|
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
|
|
|
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 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 & 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 & 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 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 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 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
|
OP
|
$1,727.00
|
|
| Hospital Charge Code |
2973628
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$502.90 |
| 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: Aetna Managed Medicare |
$502.90
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,167.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$898.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$862.12
|
| 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: Dean Health DHI/DHP/ASO |
$1,005.11
|
| Rate for Payer: Health EOS Commercial |
$1,598.51
|
| Rate for Payer: HFN Commercial |
$1,652.39
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,347.06
|
| Rate for Payer: Multiplan Commercial |
$1,436.86
|
| Rate for Payer: NAPHCARE Commercial |
$1,077.65
|
| Rate for Payer: Preferred Network Access Commercial |
$1,652.39
|
| Rate for Payer: Quartz Beloit One Network |
$880.08
|
| Rate for Payer: Quartz Commercial |
$1,167.45
|
| Rate for Payer: Quartz Medicare Advantage |
$1,077.65
|
| Rate for Payer: The Alliance Commercial |
$898.04
|
| Rate for Payer: WEA Trust Commercial |
$987.84
|
| Rate for Payer: WPS Commercial |
$1,330.31
|
|
|
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
|
|
|
SUCTION DLP CARDIAC MALLEABLE 10050
|
Facility
|
OP
|
$348.00
|
|
| Hospital Charge Code |
4088497
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$101.34 |
| Max. Negotiated Rate |
$332.97 |
| Rate for Payer: Aetna Commercial |
$325.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$311.25
|
| Rate for Payer: Aetna Managed Medicare |
$101.34
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$235.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$180.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$173.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$191.82
|
| Rate for Payer: Cash Price |
$104.40
|
| Rate for Payer: Cigna Commercial |
$332.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$202.54
|
| Rate for Payer: Health EOS Commercial |
$322.11
|
| Rate for Payer: HFN Commercial |
$332.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$271.44
|
| Rate for Payer: Multiplan Commercial |
$289.54
|
| Rate for Payer: NAPHCARE Commercial |
$217.15
|
| Rate for Payer: Preferred Network Access Commercial |
$332.97
|
| Rate for Payer: Quartz Beloit One Network |
$177.34
|
| Rate for Payer: Quartz Commercial |
$235.25
|
| Rate for Payer: Quartz Medicare Advantage |
$217.15
|
| Rate for Payer: The Alliance Commercial |
$180.96
|
| Rate for Payer: WEA Trust Commercial |
$199.06
|
| Rate for Payer: WPS Commercial |
$268.06
|
|
|
SUCTION DLP CARDIAC MALLEABLE 10050
|
Facility
|
IP
|
$348.00
|
|
| Hospital Charge Code |
4088497
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$177.34 |
| Max. Negotiated Rate |
$332.97 |
| Rate for Payer: Aetna Commercial |
$325.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$311.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$191.82
|
| Rate for Payer: Cash Price |
$104.40
|
| Rate for Payer: Cigna Commercial |
$332.97
|
| Rate for Payer: Health EOS Commercial |
$322.11
|
| Rate for Payer: HFN Commercial |
$332.97
|
| Rate for Payer: Multiplan Commercial |
$289.54
|
| Rate for Payer: Preferred Network Access Commercial |
$332.97
|
| Rate for Payer: Quartz Beloit One Network |
$177.34
|
| Rate for Payer: Quartz Commercial |
$217.15
|
| Rate for Payer: WEA Trust Commercial |
$199.06
|
| Rate for Payer: WPS Commercial |
$268.06
|
|
|
SUCTION HEMOVAC 100cc 0070740
|
Facility
|
IP
|
$162.00
|
|
| Hospital Charge Code |
2963314
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$82.56 |
| Max. Negotiated Rate |
$155.00 |
| Rate for Payer: Aetna Commercial |
$151.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$144.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$89.29
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Cigna Commercial |
$155.00
|
| Rate for Payer: Health EOS Commercial |
$149.95
|
| Rate for Payer: HFN Commercial |
$155.00
|
| Rate for Payer: Multiplan Commercial |
$134.78
|
| Rate for Payer: Preferred Network Access Commercial |
$155.00
|
| Rate for Payer: Quartz Beloit One Network |
$82.56
|
| Rate for Payer: Quartz Commercial |
$101.09
|
| Rate for Payer: WEA Trust Commercial |
$92.66
|
| Rate for Payer: WPS Commercial |
$124.79
|
|
|
SUCTION HEMOVAC 100cc 0070740
|
Facility
|
OP
|
$162.00
|
|
| Hospital Charge Code |
2963314
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$47.17 |
| Max. Negotiated Rate |
$155.00 |
| Rate for Payer: Aetna Commercial |
$151.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$144.89
|
| Rate for Payer: Aetna Managed Medicare |
$47.17
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$109.51
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$84.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$80.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$89.29
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Cigna Commercial |
$155.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$94.28
|
| Rate for Payer: Health EOS Commercial |
$149.95
|
| Rate for Payer: HFN Commercial |
$155.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$126.36
|
| Rate for Payer: Multiplan Commercial |
$134.78
|
| Rate for Payer: NAPHCARE Commercial |
$101.09
|
| Rate for Payer: Preferred Network Access Commercial |
$155.00
|
| Rate for Payer: Quartz Beloit One Network |
$82.56
|
| Rate for Payer: Quartz Commercial |
$109.51
|
| Rate for Payer: Quartz Medicare Advantage |
$101.09
|
| Rate for Payer: The Alliance Commercial |
$84.24
|
| Rate for Payer: WEA Trust Commercial |
$92.66
|
| Rate for Payer: WPS Commercial |
$124.79
|
|
|
SUCTION HEMOVAC 400cc EVACUATOR 0043650
|
Facility
|
IP
|
$192.00
|
|
| Hospital Charge Code |
2963425
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$97.84 |
| Max. Negotiated Rate |
$183.71 |
| Rate for Payer: Aetna Commercial |
$179.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$171.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$105.83
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cigna Commercial |
$183.71
|
| Rate for Payer: Health EOS Commercial |
$177.72
|
| Rate for Payer: HFN Commercial |
$183.71
|
| Rate for Payer: Multiplan Commercial |
$159.74
|
| Rate for Payer: Preferred Network Access Commercial |
$183.71
|
| Rate for Payer: Quartz Beloit One Network |
$97.84
|
| Rate for Payer: Quartz Commercial |
$119.81
|
| Rate for Payer: WEA Trust Commercial |
$109.82
|
| Rate for Payer: WPS Commercial |
$147.90
|
|
|
SUCTION HEMOVAC 400cc EVACUATOR 0043650
|
Facility
|
OP
|
$192.00
|
|
| Hospital Charge Code |
2963425
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$55.91 |
| Max. Negotiated Rate |
$183.71 |
| Rate for Payer: Aetna Commercial |
$179.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$171.72
|
| Rate for Payer: Aetna Managed Medicare |
$55.91
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$129.79
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$99.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$95.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$105.83
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cigna Commercial |
$183.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$111.74
|
| Rate for Payer: Health EOS Commercial |
$177.72
|
| Rate for Payer: HFN Commercial |
$183.71
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$149.76
|
| Rate for Payer: Multiplan Commercial |
$159.74
|
| Rate for Payer: NAPHCARE Commercial |
$119.81
|
| Rate for Payer: Preferred Network Access Commercial |
$183.71
|
| Rate for Payer: Quartz Beloit One Network |
$97.84
|
| Rate for Payer: Quartz Commercial |
$129.79
|
| Rate for Payer: Quartz Medicare Advantage |
$119.81
|
| Rate for Payer: The Alliance Commercial |
$99.84
|
| Rate for Payer: WEA Trust Commercial |
$109.82
|
| Rate for Payer: WPS Commercial |
$147.90
|
|
|
SUCTION MUCAS TRAP 8FR
|
Facility
|
OP
|
$168.00
|
|
| Hospital Charge Code |
2963346
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$48.92 |
| Max. Negotiated Rate |
$160.74 |
| Rate for Payer: Aetna Commercial |
$157.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$150.26
|
| Rate for Payer: Aetna Managed Medicare |
$48.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$113.57
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$87.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$83.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$92.60
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cigna Commercial |
$160.74
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$97.78
|
| Rate for Payer: Health EOS Commercial |
$155.50
|
| Rate for Payer: HFN Commercial |
$160.74
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$131.04
|
| Rate for Payer: Multiplan Commercial |
$139.78
|
| Rate for Payer: NAPHCARE Commercial |
$104.83
|
| Rate for Payer: Preferred Network Access Commercial |
$160.74
|
| Rate for Payer: Quartz Beloit One Network |
$85.61
|
| Rate for Payer: Quartz Commercial |
$113.57
|
| Rate for Payer: Quartz Medicare Advantage |
$104.83
|
| Rate for Payer: The Alliance Commercial |
$87.36
|
| Rate for Payer: WEA Trust Commercial |
$96.10
|
| Rate for Payer: WPS Commercial |
$129.41
|
|
|
SUCTION MUCAS TRAP 8FR
|
Facility
|
IP
|
$168.00
|
|
| Hospital Charge Code |
2963346
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$85.61 |
| Max. Negotiated Rate |
$160.74 |
| Rate for Payer: Aetna Commercial |
$157.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$150.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$92.60
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cigna Commercial |
$160.74
|
| Rate for Payer: Health EOS Commercial |
$155.50
|
| Rate for Payer: HFN Commercial |
$160.74
|
| Rate for Payer: Multiplan Commercial |
$139.78
|
| Rate for Payer: Preferred Network Access Commercial |
$160.74
|
| Rate for Payer: Quartz Beloit One Network |
$85.61
|
| Rate for Payer: Quartz Commercial |
$104.83
|
| Rate for Payer: WEA Trust Commercial |
$96.10
|
| Rate for Payer: WPS Commercial |
$129.41
|
|
