|
TUBING BIFURCATED FAS2072
|
Facility
|
OP
|
$110.00
|
|
| Hospital Charge Code |
2972383
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$30.80 |
| Max. Negotiated Rate |
$440.00 |
| Rate for Payer: Aetna Commercial |
$99.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$94.60
|
| Rate for Payer: Aetna Managed Medicare |
$30.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$71.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$55.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$52.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$58.30
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cigna Commercial |
$101.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$61.56
|
| Rate for Payer: Health EOS Commercial |
$97.90
|
| Rate for Payer: HFN Commercial |
$101.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$82.50
|
| Rate for Payer: Multiplan Commercial |
$88.00
|
| Rate for Payer: NAPHCARE Commercial |
$66.00
|
| Rate for Payer: Preferred Network Access Commercial |
$101.20
|
| Rate for Payer: Quartz Beloit One Network |
$53.90
|
| Rate for Payer: Quartz Commercial |
$71.50
|
| Rate for Payer: Quartz Medicare Advantage |
$66.00
|
| Rate for Payer: The Alliance Commercial |
$440.00
|
| Rate for Payer: WEA Trust Commercial |
$60.50
|
| Rate for Payer: WPS Commercial |
$81.48
|
|
|
TUBING BIOVAC SMOKE EVAC WITH SPECULUM ATTACHMENT 920002
|
Facility
|
OP
|
$317.00
|
|
| Hospital Charge Code |
4184847
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$88.76 |
| Max. Negotiated Rate |
$1,268.00 |
| Rate for Payer: Aetna Commercial |
$285.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$272.62
|
| Rate for Payer: Aetna Managed Medicare |
$88.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$206.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$158.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$152.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$168.01
|
| Rate for Payer: Cash Price |
$95.10
|
| Rate for Payer: Cigna Commercial |
$291.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$177.39
|
| Rate for Payer: Health EOS Commercial |
$282.13
|
| Rate for Payer: HFN Commercial |
$291.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$237.75
|
| Rate for Payer: Multiplan Commercial |
$253.60
|
| Rate for Payer: NAPHCARE Commercial |
$190.20
|
| Rate for Payer: Preferred Network Access Commercial |
$291.64
|
| Rate for Payer: Quartz Beloit One Network |
$155.33
|
| Rate for Payer: Quartz Commercial |
$206.05
|
| Rate for Payer: Quartz Medicare Advantage |
$190.20
|
| Rate for Payer: The Alliance Commercial |
$1,268.00
|
| Rate for Payer: WEA Trust Commercial |
$174.35
|
| Rate for Payer: WPS Commercial |
$234.80
|
|
|
TUBING BIOVAC SMOKE EVAC WITH SPECULUM ATTACHMENT 920002
|
Facility
|
IP
|
$317.00
|
|
| Hospital Charge Code |
4184847
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$155.33 |
| Max. Negotiated Rate |
$291.64 |
| Rate for Payer: Aetna Commercial |
$285.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$272.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$168.01
|
| Rate for Payer: Cash Price |
$95.10
|
| Rate for Payer: Cigna Commercial |
$291.64
|
| Rate for Payer: Health EOS Commercial |
$282.13
|
| Rate for Payer: HFN Commercial |
$291.64
|
| Rate for Payer: Multiplan Commercial |
$253.60
|
| Rate for Payer: NAPHCARE Commercial |
$190.20
|
| Rate for Payer: Preferred Network Access Commercial |
$291.64
|
| Rate for Payer: Quartz Beloit One Network |
$155.33
|
| Rate for Payer: Quartz Commercial |
$190.20
|
| Rate for Payer: WEA Trust Commercial |
$174.35
|
| Rate for Payer: WPS Commercial |
$234.80
|
|
|
TUBING BLOOD GRAVITY 12718-02
|
Facility
|
IP
|
$82.00
|
|
| Hospital Charge Code |
2963124
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$40.18 |
| Max. Negotiated Rate |
$75.44 |
| Rate for Payer: Aetna Commercial |
$73.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$70.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$43.46
|
| Rate for Payer: Cash Price |
$24.60
|
| Rate for Payer: Cigna Commercial |
$75.44
|
| Rate for Payer: Health EOS Commercial |
$72.98
|
| Rate for Payer: HFN Commercial |
$75.44
|
| Rate for Payer: Multiplan Commercial |
$65.60
|
| Rate for Payer: NAPHCARE Commercial |
$49.20
|
| Rate for Payer: Preferred Network Access Commercial |
$75.44
|
| Rate for Payer: Quartz Beloit One Network |
$40.18
|
| Rate for Payer: Quartz Commercial |
$49.20
|
| Rate for Payer: WEA Trust Commercial |
$45.10
|
| Rate for Payer: WPS Commercial |
$60.74
|
|
|
TUBING BLOOD GRAVITY 12718-02
|
Facility
|
OP
|
$82.00
|
|
| Hospital Charge Code |
2963124
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$22.96 |
| Max. Negotiated Rate |
$328.00 |
| Rate for Payer: Aetna Commercial |
$73.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$70.52
|
| Rate for Payer: Aetna Managed Medicare |
$22.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$53.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$41.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$39.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$43.46
|
| Rate for Payer: Cash Price |
$24.60
|
| Rate for Payer: Cigna Commercial |
$75.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$45.89
|
| Rate for Payer: Health EOS Commercial |
$72.98
|
| Rate for Payer: HFN Commercial |
$75.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$61.50
|
| Rate for Payer: Multiplan Commercial |
$65.60
|
| Rate for Payer: NAPHCARE Commercial |
$49.20
|
| Rate for Payer: Preferred Network Access Commercial |
$75.44
|
| Rate for Payer: Quartz Beloit One Network |
$40.18
|
| Rate for Payer: Quartz Commercial |
$53.30
|
| Rate for Payer: Quartz Medicare Advantage |
$49.20
|
| Rate for Payer: The Alliance Commercial |
$328.00
|
| Rate for Payer: WEA Trust Commercial |
$45.10
|
| Rate for Payer: WPS Commercial |
$60.74
|
|
|
Tubing changed - PCA Pump Related Activity
|
Facility
|
OP
|
$139.00
|
|
| Hospital Charge Code |
3000264
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$38.92 |
| Max. Negotiated Rate |
$556.00 |
| Rate for Payer: Aetna Commercial |
$125.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$119.54
|
| Rate for Payer: Aetna Managed Medicare |
$38.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$90.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$69.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$66.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$73.67
|
| Rate for Payer: Cash Price |
$41.70
|
| Rate for Payer: Cigna Commercial |
$127.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$77.78
|
| Rate for Payer: Health EOS Commercial |
$123.71
|
| Rate for Payer: HFN Commercial |
$127.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$104.25
|
| Rate for Payer: Multiplan Commercial |
$111.20
|
| Rate for Payer: NAPHCARE Commercial |
$83.40
|
| Rate for Payer: Preferred Network Access Commercial |
$127.88
|
| Rate for Payer: Quartz Beloit One Network |
$68.11
|
| Rate for Payer: Quartz Commercial |
$90.35
|
| Rate for Payer: Quartz Medicare Advantage |
$83.40
|
| Rate for Payer: The Alliance Commercial |
$556.00
|
| Rate for Payer: WEA Trust Commercial |
$76.45
|
| Rate for Payer: WPS Commercial |
$102.96
|
|
|
Tubing changed - PCA Pump Related Activity
|
Facility
|
IP
|
$139.00
|
|
| Hospital Charge Code |
3000264
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$68.11 |
| Max. Negotiated Rate |
$127.88 |
| Rate for Payer: Aetna Commercial |
$125.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$119.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$73.67
|
| Rate for Payer: Cash Price |
$41.70
|
| Rate for Payer: Cigna Commercial |
$127.88
|
| Rate for Payer: Health EOS Commercial |
$123.71
|
| Rate for Payer: HFN Commercial |
$127.88
|
| Rate for Payer: Multiplan Commercial |
$111.20
|
| Rate for Payer: NAPHCARE Commercial |
$83.40
|
| Rate for Payer: Preferred Network Access Commercial |
$127.88
|
| Rate for Payer: Quartz Beloit One Network |
$68.11
|
| Rate for Payer: Quartz Commercial |
$83.40
|
| Rate for Payer: WEA Trust Commercial |
$76.45
|
| Rate for Payer: WPS Commercial |
$102.96
|
|
|
Tubing Clave Ext Set
|
Facility
|
OP
|
$5.00
|
|
| Hospital Charge Code |
3040294
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.40 |
| Max. Negotiated Rate |
$20.00 |
| Rate for Payer: Aetna Commercial |
$4.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4.30
|
| Rate for Payer: Aetna Managed Medicare |
$1.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2.65
|
| Rate for Payer: Cash Price |
$1.50
|
| Rate for Payer: Cigna Commercial |
$4.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2.80
|
| Rate for Payer: Health EOS Commercial |
$4.45
|
| Rate for Payer: HFN Commercial |
$4.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3.75
|
| Rate for Payer: Multiplan Commercial |
$4.00
|
| Rate for Payer: NAPHCARE Commercial |
$3.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4.60
|
| Rate for Payer: Quartz Beloit One Network |
$2.45
|
| Rate for Payer: Quartz Commercial |
$3.25
|
| Rate for Payer: Quartz Medicare Advantage |
$3.00
|
| Rate for Payer: The Alliance Commercial |
$20.00
|
| Rate for Payer: WEA Trust Commercial |
$2.75
|
| Rate for Payer: WPS Commercial |
$3.70
|
|
|
Tubing Clave Ext Set
|
Facility
|
IP
|
$5.00
|
|
| Hospital Charge Code |
3040294
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$2.45 |
| Max. Negotiated Rate |
$4.60 |
| Rate for Payer: Aetna Commercial |
$4.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2.65
|
| Rate for Payer: Cash Price |
$1.50
|
| Rate for Payer: Cigna Commercial |
$4.60
|
| Rate for Payer: Health EOS Commercial |
$4.45
|
| Rate for Payer: HFN Commercial |
$4.60
|
| Rate for Payer: Multiplan Commercial |
$4.00
|
| Rate for Payer: NAPHCARE Commercial |
$3.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4.60
|
| Rate for Payer: Quartz Beloit One Network |
$2.45
|
| Rate for Payer: Quartz Commercial |
$3.00
|
| Rate for Payer: WEA Trust Commercial |
$2.75
|
| Rate for Payer: WPS Commercial |
$3.70
|
|
|
TUBING COOLFLEX E9414
|
Facility
|
IP
|
$1,726.00
|
|
| Hospital Charge Code |
2964888
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$845.74 |
| Max. Negotiated Rate |
$1,587.92 |
| Rate for Payer: Aetna Commercial |
$1,553.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,484.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$914.78
|
| Rate for Payer: Cash Price |
$517.80
|
| Rate for Payer: Cigna Commercial |
$1,587.92
|
| Rate for Payer: Health EOS Commercial |
$1,536.14
|
| Rate for Payer: HFN Commercial |
$1,587.92
|
| Rate for Payer: Multiplan Commercial |
$1,380.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,035.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,587.92
|
| Rate for Payer: Quartz Beloit One Network |
$845.74
|
| Rate for Payer: Quartz Commercial |
$1,035.60
|
| Rate for Payer: WEA Trust Commercial |
$949.30
|
| Rate for Payer: WPS Commercial |
$1,278.45
|
|
|
TUBING COOLFLEX E9414
|
Facility
|
OP
|
$1,726.00
|
|
| Hospital Charge Code |
2964888
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$483.28 |
| Max. Negotiated Rate |
$6,904.00 |
| Rate for Payer: Aetna Commercial |
$1,553.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,484.36
|
| Rate for Payer: Aetna Managed Medicare |
$483.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,121.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$863.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$828.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$914.78
|
| Rate for Payer: Cash Price |
$517.80
|
| Rate for Payer: Cigna Commercial |
$1,587.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$965.87
|
| Rate for Payer: Health EOS Commercial |
$1,536.14
|
| Rate for Payer: HFN Commercial |
$1,587.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,294.50
|
| Rate for Payer: Multiplan Commercial |
$1,380.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,035.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,587.92
|
| Rate for Payer: Quartz Beloit One Network |
$845.74
|
| Rate for Payer: Quartz Commercial |
$1,121.90
|
| Rate for Payer: Quartz Medicare Advantage |
$1,035.60
|
| Rate for Payer: The Alliance Commercial |
$6,904.00
|
| Rate for Payer: WEA Trust Commercial |
$949.30
|
| Rate for Payer: WPS Commercial |
$1,278.45
|
|
|
TUBING COOLFLEX IRRIG E9415A
|
Facility
|
OP
|
$1,212.00
|
|
| Hospital Charge Code |
2964889
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$339.36 |
| Max. Negotiated Rate |
$4,848.00 |
| Rate for Payer: Aetna Commercial |
$1,090.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,042.32
|
| Rate for Payer: Aetna Managed Medicare |
$339.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$787.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$606.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$581.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$642.36
|
| Rate for Payer: Cash Price |
$363.60
|
| Rate for Payer: Cigna Commercial |
$1,115.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$678.24
|
| Rate for Payer: Health EOS Commercial |
$1,078.68
|
| Rate for Payer: HFN Commercial |
$1,115.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$909.00
|
| Rate for Payer: Multiplan Commercial |
$969.60
|
| Rate for Payer: NAPHCARE Commercial |
$727.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,115.04
|
| Rate for Payer: Quartz Beloit One Network |
$593.88
|
| Rate for Payer: Quartz Commercial |
$787.80
|
| Rate for Payer: Quartz Medicare Advantage |
$727.20
|
| Rate for Payer: The Alliance Commercial |
$4,848.00
|
| Rate for Payer: WEA Trust Commercial |
$666.60
|
| Rate for Payer: WPS Commercial |
$897.73
|
|
|
TUBING COOLFLEX IRRIG E9415A
|
Facility
|
IP
|
$1,212.00
|
|
| Hospital Charge Code |
2964889
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$593.88 |
| Max. Negotiated Rate |
$1,115.04 |
| Rate for Payer: Aetna Commercial |
$1,090.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,042.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$642.36
|
| Rate for Payer: Cash Price |
$363.60
|
| Rate for Payer: Cigna Commercial |
$1,115.04
|
| Rate for Payer: Health EOS Commercial |
$1,078.68
|
| Rate for Payer: HFN Commercial |
$1,115.04
|
| Rate for Payer: Multiplan Commercial |
$969.60
|
| Rate for Payer: NAPHCARE Commercial |
$727.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,115.04
|
| Rate for Payer: Quartz Beloit One Network |
$593.88
|
| Rate for Payer: Quartz Commercial |
$727.20
|
| Rate for Payer: WEA Trust Commercial |
$666.60
|
| Rate for Payer: WPS Commercial |
$897.73
|
|
|
TUBING EPIDURAL PUMP 6440-13
|
Facility
|
OP
|
$313.00
|
|
| Hospital Charge Code |
2962982
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$87.64 |
| Max. Negotiated Rate |
$1,252.00 |
| Rate for Payer: Aetna Commercial |
$281.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$269.18
|
| Rate for Payer: Aetna Managed Medicare |
$87.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$203.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$156.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$150.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$165.89
|
| Rate for Payer: Cash Price |
$93.90
|
| Rate for Payer: Cigna Commercial |
$287.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$175.15
|
| Rate for Payer: Health EOS Commercial |
$278.57
|
| Rate for Payer: HFN Commercial |
$287.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$234.75
|
| Rate for Payer: Multiplan Commercial |
$250.40
|
| Rate for Payer: NAPHCARE Commercial |
$187.80
|
| Rate for Payer: Preferred Network Access Commercial |
$287.96
|
| Rate for Payer: Quartz Beloit One Network |
$153.37
|
| Rate for Payer: Quartz Commercial |
$203.45
|
| Rate for Payer: Quartz Medicare Advantage |
$187.80
|
| Rate for Payer: The Alliance Commercial |
$1,252.00
|
| Rate for Payer: WEA Trust Commercial |
$172.15
|
| Rate for Payer: WPS Commercial |
$231.84
|
|
|
TUBING EPIDURAL PUMP 6440-13
|
Facility
|
IP
|
$313.00
|
|
| Hospital Charge Code |
2962982
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$153.37 |
| Max. Negotiated Rate |
$287.96 |
| Rate for Payer: Aetna Commercial |
$281.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$269.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$165.89
|
| Rate for Payer: Cash Price |
$93.90
|
| Rate for Payer: Cigna Commercial |
$287.96
|
| Rate for Payer: Health EOS Commercial |
$278.57
|
| Rate for Payer: HFN Commercial |
$287.96
|
| Rate for Payer: Multiplan Commercial |
$250.40
|
| Rate for Payer: NAPHCARE Commercial |
$187.80
|
| Rate for Payer: Preferred Network Access Commercial |
$287.96
|
| Rate for Payer: Quartz Beloit One Network |
$153.37
|
| Rate for Payer: Quartz Commercial |
$187.80
|
| Rate for Payer: WEA Trust Commercial |
$172.15
|
| Rate for Payer: WPS Commercial |
$231.84
|
|
|
TUBING EXTENSION
|
Facility
|
IP
|
$147.00
|
|
| Hospital Charge Code |
2973342
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$72.03 |
| Max. Negotiated Rate |
$135.24 |
| Rate for Payer: Aetna Commercial |
$132.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$126.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$77.91
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cigna Commercial |
$135.24
|
| Rate for Payer: Health EOS Commercial |
$130.83
|
| Rate for Payer: HFN Commercial |
$135.24
|
| Rate for Payer: Multiplan Commercial |
$117.60
|
| Rate for Payer: NAPHCARE Commercial |
$88.20
|
| Rate for Payer: Preferred Network Access Commercial |
$135.24
|
| Rate for Payer: Quartz Beloit One Network |
$72.03
|
| Rate for Payer: Quartz Commercial |
$88.20
|
| Rate for Payer: WEA Trust Commercial |
$80.85
|
| Rate for Payer: WPS Commercial |
$108.88
|
|
|
TUBING EXTENSION
|
Facility
|
OP
|
$147.00
|
|
| Hospital Charge Code |
2973342
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$41.16 |
| Max. Negotiated Rate |
$588.00 |
| Rate for Payer: Aetna Commercial |
$132.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$126.42
|
| Rate for Payer: Aetna Managed Medicare |
$41.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$95.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$73.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$70.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$77.91
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cigna Commercial |
$135.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$82.26
|
| Rate for Payer: Health EOS Commercial |
$130.83
|
| Rate for Payer: HFN Commercial |
$135.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$110.25
|
| Rate for Payer: Multiplan Commercial |
$117.60
|
| Rate for Payer: NAPHCARE Commercial |
$88.20
|
| Rate for Payer: Preferred Network Access Commercial |
$135.24
|
| Rate for Payer: Quartz Beloit One Network |
$72.03
|
| Rate for Payer: Quartz Commercial |
$95.55
|
| Rate for Payer: Quartz Medicare Advantage |
$88.20
|
| Rate for Payer: The Alliance Commercial |
$588.00
|
| Rate for Payer: WEA Trust Commercial |
$80.85
|
| Rate for Payer: WPS Commercial |
$108.88
|
|
|
TUBING EXT SET CLAVE MICRO
|
Facility
|
OP
|
$133.00
|
|
| Hospital Charge Code |
2963054
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$37.24 |
| Max. Negotiated Rate |
$532.00 |
| Rate for Payer: Aetna Commercial |
$119.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$114.38
|
| Rate for Payer: Aetna Managed Medicare |
$37.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$86.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$66.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$63.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$70.49
|
| Rate for Payer: Cash Price |
$39.90
|
| Rate for Payer: Cigna Commercial |
$122.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$74.43
|
| Rate for Payer: Health EOS Commercial |
$118.37
|
| Rate for Payer: HFN Commercial |
$122.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$99.75
|
| Rate for Payer: Multiplan Commercial |
$106.40
|
| Rate for Payer: NAPHCARE Commercial |
$79.80
|
| Rate for Payer: Preferred Network Access Commercial |
$122.36
|
| Rate for Payer: Quartz Beloit One Network |
$65.17
|
| Rate for Payer: Quartz Commercial |
$86.45
|
| Rate for Payer: Quartz Medicare Advantage |
$79.80
|
| Rate for Payer: The Alliance Commercial |
$532.00
|
| Rate for Payer: WEA Trust Commercial |
$73.15
|
| Rate for Payer: WPS Commercial |
$98.51
|
|
|
TUBING EXT SET CLAVE MICRO
|
Facility
|
IP
|
$133.00
|
|
| Hospital Charge Code |
2963054
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$65.17 |
| Max. Negotiated Rate |
$122.36 |
| Rate for Payer: Aetna Commercial |
$119.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$114.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$70.49
|
| Rate for Payer: Cash Price |
$39.90
|
| Rate for Payer: Cigna Commercial |
$122.36
|
| Rate for Payer: Health EOS Commercial |
$118.37
|
| Rate for Payer: HFN Commercial |
$122.36
|
| Rate for Payer: Multiplan Commercial |
$106.40
|
| Rate for Payer: NAPHCARE Commercial |
$79.80
|
| Rate for Payer: Preferred Network Access Commercial |
$122.36
|
| Rate for Payer: Quartz Beloit One Network |
$65.17
|
| Rate for Payer: Quartz Commercial |
$79.80
|
| Rate for Payer: WEA Trust Commercial |
$73.15
|
| Rate for Payer: WPS Commercial |
$98.51
|
|
|
TUBING INSUFFLATION DYNJ011933
|
Facility
|
OP
|
$184.00
|
|
| Hospital Charge Code |
2963177
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$51.52 |
| Max. Negotiated Rate |
$736.00 |
| Rate for Payer: Aetna Commercial |
$165.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$158.24
|
| Rate for Payer: Aetna Managed Medicare |
$51.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$119.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$92.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$88.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$97.52
|
| Rate for Payer: Cash Price |
$55.20
|
| Rate for Payer: Cigna Commercial |
$169.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$102.97
|
| Rate for Payer: Health EOS Commercial |
$163.76
|
| Rate for Payer: HFN Commercial |
$169.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$138.00
|
| Rate for Payer: Multiplan Commercial |
$147.20
|
| Rate for Payer: NAPHCARE Commercial |
$110.40
|
| Rate for Payer: Preferred Network Access Commercial |
$169.28
|
| Rate for Payer: Quartz Beloit One Network |
$90.16
|
| Rate for Payer: Quartz Commercial |
$119.60
|
| Rate for Payer: Quartz Medicare Advantage |
$110.40
|
| Rate for Payer: The Alliance Commercial |
$736.00
|
| Rate for Payer: WEA Trust Commercial |
$101.20
|
| Rate for Payer: WPS Commercial |
$136.29
|
|
|
TUBING INSUFFLATION DYNJ011933
|
Facility
|
IP
|
$184.00
|
|
| Hospital Charge Code |
2963177
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$90.16 |
| Max. Negotiated Rate |
$169.28 |
| Rate for Payer: Aetna Commercial |
$165.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$158.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$97.52
|
| Rate for Payer: Cash Price |
$55.20
|
| Rate for Payer: Cigna Commercial |
$169.28
|
| Rate for Payer: Health EOS Commercial |
$163.76
|
| Rate for Payer: HFN Commercial |
$169.28
|
| Rate for Payer: Multiplan Commercial |
$147.20
|
| Rate for Payer: NAPHCARE Commercial |
$110.40
|
| Rate for Payer: Preferred Network Access Commercial |
$169.28
|
| Rate for Payer: Quartz Beloit One Network |
$90.16
|
| Rate for Payer: Quartz Commercial |
$110.40
|
| Rate for Payer: WEA Trust Commercial |
$101.20
|
| Rate for Payer: WPS Commercial |
$136.29
|
|
|
TUBING IRRIGATION LOW PRO IRD450
|
Facility
|
OP
|
$1,539.00
|
|
| Hospital Charge Code |
3884890
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$430.92 |
| Max. Negotiated Rate |
$6,156.00 |
| Rate for Payer: Aetna Commercial |
$1,385.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,323.54
|
| Rate for Payer: Aetna Managed Medicare |
$430.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,000.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$769.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$738.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$815.67
|
| Rate for Payer: Cash Price |
$461.70
|
| Rate for Payer: Cigna Commercial |
$1,415.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$861.22
|
| Rate for Payer: Health EOS Commercial |
$1,369.71
|
| Rate for Payer: HFN Commercial |
$1,415.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,154.25
|
| Rate for Payer: Multiplan Commercial |
$1,231.20
|
| Rate for Payer: NAPHCARE Commercial |
$923.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,415.88
|
| Rate for Payer: Quartz Beloit One Network |
$754.11
|
| Rate for Payer: Quartz Commercial |
$1,000.35
|
| Rate for Payer: Quartz Medicare Advantage |
$923.40
|
| Rate for Payer: The Alliance Commercial |
$6,156.00
|
| Rate for Payer: WEA Trust Commercial |
$846.45
|
| Rate for Payer: WPS Commercial |
$1,139.94
|
|
|
TUBING IRRIGATION LOW PRO IRD450
|
Facility
|
IP
|
$1,539.00
|
|
| Hospital Charge Code |
3884890
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$754.11 |
| Max. Negotiated Rate |
$1,415.88 |
| Rate for Payer: Aetna Commercial |
$1,385.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,323.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$815.67
|
| Rate for Payer: Cash Price |
$461.70
|
| Rate for Payer: Cigna Commercial |
$1,415.88
|
| Rate for Payer: Health EOS Commercial |
$1,369.71
|
| Rate for Payer: HFN Commercial |
$1,415.88
|
| Rate for Payer: Multiplan Commercial |
$1,231.20
|
| Rate for Payer: NAPHCARE Commercial |
$923.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,415.88
|
| Rate for Payer: Quartz Beloit One Network |
$754.11
|
| Rate for Payer: Quartz Commercial |
$923.40
|
| Rate for Payer: WEA Trust Commercial |
$846.45
|
| Rate for Payer: WPS Commercial |
$1,139.94
|
|
|
TUBING IV ANESTHESIA #B5073
|
Facility
|
OP
|
$187.00
|
|
| Hospital Charge Code |
2973007
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$52.36 |
| Max. Negotiated Rate |
$748.00 |
| Rate for Payer: Aetna Commercial |
$168.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$160.82
|
| Rate for Payer: Aetna Managed Medicare |
$52.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$121.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$93.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$89.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$99.11
|
| Rate for Payer: Cash Price |
$56.10
|
| Rate for Payer: Cigna Commercial |
$172.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$104.65
|
| Rate for Payer: Health EOS Commercial |
$166.43
|
| Rate for Payer: HFN Commercial |
$172.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$140.25
|
| Rate for Payer: Multiplan Commercial |
$149.60
|
| Rate for Payer: NAPHCARE Commercial |
$112.20
|
| Rate for Payer: Preferred Network Access Commercial |
$172.04
|
| Rate for Payer: Quartz Beloit One Network |
$91.63
|
| Rate for Payer: Quartz Commercial |
$121.55
|
| Rate for Payer: Quartz Medicare Advantage |
$112.20
|
| Rate for Payer: The Alliance Commercial |
$748.00
|
| Rate for Payer: WEA Trust Commercial |
$102.85
|
| Rate for Payer: WPS Commercial |
$138.51
|
|
|
TUBING IV ANESTHESIA #B5073
|
Facility
|
IP
|
$187.00
|
|
| Hospital Charge Code |
2973007
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$91.63 |
| Max. Negotiated Rate |
$172.04 |
| Rate for Payer: Aetna Commercial |
$168.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$160.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$99.11
|
| Rate for Payer: Cash Price |
$56.10
|
| Rate for Payer: Cigna Commercial |
$172.04
|
| Rate for Payer: Health EOS Commercial |
$166.43
|
| Rate for Payer: HFN Commercial |
$172.04
|
| Rate for Payer: Multiplan Commercial |
$149.60
|
| Rate for Payer: NAPHCARE Commercial |
$112.20
|
| Rate for Payer: Preferred Network Access Commercial |
$172.04
|
| Rate for Payer: Quartz Beloit One Network |
$91.63
|
| Rate for Payer: Quartz Commercial |
$112.20
|
| Rate for Payer: WEA Trust Commercial |
$102.85
|
| Rate for Payer: WPS Commercial |
$138.51
|
|
