|
Tube inserted - Tracheostomy Tube Activity
|
Facility
OP
|
$1,191.00
|
|
|
Service Code
|
CPT 31603
|
| Hospital Charge Code |
3000324
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$12,336.12 |
| Rate for Payer: Aetna Commercial |
$1,071.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,024.26
|
| Rate for Payer: Aetna Managed Medicare |
$1,507.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$774.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$595.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$571.68
|
| Rate for Payer: Anthem Medicare Advantage |
$1,507.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$631.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,507.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,507.37
|
| Rate for Payer: Cash Price |
$357.30
|
| Rate for Payer: Cash Price |
$357.30
|
| Rate for Payer: Cash Price |
$357.30
|
| Rate for Payer: Cigna Commercial |
$1,095.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,507.37
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,507.37
|
| Rate for Payer: Health EOS Commercial |
$1,059.99
|
| Rate for Payer: HFN Commercial |
$1,095.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,607.42
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,507.37
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,507.37
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,507.37
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,507.37
|
| Rate for Payer: Multiplan Commercial |
$952.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,261.06
|
| Rate for Payer: Preferred Network Access Commercial |
$1,095.72
|
| Rate for Payer: Quartz Beloit One Network |
$583.59
|
| Rate for Payer: Quartz Commercial |
$774.15
|
| Rate for Payer: Quartz Medicare Advantage |
$1,507.37
|
| Rate for Payer: The Alliance Commercial |
$12,336.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,507.37
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$655.05
|
| Rate for Payer: Wellcare Medicare |
$1,507.37
|
| Rate for Payer: WPS Commercial |
$882.17
|
|
|
TUBE LUKI STER.SPECIMEN TRAP 8886864604
|
Facility
IP
|
$158.00
|
|
| Hospital Charge Code |
2963419
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$77.42 |
| Max. Negotiated Rate |
$145.36 |
| Rate for Payer: Aetna Commercial |
$142.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$83.74
|
| Rate for Payer: Cash Price |
$47.40
|
| Rate for Payer: Cigna Commercial |
$145.36
|
| Rate for Payer: Health EOS Commercial |
$140.62
|
| Rate for Payer: HFN Commercial |
$145.36
|
| Rate for Payer: Multiplan Commercial |
$126.40
|
| Rate for Payer: NAPHCARE Commercial |
$94.80
|
| Rate for Payer: Preferred Network Access Commercial |
$145.36
|
| Rate for Payer: Quartz Beloit One Network |
$77.42
|
| Rate for Payer: Quartz Commercial |
$94.80
|
| Rate for Payer: WEA Trust Commercial |
$86.90
|
| Rate for Payer: WPS Commercial |
$117.03
|
|
|
TUBE LUKI STER.SPECIMEN TRAP 8886864604
|
Facility
OP
|
$158.00
|
|
| Hospital Charge Code |
2963419
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$44.24 |
| Max. Negotiated Rate |
$632.00 |
| Rate for Payer: Aetna Commercial |
$142.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$135.88
|
| Rate for Payer: Aetna Managed Medicare |
$44.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$102.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$79.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$75.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$83.74
|
| Rate for Payer: Cash Price |
$47.40
|
| Rate for Payer: Cigna Commercial |
$145.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$88.42
|
| Rate for Payer: Health EOS Commercial |
$140.62
|
| Rate for Payer: HFN Commercial |
$145.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$118.50
|
| Rate for Payer: Multiplan Commercial |
$126.40
|
| Rate for Payer: NAPHCARE Commercial |
$94.80
|
| Rate for Payer: Preferred Network Access Commercial |
$145.36
|
| Rate for Payer: Quartz Beloit One Network |
$77.42
|
| Rate for Payer: Quartz Commercial |
$102.70
|
| Rate for Payer: Quartz Medicare Advantage |
$94.80
|
| Rate for Payer: The Alliance Commercial |
$632.00
|
| Rate for Payer: WEA Trust Commercial |
$86.90
|
| Rate for Payer: WPS Commercial |
$117.03
|
|
|
TUBE MAGIL ENDOTRACHEAL 3.5MM CUFFED
|
Facility
OP
|
$73.00
|
|
| Hospital Charge Code |
2974407
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$20.44 |
| Max. Negotiated Rate |
$292.00 |
| Rate for Payer: Aetna Commercial |
$65.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$62.78
|
| Rate for Payer: Aetna Managed Medicare |
$20.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$47.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$36.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$35.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$38.69
|
| Rate for Payer: Cash Price |
$21.90
|
| Rate for Payer: Cigna Commercial |
$67.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$40.85
|
| Rate for Payer: Health EOS Commercial |
$64.97
|
| Rate for Payer: HFN Commercial |
$67.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$54.75
|
| Rate for Payer: Multiplan Commercial |
$58.40
|
| Rate for Payer: NAPHCARE Commercial |
$43.80
|
| Rate for Payer: Preferred Network Access Commercial |
$67.16
|
| Rate for Payer: Quartz Beloit One Network |
$35.77
|
| Rate for Payer: Quartz Commercial |
$47.45
|
| Rate for Payer: Quartz Medicare Advantage |
$43.80
|
| Rate for Payer: The Alliance Commercial |
$292.00
|
| Rate for Payer: WEA Trust Commercial |
$40.15
|
| Rate for Payer: WPS Commercial |
$54.07
|
|
|
TUBE MAGIL ENDOTRACHEAL 3.5MM CUFFED
|
Facility
IP
|
$73.00
|
|
| Hospital Charge Code |
2974407
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$35.77 |
| Max. Negotiated Rate |
$67.16 |
| Rate for Payer: Aetna Commercial |
$65.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$38.69
|
| Rate for Payer: Cash Price |
$21.90
|
| Rate for Payer: Cigna Commercial |
$67.16
|
| Rate for Payer: Health EOS Commercial |
$64.97
|
| Rate for Payer: HFN Commercial |
$67.16
|
| Rate for Payer: Multiplan Commercial |
$58.40
|
| Rate for Payer: NAPHCARE Commercial |
$43.80
|
| Rate for Payer: Preferred Network Access Commercial |
$67.16
|
| Rate for Payer: Quartz Beloit One Network |
$35.77
|
| Rate for Payer: Quartz Commercial |
$43.80
|
| Rate for Payer: WEA Trust Commercial |
$40.15
|
| Rate for Payer: WPS Commercial |
$54.07
|
|
|
TUBE MICROLARYNGEAL 5.0mm #5-11110
|
Facility
IP
|
$160.00
|
|
| Hospital Charge Code |
2974659
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$78.40 |
| Max. Negotiated Rate |
$147.20 |
| Rate for Payer: Aetna Commercial |
$144.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$84.80
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cigna Commercial |
$147.20
|
| Rate for Payer: Health EOS Commercial |
$142.40
|
| Rate for Payer: HFN Commercial |
$147.20
|
| Rate for Payer: Multiplan Commercial |
$128.00
|
| Rate for Payer: NAPHCARE Commercial |
$96.00
|
| Rate for Payer: Preferred Network Access Commercial |
$147.20
|
| Rate for Payer: Quartz Beloit One Network |
$78.40
|
| Rate for Payer: Quartz Commercial |
$96.00
|
| Rate for Payer: WEA Trust Commercial |
$88.00
|
| Rate for Payer: WPS Commercial |
$118.51
|
|
|
TUBE MICROLARYNGEAL 5.0mm #5-11110
|
Facility
OP
|
$160.00
|
|
| Hospital Charge Code |
2974659
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$44.80 |
| Max. Negotiated Rate |
$640.00 |
| Rate for Payer: Aetna Commercial |
$144.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$137.60
|
| Rate for Payer: Aetna Managed Medicare |
$44.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$104.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$80.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$76.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$84.80
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cigna Commercial |
$147.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$89.54
|
| Rate for Payer: Health EOS Commercial |
$142.40
|
| Rate for Payer: HFN Commercial |
$147.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$120.00
|
| Rate for Payer: Multiplan Commercial |
$128.00
|
| Rate for Payer: NAPHCARE Commercial |
$96.00
|
| Rate for Payer: Preferred Network Access Commercial |
$147.20
|
| Rate for Payer: Quartz Beloit One Network |
$78.40
|
| Rate for Payer: Quartz Commercial |
$104.00
|
| Rate for Payer: Quartz Medicare Advantage |
$96.00
|
| Rate for Payer: The Alliance Commercial |
$640.00
|
| Rate for Payer: WEA Trust Commercial |
$88.00
|
| Rate for Payer: WPS Commercial |
$118.51
|
|
|
TUBE MICROLARYNGEAL 6.0MM #5-11112
|
Facility
IP
|
$1,069.00
|
|
| Hospital Charge Code |
2974660
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$523.81 |
| Max. Negotiated Rate |
$983.48 |
| Rate for Payer: Aetna Commercial |
$962.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$566.57
|
| Rate for Payer: Cash Price |
$320.70
|
| Rate for Payer: Cigna Commercial |
$983.48
|
| Rate for Payer: Health EOS Commercial |
$951.41
|
| Rate for Payer: HFN Commercial |
$983.48
|
| Rate for Payer: Multiplan Commercial |
$855.20
|
| Rate for Payer: NAPHCARE Commercial |
$641.40
|
| Rate for Payer: Preferred Network Access Commercial |
$983.48
|
| Rate for Payer: Quartz Beloit One Network |
$523.81
|
| Rate for Payer: Quartz Commercial |
$641.40
|
| Rate for Payer: WEA Trust Commercial |
$587.95
|
| Rate for Payer: WPS Commercial |
$791.81
|
|
|
TUBE MICROLARYNGEAL 6.0MM #5-11112
|
Facility
OP
|
$1,069.00
|
|
| Hospital Charge Code |
2974660
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$299.32 |
| Max. Negotiated Rate |
$4,276.00 |
| Rate for Payer: Aetna Commercial |
$962.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$919.34
|
| Rate for Payer: Aetna Managed Medicare |
$299.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$694.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$534.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$513.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$566.57
|
| Rate for Payer: Cash Price |
$320.70
|
| Rate for Payer: Cigna Commercial |
$983.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$598.21
|
| Rate for Payer: Health EOS Commercial |
$951.41
|
| Rate for Payer: HFN Commercial |
$983.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$801.75
|
| Rate for Payer: Multiplan Commercial |
$855.20
|
| Rate for Payer: NAPHCARE Commercial |
$641.40
|
| Rate for Payer: Preferred Network Access Commercial |
$983.48
|
| Rate for Payer: Quartz Beloit One Network |
$523.81
|
| Rate for Payer: Quartz Commercial |
$694.85
|
| Rate for Payer: Quartz Medicare Advantage |
$641.40
|
| Rate for Payer: The Alliance Commercial |
$4,276.00
|
| Rate for Payer: WEA Trust Commercial |
$587.95
|
| Rate for Payer: WPS Commercial |
$791.81
|
|
|
Tube-Minidrip
|
Facility
OP
|
$7.00
|
|
| Hospital Charge Code |
3040291
|
|
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
|
|
|
Tube-Minidrip
|
Facility
IP
|
$7.00
|
|
| Hospital Charge Code |
3040291
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$3.43 |
| Max. Negotiated Rate |
$6.44 |
| Rate for Payer: Aetna Commercial |
$6.30
|
| 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: Health EOS Commercial |
$6.23
|
| Rate for Payer: HFN Commercial |
$6.44
|
| 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 |
$4.20
|
| Rate for Payer: WEA Trust Commercial |
$3.85
|
| Rate for Payer: WPS Commercial |
$5.18
|
|
|
Tube-Minidrip BCE
|
Facility
IP
|
$76.00
|
|
| Hospital Charge Code |
3101776
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$37.24 |
| Max. Negotiated Rate |
$69.92 |
| Rate for Payer: Aetna Commercial |
$68.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$40.28
|
| Rate for Payer: Cash Price |
$22.80
|
| Rate for Payer: Cigna Commercial |
$69.92
|
| Rate for Payer: Health EOS Commercial |
$67.64
|
| Rate for Payer: HFN Commercial |
$69.92
|
| Rate for Payer: Multiplan Commercial |
$60.80
|
| Rate for Payer: NAPHCARE Commercial |
$45.60
|
| Rate for Payer: Preferred Network Access Commercial |
$69.92
|
| Rate for Payer: Quartz Beloit One Network |
$37.24
|
| Rate for Payer: Quartz Commercial |
$45.60
|
| Rate for Payer: WEA Trust Commercial |
$41.80
|
| Rate for Payer: WPS Commercial |
$56.29
|
|
|
Tube-Minidrip BCE
|
Facility
OP
|
$76.00
|
|
| Hospital Charge Code |
3101776
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$21.28 |
| Max. Negotiated Rate |
$304.00 |
| Rate for Payer: Aetna Commercial |
$68.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$65.36
|
| Rate for Payer: Aetna Managed Medicare |
$21.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$49.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$38.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$36.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$40.28
|
| Rate for Payer: Cash Price |
$22.80
|
| Rate for Payer: Cigna Commercial |
$69.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$42.53
|
| Rate for Payer: Health EOS Commercial |
$67.64
|
| Rate for Payer: HFN Commercial |
$69.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$57.00
|
| Rate for Payer: Multiplan Commercial |
$60.80
|
| Rate for Payer: NAPHCARE Commercial |
$45.60
|
| Rate for Payer: Preferred Network Access Commercial |
$69.92
|
| Rate for Payer: Quartz Beloit One Network |
$37.24
|
| Rate for Payer: Quartz Commercial |
$49.40
|
| Rate for Payer: Quartz Medicare Advantage |
$45.60
|
| Rate for Payer: The Alliance Commercial |
$304.00
|
| Rate for Payer: WEA Trust Commercial |
$41.80
|
| Rate for Payer: WPS Commercial |
$56.29
|
|
|
TUBE NASAL RAE 6.0 CUFFED 96360
|
Facility
OP
|
$141.00
|
|
| Hospital Charge Code |
2974639
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$39.48 |
| Max. Negotiated Rate |
$564.00 |
| Rate for Payer: Aetna Commercial |
$126.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$121.26
|
| Rate for Payer: Aetna Managed Medicare |
$39.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$91.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$70.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$67.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$74.73
|
| Rate for Payer: Cash Price |
$42.30
|
| Rate for Payer: Cigna Commercial |
$129.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$78.90
|
| Rate for Payer: Health EOS Commercial |
$125.49
|
| Rate for Payer: HFN Commercial |
$129.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$105.75
|
| Rate for Payer: Multiplan Commercial |
$112.80
|
| Rate for Payer: NAPHCARE Commercial |
$84.60
|
| Rate for Payer: Preferred Network Access Commercial |
$129.72
|
| Rate for Payer: Quartz Beloit One Network |
$69.09
|
| Rate for Payer: Quartz Commercial |
$91.65
|
| Rate for Payer: Quartz Medicare Advantage |
$84.60
|
| Rate for Payer: The Alliance Commercial |
$564.00
|
| Rate for Payer: WEA Trust Commercial |
$77.55
|
| Rate for Payer: WPS Commercial |
$104.44
|
|
|
TUBE NASAL RAE 6.0 CUFFED 96360
|
Facility
IP
|
$141.00
|
|
| Hospital Charge Code |
2974639
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$69.09 |
| Max. Negotiated Rate |
$129.72 |
| Rate for Payer: Aetna Commercial |
$126.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$74.73
|
| Rate for Payer: Cash Price |
$42.30
|
| Rate for Payer: Cigna Commercial |
$129.72
|
| Rate for Payer: Health EOS Commercial |
$125.49
|
| Rate for Payer: HFN Commercial |
$129.72
|
| Rate for Payer: Multiplan Commercial |
$112.80
|
| Rate for Payer: NAPHCARE Commercial |
$84.60
|
| Rate for Payer: Preferred Network Access Commercial |
$129.72
|
| Rate for Payer: Quartz Beloit One Network |
$69.09
|
| Rate for Payer: Quartz Commercial |
$84.60
|
| Rate for Payer: WEA Trust Commercial |
$77.55
|
| Rate for Payer: WPS Commercial |
$104.44
|
|
|
TUBE NASAL RAE 7.0 CUFFED 96370
|
Facility
IP
|
$141.00
|
|
| Hospital Charge Code |
2974640
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$69.09 |
| Max. Negotiated Rate |
$129.72 |
| Rate for Payer: Aetna Commercial |
$126.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$74.73
|
| Rate for Payer: Cash Price |
$42.30
|
| Rate for Payer: Cigna Commercial |
$129.72
|
| Rate for Payer: Health EOS Commercial |
$125.49
|
| Rate for Payer: HFN Commercial |
$129.72
|
| Rate for Payer: Multiplan Commercial |
$112.80
|
| Rate for Payer: NAPHCARE Commercial |
$84.60
|
| Rate for Payer: Preferred Network Access Commercial |
$129.72
|
| Rate for Payer: Quartz Beloit One Network |
$69.09
|
| Rate for Payer: Quartz Commercial |
$84.60
|
| Rate for Payer: WEA Trust Commercial |
$77.55
|
| Rate for Payer: WPS Commercial |
$104.44
|
|
|
TUBE NASAL RAE 7.0 CUFFED 96370
|
Facility
OP
|
$141.00
|
|
| Hospital Charge Code |
2974640
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$39.48 |
| Max. Negotiated Rate |
$564.00 |
| Rate for Payer: Aetna Commercial |
$126.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$121.26
|
| Rate for Payer: Aetna Managed Medicare |
$39.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$91.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$70.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$67.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$74.73
|
| Rate for Payer: Cash Price |
$42.30
|
| Rate for Payer: Cigna Commercial |
$129.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$78.90
|
| Rate for Payer: Health EOS Commercial |
$125.49
|
| Rate for Payer: HFN Commercial |
$129.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$105.75
|
| Rate for Payer: Multiplan Commercial |
$112.80
|
| Rate for Payer: NAPHCARE Commercial |
$84.60
|
| Rate for Payer: Preferred Network Access Commercial |
$129.72
|
| Rate for Payer: Quartz Beloit One Network |
$69.09
|
| Rate for Payer: Quartz Commercial |
$91.65
|
| Rate for Payer: Quartz Medicare Advantage |
$84.60
|
| Rate for Payer: The Alliance Commercial |
$564.00
|
| Rate for Payer: WEA Trust Commercial |
$77.55
|
| Rate for Payer: WPS Commercial |
$104.44
|
|
|
TUBE ORAL ENDOTRACHEAL #9799
|
Facility
OP
|
$194.00
|
|
| Hospital Charge Code |
2974736
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$54.32 |
| Max. Negotiated Rate |
$776.00 |
| Rate for Payer: Aetna Commercial |
$174.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$166.84
|
| Rate for Payer: Aetna Managed Medicare |
$54.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$126.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$97.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$93.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$102.82
|
| Rate for Payer: Cash Price |
$58.20
|
| Rate for Payer: Cigna Commercial |
$178.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$108.56
|
| Rate for Payer: Health EOS Commercial |
$172.66
|
| Rate for Payer: HFN Commercial |
$178.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$145.50
|
| Rate for Payer: Multiplan Commercial |
$155.20
|
| Rate for Payer: NAPHCARE Commercial |
$116.40
|
| Rate for Payer: Preferred Network Access Commercial |
$178.48
|
| Rate for Payer: Quartz Beloit One Network |
$95.06
|
| Rate for Payer: Quartz Commercial |
$126.10
|
| Rate for Payer: Quartz Medicare Advantage |
$116.40
|
| Rate for Payer: The Alliance Commercial |
$776.00
|
| Rate for Payer: WEA Trust Commercial |
$106.70
|
| Rate for Payer: WPS Commercial |
$143.70
|
|
|
TUBE ORAL ENDOTRACHEAL #9799
|
Facility
IP
|
$194.00
|
|
| Hospital Charge Code |
2974736
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$95.06 |
| Max. Negotiated Rate |
$178.48 |
| Rate for Payer: Aetna Commercial |
$174.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$102.82
|
| Rate for Payer: Cash Price |
$58.20
|
| Rate for Payer: Cigna Commercial |
$178.48
|
| Rate for Payer: Health EOS Commercial |
$172.66
|
| Rate for Payer: HFN Commercial |
$178.48
|
| Rate for Payer: Multiplan Commercial |
$155.20
|
| Rate for Payer: NAPHCARE Commercial |
$116.40
|
| Rate for Payer: Preferred Network Access Commercial |
$178.48
|
| Rate for Payer: Quartz Beloit One Network |
$95.06
|
| Rate for Payer: Quartz Commercial |
$116.40
|
| Rate for Payer: WEA Trust Commercial |
$106.70
|
| Rate for Payer: WPS Commercial |
$143.70
|
|
|
TUBE ORAL/NASAL CO2 FOR ADULT #2013067-001
|
Facility
IP
|
$213.00
|
|
| Hospital Charge Code |
2972270
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$104.37 |
| Max. Negotiated Rate |
$195.96 |
| Rate for Payer: Aetna Commercial |
$191.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$112.89
|
| Rate for Payer: Cash Price |
$63.90
|
| Rate for Payer: Cigna Commercial |
$195.96
|
| Rate for Payer: Health EOS Commercial |
$189.57
|
| Rate for Payer: HFN Commercial |
$195.96
|
| Rate for Payer: Multiplan Commercial |
$170.40
|
| Rate for Payer: NAPHCARE Commercial |
$127.80
|
| Rate for Payer: Preferred Network Access Commercial |
$195.96
|
| Rate for Payer: Quartz Beloit One Network |
$104.37
|
| Rate for Payer: Quartz Commercial |
$127.80
|
| Rate for Payer: WEA Trust Commercial |
$117.15
|
| Rate for Payer: WPS Commercial |
$157.77
|
|
|
TUBE ORAL/NASAL CO2 FOR ADULT #2013067-001
|
Facility
OP
|
$213.00
|
|
| Hospital Charge Code |
2972270
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$59.64 |
| Max. Negotiated Rate |
$852.00 |
| Rate for Payer: Aetna Commercial |
$191.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$183.18
|
| Rate for Payer: Aetna Managed Medicare |
$59.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$138.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$106.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$102.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$112.89
|
| Rate for Payer: Cash Price |
$63.90
|
| Rate for Payer: Cigna Commercial |
$195.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$119.19
|
| Rate for Payer: Health EOS Commercial |
$189.57
|
| Rate for Payer: HFN Commercial |
$195.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$159.75
|
| Rate for Payer: Multiplan Commercial |
$170.40
|
| Rate for Payer: NAPHCARE Commercial |
$127.80
|
| Rate for Payer: Preferred Network Access Commercial |
$195.96
|
| Rate for Payer: Quartz Beloit One Network |
$104.37
|
| Rate for Payer: Quartz Commercial |
$138.45
|
| Rate for Payer: Quartz Medicare Advantage |
$127.80
|
| Rate for Payer: The Alliance Commercial |
$852.00
|
| Rate for Payer: WEA Trust Commercial |
$117.15
|
| Rate for Payer: WPS Commercial |
$157.77
|
|
|
TUBE ORAL/NASAL CO2 FOR PEDS #2013067-002
|
Facility
OP
|
$261.00
|
|
| Hospital Charge Code |
2969791
|
|
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
|
|
|
TUBE ORAL/NASAL CO2 FOR PEDS #2013067-002
|
Facility
IP
|
$261.00
|
|
| Hospital Charge Code |
2969791
|
|
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
|
|
|
TUBE RUSCH DBL LMN LT 37FR #116100370
|
Facility
IP
|
$1,023.00
|
|
| Hospital Charge Code |
2962805
|
|
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 RUSCH DBL LMN LT 37FR #116100370
|
Facility
OP
|
$1,023.00
|
|
| Hospital Charge Code |
2962805
|
|
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
|
|
