|
T-TUBE 16 FRENCH SU130-1240
|
Facility
IP
|
$196.00
|
|
| Hospital Charge Code |
2963377
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$96.04 |
| Max. Negotiated Rate |
$180.32 |
| Rate for Payer: Aetna Commercial |
$176.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$103.88
|
| Rate for Payer: Cash Price |
$58.80
|
| Rate for Payer: Cigna Commercial |
$180.32
|
| Rate for Payer: Health EOS Commercial |
$174.44
|
| Rate for Payer: HFN Commercial |
$180.32
|
| Rate for Payer: Multiplan Commercial |
$156.80
|
| Rate for Payer: NAPHCARE Commercial |
$117.60
|
| Rate for Payer: Preferred Network Access Commercial |
$180.32
|
| Rate for Payer: Quartz Beloit One Network |
$96.04
|
| Rate for Payer: Quartz Commercial |
$117.60
|
| Rate for Payer: WEA Trust Commercial |
$107.80
|
| Rate for Payer: WPS Commercial |
$145.18
|
|
|
T-TUBE 20 FRENCH
|
Facility
IP
|
$196.00
|
|
| Hospital Charge Code |
2963379
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$96.04 |
| Max. Negotiated Rate |
$180.32 |
| Rate for Payer: Aetna Commercial |
$176.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$103.88
|
| Rate for Payer: Cash Price |
$58.80
|
| Rate for Payer: Cigna Commercial |
$180.32
|
| Rate for Payer: Health EOS Commercial |
$174.44
|
| Rate for Payer: HFN Commercial |
$180.32
|
| Rate for Payer: Multiplan Commercial |
$156.80
|
| Rate for Payer: NAPHCARE Commercial |
$117.60
|
| Rate for Payer: Preferred Network Access Commercial |
$180.32
|
| Rate for Payer: Quartz Beloit One Network |
$96.04
|
| Rate for Payer: Quartz Commercial |
$117.60
|
| Rate for Payer: WEA Trust Commercial |
$107.80
|
| Rate for Payer: WPS Commercial |
$145.18
|
|
|
T-TUBE 20 FRENCH
|
Facility
OP
|
$196.00
|
|
| Hospital Charge Code |
2963379
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$54.88 |
| Max. Negotiated Rate |
$784.00 |
| Rate for Payer: Aetna Commercial |
$176.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$168.56
|
| Rate for Payer: Aetna Managed Medicare |
$54.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$127.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$98.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$94.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$103.88
|
| Rate for Payer: Cash Price |
$58.80
|
| Rate for Payer: Cigna Commercial |
$180.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$109.68
|
| Rate for Payer: Health EOS Commercial |
$174.44
|
| Rate for Payer: HFN Commercial |
$180.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$147.00
|
| Rate for Payer: Multiplan Commercial |
$156.80
|
| Rate for Payer: NAPHCARE Commercial |
$117.60
|
| Rate for Payer: Preferred Network Access Commercial |
$180.32
|
| Rate for Payer: Quartz Beloit One Network |
$96.04
|
| Rate for Payer: Quartz Commercial |
$127.40
|
| Rate for Payer: Quartz Medicare Advantage |
$117.60
|
| Rate for Payer: The Alliance Commercial |
$784.00
|
| Rate for Payer: WEA Trust Commercial |
$107.80
|
| Rate for Payer: WPS Commercial |
$145.18
|
|
|
TUBAL LIGATION, POST PARTUM
|
Facility
IP
|
$1,084.00
|
|
| Hospital Charge Code |
2960319
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$531.16 |
| Max. Negotiated Rate |
$997.28 |
| Rate for Payer: Aetna Commercial |
$975.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$574.52
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$997.28
|
| Rate for Payer: Health EOS Commercial |
$964.76
|
| Rate for Payer: HFN Commercial |
$997.28
|
| Rate for Payer: Multiplan Commercial |
$867.20
|
| Rate for Payer: NAPHCARE Commercial |
$650.40
|
| Rate for Payer: Preferred Network Access Commercial |
$997.28
|
| Rate for Payer: Quartz Beloit One Network |
$531.16
|
| Rate for Payer: Quartz Commercial |
$650.40
|
| Rate for Payer: WEA Trust Commercial |
$596.20
|
| Rate for Payer: WPS Commercial |
$802.92
|
|
|
TUBAL LIGATION, POST PARTUM
|
Facility
OP
|
$1,084.00
|
|
| Hospital Charge Code |
2960319
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$303.52 |
| Max. Negotiated Rate |
$4,336.00 |
| Rate for Payer: Aetna Commercial |
$975.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$932.24
|
| Rate for Payer: Aetna Managed Medicare |
$303.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$704.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$542.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$520.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$574.52
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$997.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$606.61
|
| Rate for Payer: Health EOS Commercial |
$964.76
|
| Rate for Payer: HFN Commercial |
$997.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$813.00
|
| Rate for Payer: Multiplan Commercial |
$867.20
|
| Rate for Payer: NAPHCARE Commercial |
$650.40
|
| Rate for Payer: Preferred Network Access Commercial |
$997.28
|
| Rate for Payer: Quartz Beloit One Network |
$531.16
|
| Rate for Payer: Quartz Commercial |
$704.60
|
| Rate for Payer: Quartz Medicare Advantage |
$650.40
|
| Rate for Payer: The Alliance Commercial |
$4,336.00
|
| Rate for Payer: WEA Trust Commercial |
$596.20
|
| Rate for Payer: WPS Commercial |
$802.92
|
|
|
TUBE 2 WAY FLUID ADM. SET
|
Facility
IP
|
$96.00
|
|
| Hospital Charge Code |
2963350
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$47.04 |
| Max. Negotiated Rate |
$88.32 |
| Rate for Payer: Aetna Commercial |
$86.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$50.88
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cigna Commercial |
$88.32
|
| Rate for Payer: Health EOS Commercial |
$85.44
|
| Rate for Payer: HFN Commercial |
$88.32
|
| Rate for Payer: Multiplan Commercial |
$76.80
|
| Rate for Payer: NAPHCARE Commercial |
$57.60
|
| Rate for Payer: Preferred Network Access Commercial |
$88.32
|
| Rate for Payer: Quartz Beloit One Network |
$47.04
|
| Rate for Payer: Quartz Commercial |
$57.60
|
| Rate for Payer: WEA Trust Commercial |
$52.80
|
| Rate for Payer: WPS Commercial |
$71.11
|
|
|
TUBE 2 WAY FLUID ADM. SET
|
Facility
OP
|
$96.00
|
|
| Hospital Charge Code |
2963350
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$26.88 |
| Max. Negotiated Rate |
$384.00 |
| Rate for Payer: Aetna Commercial |
$86.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$82.56
|
| Rate for Payer: Aetna Managed Medicare |
$26.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$62.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$48.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$46.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$50.88
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cigna Commercial |
$88.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$53.72
|
| Rate for Payer: Health EOS Commercial |
$85.44
|
| Rate for Payer: HFN Commercial |
$88.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$72.00
|
| Rate for Payer: Multiplan Commercial |
$76.80
|
| Rate for Payer: NAPHCARE Commercial |
$57.60
|
| Rate for Payer: Preferred Network Access Commercial |
$88.32
|
| Rate for Payer: Quartz Beloit One Network |
$47.04
|
| Rate for Payer: Quartz Commercial |
$62.40
|
| Rate for Payer: Quartz Medicare Advantage |
$57.60
|
| Rate for Payer: The Alliance Commercial |
$384.00
|
| Rate for Payer: WEA Trust Commercial |
$52.80
|
| Rate for Payer: WPS Commercial |
$71.11
|
|
|
TUBE BLAKEMORE ESOPH NASOGAS
|
Facility
IP
|
$3,091.00
|
|
| Hospital Charge Code |
2962942
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,514.59 |
| Max. Negotiated Rate |
$2,843.72 |
| Rate for Payer: Aetna Commercial |
$2,781.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,638.23
|
| Rate for Payer: Cash Price |
$927.30
|
| Rate for Payer: Cigna Commercial |
$2,843.72
|
| Rate for Payer: Health EOS Commercial |
$2,750.99
|
| Rate for Payer: HFN Commercial |
$2,843.72
|
| Rate for Payer: Multiplan Commercial |
$2,472.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,854.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,843.72
|
| Rate for Payer: Quartz Beloit One Network |
$1,514.59
|
| Rate for Payer: Quartz Commercial |
$1,854.60
|
| Rate for Payer: WEA Trust Commercial |
$1,700.05
|
| Rate for Payer: WPS Commercial |
$2,289.50
|
|
|
TUBE BLAKEMORE ESOPH NASOGAS
|
Facility
OP
|
$3,091.00
|
|
| Hospital Charge Code |
2962942
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$865.48 |
| Max. Negotiated Rate |
$12,364.00 |
| Rate for Payer: Aetna Commercial |
$2,781.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,658.26
|
| Rate for Payer: Aetna Managed Medicare |
$865.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,009.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,545.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,483.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,638.23
|
| Rate for Payer: Cash Price |
$927.30
|
| Rate for Payer: Cigna Commercial |
$2,843.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,729.72
|
| Rate for Payer: Health EOS Commercial |
$2,750.99
|
| Rate for Payer: HFN Commercial |
$2,843.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,318.25
|
| Rate for Payer: Multiplan Commercial |
$2,472.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,854.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,843.72
|
| Rate for Payer: Quartz Beloit One Network |
$1,514.59
|
| Rate for Payer: Quartz Commercial |
$2,009.15
|
| Rate for Payer: Quartz Medicare Advantage |
$1,854.60
|
| Rate for Payer: The Alliance Commercial |
$12,364.00
|
| Rate for Payer: WEA Trust Commercial |
$1,700.05
|
| Rate for Payer: WPS Commercial |
$2,289.50
|
|
|
TUBE BRONCH RUSCH DBL LMN LT 35FR #116100035
|
Facility
IP
|
$1,023.00
|
|
| Hospital Charge Code |
2974654
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$501.27 |
| Max. Negotiated Rate |
$941.16 |
| Rate for Payer: Aetna Commercial |
$920.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$542.19
|
| Rate for Payer: Cash Price |
$306.90
|
| Rate for Payer: Cigna Commercial |
$941.16
|
| Rate for Payer: Health EOS Commercial |
$910.47
|
| Rate for Payer: HFN Commercial |
$941.16
|
| Rate for Payer: Multiplan Commercial |
$818.40
|
| Rate for Payer: NAPHCARE Commercial |
$613.80
|
| Rate for Payer: Preferred Network Access Commercial |
$941.16
|
| Rate for Payer: Quartz Beloit One Network |
$501.27
|
| Rate for Payer: Quartz Commercial |
$613.80
|
| Rate for Payer: WEA Trust Commercial |
$562.65
|
| Rate for Payer: WPS Commercial |
$757.74
|
|
|
TUBE BRONCH RUSCH DBL LMN LT 35FR #116100035
|
Facility
OP
|
$1,023.00
|
|
| Hospital Charge Code |
2974654
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$286.44 |
| Max. Negotiated Rate |
$4,092.00 |
| Rate for Payer: Aetna Commercial |
$920.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$879.78
|
| Rate for Payer: Aetna Managed Medicare |
$286.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$664.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$511.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$491.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$542.19
|
| Rate for Payer: Cash Price |
$306.90
|
| Rate for Payer: Cigna Commercial |
$941.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$572.47
|
| Rate for Payer: Health EOS Commercial |
$910.47
|
| Rate for Payer: HFN Commercial |
$941.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$767.25
|
| Rate for Payer: Multiplan Commercial |
$818.40
|
| Rate for Payer: NAPHCARE Commercial |
$613.80
|
| Rate for Payer: Preferred Network Access Commercial |
$941.16
|
| Rate for Payer: Quartz Beloit One Network |
$501.27
|
| Rate for Payer: Quartz Commercial |
$664.95
|
| Rate for Payer: Quartz Medicare Advantage |
$613.80
|
| Rate for Payer: The Alliance Commercial |
$4,092.00
|
| Rate for Payer: WEA Trust Commercial |
$562.65
|
| Rate for Payer: WPS Commercial |
$757.74
|
|
|
Tube-Cont-Flo Adm
|
Facility
IP
|
$152.00
|
|
| Hospital Charge Code |
3101774
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$74.48 |
| Max. Negotiated Rate |
$139.84 |
| Rate for Payer: Aetna Commercial |
$136.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$80.56
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cigna Commercial |
$139.84
|
| Rate for Payer: Health EOS Commercial |
$135.28
|
| Rate for Payer: HFN Commercial |
$139.84
|
| Rate for Payer: Multiplan Commercial |
$121.60
|
| Rate for Payer: NAPHCARE Commercial |
$91.20
|
| Rate for Payer: Preferred Network Access Commercial |
$139.84
|
| Rate for Payer: Quartz Beloit One Network |
$74.48
|
| Rate for Payer: Quartz Commercial |
$91.20
|
| Rate for Payer: WEA Trust Commercial |
$83.60
|
| Rate for Payer: WPS Commercial |
$112.59
|
|
|
Tube-Cont-Flo Adm
|
Facility
OP
|
$152.00
|
|
| Hospital Charge Code |
3101774
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$42.56 |
| Max. Negotiated Rate |
$608.00 |
| Rate for Payer: Aetna Commercial |
$136.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$130.72
|
| Rate for Payer: Aetna Managed Medicare |
$42.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$98.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$76.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$72.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$80.56
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cigna Commercial |
$139.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$85.06
|
| Rate for Payer: Health EOS Commercial |
$135.28
|
| Rate for Payer: HFN Commercial |
$139.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$114.00
|
| Rate for Payer: Multiplan Commercial |
$121.60
|
| Rate for Payer: NAPHCARE Commercial |
$91.20
|
| Rate for Payer: Preferred Network Access Commercial |
$139.84
|
| Rate for Payer: Quartz Beloit One Network |
$74.48
|
| Rate for Payer: Quartz Commercial |
$98.80
|
| Rate for Payer: Quartz Medicare Advantage |
$91.20
|
| Rate for Payer: The Alliance Commercial |
$608.00
|
| Rate for Payer: WEA Trust Commercial |
$83.60
|
| Rate for Payer: WPS Commercial |
$112.59
|
|
|
TUBE DIGIT EXT.DYNAMIC SMALL #9272-55-02
|
Facility
IP
|
$363.00
|
|
| Hospital Charge Code |
2969531
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$177.87 |
| Max. Negotiated Rate |
$333.96 |
| Rate for Payer: Aetna Commercial |
$326.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$192.39
|
| Rate for Payer: Cash Price |
$108.90
|
| Rate for Payer: Cigna Commercial |
$333.96
|
| Rate for Payer: Health EOS Commercial |
$323.07
|
| Rate for Payer: HFN Commercial |
$333.96
|
| Rate for Payer: Multiplan Commercial |
$290.40
|
| Rate for Payer: NAPHCARE Commercial |
$217.80
|
| Rate for Payer: Preferred Network Access Commercial |
$333.96
|
| Rate for Payer: Quartz Beloit One Network |
$177.87
|
| Rate for Payer: Quartz Commercial |
$217.80
|
| Rate for Payer: WEA Trust Commercial |
$199.65
|
| Rate for Payer: WPS Commercial |
$268.87
|
|
|
TUBE DIGIT EXT.DYNAMIC SMALL #9272-55-02
|
Facility
OP
|
$363.00
|
|
| Hospital Charge Code |
2969531
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$101.64 |
| Max. Negotiated Rate |
$1,452.00 |
| Rate for Payer: Aetna Commercial |
$326.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$312.18
|
| Rate for Payer: Aetna Managed Medicare |
$101.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$235.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$181.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$174.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$192.39
|
| Rate for Payer: Cash Price |
$108.90
|
| Rate for Payer: Cigna Commercial |
$333.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$203.13
|
| Rate for Payer: Health EOS Commercial |
$323.07
|
| Rate for Payer: HFN Commercial |
$333.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$272.25
|
| Rate for Payer: Multiplan Commercial |
$290.40
|
| Rate for Payer: NAPHCARE Commercial |
$217.80
|
| Rate for Payer: Preferred Network Access Commercial |
$333.96
|
| Rate for Payer: Quartz Beloit One Network |
$177.87
|
| Rate for Payer: Quartz Commercial |
$235.95
|
| Rate for Payer: Quartz Medicare Advantage |
$217.80
|
| Rate for Payer: The Alliance Commercial |
$1,452.00
|
| Rate for Payer: WEA Trust Commercial |
$199.65
|
| Rate for Payer: WPS Commercial |
$268.87
|
|
|
TUBE DIGIT EXTENSION LARGE #92725505
|
Facility
IP
|
$233.00
|
|
| Hospital Charge Code |
2969643
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$114.17 |
| Max. Negotiated Rate |
$214.36 |
| Rate for Payer: Aetna Commercial |
$209.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$123.49
|
| Rate for Payer: Cash Price |
$69.90
|
| Rate for Payer: Cigna Commercial |
$214.36
|
| Rate for Payer: Health EOS Commercial |
$207.37
|
| Rate for Payer: HFN Commercial |
$214.36
|
| Rate for Payer: Multiplan Commercial |
$186.40
|
| Rate for Payer: NAPHCARE Commercial |
$139.80
|
| Rate for Payer: Preferred Network Access Commercial |
$214.36
|
| Rate for Payer: Quartz Beloit One Network |
$114.17
|
| Rate for Payer: Quartz Commercial |
$139.80
|
| Rate for Payer: WEA Trust Commercial |
$128.15
|
| Rate for Payer: WPS Commercial |
$172.58
|
|
|
TUBE DIGIT EXTENSION LARGE #92725505
|
Facility
OP
|
$233.00
|
|
| Hospital Charge Code |
2969643
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$65.24 |
| Max. Negotiated Rate |
$932.00 |
| Rate for Payer: Aetna Commercial |
$209.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$200.38
|
| Rate for Payer: Aetna Managed Medicare |
$65.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$151.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$116.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$111.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$123.49
|
| Rate for Payer: Cash Price |
$69.90
|
| Rate for Payer: Cigna Commercial |
$214.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$130.39
|
| Rate for Payer: Health EOS Commercial |
$207.37
|
| Rate for Payer: HFN Commercial |
$214.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$174.75
|
| Rate for Payer: Multiplan Commercial |
$186.40
|
| Rate for Payer: NAPHCARE Commercial |
$139.80
|
| Rate for Payer: Preferred Network Access Commercial |
$214.36
|
| Rate for Payer: Quartz Beloit One Network |
$114.17
|
| Rate for Payer: Quartz Commercial |
$151.45
|
| Rate for Payer: Quartz Medicare Advantage |
$139.80
|
| Rate for Payer: The Alliance Commercial |
$932.00
|
| Rate for Payer: WEA Trust Commercial |
$128.15
|
| Rate for Payer: WPS Commercial |
$172.58
|
|
|
TUBE DYNAMIC DIGIT EXT MEDIUM #9272-55-03
|
Facility
IP
|
$339.00
|
|
| Hospital Charge Code |
2969622
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$166.11 |
| Max. Negotiated Rate |
$311.88 |
| Rate for Payer: Aetna Commercial |
$305.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$179.67
|
| Rate for Payer: Cash Price |
$101.70
|
| Rate for Payer: Cigna Commercial |
$311.88
|
| Rate for Payer: Health EOS Commercial |
$301.71
|
| Rate for Payer: HFN Commercial |
$311.88
|
| Rate for Payer: Multiplan Commercial |
$271.20
|
| Rate for Payer: NAPHCARE Commercial |
$203.40
|
| Rate for Payer: Preferred Network Access Commercial |
$311.88
|
| Rate for Payer: Quartz Beloit One Network |
$166.11
|
| Rate for Payer: Quartz Commercial |
$203.40
|
| Rate for Payer: WEA Trust Commercial |
$186.45
|
| Rate for Payer: WPS Commercial |
$251.10
|
|
|
TUBE DYNAMIC DIGIT EXT MEDIUM #9272-55-03
|
Facility
OP
|
$339.00
|
|
| Hospital Charge Code |
2969622
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$94.92 |
| Max. Negotiated Rate |
$1,356.00 |
| Rate for Payer: Aetna Commercial |
$305.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$291.54
|
| Rate for Payer: Aetna Managed Medicare |
$94.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$220.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$169.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$162.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$179.67
|
| Rate for Payer: Cash Price |
$101.70
|
| Rate for Payer: Cigna Commercial |
$311.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$189.70
|
| Rate for Payer: Health EOS Commercial |
$301.71
|
| Rate for Payer: HFN Commercial |
$311.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$254.25
|
| Rate for Payer: Multiplan Commercial |
$271.20
|
| Rate for Payer: NAPHCARE Commercial |
$203.40
|
| Rate for Payer: Preferred Network Access Commercial |
$311.88
|
| Rate for Payer: Quartz Beloit One Network |
$166.11
|
| Rate for Payer: Quartz Commercial |
$220.35
|
| Rate for Payer: Quartz Medicare Advantage |
$203.40
|
| Rate for Payer: The Alliance Commercial |
$1,356.00
|
| Rate for Payer: WEA Trust Commercial |
$186.45
|
| Rate for Payer: WPS Commercial |
$251.10
|
|
|
TUBE DYNAMIC MONOTUBE TRIAX BLUE 20MM 5150-0-470
|
Facility
IP
|
$7,006.00
|
|
| Hospital Charge Code |
5685881
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,432.94 |
| Max. Negotiated Rate |
$6,445.52 |
| Rate for Payer: Aetna Commercial |
$6,305.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,713.18
|
| Rate for Payer: Cash Price |
$2,101.80
|
| Rate for Payer: Cigna Commercial |
$6,445.52
|
| Rate for Payer: Health EOS Commercial |
$6,235.34
|
| Rate for Payer: HFN Commercial |
$6,445.52
|
| Rate for Payer: Multiplan Commercial |
$5,604.80
|
| Rate for Payer: NAPHCARE Commercial |
$4,203.60
|
| Rate for Payer: Preferred Network Access Commercial |
$6,445.52
|
| Rate for Payer: Quartz Beloit One Network |
$3,432.94
|
| Rate for Payer: Quartz Commercial |
$4,203.60
|
| Rate for Payer: WEA Trust Commercial |
$3,853.30
|
| Rate for Payer: WPS Commercial |
$5,189.34
|
|
|
TUBE DYNAMIC MONOTUBE TRIAX BLUE 20MM 5150-0-470
|
Facility
OP
|
$7,006.00
|
|
| Hospital Charge Code |
5685881
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,961.68 |
| Max. Negotiated Rate |
$28,024.00 |
| Rate for Payer: Aetna Commercial |
$6,305.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,025.16
|
| Rate for Payer: Aetna Managed Medicare |
$1,961.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,553.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,503.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,362.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,713.18
|
| Rate for Payer: Cash Price |
$2,101.80
|
| Rate for Payer: Cigna Commercial |
$6,445.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,920.56
|
| Rate for Payer: Health EOS Commercial |
$6,235.34
|
| Rate for Payer: HFN Commercial |
$6,445.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,254.50
|
| Rate for Payer: Multiplan Commercial |
$5,604.80
|
| Rate for Payer: NAPHCARE Commercial |
$4,203.60
|
| Rate for Payer: Preferred Network Access Commercial |
$6,445.52
|
| Rate for Payer: Quartz Beloit One Network |
$3,432.94
|
| Rate for Payer: Quartz Commercial |
$4,553.90
|
| Rate for Payer: Quartz Medicare Advantage |
$4,203.60
|
| Rate for Payer: The Alliance Commercial |
$28,024.00
|
| Rate for Payer: WEA Trust Commercial |
$3,853.30
|
| Rate for Payer: WPS Commercial |
$5,189.34
|
|
|
TUBE EAR 240050
|
Facility
IP
|
$378.00
|
|
| Hospital Charge Code |
2965423
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$185.22 |
| Max. Negotiated Rate |
$347.76 |
| Rate for Payer: Aetna Commercial |
$340.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$200.34
|
| Rate for Payer: Cash Price |
$113.40
|
| Rate for Payer: Cigna Commercial |
$347.76
|
| Rate for Payer: Health EOS Commercial |
$336.42
|
| Rate for Payer: HFN Commercial |
$347.76
|
| Rate for Payer: Multiplan Commercial |
$302.40
|
| Rate for Payer: NAPHCARE Commercial |
$226.80
|
| Rate for Payer: Preferred Network Access Commercial |
$347.76
|
| Rate for Payer: Quartz Beloit One Network |
$185.22
|
| Rate for Payer: Quartz Commercial |
$226.80
|
| Rate for Payer: WEA Trust Commercial |
$207.90
|
| Rate for Payer: WPS Commercial |
$279.98
|
|
|
TUBE EAR 240050
|
Facility
OP
|
$378.00
|
|
| Hospital Charge Code |
2965423
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$105.84 |
| Max. Negotiated Rate |
$1,512.00 |
| Rate for Payer: Aetna Commercial |
$340.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$325.08
|
| Rate for Payer: Aetna Managed Medicare |
$105.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$245.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$189.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$181.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$200.34
|
| Rate for Payer: Cash Price |
$113.40
|
| Rate for Payer: Cigna Commercial |
$347.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$211.53
|
| Rate for Payer: Health EOS Commercial |
$336.42
|
| Rate for Payer: HFN Commercial |
$347.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$283.50
|
| Rate for Payer: Multiplan Commercial |
$302.40
|
| Rate for Payer: NAPHCARE Commercial |
$226.80
|
| Rate for Payer: Preferred Network Access Commercial |
$347.76
|
| Rate for Payer: Quartz Beloit One Network |
$185.22
|
| Rate for Payer: Quartz Commercial |
$245.70
|
| Rate for Payer: Quartz Medicare Advantage |
$226.80
|
| Rate for Payer: The Alliance Commercial |
$1,512.00
|
| Rate for Payer: WEA Trust Commercial |
$207.90
|
| Rate for Payer: WPS Commercial |
$279.98
|
|
|
TUBE ENDOTRACHEAL 2.5MM CUFFED
|
Facility
IP
|
$88.00
|
|
| Hospital Charge Code |
2974570
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$43.12 |
| Max. Negotiated Rate |
$80.96 |
| Rate for Payer: Aetna Commercial |
$79.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$46.64
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cigna Commercial |
$80.96
|
| Rate for Payer: Health EOS Commercial |
$78.32
|
| Rate for Payer: HFN Commercial |
$80.96
|
| Rate for Payer: Multiplan Commercial |
$70.40
|
| Rate for Payer: NAPHCARE Commercial |
$52.80
|
| Rate for Payer: Preferred Network Access Commercial |
$80.96
|
| Rate for Payer: Quartz Beloit One Network |
$43.12
|
| Rate for Payer: Quartz Commercial |
$52.80
|
| Rate for Payer: WEA Trust Commercial |
$48.40
|
| Rate for Payer: WPS Commercial |
$65.18
|
|
|
TUBE ENDOTRACHEAL 2.5MM CUFFED
|
Facility
OP
|
$88.00
|
|
| Hospital Charge Code |
2974570
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$24.64 |
| Max. Negotiated Rate |
$352.00 |
| Rate for Payer: Aetna Commercial |
$79.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$75.68
|
| Rate for Payer: Aetna Managed Medicare |
$24.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$57.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$44.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$42.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$46.64
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cigna Commercial |
$80.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$49.24
|
| Rate for Payer: Health EOS Commercial |
$78.32
|
| Rate for Payer: HFN Commercial |
$80.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$66.00
|
| Rate for Payer: Multiplan Commercial |
$70.40
|
| Rate for Payer: NAPHCARE Commercial |
$52.80
|
| Rate for Payer: Preferred Network Access Commercial |
$80.96
|
| Rate for Payer: Quartz Beloit One Network |
$43.12
|
| Rate for Payer: Quartz Commercial |
$57.20
|
| Rate for Payer: Quartz Medicare Advantage |
$52.80
|
| Rate for Payer: The Alliance Commercial |
$352.00
|
| Rate for Payer: WEA Trust Commercial |
$48.40
|
| Rate for Payer: WPS Commercial |
$65.18
|
|
