|
TRACH TUBE 3.0MM PEDIATRIC
|
Facility
|
IP
|
$493.00
|
|
| Hospital Charge Code |
2963752
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$241.57 |
| Max. Negotiated Rate |
$453.56 |
| Rate for Payer: Aetna Commercial |
$443.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$423.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$261.29
|
| Rate for Payer: Cash Price |
$147.90
|
| Rate for Payer: Cigna Commercial |
$453.56
|
| Rate for Payer: Health EOS Commercial |
$438.77
|
| Rate for Payer: HFN Commercial |
$453.56
|
| Rate for Payer: Multiplan Commercial |
$394.40
|
| Rate for Payer: NAPHCARE Commercial |
$295.80
|
| Rate for Payer: Preferred Network Access Commercial |
$453.56
|
| Rate for Payer: Quartz Beloit One Network |
$241.57
|
| Rate for Payer: Quartz Commercial |
$295.80
|
| Rate for Payer: WEA Trust Commercial |
$271.15
|
| Rate for Payer: WPS Commercial |
$365.17
|
|
|
TRACH TUBE 3.5MM PEDIATRIC
|
Facility
|
OP
|
$493.00
|
|
| Hospital Charge Code |
2963751
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$138.04 |
| Max. Negotiated Rate |
$1,972.00 |
| Rate for Payer: Aetna Commercial |
$443.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$423.98
|
| Rate for Payer: Aetna Managed Medicare |
$138.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$320.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$246.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$236.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$261.29
|
| Rate for Payer: Cash Price |
$147.90
|
| Rate for Payer: Cigna Commercial |
$453.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$275.88
|
| Rate for Payer: Health EOS Commercial |
$438.77
|
| Rate for Payer: HFN Commercial |
$453.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$369.75
|
| Rate for Payer: Multiplan Commercial |
$394.40
|
| Rate for Payer: NAPHCARE Commercial |
$295.80
|
| Rate for Payer: Preferred Network Access Commercial |
$453.56
|
| Rate for Payer: Quartz Beloit One Network |
$241.57
|
| Rate for Payer: Quartz Commercial |
$320.45
|
| Rate for Payer: Quartz Medicare Advantage |
$295.80
|
| Rate for Payer: The Alliance Commercial |
$1,972.00
|
| Rate for Payer: WEA Trust Commercial |
$271.15
|
| Rate for Payer: WPS Commercial |
$365.17
|
|
|
TRACH TUBE 3.5MM PEDIATRIC
|
Facility
|
IP
|
$493.00
|
|
| Hospital Charge Code |
2963751
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$241.57 |
| Max. Negotiated Rate |
$453.56 |
| Rate for Payer: Aetna Commercial |
$443.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$423.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$261.29
|
| Rate for Payer: Cash Price |
$147.90
|
| Rate for Payer: Cigna Commercial |
$453.56
|
| Rate for Payer: Health EOS Commercial |
$438.77
|
| Rate for Payer: HFN Commercial |
$453.56
|
| Rate for Payer: Multiplan Commercial |
$394.40
|
| Rate for Payer: NAPHCARE Commercial |
$295.80
|
| Rate for Payer: Preferred Network Access Commercial |
$453.56
|
| Rate for Payer: Quartz Beloit One Network |
$241.57
|
| Rate for Payer: Quartz Commercial |
$295.80
|
| Rate for Payer: WEA Trust Commercial |
$271.15
|
| Rate for Payer: WPS Commercial |
$365.17
|
|
|
TRACH TUBE 4.0MM PEDIATRIC
|
Facility
|
OP
|
$493.00
|
|
| Hospital Charge Code |
2963750
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$138.04 |
| Max. Negotiated Rate |
$1,972.00 |
| Rate for Payer: Aetna Commercial |
$443.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$423.98
|
| Rate for Payer: Aetna Managed Medicare |
$138.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$320.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$246.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$236.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$261.29
|
| Rate for Payer: Cash Price |
$147.90
|
| Rate for Payer: Cigna Commercial |
$453.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$275.88
|
| Rate for Payer: Health EOS Commercial |
$438.77
|
| Rate for Payer: HFN Commercial |
$453.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$369.75
|
| Rate for Payer: Multiplan Commercial |
$394.40
|
| Rate for Payer: NAPHCARE Commercial |
$295.80
|
| Rate for Payer: Preferred Network Access Commercial |
$453.56
|
| Rate for Payer: Quartz Beloit One Network |
$241.57
|
| Rate for Payer: Quartz Commercial |
$320.45
|
| Rate for Payer: Quartz Medicare Advantage |
$295.80
|
| Rate for Payer: The Alliance Commercial |
$1,972.00
|
| Rate for Payer: WEA Trust Commercial |
$271.15
|
| Rate for Payer: WPS Commercial |
$365.17
|
|
|
TRACH TUBE 4.0MM PEDIATRIC
|
Facility
|
IP
|
$493.00
|
|
| Hospital Charge Code |
2963750
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$241.57 |
| Max. Negotiated Rate |
$453.56 |
| Rate for Payer: Aetna Commercial |
$443.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$423.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$261.29
|
| Rate for Payer: Cash Price |
$147.90
|
| Rate for Payer: Cigna Commercial |
$453.56
|
| Rate for Payer: Health EOS Commercial |
$438.77
|
| Rate for Payer: HFN Commercial |
$453.56
|
| Rate for Payer: Multiplan Commercial |
$394.40
|
| Rate for Payer: NAPHCARE Commercial |
$295.80
|
| Rate for Payer: Preferred Network Access Commercial |
$453.56
|
| Rate for Payer: Quartz Beloit One Network |
$241.57
|
| Rate for Payer: Quartz Commercial |
$295.80
|
| Rate for Payer: WEA Trust Commercial |
$271.15
|
| Rate for Payer: WPS Commercial |
$365.17
|
|
|
TRACH TUBE BIVONA 7.0MM 75FHXL70
|
Facility
|
IP
|
$1,716.00
|
|
| Hospital Charge Code |
4058137
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$840.84 |
| Max. Negotiated Rate |
$1,578.72 |
| Rate for Payer: Aetna Commercial |
$1,544.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,475.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$909.48
|
| Rate for Payer: Cash Price |
$514.80
|
| Rate for Payer: Cigna Commercial |
$1,578.72
|
| Rate for Payer: Health EOS Commercial |
$1,527.24
|
| Rate for Payer: HFN Commercial |
$1,578.72
|
| Rate for Payer: Multiplan Commercial |
$1,372.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,029.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,578.72
|
| Rate for Payer: Quartz Beloit One Network |
$840.84
|
| Rate for Payer: Quartz Commercial |
$1,029.60
|
| Rate for Payer: WEA Trust Commercial |
$943.80
|
| Rate for Payer: WPS Commercial |
$1,271.04
|
|
|
TRACH TUBE BIVONA 7.0MM 75FHXL70
|
Facility
|
OP
|
$1,716.00
|
|
| Hospital Charge Code |
4058137
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$480.48 |
| Max. Negotiated Rate |
$6,864.00 |
| Rate for Payer: Aetna Commercial |
$1,544.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,475.76
|
| Rate for Payer: Aetna Managed Medicare |
$480.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,115.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$858.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$823.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$909.48
|
| Rate for Payer: Cash Price |
$514.80
|
| Rate for Payer: Cigna Commercial |
$1,578.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$960.27
|
| Rate for Payer: Health EOS Commercial |
$1,527.24
|
| Rate for Payer: HFN Commercial |
$1,578.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,287.00
|
| Rate for Payer: Multiplan Commercial |
$1,372.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,029.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,578.72
|
| Rate for Payer: Quartz Beloit One Network |
$840.84
|
| Rate for Payer: Quartz Commercial |
$1,115.40
|
| Rate for Payer: Quartz Medicare Advantage |
$1,029.60
|
| Rate for Payer: The Alliance Commercial |
$6,864.00
|
| Rate for Payer: WEA Trust Commercial |
$943.80
|
| Rate for Payer: WPS Commercial |
$1,271.04
|
|
|
TRACH TUBE BIVONA 8.0MM 75FHXL80
|
Facility
|
IP
|
$1,716.00
|
|
| Hospital Charge Code |
4004564
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$840.84 |
| Max. Negotiated Rate |
$1,578.72 |
| Rate for Payer: Aetna Commercial |
$1,544.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,475.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$909.48
|
| Rate for Payer: Cash Price |
$514.80
|
| Rate for Payer: Cigna Commercial |
$1,578.72
|
| Rate for Payer: Health EOS Commercial |
$1,527.24
|
| Rate for Payer: HFN Commercial |
$1,578.72
|
| Rate for Payer: Multiplan Commercial |
$1,372.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,029.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,578.72
|
| Rate for Payer: Quartz Beloit One Network |
$840.84
|
| Rate for Payer: Quartz Commercial |
$1,029.60
|
| Rate for Payer: WEA Trust Commercial |
$943.80
|
| Rate for Payer: WPS Commercial |
$1,271.04
|
|
|
TRACH TUBE BIVONA 8.0MM 75FHXL80
|
Facility
|
OP
|
$1,716.00
|
|
| Hospital Charge Code |
4004564
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$480.48 |
| Max. Negotiated Rate |
$6,864.00 |
| Rate for Payer: Aetna Commercial |
$1,544.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,475.76
|
| Rate for Payer: Aetna Managed Medicare |
$480.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,115.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$858.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$823.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$909.48
|
| Rate for Payer: Cash Price |
$514.80
|
| Rate for Payer: Cigna Commercial |
$1,578.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$960.27
|
| Rate for Payer: Health EOS Commercial |
$1,527.24
|
| Rate for Payer: HFN Commercial |
$1,578.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,287.00
|
| Rate for Payer: Multiplan Commercial |
$1,372.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,029.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,578.72
|
| Rate for Payer: Quartz Beloit One Network |
$840.84
|
| Rate for Payer: Quartz Commercial |
$1,115.40
|
| Rate for Payer: Quartz Medicare Advantage |
$1,029.60
|
| Rate for Payer: The Alliance Commercial |
$6,864.00
|
| Rate for Payer: WEA Trust Commercial |
$943.80
|
| Rate for Payer: WPS Commercial |
$1,271.04
|
|
|
TRACH TUBE BIVONA 9.0MM 75FHXL90
|
Facility
|
IP
|
$1,716.00
|
|
| Hospital Charge Code |
4004565
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$840.84 |
| Max. Negotiated Rate |
$1,578.72 |
| Rate for Payer: Aetna Commercial |
$1,544.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,475.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$909.48
|
| Rate for Payer: Cash Price |
$514.80
|
| Rate for Payer: Cigna Commercial |
$1,578.72
|
| Rate for Payer: Health EOS Commercial |
$1,527.24
|
| Rate for Payer: HFN Commercial |
$1,578.72
|
| Rate for Payer: Multiplan Commercial |
$1,372.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,029.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,578.72
|
| Rate for Payer: Quartz Beloit One Network |
$840.84
|
| Rate for Payer: Quartz Commercial |
$1,029.60
|
| Rate for Payer: WEA Trust Commercial |
$943.80
|
| Rate for Payer: WPS Commercial |
$1,271.04
|
|
|
TRACH TUBE BIVONA 9.0MM 75FHXL90
|
Facility
|
OP
|
$1,716.00
|
|
| Hospital Charge Code |
4004565
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$480.48 |
| Max. Negotiated Rate |
$6,864.00 |
| Rate for Payer: Aetna Commercial |
$1,544.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,475.76
|
| Rate for Payer: Aetna Managed Medicare |
$480.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,115.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$858.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$823.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$909.48
|
| Rate for Payer: Cash Price |
$514.80
|
| Rate for Payer: Cigna Commercial |
$1,578.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$960.27
|
| Rate for Payer: Health EOS Commercial |
$1,527.24
|
| Rate for Payer: HFN Commercial |
$1,578.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,287.00
|
| Rate for Payer: Multiplan Commercial |
$1,372.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,029.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,578.72
|
| Rate for Payer: Quartz Beloit One Network |
$840.84
|
| Rate for Payer: Quartz Commercial |
$1,115.40
|
| Rate for Payer: Quartz Medicare Advantage |
$1,029.60
|
| Rate for Payer: The Alliance Commercial |
$6,864.00
|
| Rate for Payer: WEA Trust Commercial |
$943.80
|
| Rate for Payer: WPS Commercial |
$1,271.04
|
|
|
TRACH TUBE CUFFED FEN 6.0MM
|
Facility
|
IP
|
$493.00
|
|
| Hospital Charge Code |
2963686
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$241.57 |
| Max. Negotiated Rate |
$453.56 |
| Rate for Payer: Aetna Commercial |
$443.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$423.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$261.29
|
| Rate for Payer: Cash Price |
$147.90
|
| Rate for Payer: Cigna Commercial |
$453.56
|
| Rate for Payer: Health EOS Commercial |
$438.77
|
| Rate for Payer: HFN Commercial |
$453.56
|
| Rate for Payer: Multiplan Commercial |
$394.40
|
| Rate for Payer: NAPHCARE Commercial |
$295.80
|
| Rate for Payer: Preferred Network Access Commercial |
$453.56
|
| Rate for Payer: Quartz Beloit One Network |
$241.57
|
| Rate for Payer: Quartz Commercial |
$295.80
|
| Rate for Payer: WEA Trust Commercial |
$271.15
|
| Rate for Payer: WPS Commercial |
$365.17
|
|
|
TRACH TUBE CUFFED FEN 6.0MM
|
Facility
|
OP
|
$493.00
|
|
| Hospital Charge Code |
2963686
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$138.04 |
| Max. Negotiated Rate |
$1,972.00 |
| Rate for Payer: Aetna Commercial |
$443.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$423.98
|
| Rate for Payer: Aetna Managed Medicare |
$138.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$320.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$246.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$236.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$261.29
|
| Rate for Payer: Cash Price |
$147.90
|
| Rate for Payer: Cigna Commercial |
$453.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$275.88
|
| Rate for Payer: Health EOS Commercial |
$438.77
|
| Rate for Payer: HFN Commercial |
$453.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$369.75
|
| Rate for Payer: Multiplan Commercial |
$394.40
|
| Rate for Payer: NAPHCARE Commercial |
$295.80
|
| Rate for Payer: Preferred Network Access Commercial |
$453.56
|
| Rate for Payer: Quartz Beloit One Network |
$241.57
|
| Rate for Payer: Quartz Commercial |
$320.45
|
| Rate for Payer: Quartz Medicare Advantage |
$295.80
|
| Rate for Payer: The Alliance Commercial |
$1,972.00
|
| Rate for Payer: WEA Trust Commercial |
$271.15
|
| Rate for Payer: WPS Commercial |
$365.17
|
|
|
TRACH TUBE CUFFED FEN 8.0MM 513080
|
Facility
|
OP
|
$493.00
|
|
| Hospital Charge Code |
2969235
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$138.04 |
| Max. Negotiated Rate |
$1,972.00 |
| Rate for Payer: Aetna Commercial |
$443.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$423.98
|
| Rate for Payer: Aetna Managed Medicare |
$138.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$320.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$246.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$236.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$261.29
|
| Rate for Payer: Cash Price |
$147.90
|
| Rate for Payer: Cigna Commercial |
$453.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$275.88
|
| Rate for Payer: Health EOS Commercial |
$438.77
|
| Rate for Payer: HFN Commercial |
$453.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$369.75
|
| Rate for Payer: Multiplan Commercial |
$394.40
|
| Rate for Payer: NAPHCARE Commercial |
$295.80
|
| Rate for Payer: Preferred Network Access Commercial |
$453.56
|
| Rate for Payer: Quartz Beloit One Network |
$241.57
|
| Rate for Payer: Quartz Commercial |
$320.45
|
| Rate for Payer: Quartz Medicare Advantage |
$295.80
|
| Rate for Payer: The Alliance Commercial |
$1,972.00
|
| Rate for Payer: WEA Trust Commercial |
$271.15
|
| Rate for Payer: WPS Commercial |
$365.17
|
|
|
TRACH TUBE CUFFED FEN 8.0MM 513080
|
Facility
|
IP
|
$493.00
|
|
| Hospital Charge Code |
2969235
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$241.57 |
| Max. Negotiated Rate |
$453.56 |
| Rate for Payer: Aetna Commercial |
$443.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$423.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$261.29
|
| Rate for Payer: Cash Price |
$147.90
|
| Rate for Payer: Cigna Commercial |
$453.56
|
| Rate for Payer: Health EOS Commercial |
$438.77
|
| Rate for Payer: HFN Commercial |
$453.56
|
| Rate for Payer: Multiplan Commercial |
$394.40
|
| Rate for Payer: NAPHCARE Commercial |
$295.80
|
| Rate for Payer: Preferred Network Access Commercial |
$453.56
|
| Rate for Payer: Quartz Beloit One Network |
$241.57
|
| Rate for Payer: Quartz Commercial |
$295.80
|
| Rate for Payer: WEA Trust Commercial |
$271.15
|
| Rate for Payer: WPS Commercial |
$365.17
|
|
|
TRACH TUBE CUFFED FEN 9.0MM
|
Facility
|
OP
|
$493.00
|
|
| Hospital Charge Code |
2963685
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$138.04 |
| Max. Negotiated Rate |
$1,972.00 |
| Rate for Payer: Aetna Commercial |
$443.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$423.98
|
| Rate for Payer: Aetna Managed Medicare |
$138.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$320.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$246.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$236.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$261.29
|
| Rate for Payer: Cash Price |
$147.90
|
| Rate for Payer: Cigna Commercial |
$453.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$275.88
|
| Rate for Payer: Health EOS Commercial |
$438.77
|
| Rate for Payer: HFN Commercial |
$453.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$369.75
|
| Rate for Payer: Multiplan Commercial |
$394.40
|
| Rate for Payer: NAPHCARE Commercial |
$295.80
|
| Rate for Payer: Preferred Network Access Commercial |
$453.56
|
| Rate for Payer: Quartz Beloit One Network |
$241.57
|
| Rate for Payer: Quartz Commercial |
$320.45
|
| Rate for Payer: Quartz Medicare Advantage |
$295.80
|
| Rate for Payer: The Alliance Commercial |
$1,972.00
|
| Rate for Payer: WEA Trust Commercial |
$271.15
|
| Rate for Payer: WPS Commercial |
$365.17
|
|
|
TRACH TUBE CUFFED FEN 9.0MM
|
Facility
|
IP
|
$493.00
|
|
| Hospital Charge Code |
2963685
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$241.57 |
| Max. Negotiated Rate |
$453.56 |
| Rate for Payer: Aetna Commercial |
$443.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$423.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$261.29
|
| Rate for Payer: Cash Price |
$147.90
|
| Rate for Payer: Cigna Commercial |
$453.56
|
| Rate for Payer: Health EOS Commercial |
$438.77
|
| Rate for Payer: HFN Commercial |
$453.56
|
| Rate for Payer: Multiplan Commercial |
$394.40
|
| Rate for Payer: NAPHCARE Commercial |
$295.80
|
| Rate for Payer: Preferred Network Access Commercial |
$453.56
|
| Rate for Payer: Quartz Beloit One Network |
$241.57
|
| Rate for Payer: Quartz Commercial |
$295.80
|
| Rate for Payer: WEA Trust Commercial |
$271.15
|
| Rate for Payer: WPS Commercial |
$365.17
|
|
|
TRACH TUBE FLEX CUFFED SZ 10
|
Facility
|
IP
|
$493.00
|
|
| Hospital Charge Code |
2963698
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$241.57 |
| Max. Negotiated Rate |
$453.56 |
| Rate for Payer: Aetna Commercial |
$443.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$423.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$261.29
|
| Rate for Payer: Cash Price |
$147.90
|
| Rate for Payer: Cigna Commercial |
$453.56
|
| Rate for Payer: Health EOS Commercial |
$438.77
|
| Rate for Payer: HFN Commercial |
$453.56
|
| Rate for Payer: Multiplan Commercial |
$394.40
|
| Rate for Payer: NAPHCARE Commercial |
$295.80
|
| Rate for Payer: Preferred Network Access Commercial |
$453.56
|
| Rate for Payer: Quartz Beloit One Network |
$241.57
|
| Rate for Payer: Quartz Commercial |
$295.80
|
| Rate for Payer: WEA Trust Commercial |
$271.15
|
| Rate for Payer: WPS Commercial |
$365.17
|
|
|
TRACH TUBE FLEX CUFFED SZ 10
|
Facility
|
OP
|
$493.00
|
|
| Hospital Charge Code |
2963698
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$138.04 |
| Max. Negotiated Rate |
$1,972.00 |
| Rate for Payer: Aetna Commercial |
$443.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$423.98
|
| Rate for Payer: Aetna Managed Medicare |
$138.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$320.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$246.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$236.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$261.29
|
| Rate for Payer: Cash Price |
$147.90
|
| Rate for Payer: Cigna Commercial |
$453.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$275.88
|
| Rate for Payer: Health EOS Commercial |
$438.77
|
| Rate for Payer: HFN Commercial |
$453.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$369.75
|
| Rate for Payer: Multiplan Commercial |
$394.40
|
| Rate for Payer: NAPHCARE Commercial |
$295.80
|
| Rate for Payer: Preferred Network Access Commercial |
$453.56
|
| Rate for Payer: Quartz Beloit One Network |
$241.57
|
| Rate for Payer: Quartz Commercial |
$320.45
|
| Rate for Payer: Quartz Medicare Advantage |
$295.80
|
| Rate for Payer: The Alliance Commercial |
$1,972.00
|
| Rate for Payer: WEA Trust Commercial |
$271.15
|
| Rate for Payer: WPS Commercial |
$365.17
|
|
|
TRACH TUBE FLEXIBLE CUFFED SZ8 505080
|
Facility
|
IP
|
$598.00
|
|
| Hospital Charge Code |
2963700
|
|
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
|
|
|
TRACH TUBE FLEXIBLE CUFFED SZ8 505080
|
Facility
|
OP
|
$598.00
|
|
| Hospital Charge Code |
2963700
|
|
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
|
|
|
TRACH TUBE FLEXIBLE CUFFED SZ9 505090
|
Facility
|
OP
|
$493.00
|
|
| Hospital Charge Code |
2963699
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$138.04 |
| Max. Negotiated Rate |
$1,972.00 |
| Rate for Payer: Aetna Commercial |
$443.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$423.98
|
| Rate for Payer: Aetna Managed Medicare |
$138.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$320.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$246.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$236.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$261.29
|
| Rate for Payer: Cash Price |
$147.90
|
| Rate for Payer: Cigna Commercial |
$453.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$275.88
|
| Rate for Payer: Health EOS Commercial |
$438.77
|
| Rate for Payer: HFN Commercial |
$453.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$369.75
|
| Rate for Payer: Multiplan Commercial |
$394.40
|
| Rate for Payer: NAPHCARE Commercial |
$295.80
|
| Rate for Payer: Preferred Network Access Commercial |
$453.56
|
| Rate for Payer: Quartz Beloit One Network |
$241.57
|
| Rate for Payer: Quartz Commercial |
$320.45
|
| Rate for Payer: Quartz Medicare Advantage |
$295.80
|
| Rate for Payer: The Alliance Commercial |
$1,972.00
|
| Rate for Payer: WEA Trust Commercial |
$271.15
|
| Rate for Payer: WPS Commercial |
$365.17
|
|
|
TRACH TUBE FLEXIBLE CUFFED SZ9 505090
|
Facility
|
IP
|
$493.00
|
|
| Hospital Charge Code |
2963699
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$241.57 |
| Max. Negotiated Rate |
$453.56 |
| Rate for Payer: Aetna Commercial |
$443.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$423.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$261.29
|
| Rate for Payer: Cash Price |
$147.90
|
| Rate for Payer: Cigna Commercial |
$453.56
|
| Rate for Payer: Health EOS Commercial |
$438.77
|
| Rate for Payer: HFN Commercial |
$453.56
|
| Rate for Payer: Multiplan Commercial |
$394.40
|
| Rate for Payer: NAPHCARE Commercial |
$295.80
|
| Rate for Payer: Preferred Network Access Commercial |
$453.56
|
| Rate for Payer: Quartz Beloit One Network |
$241.57
|
| Rate for Payer: Quartz Commercial |
$295.80
|
| Rate for Payer: WEA Trust Commercial |
$271.15
|
| Rate for Payer: WPS Commercial |
$365.17
|
|
|
TRACH TUBE UNCUFF FEN 4.0 4CFN
|
Facility
|
IP
|
$1,516.00
|
|
| Hospital Charge Code |
2963516
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$742.84 |
| Max. Negotiated Rate |
$1,394.72 |
| Rate for Payer: Aetna Commercial |
$1,364.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,303.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$803.48
|
| Rate for Payer: Cash Price |
$454.80
|
| Rate for Payer: Cigna Commercial |
$1,394.72
|
| Rate for Payer: Health EOS Commercial |
$1,349.24
|
| Rate for Payer: HFN Commercial |
$1,394.72
|
| Rate for Payer: Multiplan Commercial |
$1,212.80
|
| Rate for Payer: NAPHCARE Commercial |
$909.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,394.72
|
| Rate for Payer: Quartz Beloit One Network |
$742.84
|
| Rate for Payer: Quartz Commercial |
$909.60
|
| Rate for Payer: WEA Trust Commercial |
$833.80
|
| Rate for Payer: WPS Commercial |
$1,122.90
|
|
|
TRACH TUBE UNCUFF FEN 4.0 4CFN
|
Facility
|
OP
|
$1,516.00
|
|
| Hospital Charge Code |
2963516
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$424.48 |
| Max. Negotiated Rate |
$6,064.00 |
| Rate for Payer: Aetna Commercial |
$1,364.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,303.76
|
| Rate for Payer: Aetna Managed Medicare |
$424.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$985.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$758.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$727.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$803.48
|
| Rate for Payer: Cash Price |
$454.80
|
| Rate for Payer: Cigna Commercial |
$1,394.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$848.35
|
| Rate for Payer: Health EOS Commercial |
$1,349.24
|
| Rate for Payer: HFN Commercial |
$1,394.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,137.00
|
| Rate for Payer: Multiplan Commercial |
$1,212.80
|
| Rate for Payer: NAPHCARE Commercial |
$909.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,394.72
|
| Rate for Payer: Quartz Beloit One Network |
$742.84
|
| Rate for Payer: Quartz Commercial |
$985.40
|
| Rate for Payer: Quartz Medicare Advantage |
$909.60
|
| Rate for Payer: The Alliance Commercial |
$6,064.00
|
| Rate for Payer: WEA Trust Commercial |
$833.80
|
| Rate for Payer: WPS Commercial |
$1,122.90
|
|
