|
Tubing Rapid Flow
|
Facility
|
OP
|
$7.00
|
|
| Hospital Charge Code |
3040295
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.96 |
| Max. Negotiated Rate |
$28.00 |
| Rate for Payer: Aetna Commercial |
$6.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6.02
|
| Rate for Payer: Aetna Managed Medicare |
$1.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3.71
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: Cigna Commercial |
$6.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3.92
|
| Rate for Payer: Health EOS Commercial |
$6.23
|
| Rate for Payer: HFN Commercial |
$6.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5.25
|
| Rate for Payer: Multiplan Commercial |
$5.60
|
| Rate for Payer: NAPHCARE Commercial |
$4.20
|
| Rate for Payer: Preferred Network Access Commercial |
$6.44
|
| Rate for Payer: Quartz Beloit One Network |
$3.43
|
| Rate for Payer: Quartz Commercial |
$4.55
|
| Rate for Payer: Quartz Medicare Advantage |
$4.20
|
| Rate for Payer: The Alliance Commercial |
$28.00
|
| Rate for Payer: WEA Trust Commercial |
$3.85
|
| Rate for Payer: WPS Commercial |
$5.18
|
|
|
TUBING RAPID FLOW BLOOD TRAUMA
|
Facility
|
OP
|
$823.00
|
|
| Hospital Charge Code |
2963093
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$230.44 |
| Max. Negotiated Rate |
$3,292.00 |
| Rate for Payer: Aetna Commercial |
$740.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$707.78
|
| Rate for Payer: Aetna Managed Medicare |
$230.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$534.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$411.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$395.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$436.19
|
| Rate for Payer: Cash Price |
$246.90
|
| Rate for Payer: Cigna Commercial |
$757.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$460.55
|
| Rate for Payer: Health EOS Commercial |
$732.47
|
| Rate for Payer: HFN Commercial |
$757.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$617.25
|
| Rate for Payer: Multiplan Commercial |
$658.40
|
| Rate for Payer: NAPHCARE Commercial |
$493.80
|
| Rate for Payer: Preferred Network Access Commercial |
$757.16
|
| Rate for Payer: Quartz Beloit One Network |
$403.27
|
| Rate for Payer: Quartz Commercial |
$534.95
|
| Rate for Payer: Quartz Medicare Advantage |
$493.80
|
| Rate for Payer: The Alliance Commercial |
$3,292.00
|
| Rate for Payer: WEA Trust Commercial |
$452.65
|
| Rate for Payer: WPS Commercial |
$609.60
|
|
|
TUBING RAPID FLOW BLOOD TRAUMA
|
Facility
|
IP
|
$823.00
|
|
| Hospital Charge Code |
2963093
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$403.27 |
| Max. Negotiated Rate |
$757.16 |
| Rate for Payer: Aetna Commercial |
$740.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$707.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$436.19
|
| Rate for Payer: Cash Price |
$246.90
|
| Rate for Payer: Cigna Commercial |
$757.16
|
| Rate for Payer: Health EOS Commercial |
$732.47
|
| Rate for Payer: HFN Commercial |
$757.16
|
| Rate for Payer: Multiplan Commercial |
$658.40
|
| Rate for Payer: NAPHCARE Commercial |
$493.80
|
| Rate for Payer: Preferred Network Access Commercial |
$757.16
|
| Rate for Payer: Quartz Beloit One Network |
$403.27
|
| Rate for Payer: Quartz Commercial |
$493.80
|
| Rate for Payer: WEA Trust Commercial |
$452.65
|
| Rate for Payer: WPS Commercial |
$609.60
|
|
|
TUBING REPLACEMENT KIT 94.0010
|
Facility
|
OP
|
$769.00
|
|
| Hospital Charge Code |
2971617
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$215.32 |
| Max. Negotiated Rate |
$3,076.00 |
| Rate for Payer: Aetna Commercial |
$692.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$661.34
|
| Rate for Payer: Aetna Managed Medicare |
$215.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$499.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$384.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$369.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$407.57
|
| Rate for Payer: Cash Price |
$230.70
|
| Rate for Payer: Cigna Commercial |
$707.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$430.33
|
| Rate for Payer: Health EOS Commercial |
$684.41
|
| Rate for Payer: HFN Commercial |
$707.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$576.75
|
| Rate for Payer: Multiplan Commercial |
$615.20
|
| Rate for Payer: NAPHCARE Commercial |
$461.40
|
| Rate for Payer: Preferred Network Access Commercial |
$707.48
|
| Rate for Payer: Quartz Beloit One Network |
$376.81
|
| Rate for Payer: Quartz Commercial |
$499.85
|
| Rate for Payer: Quartz Medicare Advantage |
$461.40
|
| Rate for Payer: The Alliance Commercial |
$3,076.00
|
| Rate for Payer: WEA Trust Commercial |
$422.95
|
| Rate for Payer: WPS Commercial |
$569.60
|
|
|
TUBING REPLACEMENT KIT 94.0010
|
Facility
|
IP
|
$769.00
|
|
| Hospital Charge Code |
2971617
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$376.81 |
| Max. Negotiated Rate |
$707.48 |
| Rate for Payer: Aetna Commercial |
$692.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$661.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$407.57
|
| Rate for Payer: Cash Price |
$230.70
|
| Rate for Payer: Cigna Commercial |
$707.48
|
| Rate for Payer: Health EOS Commercial |
$684.41
|
| Rate for Payer: HFN Commercial |
$707.48
|
| Rate for Payer: Multiplan Commercial |
$615.20
|
| Rate for Payer: NAPHCARE Commercial |
$461.40
|
| Rate for Payer: Preferred Network Access Commercial |
$707.48
|
| Rate for Payer: Quartz Beloit One Network |
$376.81
|
| Rate for Payer: Quartz Commercial |
$461.40
|
| Rate for Payer: WEA Trust Commercial |
$422.95
|
| Rate for Payer: WPS Commercial |
$569.60
|
|
|
TUBING SECONDARY LF 14230-28
|
Facility
|
IP
|
$44.00
|
|
| Hospital Charge Code |
2963563
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.56 |
| Max. Negotiated Rate |
$40.48 |
| Rate for Payer: Aetna Commercial |
$39.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$37.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$23.32
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Cigna Commercial |
$40.48
|
| Rate for Payer: Health EOS Commercial |
$39.16
|
| Rate for Payer: HFN Commercial |
$40.48
|
| Rate for Payer: Multiplan Commercial |
$35.20
|
| Rate for Payer: NAPHCARE Commercial |
$26.40
|
| Rate for Payer: Preferred Network Access Commercial |
$40.48
|
| Rate for Payer: Quartz Beloit One Network |
$21.56
|
| Rate for Payer: Quartz Commercial |
$26.40
|
| Rate for Payer: WEA Trust Commercial |
$24.20
|
| Rate for Payer: WPS Commercial |
$32.59
|
|
|
TUBING SECONDARY LF 14230-28
|
Facility
|
OP
|
$44.00
|
|
| Hospital Charge Code |
2963563
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.32 |
| Max. Negotiated Rate |
$176.00 |
| Rate for Payer: Aetna Commercial |
$39.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$37.84
|
| Rate for Payer: Aetna Managed Medicare |
$12.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$28.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$22.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$21.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$23.32
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Cigna Commercial |
$40.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$24.62
|
| Rate for Payer: Health EOS Commercial |
$39.16
|
| Rate for Payer: HFN Commercial |
$40.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$33.00
|
| Rate for Payer: Multiplan Commercial |
$35.20
|
| Rate for Payer: NAPHCARE Commercial |
$26.40
|
| Rate for Payer: Preferred Network Access Commercial |
$40.48
|
| Rate for Payer: Quartz Beloit One Network |
$21.56
|
| Rate for Payer: Quartz Commercial |
$28.60
|
| Rate for Payer: Quartz Medicare Advantage |
$26.40
|
| Rate for Payer: The Alliance Commercial |
$176.00
|
| Rate for Payer: WEA Trust Commercial |
$24.20
|
| Rate for Payer: WPS Commercial |
$32.59
|
|
|
TUBING SET AR-200 IRRIGATION OEM04364100
|
Facility
|
IP
|
$583.00
|
|
| Hospital Charge Code |
5787770
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$285.67 |
| Max. Negotiated Rate |
$536.36 |
| Rate for Payer: Aetna Commercial |
$524.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$501.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$308.99
|
| Rate for Payer: Cash Price |
$174.90
|
| Rate for Payer: Cigna Commercial |
$536.36
|
| Rate for Payer: Health EOS Commercial |
$518.87
|
| Rate for Payer: HFN Commercial |
$536.36
|
| Rate for Payer: Multiplan Commercial |
$466.40
|
| Rate for Payer: NAPHCARE Commercial |
$349.80
|
| Rate for Payer: Preferred Network Access Commercial |
$536.36
|
| Rate for Payer: Quartz Beloit One Network |
$285.67
|
| Rate for Payer: Quartz Commercial |
$349.80
|
| Rate for Payer: WEA Trust Commercial |
$320.65
|
| Rate for Payer: WPS Commercial |
$431.83
|
|
|
TUBING SET AR-200 IRRIGATION OEM04364100
|
Facility
|
OP
|
$583.00
|
|
| Hospital Charge Code |
5787770
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$163.24 |
| Max. Negotiated Rate |
$2,332.00 |
| Rate for Payer: Aetna Commercial |
$524.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$501.38
|
| Rate for Payer: Aetna Managed Medicare |
$163.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$378.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$291.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$279.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$308.99
|
| Rate for Payer: Cash Price |
$174.90
|
| Rate for Payer: Cigna Commercial |
$536.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$326.25
|
| Rate for Payer: Health EOS Commercial |
$518.87
|
| Rate for Payer: HFN Commercial |
$536.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$437.25
|
| Rate for Payer: Multiplan Commercial |
$466.40
|
| Rate for Payer: NAPHCARE Commercial |
$349.80
|
| Rate for Payer: Preferred Network Access Commercial |
$536.36
|
| Rate for Payer: Quartz Beloit One Network |
$285.67
|
| Rate for Payer: Quartz Commercial |
$378.95
|
| Rate for Payer: Quartz Medicare Advantage |
$349.80
|
| Rate for Payer: The Alliance Commercial |
$2,332.00
|
| Rate for Payer: WEA Trust Commercial |
$320.65
|
| Rate for Payer: WPS Commercial |
$431.83
|
|
|
TUBING SMALL JOINT #9350
|
Facility
|
IP
|
$1,446.00
|
|
| Hospital Charge Code |
2964967
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$708.54 |
| Max. Negotiated Rate |
$1,330.32 |
| Rate for Payer: Aetna Commercial |
$1,301.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,243.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$766.38
|
| Rate for Payer: Cash Price |
$433.80
|
| Rate for Payer: Cigna Commercial |
$1,330.32
|
| Rate for Payer: Health EOS Commercial |
$1,286.94
|
| Rate for Payer: HFN Commercial |
$1,330.32
|
| Rate for Payer: Multiplan Commercial |
$1,156.80
|
| Rate for Payer: NAPHCARE Commercial |
$867.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,330.32
|
| Rate for Payer: Quartz Beloit One Network |
$708.54
|
| Rate for Payer: Quartz Commercial |
$867.60
|
| Rate for Payer: WEA Trust Commercial |
$795.30
|
| Rate for Payer: WPS Commercial |
$1,071.05
|
|
|
TUBING SMALL JOINT #9350
|
Facility
|
OP
|
$1,446.00
|
|
| Hospital Charge Code |
2964967
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$404.88 |
| Max. Negotiated Rate |
$5,784.00 |
| Rate for Payer: Aetna Commercial |
$1,301.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,243.56
|
| Rate for Payer: Aetna Managed Medicare |
$404.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$939.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$723.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$694.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$766.38
|
| Rate for Payer: Cash Price |
$433.80
|
| Rate for Payer: Cigna Commercial |
$1,330.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$809.18
|
| Rate for Payer: Health EOS Commercial |
$1,286.94
|
| Rate for Payer: HFN Commercial |
$1,330.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,084.50
|
| Rate for Payer: Multiplan Commercial |
$1,156.80
|
| Rate for Payer: NAPHCARE Commercial |
$867.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,330.32
|
| Rate for Payer: Quartz Beloit One Network |
$708.54
|
| Rate for Payer: Quartz Commercial |
$939.90
|
| Rate for Payer: Quartz Medicare Advantage |
$867.60
|
| Rate for Payer: The Alliance Commercial |
$5,784.00
|
| Rate for Payer: WEA Trust Commercial |
$795.30
|
| Rate for Payer: WPS Commercial |
$1,071.05
|
|
|
TUBING SMOKE EVAC SM-BLAP100
|
Facility
|
IP
|
$131.00
|
|
| Hospital Charge Code |
2967383
|
|
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
|
|
|
TUBING SMOKE EVAC SM-BLAP100
|
Facility
|
OP
|
$131.00
|
|
| Hospital Charge Code |
2967383
|
|
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
|
|
|
TUBING STRAIGHTSHOT XPS 1895522
|
Facility
|
IP
|
$680.00
|
|
| Hospital Charge Code |
3259480
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$333.20 |
| Max. Negotiated Rate |
$625.60 |
| Rate for Payer: Aetna Commercial |
$612.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$584.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$360.40
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Cigna Commercial |
$625.60
|
| Rate for Payer: Health EOS Commercial |
$605.20
|
| Rate for Payer: HFN Commercial |
$625.60
|
| Rate for Payer: Multiplan Commercial |
$544.00
|
| Rate for Payer: NAPHCARE Commercial |
$408.00
|
| Rate for Payer: Preferred Network Access Commercial |
$625.60
|
| Rate for Payer: Quartz Beloit One Network |
$333.20
|
| Rate for Payer: Quartz Commercial |
$408.00
|
| Rate for Payer: WEA Trust Commercial |
$374.00
|
| Rate for Payer: WPS Commercial |
$503.68
|
|
|
TUBING STRAIGHTSHOT XPS 1895522
|
Facility
|
OP
|
$680.00
|
|
| Hospital Charge Code |
3259480
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$190.40 |
| Max. Negotiated Rate |
$2,720.00 |
| Rate for Payer: Aetna Commercial |
$612.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$584.80
|
| Rate for Payer: Aetna Managed Medicare |
$190.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$442.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$340.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$326.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$360.40
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Cigna Commercial |
$625.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$380.53
|
| Rate for Payer: Health EOS Commercial |
$605.20
|
| Rate for Payer: HFN Commercial |
$625.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$510.00
|
| Rate for Payer: Multiplan Commercial |
$544.00
|
| Rate for Payer: NAPHCARE Commercial |
$408.00
|
| Rate for Payer: Preferred Network Access Commercial |
$625.60
|
| Rate for Payer: Quartz Beloit One Network |
$333.20
|
| Rate for Payer: Quartz Commercial |
$442.00
|
| Rate for Payer: Quartz Medicare Advantage |
$408.00
|
| Rate for Payer: The Alliance Commercial |
$2,720.00
|
| Rate for Payer: WEA Trust Commercial |
$374.00
|
| Rate for Payer: WPS Commercial |
$503.68
|
|
|
TUBING SUCTION CONNECTING 6FT N56A
|
Facility
|
OP
|
$22.00
|
|
| Hospital Charge Code |
2963771
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.16 |
| Max. Negotiated Rate |
$88.00 |
| Rate for Payer: Aetna Commercial |
$19.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$18.92
|
| Rate for Payer: Aetna Managed Medicare |
$6.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$14.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$11.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11.66
|
| Rate for Payer: Cash Price |
$6.60
|
| Rate for Payer: Cigna Commercial |
$20.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12.31
|
| Rate for Payer: Health EOS Commercial |
$19.58
|
| Rate for Payer: HFN Commercial |
$20.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$16.50
|
| Rate for Payer: Multiplan Commercial |
$17.60
|
| Rate for Payer: NAPHCARE Commercial |
$13.20
|
| Rate for Payer: Preferred Network Access Commercial |
$20.24
|
| Rate for Payer: Quartz Beloit One Network |
$10.78
|
| Rate for Payer: Quartz Commercial |
$14.30
|
| Rate for Payer: Quartz Medicare Advantage |
$13.20
|
| Rate for Payer: The Alliance Commercial |
$88.00
|
| Rate for Payer: WEA Trust Commercial |
$12.10
|
| Rate for Payer: WPS Commercial |
$16.30
|
|
|
TUBING SUCTION CONNECTING 6FT N56A
|
Facility
|
IP
|
$22.00
|
|
| Hospital Charge Code |
2963771
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.78 |
| Max. Negotiated Rate |
$20.24 |
| Rate for Payer: Aetna Commercial |
$19.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$18.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11.66
|
| Rate for Payer: Cash Price |
$6.60
|
| Rate for Payer: Cigna Commercial |
$20.24
|
| Rate for Payer: Health EOS Commercial |
$19.58
|
| Rate for Payer: HFN Commercial |
$20.24
|
| Rate for Payer: Multiplan Commercial |
$17.60
|
| Rate for Payer: NAPHCARE Commercial |
$13.20
|
| Rate for Payer: Preferred Network Access Commercial |
$20.24
|
| Rate for Payer: Quartz Beloit One Network |
$10.78
|
| Rate for Payer: Quartz Commercial |
$13.20
|
| Rate for Payer: WEA Trust Commercial |
$12.10
|
| Rate for Payer: WPS Commercial |
$16.30
|
|
|
TUBING SYRINGE PUMP MICROBORE W/FILTER 10014916
|
Facility
|
IP
|
$87.00
|
|
| Hospital Charge Code |
4595038
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$42.63 |
| Max. Negotiated Rate |
$80.04 |
| Rate for Payer: Aetna Commercial |
$78.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$74.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$46.11
|
| Rate for Payer: Cash Price |
$26.10
|
| Rate for Payer: Cigna Commercial |
$80.04
|
| Rate for Payer: Health EOS Commercial |
$77.43
|
| Rate for Payer: HFN Commercial |
$80.04
|
| Rate for Payer: Multiplan Commercial |
$69.60
|
| Rate for Payer: NAPHCARE Commercial |
$52.20
|
| Rate for Payer: Preferred Network Access Commercial |
$80.04
|
| Rate for Payer: Quartz Beloit One Network |
$42.63
|
| Rate for Payer: Quartz Commercial |
$52.20
|
| Rate for Payer: WEA Trust Commercial |
$47.85
|
| Rate for Payer: WPS Commercial |
$64.44
|
|
|
TUBING SYRINGE PUMP MICROBORE W/FILTER 10014916
|
Facility
|
OP
|
$87.00
|
|
| Hospital Charge Code |
4595038
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$24.36 |
| Max. Negotiated Rate |
$348.00 |
| Rate for Payer: Aetna Commercial |
$78.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$74.82
|
| Rate for Payer: Aetna Managed Medicare |
$24.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$56.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$43.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$41.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$46.11
|
| Rate for Payer: Cash Price |
$26.10
|
| Rate for Payer: Cigna Commercial |
$80.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$48.69
|
| Rate for Payer: Health EOS Commercial |
$77.43
|
| Rate for Payer: HFN Commercial |
$80.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$65.25
|
| Rate for Payer: Multiplan Commercial |
$69.60
|
| Rate for Payer: NAPHCARE Commercial |
$52.20
|
| Rate for Payer: Preferred Network Access Commercial |
$80.04
|
| Rate for Payer: Quartz Beloit One Network |
$42.63
|
| Rate for Payer: Quartz Commercial |
$56.55
|
| Rate for Payer: Quartz Medicare Advantage |
$52.20
|
| Rate for Payer: The Alliance Commercial |
$348.00
|
| Rate for Payer: WEA Trust Commercial |
$47.85
|
| Rate for Payer: WPS Commercial |
$64.44
|
|
|
TUBING SYRINGE PUMP MICROBORE W/O FILTER 10014914
|
Facility
|
OP
|
$93.00
|
|
| Hospital Charge Code |
4595049
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$26.04 |
| Max. Negotiated Rate |
$372.00 |
| Rate for Payer: Aetna Commercial |
$83.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$79.98
|
| Rate for Payer: Aetna Managed Medicare |
$26.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$60.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$46.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$44.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$49.29
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cigna Commercial |
$85.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$52.04
|
| Rate for Payer: Health EOS Commercial |
$82.77
|
| Rate for Payer: HFN Commercial |
$85.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$69.75
|
| Rate for Payer: Multiplan Commercial |
$74.40
|
| Rate for Payer: NAPHCARE Commercial |
$55.80
|
| Rate for Payer: Preferred Network Access Commercial |
$85.56
|
| Rate for Payer: Quartz Beloit One Network |
$45.57
|
| Rate for Payer: Quartz Commercial |
$60.45
|
| Rate for Payer: Quartz Medicare Advantage |
$55.80
|
| Rate for Payer: The Alliance Commercial |
$372.00
|
| Rate for Payer: WEA Trust Commercial |
$51.15
|
| Rate for Payer: WPS Commercial |
$68.89
|
|
|
TUBING SYRINGE PUMP MICROBORE W/O FILTER 10014914
|
Facility
|
IP
|
$93.00
|
|
| Hospital Charge Code |
4595049
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$45.57 |
| Max. Negotiated Rate |
$85.56 |
| Rate for Payer: Aetna Commercial |
$83.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$79.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$49.29
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cigna Commercial |
$85.56
|
| Rate for Payer: Health EOS Commercial |
$82.77
|
| Rate for Payer: HFN Commercial |
$85.56
|
| Rate for Payer: Multiplan Commercial |
$74.40
|
| Rate for Payer: NAPHCARE Commercial |
$55.80
|
| Rate for Payer: Preferred Network Access Commercial |
$85.56
|
| Rate for Payer: Quartz Beloit One Network |
$45.57
|
| Rate for Payer: Quartz Commercial |
$55.80
|
| Rate for Payer: WEA Trust Commercial |
$51.15
|
| Rate for Payer: WPS Commercial |
$68.89
|
|
|
TUMESCENT INFILTRATION KIT TIK-01
|
Facility
|
OP
|
$410.00
|
|
| Hospital Charge Code |
4069312
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$114.80 |
| Max. Negotiated Rate |
$1,640.00 |
| Rate for Payer: Aetna Commercial |
$369.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$352.60
|
| Rate for Payer: Aetna Managed Medicare |
$114.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$266.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$205.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$196.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$217.30
|
| Rate for Payer: Cash Price |
$123.00
|
| Rate for Payer: Cigna Commercial |
$377.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$229.44
|
| Rate for Payer: Health EOS Commercial |
$364.90
|
| Rate for Payer: HFN Commercial |
$377.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$307.50
|
| Rate for Payer: Multiplan Commercial |
$328.00
|
| Rate for Payer: NAPHCARE Commercial |
$246.00
|
| Rate for Payer: Preferred Network Access Commercial |
$377.20
|
| Rate for Payer: Quartz Beloit One Network |
$200.90
|
| Rate for Payer: Quartz Commercial |
$266.50
|
| Rate for Payer: Quartz Medicare Advantage |
$246.00
|
| Rate for Payer: The Alliance Commercial |
$1,640.00
|
| Rate for Payer: WEA Trust Commercial |
$225.50
|
| Rate for Payer: WPS Commercial |
$303.69
|
|
|
TUMESCENT INFILTRATION KIT TIK-01
|
Facility
|
IP
|
$410.00
|
|
| Hospital Charge Code |
4069312
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$200.90 |
| Max. Negotiated Rate |
$377.20 |
| Rate for Payer: Aetna Commercial |
$369.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$352.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$217.30
|
| Rate for Payer: Cash Price |
$123.00
|
| Rate for Payer: Cigna Commercial |
$377.20
|
| Rate for Payer: Health EOS Commercial |
$364.90
|
| Rate for Payer: HFN Commercial |
$377.20
|
| Rate for Payer: Multiplan Commercial |
$328.00
|
| Rate for Payer: NAPHCARE Commercial |
$246.00
|
| Rate for Payer: Preferred Network Access Commercial |
$377.20
|
| Rate for Payer: Quartz Beloit One Network |
$200.90
|
| Rate for Payer: Quartz Commercial |
$246.00
|
| Rate for Payer: WEA Trust Commercial |
$225.50
|
| Rate for Payer: WPS Commercial |
$303.69
|
|
|
Tumor Immunohisto/Comp
|
Professional
|
Both
|
$324.00
|
|
|
Service Code
|
CPT 88361
|
| Hospital Charge Code |
2780799
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$53.72 |
| Max. Negotiated Rate |
$418.27 |
| Rate for Payer: Aetna Commercial |
$307.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$278.64
|
| Rate for Payer: Anthem Commercial |
$53.72
|
| Rate for Payer: Cash Price |
$97.20
|
| Rate for Payer: Cash Price |
$97.20
|
| Rate for Payer: Cigna Commercial |
$307.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$162.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$194.40
|
| Rate for Payer: Health EOS Commercial |
$294.84
|
| Rate for Payer: HFN Commercial |
$307.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$418.27
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$418.27
|
| Rate for Payer: Multiplan Commercial |
$259.20
|
| Rate for Payer: Preferred Network Access Commercial |
$307.80
|
| Rate for Payer: Quartz Beloit One Network |
$142.56
|
| Rate for Payer: Quartz Commercial |
$184.68
|
| Rate for Payer: The Alliance Commercial |
$162.00
|
| Rate for Payer: WEA Trust Commercial |
$178.20
|
| Rate for Payer: WPS Commercial |
$239.99
|
|
|
Tumor Immunohisto/Comp
|
Facility
|
IP
|
$324.00
|
|
|
Service Code
|
CPT 88361
|
| Hospital Charge Code |
2780799
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$158.76 |
| Max. Negotiated Rate |
$298.08 |
| Rate for Payer: Aetna Commercial |
$291.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$278.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$171.72
|
| Rate for Payer: Cash Price |
$97.20
|
| Rate for Payer: Cigna Commercial |
$298.08
|
| Rate for Payer: Health EOS Commercial |
$288.36
|
| Rate for Payer: HFN Commercial |
$298.08
|
| Rate for Payer: Multiplan Commercial |
$259.20
|
| Rate for Payer: NAPHCARE Commercial |
$194.40
|
| Rate for Payer: Preferred Network Access Commercial |
$298.08
|
| Rate for Payer: Quartz Beloit One Network |
$158.76
|
| Rate for Payer: Quartz Commercial |
$194.40
|
| Rate for Payer: WEA Trust Commercial |
$178.20
|
| Rate for Payer: WPS Commercial |
$239.99
|
|
