|
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: 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
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: 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 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 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: 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
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 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: 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 PROVIDINE IODINE 4468
|
Facility
OP
|
$131.00
|
|
| Hospital Charge Code |
2963477
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$36.68 |
| Max. Negotiated Rate |
$524.00 |
| Rate for Payer: Aetna Commercial |
$117.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$112.66
|
| Rate for Payer: Aetna Managed Medicare |
$36.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$85.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$65.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$62.88
|
| 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: Dean Health DHI/DHP/ASO |
$73.31
|
| Rate for Payer: Health EOS Commercial |
$116.59
|
| Rate for Payer: HFN Commercial |
$120.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$98.25
|
| 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 |
$85.15
|
| Rate for Payer: Quartz Medicare Advantage |
$78.60
|
| Rate for Payer: The Alliance Commercial |
$524.00
|
| Rate for Payer: WEA Trust Commercial |
$72.05
|
| Rate for Payer: WPS Commercial |
$97.03
|
|
|
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: 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
|
|
|
Tray Spinal Anesthesia
|
Facility
IP
|
$575.00
|
|
| Hospital Charge Code |
3101767
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$281.75 |
| Max. Negotiated Rate |
$529.00 |
| Rate for Payer: Aetna Commercial |
$517.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$304.75
|
| Rate for Payer: Cash Price |
$172.50
|
| Rate for Payer: Cigna Commercial |
$529.00
|
| Rate for Payer: Health EOS Commercial |
$511.75
|
| Rate for Payer: HFN Commercial |
$529.00
|
| Rate for Payer: Multiplan Commercial |
$460.00
|
| Rate for Payer: NAPHCARE Commercial |
$345.00
|
| Rate for Payer: Preferred Network Access Commercial |
$529.00
|
| Rate for Payer: Quartz Beloit One Network |
$281.75
|
| Rate for Payer: Quartz Commercial |
$345.00
|
| Rate for Payer: WEA Trust Commercial |
$316.25
|
| Rate for Payer: WPS Commercial |
$425.90
|
|
|
Tray Spinal Anesthesia
|
Facility
OP
|
$575.00
|
|
| Hospital Charge Code |
3101767
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$161.00 |
| Max. Negotiated Rate |
$2,300.00 |
| Rate for Payer: Aetna Commercial |
$517.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$494.50
|
| Rate for Payer: Aetna Managed Medicare |
$161.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$373.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$287.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$276.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$304.75
|
| Rate for Payer: Cash Price |
$172.50
|
| Rate for Payer: Cigna Commercial |
$529.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$321.77
|
| Rate for Payer: Health EOS Commercial |
$511.75
|
| Rate for Payer: HFN Commercial |
$529.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$431.25
|
| Rate for Payer: Multiplan Commercial |
$460.00
|
| Rate for Payer: NAPHCARE Commercial |
$345.00
|
| Rate for Payer: Preferred Network Access Commercial |
$529.00
|
| Rate for Payer: Quartz Beloit One Network |
$281.75
|
| Rate for Payer: Quartz Commercial |
$373.75
|
| Rate for Payer: Quartz Medicare Advantage |
$345.00
|
| Rate for Payer: The Alliance Commercial |
$2,300.00
|
| Rate for Payer: WEA Trust Commercial |
$316.25
|
| Rate for Payer: WPS Commercial |
$425.90
|
|
|
TRAY SPINAL ANESTHESIA B
|
Facility
OP
|
$261.00
|
|
| Hospital Charge Code |
2969065
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$73.08 |
| Max. Negotiated Rate |
$1,044.00 |
| Rate for Payer: Aetna Commercial |
$234.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$224.46
|
| Rate for Payer: Aetna Managed Medicare |
$73.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$169.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$130.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$125.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$138.33
|
| Rate for Payer: Cash Price |
$78.30
|
| Rate for Payer: Cigna Commercial |
$240.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$146.06
|
| Rate for Payer: Health EOS Commercial |
$232.29
|
| Rate for Payer: HFN Commercial |
$240.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$195.75
|
| Rate for Payer: Multiplan Commercial |
$208.80
|
| Rate for Payer: NAPHCARE Commercial |
$156.60
|
| Rate for Payer: Preferred Network Access Commercial |
$240.12
|
| Rate for Payer: Quartz Beloit One Network |
$127.89
|
| Rate for Payer: Quartz Commercial |
$169.65
|
| Rate for Payer: Quartz Medicare Advantage |
$156.60
|
| Rate for Payer: The Alliance Commercial |
$1,044.00
|
| Rate for Payer: WEA Trust Commercial |
$143.55
|
| Rate for Payer: WPS Commercial |
$193.32
|
|
|
TRAY SPINAL ANESTHESIA B
|
Facility
IP
|
$261.00
|
|
| Hospital Charge Code |
2969065
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$127.89 |
| Max. Negotiated Rate |
$240.12 |
| Rate for Payer: Aetna Commercial |
$234.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$138.33
|
| Rate for Payer: Cash Price |
$78.30
|
| Rate for Payer: Cigna Commercial |
$240.12
|
| Rate for Payer: Health EOS Commercial |
$232.29
|
| Rate for Payer: HFN Commercial |
$240.12
|
| Rate for Payer: Multiplan Commercial |
$208.80
|
| Rate for Payer: NAPHCARE Commercial |
$156.60
|
| Rate for Payer: Preferred Network Access Commercial |
$240.12
|
| Rate for Payer: Quartz Beloit One Network |
$127.89
|
| Rate for Payer: Quartz Commercial |
$156.60
|
| Rate for Payer: WEA Trust Commercial |
$143.55
|
| Rate for Payer: WPS Commercial |
$193.32
|
|
|
TRAY SPINAL/EPIDURAL COMBINED NEPI-12093-20
|
Facility
IP
|
$656.00
|
|
| Hospital Charge Code |
4373908
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$321.44 |
| Max. Negotiated Rate |
$603.52 |
| Rate for Payer: Aetna Commercial |
$590.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$347.68
|
| Rate for Payer: Cash Price |
$196.80
|
| Rate for Payer: Cigna Commercial |
$603.52
|
| Rate for Payer: Health EOS Commercial |
$583.84
|
| Rate for Payer: HFN Commercial |
$603.52
|
| Rate for Payer: Multiplan Commercial |
$524.80
|
| Rate for Payer: NAPHCARE Commercial |
$393.60
|
| Rate for Payer: Preferred Network Access Commercial |
$603.52
|
| Rate for Payer: Quartz Beloit One Network |
$321.44
|
| Rate for Payer: Quartz Commercial |
$393.60
|
| Rate for Payer: WEA Trust Commercial |
$360.80
|
| Rate for Payer: WPS Commercial |
$485.90
|
|
|
TRAY SPINAL/EPIDURAL COMBINED NEPI-12093-20
|
Facility
OP
|
$656.00
|
|
| Hospital Charge Code |
4373908
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$183.68 |
| Max. Negotiated Rate |
$2,624.00 |
| Rate for Payer: Aetna Commercial |
$590.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$564.16
|
| Rate for Payer: Aetna Managed Medicare |
$183.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$426.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$328.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$314.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$347.68
|
| Rate for Payer: Cash Price |
$196.80
|
| Rate for Payer: Cigna Commercial |
$603.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$367.10
|
| Rate for Payer: Health EOS Commercial |
$583.84
|
| Rate for Payer: HFN Commercial |
$603.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$492.00
|
| Rate for Payer: Multiplan Commercial |
$524.80
|
| Rate for Payer: NAPHCARE Commercial |
$393.60
|
| Rate for Payer: Preferred Network Access Commercial |
$603.52
|
| Rate for Payer: Quartz Beloit One Network |
$321.44
|
| Rate for Payer: Quartz Commercial |
$426.40
|
| Rate for Payer: Quartz Medicare Advantage |
$393.60
|
| Rate for Payer: The Alliance Commercial |
$2,624.00
|
| Rate for Payer: WEA Trust Commercial |
$360.80
|
| Rate for Payer: WPS Commercial |
$485.90
|
|
|
TRAY TRANSFER SAFE-T-TRAY 31140398
|
Facility
IP
|
$84.00
|
|
| Hospital Charge Code |
2963216
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$41.16 |
| Max. Negotiated Rate |
$77.28 |
| Rate for Payer: Aetna Commercial |
$75.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$44.52
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cigna Commercial |
$77.28
|
| Rate for Payer: Health EOS Commercial |
$74.76
|
| Rate for Payer: HFN Commercial |
$77.28
|
| Rate for Payer: Multiplan Commercial |
$67.20
|
| Rate for Payer: NAPHCARE Commercial |
$50.40
|
| Rate for Payer: Preferred Network Access Commercial |
$77.28
|
| Rate for Payer: Quartz Beloit One Network |
$41.16
|
| Rate for Payer: Quartz Commercial |
$50.40
|
| Rate for Payer: WEA Trust Commercial |
$46.20
|
| Rate for Payer: WPS Commercial |
$62.22
|
|
|
TRAY TRANSFER SAFE-T-TRAY 31140398
|
Facility
OP
|
$84.00
|
|
| Hospital Charge Code |
2963216
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$23.52 |
| Max. Negotiated Rate |
$336.00 |
| Rate for Payer: Aetna Commercial |
$75.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$72.24
|
| Rate for Payer: Aetna Managed Medicare |
$23.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$54.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$42.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$40.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$44.52
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cigna Commercial |
$77.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$47.01
|
| Rate for Payer: Health EOS Commercial |
$74.76
|
| Rate for Payer: HFN Commercial |
$77.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$63.00
|
| Rate for Payer: Multiplan Commercial |
$67.20
|
| Rate for Payer: NAPHCARE Commercial |
$50.40
|
| Rate for Payer: Preferred Network Access Commercial |
$77.28
|
| Rate for Payer: Quartz Beloit One Network |
$41.16
|
| Rate for Payer: Quartz Commercial |
$54.60
|
| Rate for Payer: Quartz Medicare Advantage |
$50.40
|
| Rate for Payer: The Alliance Commercial |
$336.00
|
| Rate for Payer: WEA Trust Commercial |
$46.20
|
| Rate for Payer: WPS Commercial |
$62.22
|
|
|
TRAY UMBILICAL ARTERY 43201
|
Facility
IP
|
$853.00
|
|
| Hospital Charge Code |
2962920
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$417.97 |
| Max. Negotiated Rate |
$784.76 |
| Rate for Payer: Aetna Commercial |
$767.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$452.09
|
| Rate for Payer: Cash Price |
$255.90
|
| Rate for Payer: Cigna Commercial |
$784.76
|
| Rate for Payer: Health EOS Commercial |
$759.17
|
| Rate for Payer: HFN Commercial |
$784.76
|
| Rate for Payer: Multiplan Commercial |
$682.40
|
| Rate for Payer: NAPHCARE Commercial |
$511.80
|
| Rate for Payer: Preferred Network Access Commercial |
$784.76
|
| Rate for Payer: Quartz Beloit One Network |
$417.97
|
| Rate for Payer: Quartz Commercial |
$511.80
|
| Rate for Payer: WEA Trust Commercial |
$469.15
|
| Rate for Payer: WPS Commercial |
$631.82
|
|
|
TRAY UMBILICAL ARTERY 43201
|
Facility
OP
|
$853.00
|
|
| Hospital Charge Code |
2962920
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$238.84 |
| Max. Negotiated Rate |
$3,412.00 |
| Rate for Payer: Aetna Commercial |
$767.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$733.58
|
| Rate for Payer: Aetna Managed Medicare |
$238.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$554.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$426.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$409.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$452.09
|
| Rate for Payer: Cash Price |
$255.90
|
| Rate for Payer: Cigna Commercial |
$784.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$477.34
|
| Rate for Payer: Health EOS Commercial |
$759.17
|
| Rate for Payer: HFN Commercial |
$784.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$639.75
|
| Rate for Payer: Multiplan Commercial |
$682.40
|
| Rate for Payer: NAPHCARE Commercial |
$511.80
|
| Rate for Payer: Preferred Network Access Commercial |
$784.76
|
| Rate for Payer: Quartz Beloit One Network |
$417.97
|
| Rate for Payer: Quartz Commercial |
$554.45
|
| Rate for Payer: Quartz Medicare Advantage |
$511.80
|
| Rate for Payer: The Alliance Commercial |
$3,412.00
|
| Rate for Payer: WEA Trust Commercial |
$469.15
|
| Rate for Payer: WPS Commercial |
$631.82
|
|
|
TRAY UNIVERSAL BLOCK 181A143
|
Facility
OP
|
$574.00
|
|
| Hospital Charge Code |
4595216
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$160.72 |
| Max. Negotiated Rate |
$2,296.00 |
| Rate for Payer: Aetna Commercial |
$516.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$493.64
|
| Rate for Payer: Aetna Managed Medicare |
$160.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$373.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$287.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$275.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$304.22
|
| Rate for Payer: Cash Price |
$172.20
|
| Rate for Payer: Cigna Commercial |
$528.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$321.21
|
| Rate for Payer: Health EOS Commercial |
$510.86
|
| Rate for Payer: HFN Commercial |
$528.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$430.50
|
| Rate for Payer: Multiplan Commercial |
$459.20
|
| Rate for Payer: NAPHCARE Commercial |
$344.40
|
| Rate for Payer: Preferred Network Access Commercial |
$528.08
|
| Rate for Payer: Quartz Beloit One Network |
$281.26
|
| Rate for Payer: Quartz Commercial |
$373.10
|
| Rate for Payer: Quartz Medicare Advantage |
$344.40
|
| Rate for Payer: The Alliance Commercial |
$2,296.00
|
| Rate for Payer: WEA Trust Commercial |
$315.70
|
| Rate for Payer: WPS Commercial |
$425.16
|
|
|
TRAY UNIVERSAL BLOCK 181A143
|
Facility
IP
|
$574.00
|
|
| Hospital Charge Code |
4595216
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$281.26 |
| Max. Negotiated Rate |
$528.08 |
| Rate for Payer: Aetna Commercial |
$516.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$304.22
|
| Rate for Payer: Cash Price |
$172.20
|
| Rate for Payer: Cigna Commercial |
$528.08
|
| Rate for Payer: Health EOS Commercial |
$510.86
|
| Rate for Payer: HFN Commercial |
$528.08
|
| Rate for Payer: Multiplan Commercial |
$459.20
|
| Rate for Payer: NAPHCARE Commercial |
$344.40
|
| Rate for Payer: Preferred Network Access Commercial |
$528.08
|
| Rate for Payer: Quartz Beloit One Network |
$281.26
|
| Rate for Payer: Quartz Commercial |
$344.40
|
| Rate for Payer: WEA Trust Commercial |
$315.70
|
| Rate for Payer: WPS Commercial |
$425.16
|
|
|
TRAY UROLOGIST DISP 123400
|
Facility
IP
|
$3,002.00
|
|
| Hospital Charge Code |
2962998
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,470.98 |
| Max. Negotiated Rate |
$2,761.84 |
| Rate for Payer: Aetna Commercial |
$2,701.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,591.06
|
| Rate for Payer: Cash Price |
$900.60
|
| Rate for Payer: Cigna Commercial |
$2,761.84
|
| Rate for Payer: Health EOS Commercial |
$2,671.78
|
| Rate for Payer: HFN Commercial |
$2,761.84
|
| Rate for Payer: Multiplan Commercial |
$2,401.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,801.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,761.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,470.98
|
| Rate for Payer: Quartz Commercial |
$1,801.20
|
| Rate for Payer: WEA Trust Commercial |
$1,651.10
|
| Rate for Payer: WPS Commercial |
$2,223.58
|
|
|
TRAY UROLOGIST DISP 123400
|
Facility
OP
|
$3,002.00
|
|
| Hospital Charge Code |
2962998
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$840.56 |
| Max. Negotiated Rate |
$12,008.00 |
| Rate for Payer: Aetna Commercial |
$2,701.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,581.72
|
| Rate for Payer: Aetna Managed Medicare |
$840.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,951.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,501.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,440.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,591.06
|
| Rate for Payer: Cash Price |
$900.60
|
| Rate for Payer: Cigna Commercial |
$2,761.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,679.92
|
| Rate for Payer: Health EOS Commercial |
$2,671.78
|
| Rate for Payer: HFN Commercial |
$2,761.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,251.50
|
| Rate for Payer: Multiplan Commercial |
$2,401.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,801.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,761.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,470.98
|
| Rate for Payer: Quartz Commercial |
$1,951.30
|
| Rate for Payer: Quartz Medicare Advantage |
$1,801.20
|
| Rate for Payer: The Alliance Commercial |
$12,008.00
|
| Rate for Payer: WEA Trust Commercial |
$1,651.10
|
| Rate for Payer: WPS Commercial |
$2,223.58
|
|
|
Trazodone Level
|
Professional
|
$158.00
|
|
|
Service Code
|
CPT 80338
|
| Hospital Charge Code |
3256241
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$45.01 |
| Max. Negotiated Rate |
$150.10 |
| Rate for Payer: Aetna Commercial |
$150.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$135.88
|
| Rate for Payer: Cash Price |
$47.40
|
| Rate for Payer: Cash Price |
$47.40
|
| Rate for Payer: Cigna Commercial |
$150.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$79.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$94.80
|
| Rate for Payer: Health EOS Commercial |
$143.78
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$45.01
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$45.01
|
| Rate for Payer: Multiplan Commercial |
$126.40
|
| Rate for Payer: Preferred Network Access Commercial |
$150.10
|
| Rate for Payer: Quartz Beloit One Network |
$69.52
|
| Rate for Payer: Quartz Commercial |
$90.06
|
| Rate for Payer: The Alliance Commercial |
$79.00
|
| Rate for Payer: WEA Trust Commercial |
$86.90
|
| Rate for Payer: WPS Commercial |
$117.03
|
|
