497.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$475.82
|
| Rate for Payer: Aetna Managed Medicare |
$154.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$359.63
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$276.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$265.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$293.24
|
| Rate for Payer: Cash Price |
$159.60
|
| Rate for Payer: Cigna Commercial |
$509.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$309.62
|
| Rate for Payer: Health EOS Commercial |
$492.42
|
| Rate for Payer: HFN Commercial |
$509.02
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$414.96
|
| Rate for Payer: Multiplan Commercial |
$442.62
|
| Rate for Payer: NAPHCARE Commercial |
$331.97
|
| Rate for Payer: Preferred Network Access Commercial |
$509.02
|
| Rate for Payer: Quartz Beloit One Network |
$271.11
|
| Rate for Payer: Quartz Commercial |
$359.63
|
| Rate for Payer: Quartz Medicare Advantage |
$331.97
|
| Rate for Payer: The Alliance Commercial |
$276.64
|
| Rate for Payer: WEA Trust Commercial |
$304.30
|
| Rate for Payer: WPS Commercial |
$409.80
|
|
|
successful insertion pacing Swan-Ganz catheter - PA Line Procedure Result
|
Facility
|
IP
|
$532.00
|
|
| Hospital Charge Code |
3025927
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$271.11 |
| Max. Negotiated Rate |
$509.02 |
| Rate for Payer: Aetna Commercial |
$497.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$475.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$293.24
|
| Rate for Payer: Cash Price |
$159.60
|
| Rate for Payer: Cigna Commercial |
$509.02
|
| Rate for Payer: Health EOS Commercial |
$492.42
|
| Rate for Payer: HFN Commercial |
$509.02
|
| Rate for Payer: Multiplan Commercial |
$442.62
|
| Rate for Payer: Preferred Network Access Commercial |
$509.02
|
| Rate for Payer: Quartz Beloit One Network |
$271.11
|
| Rate for Payer: Quartz Commercial |
$331.97
|
| Rate for Payer: WEA Trust Commercial |
$304.30
|
| Rate for Payer: WPS Commercial |
$409.80
|
|
|
successful insertion radial artery - Arterial Line Procedure Result:
|
Facility
|
IP
|
$1,359.00
|
|
|
Service Code
|
CPT 36620
|
| Hospital Charge Code |
3005241
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$692.55 |
| Max. Negotiated Rate |
$1,300.29 |
| Rate for Payer: Aetna Commercial |
$1,272.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,215.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$749.08
|
| Rate for Payer: Cash Price |
$407.70
|
| Rate for Payer: Cigna Commercial |
$1,300.29
|
| Rate for Payer: Health EOS Commercial |
$1,257.89
|
| Rate for Payer: HFN Commercial |
$1,300.29
|
| Rate for Payer: Multiplan Commercial |
$1,130.69
|
| Rate for Payer: Preferred Network Access Commercial |
$1,300.29
|
| Rate for Payer: Quartz Beloit One Network |
$692.55
|
| Rate for Payer: Quartz Commercial |
$848.02
|
| Rate for Payer: WEA Trust Commercial |
$777.35
|
| Rate for Payer: WPS Commercial |
$1,046.84
|
|
|
successful insertion radial artery - Arterial Line Procedure Result:
|
Facility
|
OP
|
$1,359.00
|
|
|
Service Code
|
CPT 36620
|
| Hospital Charge Code |
3005241
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$160.91 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$1,272.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,215.49
|
| Rate for Payer: Aetna Managed Medicare |
$395.74
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$918.68
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$706.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$678.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$749.08
|
| Rate for Payer: Cash Price |
$407.70
|
| Rate for Payer: Cash Price |
$407.70
|
| Rate for Payer: Cigna Commercial |
$1,300.29
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Health EOS Commercial |
$1,257.89
|
| Rate for Payer: HFN Commercial |
$1,300.29
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,060.02
|
| Rate for Payer: Multiplan Commercial |
$1,130.69
|
| Rate for Payer: NAPHCARE Commercial |
$848.02
|
| Rate for Payer: Preferred Network Access Commercial |
$1,300.29
|
| Rate for Payer: Quartz Beloit One Network |
$692.55
|
| Rate for Payer: Quartz Commercial |
$918.68
|
| Rate for Payer: Quartz Medicare Advantage |
$848.02
|
| Rate for Payer: The Alliance Commercial |
$160.91
|
| Rate for Payer: United Healthcare PPO |
$1,060.02
|
| Rate for Payer: WEA Trust Commercial |
$777.35
|
| Rate for Payer: WPS Commercial |
$1,046.84
|
|
|
successful insertion subclavian site - Central IV Procedure Result:
|
Facility
|
OP
|
$1,453.00
|
|
|
Service Code
|
CPT 36556
|
| Hospital Charge Code |
3025905
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$313.04 |
| Max. Negotiated Rate |
$13,291.62 |
| Rate for Payer: Aetna Commercial |
$1,360.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,299.56
|
| Rate for Payer: Aetna Managed Medicare |
$3,322.90
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$982.23
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$755.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$725.34
|
| Rate for Payer: Anthem Medicare Advantage |
$3,322.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$800.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,322.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,322.90
|
| Rate for Payer: Cash Price |
$435.90
|
| Rate for Payer: Cash Price |
$435.90
|
| Rate for Payer: Cash Price |
$435.90
|
| Rate for Payer: Cigna Commercial |
$1,390.23
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,322.90
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,322.90
|
| Rate for Payer: Health EOS Commercial |
$1,344.90
|
| Rate for Payer: HFN Commercial |
$1,390.23
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,361.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,322.90
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,322.90
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,322.90
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,322.90
|
| Rate for Payer: Multiplan Commercial |
$1,208.90
|
| Rate for Payer: NAPHCARE Commercial |
$4,984.36
|
| Rate for Payer: Preferred Network Access Commercial |
$1,390.23
|
| Rate for Payer: Quartz Beloit One Network |
$740.45
|
| Rate for Payer: Quartz Commercial |
$982.23
|
| Rate for Payer: Quartz Medicare Advantage |
$3,322.90
|
| Rate for Payer: The Alliance Commercial |
$13,291.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,322.90
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$831.12
|
| Rate for Payer: Wellcare Medicare |
$3,322.90
|
| Rate for Payer: WPS Commercial |
$1,119.25
|
|
|
successful insertion subclavian site - Central IV Procedure Result:
|
Facility
|
IP
|
$1,453.00
|
|
|
Service Code
|
CPT 36556
|
| Hospital Charge Code |
3025905
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$740.45 |
| Max. Negotiated Rate |
$1,390.23 |
| Rate for Payer: Aetna Commercial |
$1,360.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,299.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$800.89
|
| Rate for Payer: Cash Price |
$435.90
|
| Rate for Payer: Cigna Commercial |
$1,390.23
|
| Rate for Payer: Health EOS Commercial |
$1,344.90
|
| Rate for Payer: HFN Commercial |
$1,390.23
|
| Rate for Payer: Multiplan Commercial |
$1,208.90
|
| Rate for Payer: Preferred Network Access Commercial |
$1,390.23
|
| Rate for Payer: Quartz Beloit One Network |
$740.45
|
| Rate for Payer: Quartz Commercial |
$906.67
|
| Rate for Payer: WEA Trust Commercial |
$831.12
|
| Rate for Payer: WPS Commercial |
$1,119.25
|
|
|
successful insertion thermodilution catheter - PA Line Procedure Result
|
Facility
|
IP
|
$1,778.00
|
|
|
Service Code
|
CPT 93503
|
| Hospital Charge Code |
3025926
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$906.07 |
| Max. Negotiated Rate |
$1,701.19 |
| Rate for Payer: Aetna Commercial |
$1,664.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,590.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$980.03
|
| Rate for Payer: Cash Price |
$533.40
|
| Rate for Payer: Cigna Commercial |
$1,701.19
|
| Rate for Payer: Health EOS Commercial |
$1,645.72
|
| Rate for Payer: HFN Commercial |
$1,701.19
|
| Rate for Payer: Multiplan Commercial |
$1,479.30
|
| Rate for Payer: Preferred Network Access Commercial |
$1,701.19
|
| Rate for Payer: Quartz Beloit One Network |
$906.07
|
| Rate for Payer: Quartz Commercial |
$1,109.47
|
| Rate for Payer: WEA Trust Commercial |
$1,017.02
|
| Rate for Payer: WPS Commercial |
$1,369.59
|
|
|
successful insertion thermodilution catheter - PA Line Procedure Result
|
Facility
|
OP
|
$1,778.00
|
|
|
Service Code
|
CPT 93503
|
| Hospital Charge Code |
3025926
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$906.07 |
| Max. Negotiated Rate |
$18,182.32 |
| Rate for Payer: Aetna Commercial |
$1,664.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,590.24
|
| Rate for Payer: Aetna Managed Medicare |
$1,656.63
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$18,182.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$15,530.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$14,753.44
|
| Rate for Payer: Anthem Medicare Advantage |
$1,656.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$980.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,656.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,656.63
|
| Rate for Payer: Cash Price |
$533.40
|
| Rate for Payer: Cash Price |
$533.40
|
| Rate for Payer: Cash Price |
$533.40
|
| Rate for Payer: Cigna Commercial |
$1,701.19
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,656.63
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,034.80
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,656.63
|
| Rate for Payer: Health EOS Commercial |
$1,645.72
|
| Rate for Payer: HFN Commercial |
$1,701.19
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,162.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,656.63
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,656.63
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,656.63
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,656.63
|
| Rate for Payer: Multiplan Commercial |
$1,479.30
|
| Rate for Payer: NAPHCARE Commercial |
$2,484.94
|
| Rate for Payer: Preferred Network Access Commercial |
$1,701.19
|
| Rate for Payer: Quartz Beloit One Network |
$906.07
|
| Rate for Payer: Quartz Commercial |
$1,201.93
|
| Rate for Payer: Quartz Medicare Advantage |
$1,656.63
|
| Rate for Payer: The Alliance Commercial |
$6,626.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,656.63
|
| Rate for Payer: United Healthcare PPO |
$3,726.32
|
| Rate for Payer: WEA Trust Commercial |
$1,017.02
|
| Rate for Payer: Wellcare Medicare |
$1,656.63
|
| Rate for Payer: WPS Commercial |
$1,369.59
|
|
|
SUCKER MINI 1/4 IN X 9 IN SOFT TIP WITH SIDE PORTS TERUMO 14991S
|
Facility
|
IP
|
$466.00
|
|
| Hospital Charge Code |
2965160
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$237.47 |
| Max. Negotiated Rate |
$445.87 |
| Rate for Payer: Aetna Commercial |
$436.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$416.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$256.86
|
| Rate for Payer: Cash Price |
$139.80
|
| Rate for Payer: Cigna Commercial |
$445.87
|
| Rate for Payer: Health EOS Commercial |
$431.33
|
| Rate for Payer: HFN Commercial |
$445.87
|
| Rate for Payer: Multiplan Commercial |
$387.71
|
| Rate for Payer: Preferred Network Access Commercial |
$445.87
|
| Rate for Payer: Quartz Beloit One Network |
$237.47
|
| Rate for Payer: Quartz Commercial |
$290.78
|
| Rate for Payer: WEA Trust Commercial |
$266.55
|
| Rate for Payer: WPS Commercial |
$358.96
|
|
|
SUCKER MINI 1/4 IN X 9 IN SOFT TIP WITH SIDE PORTS TERUMO 14991S
|
Facility
|
OP
|
$466.00
|
|
| Hospital Charge Code |
2965160
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$135.70 |
| Max. Negotiated Rate |
$445.87 |
| Rate for Payer: Aetna Commercial |
$436.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$416.79
|
| Rate for Payer: Aetna Managed Medicare |
$135.70
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$315.02
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$242.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$232.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$256.86
|
| Rate for Payer: Cash Price |
$139.80
|
| Rate for Payer: Cigna Commercial |
$445.87
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$271.21
|
| Rate for Payer: Health EOS Commercial |
$431.33
|
| Rate for Payer: HFN Commercial |
$445.87
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$363.48
|
| Rate for Payer: Multiplan Commercial |
$387.71
|
| Rate for Payer: NAPHCARE Commercial |
$290.78
|
| Rate for Payer: Preferred Network Access Commercial |
$445.87
|
| Rate for Payer: Quartz Beloit One Network |
$237.47
|
| Rate for Payer: Quartz Commercial |
$315.02
|
| Rate for Payer: Quartz Medicare Advantage |
$290.78
|
| Rate for Payer: The Alliance Commercial |
$242.32
|
| Rate for Payer: WEA Trust Commercial |
$266.55
|
| Rate for Payer: WPS Commercial |
$358.96
|
|
|
SUCTION 1000ccEVAC CON.1614-05
|
Facility
|
OP
|
$58.00
|
|
| Hospital Charge Code |
2963569
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.89 |
| Max. Negotiated Rate |
$55.49 |
| Rate for Payer: Aetna Commercial |
$54.29
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$51.88
|
| Rate for Payer: Aetna Managed Medicare |
$16.89
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$39.21
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$30.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$28.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$31.97
|
| Rate for Payer: Cash Price |
$17.40
|
| Rate for Payer: Cigna Commercial |
$55.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$33.76
|
| Rate for Payer: Health EOS Commercial |
$53.68
|
| Rate for Payer: HFN Commercial |
$55.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$45.24
|
| Rate for Payer: Multiplan Commercial |
$48.26
|
| Rate for Payer: NAPHCARE Commercial |
$36.19
|
| Rate for Payer: Preferred Network Access Commercial |
$55.49
|
| Rate for Payer: Quartz Beloit One Network |
$29.56
|
| Rate for Payer: Quartz Commercial |
$39.21
|
| Rate for Payer: Quartz Medicare Advantage |
$36.19
|
| Rate for Payer: The Alliance Commercial |
$30.16
|
| Rate for Payer: WEA Trust Commercial |
$33.18
|
| Rate for Payer: WPS Commercial |
$44.68
|
|
|
SUCTION 1000ccEVAC CON.1614-05
|
Facility
|
IP
|
$58.00
|
|
| Hospital Charge Code |
2963569
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$29.56 |
| Max. Negotiated Rate |
$55.49 |
| Rate for Payer: Aetna Commercial |
$54.29
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$51.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$31.97
|
| Rate for Payer: Cash Price |
$17.40
|
| Rate for Payer: Cigna Commercial |
$55.49
|
| Rate for Payer: Health EOS Commercial |
$53.68
|
| Rate for Payer: HFN Commercial |
$55.49
|
| Rate for Payer: Multiplan Commercial |
$48.26
|
| Rate for Payer: Preferred Network Access Commercial |
$55.49
|
| Rate for Payer: Quartz Beloit One Network |
$29.56
|
| Rate for Payer: Quartz Commercial |
$36.19
|
| Rate for Payer: WEA Trust Commercial |
$33.18
|
| Rate for Payer: WPS Commercial |
$44.68
|
|
|
SUCTION & AUXILLARY TUBING
|
Facility
|
IP
|
$2,451.00
|
|
| Hospital Charge Code |
2972989
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,249.03 |
| Max. Negotiated Rate |
$2,345.12 |
| Rate for Payer: Aetna Commercial |
$2,294.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,192.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,350.99
|
| Rate for Payer: Cash Price |
$735.30
|
| Rate for Payer: Cigna Commercial |
$2,345.12
|
| Rate for Payer: Health EOS Commercial |
$2,268.65
|
| Rate for Payer: HFN Commercial |
$2,345.12
|
| Rate for Payer: Multiplan Commercial |
$2,039.23
|
| Rate for Payer: Preferred Network Access Commercial |
$2,345.12
|
| Rate for Payer: Quartz Beloit One Network |
$1,249.03
|
| Rate for Payer: Quartz Commercial |
$1,529.42
|
| Rate for Payer: WEA Trust Commercial |
$1,401.97
|
| Rate for Payer: WPS Commercial |
$1,888.01
|
|
|
SUCTION & AUXILLARY TUBING
|
Facility
|
OP
|
$2,451.00
|
|
| Hospital Charge Code |
2972989
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$713.73 |
| Max. Negotiated Rate |
$2,345.12 |
| Rate for Payer: Aetna Commercial |
$2,294.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,192.17
|
| Rate for Payer: Aetna Managed Medicare |
$713.73
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,656.88
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,274.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,223.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,350.99
|
| Rate for Payer: Cash Price |
$735.30
|
| Rate for Payer: Cigna Commercial |
$2,345.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,426.48
|
| Rate for Payer: Health EOS Commercial |
$2,268.65
|
| Rate for Payer: HFN Commercial |
$2,345.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,911.78
|
| Rate for Payer: Multiplan Commercial |
$2,039.23
|
| Rate for Payer: NAPHCARE Commercial |
$1,529.42
|
| Rate for Payer: Preferred Network Access Commercial |
$2,345.12
|
| Rate for Payer: Quartz Beloit One Network |
$1,249.03
|
| Rate for Payer: Quartz Commercial |
$1,656.88
|
| Rate for Payer: Quartz Medicare Advantage |
$1,529.42
|
| Rate for Payer: The Alliance Commercial |
$1,274.52
|
| Rate for Payer: WEA Trust Commercial |
$1,401.97
|
| Rate for Payer: WPS Commercial |
$1,888.01
|
|
|
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 |
$23.30 |
| Max. Negotiated Rate |
$76.54 |
| Rate for Payer: Aetna Commercial |
$74.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$71.55
|
| Rate for Payer: Aetna Managed Medicare |
$23.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$54.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$41.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$39.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$44.10
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cigna Commercial |
$76.54
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$46.56
|
| Rate for Payer: Health EOS Commercial |
$74.05
|
| Rate for Payer: HFN Commercial |
$76.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$62.40
|
| Rate for Payer: Multiplan Commercial |
$66.56
|
| Rate for Payer: NAPHCARE Commercial |
$49.92
|
| Rate for Payer: Preferred Network Access Commercial |
$76.54
|
| Rate for Payer: Quartz Beloit One Network |
$40.77
|
| Rate for Payer: Quartz Commercial |
$54.08
|
| Rate for Payer: Quartz Medicare Advantage |
$49.92
|
| Rate for Payer: The Alliance Commercial |
$41.60
|
| Rate for Payer: WEA Trust Commercial |
$45.76
|
| Rate for Payer: WPS Commercial |
$61.62
|
|
|
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 |
$40.77 |
| Max. Negotiated Rate |
$76.54 |
| Rate for Payer: Aetna Commercial |
$74.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$71.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$44.10
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cigna Commercial |
$76.54
|
| Rate for Payer: Health EOS Commercial |
$74.05
|
| Rate for Payer: HFN Commercial |
$76.54
|
| Rate for Payer: Multiplan Commercial |
$66.56
|
| Rate for Payer: Preferred Network Access Commercial |
$76.54
|
| Rate for Payer: Quartz Beloit One Network |
$40.77
|
| Rate for Payer: Quartz Commercial |
$49.92
|
| Rate for Payer: WEA Trust Commercial |
$45.76
|
| Rate for Payer: WPS Commercial |
$61.62
|
|
|
Suction Cannister
|
Facility
|
IP
|
$6.00
|
|
| Hospital Charge Code |
3040352
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$3.06 |
| Max. Negotiated Rate |
$5.74 |
| Rate for Payer: Aetna Commercial |
$5.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3.31
|
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Cigna Commercial |
$5.74
|
| Rate for Payer: Health EOS Commercial |
$5.55
|
| Rate for Payer: HFN Commercial |
$5.74
|
| Rate for Payer: Multiplan Commercial |
$4.99
|
| Rate for Payer: Preferred Network Access Commercial |
$5.74
|
| Rate for Payer: Quartz Beloit One Network |
$3.06
|
| Rate for Payer: Quartz Commercial |
$3.74
|
| Rate for Payer: WEA Trust Commercial |
$3.43
|
| Rate for Payer: WPS Commercial |
$4.62
|
|
|
Suction Cannister
|
Facility
|
OP
|
$6.00
|
|
| Hospital Charge Code |
3040352
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.75 |
| Max. Negotiated Rate |
$5.74 |
| Rate for Payer: Aetna Commercial |
$5.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5.37
|
| Rate for Payer: Aetna Managed Medicare |
$1.75
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3.31
|
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Cigna Commercial |
$5.74
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3.49
|
| Rate for Payer: Health EOS Commercial |
$5.55
|
| Rate for Payer: HFN Commercial |
$5.74
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4.68
|
| Rate for Payer: Multiplan Commercial |
$4.99
|
| Rate for Payer: NAPHCARE Commercial |
$3.74
|
| Rate for Payer: Preferred Network Access Commercial |
$5.74
|
| Rate for Payer: Quartz Beloit One Network |
$3.06
|
| Rate for Payer: Quartz Commercial |
$4.06
|
| Rate for Payer: Quartz Medicare Advantage |
$3.74
|
| Rate for Payer: The Alliance Commercial |
$3.12
|
| Rate for Payer: WEA Trust Commercial |
$3.43
|
| Rate for Payer: WPS Commercial |
$4.62
|
|
|
SUCTION/CAUTERY 13FR BIPOLAR DISPOSABLE
|
Facility
|
OP
|
$915.00
|
|
| Hospital Charge Code |
2964132
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$266.45 |
| Max. Negotiated Rate |
$875.47 |
| Rate for Payer: Aetna Commercial |
$856.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$818.38
|
| Rate for Payer: Aetna Managed Medicare |
$266.45
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$618.54
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$475.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$456.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$504.35
|
| Rate for Payer: Cash Price |
$274.50
|
| Rate for Payer: Cigna Commercial |
$875.47
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$532.53
|
| Rate for Payer: Health EOS Commercial |
$846.92
|
| Rate for Payer: HFN Commercial |
$875.47
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$713.70
|
| Rate for Payer: Multiplan Commercial |
$761.28
|
| Rate for Payer: NAPHCARE Commercial |
$570.96
|
| Rate for Payer: Preferred Network Access Commercial |
$875.47
|
| Rate for Payer: Quartz Beloit One Network |
$466.28
|
| Rate for Payer: Quartz Commercial |
$618.54
|
| Rate for Payer: Quartz Medicare Advantage |
$570.96
|
| Rate for Payer: The Alliance Commercial |
$475.80
|
| Rate for Payer: WEA Trust Commercial |
$523.38
|
| Rate for Payer: WPS Commercial |
$704.82
|
|
|
SUCTION/CAUTERY 13FR BIPOLAR DISPOSABLE
|
Facility
|
IP
|
$915.00
|
|
| Hospital Charge Code |
2964132
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$466.28 |
| Max. Negotiated Rate |
$875.47 |
| Rate for Payer: Aetna Commercial |
$856.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$818.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$504.35
|
| Rate for Payer: Cash Price |
$274.50
|
| Rate for Payer: Cigna Commercial |
$875.47
|
| Rate for Payer: Health EOS Commercial |
$846.92
|
| Rate for Payer: HFN Commercial |
$875.47
|
| Rate for Payer: Multiplan Commercial |
$761.28
|
| Rate for Payer: Preferred Network Access Commercial |
$875.47
|
| Rate for Payer: Quartz Beloit One Network |
$466.28
|
| Rate for Payer: Quartz Commercial |
$570.96
|
| Rate for Payer: WEA Trust Commercial |
$523.38
|
| Rate for Payer: WPS Commercial |
$704.82
|
|
|
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 |
$304.74 |
| Max. Negotiated Rate |
$572.17 |
| Rate for Payer: Aetna Commercial |
$559.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$534.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$329.62
|
| Rate for Payer: Cash Price |
$179.40
|
| Rate for Payer: Cigna Commercial |
$572.17
|
| Rate for Payer: Health EOS Commercial |
$553.51
|
| Rate for Payer: HFN Commercial |
$572.17
|
| Rate for Payer: Multiplan Commercial |
$497.54
|
| Rate for Payer: Preferred Network Access Commercial |
$572.17
|
| Rate for Payer: Quartz Beloit One Network |
$304.74
|
| Rate for Payer: Quartz Commercial |
$373.15
|
| Rate for Payer: WEA Trust Commercial |
$342.06
|
| Rate for Payer: WPS Commercial |
$460.64
|
|
|
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 |
$174.14 |
| Max. Negotiated Rate |
$572.17 |
| Rate for Payer: Aetna Commercial |
$559.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$534.85
|
| Rate for Payer: Aetna Managed Medicare |
$174.14
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$404.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$310.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$298.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$329.62
|
| Rate for Payer: Cash Price |
$179.40
|
| Rate for Payer: Cash Price |
$179.40
|
| Rate for Payer: Cigna Commercial |
$572.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$348.04
|
| Rate for Payer: Health EOS Commercial |
$553.51
|
| Rate for Payer: HFN Commercial |
$572.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$466.44
|
| Rate for Payer: Multiplan Commercial |
$497.54
|
| Rate for Payer: NAPHCARE Commercial |
$373.15
|
| Rate for Payer: Preferred Network Access Commercial |
$572.17
|
| Rate for Payer: Quartz Beloit One Network |
$304.74
|
| Rate for Payer: Quartz Commercial |
$404.25
|
| Rate for Payer: Quartz Medicare Advantage |
$373.15
|
| Rate for Payer: The Alliance Commercial |
$450.65
|
| Rate for Payer: WEA Trust Commercial |
$342.06
|
| Rate for Payer: WPS Commercial |
$460.64
|
|
|
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 |
$125.36 |
| Max. Negotiated Rate |
$235.37 |
| Rate for Payer: Aetna Commercial |
$230.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$220.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$135.60
|
| Rate for Payer: Cash Price |
$73.80
|
| Rate for Payer: Cigna Commercial |
$235.37
|
| Rate for Payer: Health EOS Commercial |
$227.70
|
| Rate for Payer: HFN Commercial |
$235.37
|
| Rate for Payer: Multiplan Commercial |
$204.67
|
| Rate for Payer: Preferred Network Access Commercial |
$235.37
|
| Rate for Payer: Quartz Beloit One Network |
$125.36
|
| Rate for Payer: Quartz Commercial |
$153.50
|
| Rate for Payer: WEA Trust Commercial |
$140.71
|
| Rate for Payer: WPS Commercial |
$189.49
|
|
|
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 |
$71.64 |
| Max. Negotiated Rate |
$235.37 |
| Rate for Payer: Aetna Commercial |
$230.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$220.02
|
| Rate for Payer: Aetna Managed Medicare |
$71.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$166.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$127.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$122.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$135.60
|
| Rate for Payer: Cash Price |
$73.80
|
| Rate for Payer: Cigna Commercial |
$235.37
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$143.17
|
| Rate for Payer: Health EOS Commercial |
$227.70
|
| Rate for Payer: HFN Commercial |
$235.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$191.88
|
| Rate for Payer: Multiplan Commercial |
$204.67
|
| Rate for Payer: NAPHCARE Commercial |
$153.50
|
| Rate for Payer: Preferred Network Access Commercial |
$235.37
|
| Rate for Payer: Quartz Beloit One Network |
$125.36
|
| Rate for Payer: Quartz Commercial |
$166.30
|
| Rate for Payer: Quartz Medicare Advantage |
$153.50
|
| Rate for Payer: The Alliance Commercial |
$127.92
|
| Rate for Payer: WEA Trust Commercial |
$140.71
|
| Rate for Payer: WPS Commercial |
$189.49
|
|
|
SUCTION DEVICE BIO-VAC BX00711513
|
Facility
|
IP
|
$1,727.00
|
|
| Hospital Charge Code |
2973628
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$880.08 |
| Max. Negotiated Rate |
$1,652.39 |
| Rate for Payer: Aetna Commercial |
$1,616.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,544.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$951.92
|
| Rate for Payer: Cash Price |
$518.10
|
| Rate for Payer: Cigna Commercial |
$1,652.39
|
| Rate for Payer: Health EOS Commercial |
$1,598.51
|
| Rate for Payer: HFN Commercial |
$1,652.39
|
| Rate for Payer: Multiplan Commercial |
$1,436.86
|
| Rate for Payer: Preferred Network Access Commercial |
$1,652.39
|
| Rate for Payer: Quartz Beloit One Network |
$880.08
|
| Rate for Payer: Quartz Commercial |
$1,077.65
|
| Rate for Payer: WEA Trust Commercial |
$987.84
|
| Rate for Payer: WPS Commercial |
$1,330.31
|
|
