|
TRAY HUMERAL ADAPTER +0MM EQUINOXE REVERSE SHOULDER 320-10-00
|
Facility
|
OP
|
$7,502.01
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6240165
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,100.56 |
| Max. Negotiated Rate |
$30,008.04 |
| Rate for Payer: Aetna Commercial |
$6,751.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,451.73
|
| Rate for Payer: Aetna Managed Medicare |
$2,100.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,876.31
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,751.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,600.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,976.07
|
| Rate for Payer: Cash Price |
$2,250.60
|
| Rate for Payer: Cigna Commercial |
$6,901.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,198.12
|
| Rate for Payer: Health EOS Commercial |
$6,676.79
|
| Rate for Payer: HFN Commercial |
$6,901.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,626.51
|
| Rate for Payer: Multiplan Commercial |
$6,001.61
|
| Rate for Payer: NAPHCARE Commercial |
$4,501.21
|
| Rate for Payer: Preferred Network Access Commercial |
$6,901.85
|
| Rate for Payer: Quartz Beloit One Network |
$3,675.98
|
| Rate for Payer: Quartz Commercial |
$4,876.31
|
| Rate for Payer: Quartz Medicare Advantage |
$4,501.21
|
| Rate for Payer: The Alliance Commercial |
$30,008.04
|
| Rate for Payer: WEA Trust Commercial |
$4,126.11
|
| Rate for Payer: WPS Commercial |
$5,556.74
|
|
|
TRAY HUMERAL ADAPTER +0MM EQUINOXE REVERSE SHOULDER 320-10-00
|
Facility
|
IP
|
$7,502.01
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6240165
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,675.98 |
| Max. Negotiated Rate |
$6,901.85 |
| Rate for Payer: Aetna Commercial |
$6,751.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,451.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,976.07
|
| Rate for Payer: Cash Price |
$2,250.60
|
| Rate for Payer: Cigna Commercial |
$6,901.85
|
| Rate for Payer: Health EOS Commercial |
$6,676.79
|
| Rate for Payer: HFN Commercial |
$6,901.85
|
| Rate for Payer: Multiplan Commercial |
$6,001.61
|
| Rate for Payer: NAPHCARE Commercial |
$4,501.21
|
| Rate for Payer: Preferred Network Access Commercial |
$6,901.85
|
| Rate for Payer: Quartz Beloit One Network |
$3,675.98
|
| Rate for Payer: Quartz Commercial |
$4,501.21
|
| Rate for Payer: WEA Trust Commercial |
$4,126.11
|
| Rate for Payer: WPS Commercial |
$5,556.74
|
|
|
TRAY IRRIGATION W/PISTON 60CC 750301***DEDE 11/20
|
Facility
|
IP
|
$49.00
|
|
| Hospital Charge Code |
2963727
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$24.01 |
| Max. Negotiated Rate |
$45.08 |
| Rate for Payer: Aetna Commercial |
$44.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$42.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$25.97
|
| Rate for Payer: Cash Price |
$14.70
|
| Rate for Payer: Cigna Commercial |
$45.08
|
| Rate for Payer: Health EOS Commercial |
$43.61
|
| Rate for Payer: HFN Commercial |
$45.08
|
| Rate for Payer: Multiplan Commercial |
$39.20
|
| Rate for Payer: NAPHCARE Commercial |
$29.40
|
| Rate for Payer: Preferred Network Access Commercial |
$45.08
|
| Rate for Payer: Quartz Beloit One Network |
$24.01
|
| Rate for Payer: Quartz Commercial |
$29.40
|
| Rate for Payer: WEA Trust Commercial |
$26.95
|
| Rate for Payer: WPS Commercial |
$36.29
|
|
|
TRAY IRRIGATION W/PISTON 60CC 750301***DEDE 11/20
|
Facility
|
OP
|
$49.00
|
|
| Hospital Charge Code |
2963727
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.72 |
| Max. Negotiated Rate |
$196.00 |
| Rate for Payer: Aetna Commercial |
$44.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$42.14
|
| Rate for Payer: Aetna Managed Medicare |
$13.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$31.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$24.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$23.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$25.97
|
| Rate for Payer: Cash Price |
$14.70
|
| Rate for Payer: Cigna Commercial |
$45.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$27.42
|
| Rate for Payer: Health EOS Commercial |
$43.61
|
| Rate for Payer: HFN Commercial |
$45.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$36.75
|
| Rate for Payer: Multiplan Commercial |
$39.20
|
| Rate for Payer: NAPHCARE Commercial |
$29.40
|
| Rate for Payer: Preferred Network Access Commercial |
$45.08
|
| Rate for Payer: Quartz Beloit One Network |
$24.01
|
| Rate for Payer: Quartz Commercial |
$31.85
|
| Rate for Payer: Quartz Medicare Advantage |
$29.40
|
| Rate for Payer: The Alliance Commercial |
$196.00
|
| Rate for Payer: WEA Trust Commercial |
$26.95
|
| Rate for Payer: WPS Commercial |
$36.29
|
|
|
TRAY KNEE ARTHROSCOPY DYNJS0811
|
Facility
|
OP
|
$1,523.00
|
|
| Hospital Charge Code |
2963075
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$426.44 |
| Max. Negotiated Rate |
$6,092.00 |
| Rate for Payer: Aetna Commercial |
$1,370.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,309.78
|
| Rate for Payer: Aetna Managed Medicare |
$426.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$989.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$761.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$731.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$807.19
|
| Rate for Payer: Cash Price |
$456.90
|
| Rate for Payer: Cigna Commercial |
$1,401.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$852.27
|
| Rate for Payer: Health EOS Commercial |
$1,355.47
|
| Rate for Payer: HFN Commercial |
$1,401.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,142.25
|
| Rate for Payer: Multiplan Commercial |
$1,218.40
|
| Rate for Payer: NAPHCARE Commercial |
$913.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,401.16
|
| Rate for Payer: Quartz Beloit One Network |
$746.27
|
| Rate for Payer: Quartz Commercial |
$989.95
|
| Rate for Payer: Quartz Medicare Advantage |
$913.80
|
| Rate for Payer: The Alliance Commercial |
$6,092.00
|
| Rate for Payer: WEA Trust Commercial |
$837.65
|
| Rate for Payer: WPS Commercial |
$1,128.09
|
|
|
TRAY KNEE ARTHROSCOPY DYNJS0811
|
Facility
|
IP
|
$1,523.00
|
|
| Hospital Charge Code |
2963075
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$746.27 |
| Max. Negotiated Rate |
$1,401.16 |
| Rate for Payer: Aetna Commercial |
$1,370.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,309.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$807.19
|
| Rate for Payer: Cash Price |
$456.90
|
| Rate for Payer: Cigna Commercial |
$1,401.16
|
| Rate for Payer: Health EOS Commercial |
$1,355.47
|
| Rate for Payer: HFN Commercial |
$1,401.16
|
| Rate for Payer: Multiplan Commercial |
$1,218.40
|
| Rate for Payer: NAPHCARE Commercial |
$913.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,401.16
|
| Rate for Payer: Quartz Beloit One Network |
$746.27
|
| Rate for Payer: Quartz Commercial |
$913.80
|
| Rate for Payer: WEA Trust Commercial |
$837.65
|
| Rate for Payer: WPS Commercial |
$1,128.09
|
|
|
TRAY LUMBAR PUNCTURE ADULT 20G QUINCKE
|
Facility
|
OP
|
$292.00
|
|
| Hospital Charge Code |
2963196
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$81.76 |
| Max. Negotiated Rate |
$1,168.00 |
| Rate for Payer: Aetna Commercial |
$262.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$251.12
|
| Rate for Payer: Aetna Managed Medicare |
$81.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$189.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$146.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$140.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$154.76
|
| Rate for Payer: Cash Price |
$87.60
|
| Rate for Payer: Cigna Commercial |
$268.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$163.40
|
| Rate for Payer: Health EOS Commercial |
$259.88
|
| Rate for Payer: HFN Commercial |
$268.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$219.00
|
| Rate for Payer: Multiplan Commercial |
$233.60
|
| Rate for Payer: NAPHCARE Commercial |
$175.20
|
| Rate for Payer: Preferred Network Access Commercial |
$268.64
|
| Rate for Payer: Quartz Beloit One Network |
$143.08
|
| Rate for Payer: Quartz Commercial |
$189.80
|
| Rate for Payer: Quartz Medicare Advantage |
$175.20
|
| Rate for Payer: The Alliance Commercial |
$1,168.00
|
| Rate for Payer: WEA Trust Commercial |
$160.60
|
| Rate for Payer: WPS Commercial |
$216.28
|
|
|
TRAY LUMBAR PUNCTURE ADULT 20G QUINCKE
|
Facility
|
IP
|
$292.00
|
|
| Hospital Charge Code |
2963196
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$143.08 |
| Max. Negotiated Rate |
$268.64 |
| Rate for Payer: Aetna Commercial |
$262.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$251.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$154.76
|
| Rate for Payer: Cash Price |
$87.60
|
| Rate for Payer: Cigna Commercial |
$268.64
|
| Rate for Payer: Health EOS Commercial |
$259.88
|
| Rate for Payer: HFN Commercial |
$268.64
|
| Rate for Payer: Multiplan Commercial |
$233.60
|
| Rate for Payer: NAPHCARE Commercial |
$175.20
|
| Rate for Payer: Preferred Network Access Commercial |
$268.64
|
| Rate for Payer: Quartz Beloit One Network |
$143.08
|
| Rate for Payer: Quartz Commercial |
$175.20
|
| Rate for Payer: WEA Trust Commercial |
$160.60
|
| Rate for Payer: WPS Commercial |
$216.28
|
|
|
TRAY LUMBAR PUNCTURE INFANT 22G QUINCKE
|
Facility
|
IP
|
$292.00
|
|
| Hospital Charge Code |
2963248
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$143.08 |
| Max. Negotiated Rate |
$268.64 |
| Rate for Payer: Aetna Commercial |
$262.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$251.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$154.76
|
| Rate for Payer: Cash Price |
$87.60
|
| Rate for Payer: Cigna Commercial |
$268.64
|
| Rate for Payer: Health EOS Commercial |
$259.88
|
| Rate for Payer: HFN Commercial |
$268.64
|
| Rate for Payer: Multiplan Commercial |
$233.60
|
| Rate for Payer: NAPHCARE Commercial |
$175.20
|
| Rate for Payer: Preferred Network Access Commercial |
$268.64
|
| Rate for Payer: Quartz Beloit One Network |
$143.08
|
| Rate for Payer: Quartz Commercial |
$175.20
|
| Rate for Payer: WEA Trust Commercial |
$160.60
|
| Rate for Payer: WPS Commercial |
$216.28
|
|
|
TRAY LUMBAR PUNCTURE INFANT 22G QUINCKE
|
Facility
|
OP
|
$292.00
|
|
| Hospital Charge Code |
2963248
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$81.76 |
| Max. Negotiated Rate |
$1,168.00 |
| Rate for Payer: Aetna Commercial |
$262.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$251.12
|
| Rate for Payer: Aetna Managed Medicare |
$81.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$189.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$146.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$140.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$154.76
|
| Rate for Payer: Cash Price |
$87.60
|
| Rate for Payer: Cigna Commercial |
$268.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$163.40
|
| Rate for Payer: Health EOS Commercial |
$259.88
|
| Rate for Payer: HFN Commercial |
$268.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$219.00
|
| Rate for Payer: Multiplan Commercial |
$233.60
|
| Rate for Payer: NAPHCARE Commercial |
$175.20
|
| Rate for Payer: Preferred Network Access Commercial |
$268.64
|
| Rate for Payer: Quartz Beloit One Network |
$143.08
|
| Rate for Payer: Quartz Commercial |
$189.80
|
| Rate for Payer: Quartz Medicare Advantage |
$175.20
|
| Rate for Payer: The Alliance Commercial |
$1,168.00
|
| Rate for Payer: WEA Trust Commercial |
$160.60
|
| Rate for Payer: WPS Commercial |
$216.28
|
|
|
TRAY PARACERV PUDENDAL BLK. DYNJRA9046
|
Facility
|
IP
|
$240.00
|
|
| Hospital Charge Code |
2963046
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$117.60 |
| Max. Negotiated Rate |
$220.80 |
| Rate for Payer: Aetna Commercial |
$216.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$206.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$127.20
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cigna Commercial |
$220.80
|
| Rate for Payer: Health EOS Commercial |
$213.60
|
| Rate for Payer: HFN Commercial |
$220.80
|
| Rate for Payer: Multiplan Commercial |
$192.00
|
| Rate for Payer: NAPHCARE Commercial |
$144.00
|
| Rate for Payer: Preferred Network Access Commercial |
$220.80
|
| Rate for Payer: Quartz Beloit One Network |
$117.60
|
| Rate for Payer: Quartz Commercial |
$144.00
|
| Rate for Payer: WEA Trust Commercial |
$132.00
|
| Rate for Payer: WPS Commercial |
$177.77
|
|
|
TRAY PARACERV PUDENDAL BLK. DYNJRA9046
|
Facility
|
OP
|
$240.00
|
|
| Hospital Charge Code |
2963046
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$67.20 |
| Max. Negotiated Rate |
$960.00 |
| Rate for Payer: Aetna Commercial |
$216.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$206.40
|
| Rate for Payer: Aetna Managed Medicare |
$67.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$156.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$120.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$115.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$127.20
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cigna Commercial |
$220.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$134.30
|
| Rate for Payer: Health EOS Commercial |
$213.60
|
| Rate for Payer: HFN Commercial |
$220.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$180.00
|
| Rate for Payer: Multiplan Commercial |
$192.00
|
| Rate for Payer: NAPHCARE Commercial |
$144.00
|
| Rate for Payer: Preferred Network Access Commercial |
$220.80
|
| Rate for Payer: Quartz Beloit One Network |
$117.60
|
| Rate for Payer: Quartz Commercial |
$156.00
|
| Rate for Payer: Quartz Medicare Advantage |
$144.00
|
| Rate for Payer: The Alliance Commercial |
$960.00
|
| Rate for Payer: WEA Trust Commercial |
$132.00
|
| Rate for Payer: WPS Commercial |
$177.77
|
|
|
TRAY PD CATHETER PRE-STERNAL 8888111132
|
Facility
|
OP
|
$5,699.00
|
|
|
Service Code
|
HCPCS C1750
|
| Hospital Charge Code |
4520299
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,595.72 |
| Max. Negotiated Rate |
$22,796.00 |
| Rate for Payer: Aetna Commercial |
$5,129.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,901.14
|
| Rate for Payer: Aetna Managed Medicare |
$1,595.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,704.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,849.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,735.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,020.47
|
| Rate for Payer: Cash Price |
$1,709.70
|
| Rate for Payer: Cigna Commercial |
$5,243.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,189.16
|
| Rate for Payer: Health EOS Commercial |
$5,072.11
|
| Rate for Payer: HFN Commercial |
$5,243.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,274.25
|
| Rate for Payer: Multiplan Commercial |
$4,559.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,419.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,243.08
|
| Rate for Payer: Quartz Beloit One Network |
$2,792.51
|
| Rate for Payer: Quartz Commercial |
$3,704.35
|
| Rate for Payer: Quartz Medicare Advantage |
$3,419.40
|
| Rate for Payer: The Alliance Commercial |
$22,796.00
|
| Rate for Payer: WEA Trust Commercial |
$3,134.45
|
| Rate for Payer: WPS Commercial |
$4,221.25
|
|
|
TRAY PD CATHETER PRE-STERNAL 8888111132
|
Facility
|
IP
|
$5,699.00
|
|
|
Service Code
|
HCPCS C1750
|
| Hospital Charge Code |
4520299
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,792.51 |
| Max. Negotiated Rate |
$5,243.08 |
| Rate for Payer: Aetna Commercial |
$5,129.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,901.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,020.47
|
| Rate for Payer: Cash Price |
$1,709.70
|
| Rate for Payer: Cigna Commercial |
$5,243.08
|
| Rate for Payer: Health EOS Commercial |
$5,072.11
|
| Rate for Payer: HFN Commercial |
$5,243.08
|
| Rate for Payer: Multiplan Commercial |
$4,559.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,419.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,243.08
|
| Rate for Payer: Quartz Beloit One Network |
$2,792.51
|
| Rate for Payer: Quartz Commercial |
$3,419.40
|
| Rate for Payer: WEA Trust Commercial |
$3,134.45
|
| Rate for Payer: WPS Commercial |
$4,221.25
|
|
|
TRAY PERIFIX COMPLETE 18GX3.5 332236"
|
Facility
|
IP
|
$404.00
|
|
| Hospital Charge Code |
4595228
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$197.96 |
| Max. Negotiated Rate |
$371.68 |
| Rate for Payer: Aetna Commercial |
$363.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$347.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$214.12
|
| Rate for Payer: Cash Price |
$121.20
|
| Rate for Payer: Cigna Commercial |
$371.68
|
| Rate for Payer: Health EOS Commercial |
$359.56
|
| Rate for Payer: HFN Commercial |
$371.68
|
| Rate for Payer: Multiplan Commercial |
$323.20
|
| Rate for Payer: NAPHCARE Commercial |
$242.40
|
| Rate for Payer: Preferred Network Access Commercial |
$371.68
|
| Rate for Payer: Quartz Beloit One Network |
$197.96
|
| Rate for Payer: Quartz Commercial |
$242.40
|
| Rate for Payer: WEA Trust Commercial |
$222.20
|
| Rate for Payer: WPS Commercial |
$299.24
|
|
|
TRAY PERIFIX COMPLETE 18GX3.5 332236"
|
Facility
|
OP
|
$404.00
|
|
| Hospital Charge Code |
4595228
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$113.12 |
| Max. Negotiated Rate |
$1,616.00 |
| Rate for Payer: Aetna Commercial |
$363.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$347.44
|
| Rate for Payer: Aetna Managed Medicare |
$113.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$262.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$202.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$193.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$214.12
|
| Rate for Payer: Cash Price |
$121.20
|
| Rate for Payer: Cigna Commercial |
$371.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$226.08
|
| Rate for Payer: Health EOS Commercial |
$359.56
|
| Rate for Payer: HFN Commercial |
$371.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$303.00
|
| Rate for Payer: Multiplan Commercial |
$323.20
|
| Rate for Payer: NAPHCARE Commercial |
$242.40
|
| Rate for Payer: Preferred Network Access Commercial |
$371.68
|
| Rate for Payer: Quartz Beloit One Network |
$197.96
|
| Rate for Payer: Quartz Commercial |
$262.60
|
| Rate for Payer: Quartz Medicare Advantage |
$242.40
|
| Rate for Payer: The Alliance Commercial |
$1,616.00
|
| Rate for Payer: WEA Trust Commercial |
$222.20
|
| Rate for Payer: WPS Commercial |
$299.24
|
|
|
TRAY PERITONEAL DIALYSIS #5C4150A
|
Facility
|
OP
|
$108.00
|
|
| Hospital Charge Code |
2972154
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$30.24 |
| Max. Negotiated Rate |
$432.00 |
| Rate for Payer: Aetna Commercial |
$97.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$92.88
|
| Rate for Payer: Aetna Managed Medicare |
$30.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$70.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$54.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$51.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$57.24
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cigna Commercial |
$99.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$60.44
|
| Rate for Payer: Health EOS Commercial |
$96.12
|
| Rate for Payer: HFN Commercial |
$99.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$81.00
|
| Rate for Payer: Multiplan Commercial |
$86.40
|
| Rate for Payer: NAPHCARE Commercial |
$64.80
|
| Rate for Payer: Preferred Network Access Commercial |
$99.36
|
| Rate for Payer: Quartz Beloit One Network |
$52.92
|
| Rate for Payer: Quartz Commercial |
$70.20
|
| Rate for Payer: Quartz Medicare Advantage |
$64.80
|
| Rate for Payer: The Alliance Commercial |
$432.00
|
| Rate for Payer: WEA Trust Commercial |
$59.40
|
| Rate for Payer: WPS Commercial |
$80.00
|
|
|
TRAY PERITONEAL DIALYSIS #5C4150A
|
Facility
|
IP
|
$108.00
|
|
| Hospital Charge Code |
2972154
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$52.92 |
| Max. Negotiated Rate |
$99.36 |
| Rate for Payer: Aetna Commercial |
$97.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$92.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$57.24
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cigna Commercial |
$99.36
|
| Rate for Payer: Health EOS Commercial |
$96.12
|
| Rate for Payer: HFN Commercial |
$99.36
|
| Rate for Payer: Multiplan Commercial |
$86.40
|
| Rate for Payer: NAPHCARE Commercial |
$64.80
|
| Rate for Payer: Preferred Network Access Commercial |
$99.36
|
| Rate for Payer: Quartz Beloit One Network |
$52.92
|
| Rate for Payer: Quartz Commercial |
$64.80
|
| Rate for Payer: WEA Trust Commercial |
$59.40
|
| Rate for Payer: WPS Commercial |
$80.00
|
|
|
TRAY PNEUMOTHORAX WAYNE G56537
|
Facility
|
OP
|
$2,630.00
|
|
| Hospital Charge Code |
3453504
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$736.40 |
| Max. Negotiated Rate |
$10,520.00 |
| Rate for Payer: Aetna Commercial |
$2,367.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,261.80
|
| Rate for Payer: Aetna Managed Medicare |
$736.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,709.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,315.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,262.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,393.90
|
| Rate for Payer: Cash Price |
$789.00
|
| Rate for Payer: Cigna Commercial |
$2,419.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,471.75
|
| Rate for Payer: Health EOS Commercial |
$2,340.70
|
| Rate for Payer: HFN Commercial |
$2,419.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,972.50
|
| Rate for Payer: Multiplan Commercial |
$2,104.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,578.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,419.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,288.70
|
| Rate for Payer: Quartz Commercial |
$1,709.50
|
| Rate for Payer: Quartz Medicare Advantage |
$1,578.00
|
| Rate for Payer: The Alliance Commercial |
$10,520.00
|
| Rate for Payer: WEA Trust Commercial |
$1,446.50
|
| Rate for Payer: WPS Commercial |
$1,948.04
|
|
|
TRAY PNEUMOTHORAX WAYNE G56537
|
Facility
|
IP
|
$2,630.00
|
|
| Hospital Charge Code |
3453504
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,288.70 |
| Max. Negotiated Rate |
$2,419.60 |
| Rate for Payer: Aetna Commercial |
$2,367.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,261.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,393.90
|
| Rate for Payer: Cash Price |
$789.00
|
| Rate for Payer: Cigna Commercial |
$2,419.60
|
| Rate for Payer: Health EOS Commercial |
$2,340.70
|
| Rate for Payer: HFN Commercial |
$2,419.60
|
| Rate for Payer: Multiplan Commercial |
$2,104.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,578.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,419.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,288.70
|
| Rate for Payer: Quartz Commercial |
$1,578.00
|
| Rate for Payer: WEA Trust Commercial |
$1,446.50
|
| Rate for Payer: WPS Commercial |
$1,948.04
|
|
|
TRAY SINGLE DOSE EPIDURAL 18ga 11992-20
|
Facility
|
IP
|
$356.00
|
|
| Hospital Charge Code |
2969063
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$174.44 |
| Max. Negotiated Rate |
$327.52 |
| Rate for Payer: Aetna Commercial |
$320.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$306.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$188.68
|
| Rate for Payer: Cash Price |
$106.80
|
| Rate for Payer: Cigna Commercial |
$327.52
|
| Rate for Payer: Health EOS Commercial |
$316.84
|
| Rate for Payer: HFN Commercial |
$327.52
|
| Rate for Payer: Multiplan Commercial |
$284.80
|
| Rate for Payer: NAPHCARE Commercial |
$213.60
|
| Rate for Payer: Preferred Network Access Commercial |
$327.52
|
| Rate for Payer: Quartz Beloit One Network |
$174.44
|
| Rate for Payer: Quartz Commercial |
$213.60
|
| Rate for Payer: WEA Trust Commercial |
$195.80
|
| Rate for Payer: WPS Commercial |
$263.69
|
|
|
TRAY SINGLE DOSE EPIDURAL 18ga 11992-20
|
Facility
|
OP
|
$356.00
|
|
| Hospital Charge Code |
2969063
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$99.68 |
| Max. Negotiated Rate |
$1,424.00 |
| Rate for Payer: Aetna Commercial |
$320.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$306.16
|
| Rate for Payer: Aetna Managed Medicare |
$99.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$231.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$178.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$170.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$188.68
|
| Rate for Payer: Cash Price |
$106.80
|
| Rate for Payer: Cigna Commercial |
$327.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$199.22
|
| Rate for Payer: Health EOS Commercial |
$316.84
|
| Rate for Payer: HFN Commercial |
$327.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$267.00
|
| Rate for Payer: Multiplan Commercial |
$284.80
|
| Rate for Payer: NAPHCARE Commercial |
$213.60
|
| Rate for Payer: Preferred Network Access Commercial |
$327.52
|
| Rate for Payer: Quartz Beloit One Network |
$174.44
|
| Rate for Payer: Quartz Commercial |
$231.40
|
| Rate for Payer: Quartz Medicare Advantage |
$213.60
|
| Rate for Payer: The Alliance Commercial |
$1,424.00
|
| Rate for Payer: WEA Trust Commercial |
$195.80
|
| Rate for Payer: WPS Commercial |
$263.69
|
|
|
TRAY SKIN SCRUB PREP CHG 4489
|
Facility
|
IP
|
$115.00
|
|
| Hospital Charge Code |
2962820
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$56.35 |
| Max. Negotiated Rate |
$105.80 |
| Rate for Payer: Aetna Commercial |
$103.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$98.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$60.95
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cigna Commercial |
$105.80
|
| Rate for Payer: Health EOS Commercial |
$102.35
|
| Rate for Payer: HFN Commercial |
$105.80
|
| Rate for Payer: Multiplan Commercial |
$92.00
|
| Rate for Payer: NAPHCARE Commercial |
$69.00
|
| Rate for Payer: Preferred Network Access Commercial |
$105.80
|
| Rate for Payer: Quartz Beloit One Network |
$56.35
|
| Rate for Payer: Quartz Commercial |
$69.00
|
| Rate for Payer: WEA Trust Commercial |
$63.25
|
| Rate for Payer: WPS Commercial |
$85.18
|
|
|
TRAY SKIN SCRUB PREP CHG 4489
|
Facility
|
OP
|
$115.00
|
|
| Hospital Charge Code |
2962820
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$32.20 |
| Max. Negotiated Rate |
$460.00 |
| Rate for Payer: Aetna Commercial |
$103.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$98.90
|
| Rate for Payer: Aetna Managed Medicare |
$32.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$74.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$57.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$55.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$60.95
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cigna Commercial |
$105.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$64.35
|
| Rate for Payer: Health EOS Commercial |
$102.35
|
| Rate for Payer: HFN Commercial |
$105.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$86.25
|
| Rate for Payer: Multiplan Commercial |
$92.00
|
| Rate for Payer: NAPHCARE Commercial |
$69.00
|
| Rate for Payer: Preferred Network Access Commercial |
$105.80
|
| Rate for Payer: Quartz Beloit One Network |
$56.35
|
| Rate for Payer: Quartz Commercial |
$74.75
|
| Rate for Payer: Quartz Medicare Advantage |
$69.00
|
| Rate for Payer: The Alliance Commercial |
$460.00
|
| Rate for Payer: WEA Trust Commercial |
$63.25
|
| Rate for Payer: WPS Commercial |
$85.18
|
|
|
TRAY SKIN SCRUB PREP PROVIDINE IODINE 4468
|
Facility
|
IP
|
$131.00
|
|
| Hospital Charge Code |
2963477
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$64.19 |
| Max. Negotiated Rate |
$120.52 |
| Rate for Payer: Aetna Commercial |
$117.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$112.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$69.43
|
| Rate for Payer: Cash Price |
$39.30
|
| Rate for Payer: Cigna Commercial |
$120.52
|
| Rate for Payer: Health EOS Commercial |
$116.59
|
| Rate for Payer: HFN Commercial |
$120.52
|
| Rate for Payer: Multiplan Commercial |
$104.80
|
| Rate for Payer: NAPHCARE Commercial |
$78.60
|
| Rate for Payer: Preferred Network Access Commercial |
$120.52
|
| Rate for Payer: Quartz Beloit One Network |
$64.19
|
| Rate for Payer: Quartz Commercial |
$78.60
|
| Rate for Payer: WEA Trust Commercial |
$72.05
|
| Rate for Payer: WPS Commercial |
$97.03
|
|
