|
TUBE TRACH BIVONA 5.0MM 670150
|
Facility
OP
|
$1,159.00
|
|
| Hospital Charge Code |
5385011
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$324.52 |
| Max. Negotiated Rate |
$4,636.00 |
| Rate for Payer: Aetna Commercial |
$1,043.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$996.74
|
| Rate for Payer: Aetna Managed Medicare |
$324.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$753.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$579.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$556.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$614.27
|
| Rate for Payer: Cash Price |
$347.70
|
| Rate for Payer: Cigna Commercial |
$1,066.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$648.58
|
| Rate for Payer: Health EOS Commercial |
$1,031.51
|
| Rate for Payer: HFN Commercial |
$1,066.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$869.25
|
| Rate for Payer: Multiplan Commercial |
$927.20
|
| Rate for Payer: NAPHCARE Commercial |
$695.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,066.28
|
| Rate for Payer: Quartz Beloit One Network |
$567.91
|
| Rate for Payer: Quartz Commercial |
$753.35
|
| Rate for Payer: Quartz Medicare Advantage |
$695.40
|
| Rate for Payer: The Alliance Commercial |
$4,636.00
|
| Rate for Payer: WEA Trust Commercial |
$637.45
|
| Rate for Payer: WPS Commercial |
$858.47
|
|
|
TUBE TRACH BIVONA 5.0MM 670150
|
Facility
IP
|
$1,159.00
|
|
| Hospital Charge Code |
5385011
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$567.91 |
| Max. Negotiated Rate |
$1,066.28 |
| Rate for Payer: Aetna Commercial |
$1,043.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$614.27
|
| Rate for Payer: Cash Price |
$347.70
|
| Rate for Payer: Cigna Commercial |
$1,066.28
|
| Rate for Payer: Health EOS Commercial |
$1,031.51
|
| Rate for Payer: HFN Commercial |
$1,066.28
|
| Rate for Payer: Multiplan Commercial |
$927.20
|
| Rate for Payer: NAPHCARE Commercial |
$695.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,066.28
|
| Rate for Payer: Quartz Beloit One Network |
$567.91
|
| Rate for Payer: Quartz Commercial |
$695.40
|
| Rate for Payer: WEA Trust Commercial |
$637.45
|
| Rate for Payer: WPS Commercial |
$858.47
|
|
|
TUBE TRACH BIVONA 6.0MM 670160
|
Facility
OP
|
$1,216.00
|
|
| Hospital Charge Code |
4494190
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$340.48 |
| Max. Negotiated Rate |
$4,864.00 |
| Rate for Payer: Aetna Commercial |
$1,094.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,045.76
|
| Rate for Payer: Aetna Managed Medicare |
$340.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$790.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$608.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$583.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$644.48
|
| Rate for Payer: Cash Price |
$364.80
|
| Rate for Payer: Cigna Commercial |
$1,118.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$680.47
|
| Rate for Payer: Health EOS Commercial |
$1,082.24
|
| Rate for Payer: HFN Commercial |
$1,118.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$912.00
|
| Rate for Payer: Multiplan Commercial |
$972.80
|
| Rate for Payer: NAPHCARE Commercial |
$729.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,118.72
|
| Rate for Payer: Quartz Beloit One Network |
$595.84
|
| Rate for Payer: Quartz Commercial |
$790.40
|
| Rate for Payer: Quartz Medicare Advantage |
$729.60
|
| Rate for Payer: The Alliance Commercial |
$4,864.00
|
| Rate for Payer: WEA Trust Commercial |
$668.80
|
| Rate for Payer: WPS Commercial |
$900.69
|
|
|
TUBE TRACH BIVONA 6.0MM 670160
|
Facility
IP
|
$1,216.00
|
|
| Hospital Charge Code |
4494190
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$595.84 |
| Max. Negotiated Rate |
$1,118.72 |
| Rate for Payer: Aetna Commercial |
$1,094.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$644.48
|
| Rate for Payer: Cash Price |
$364.80
|
| Rate for Payer: Cigna Commercial |
$1,118.72
|
| Rate for Payer: Health EOS Commercial |
$1,082.24
|
| Rate for Payer: HFN Commercial |
$1,118.72
|
| Rate for Payer: Multiplan Commercial |
$972.80
|
| Rate for Payer: NAPHCARE Commercial |
$729.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,118.72
|
| Rate for Payer: Quartz Beloit One Network |
$595.84
|
| Rate for Payer: Quartz Commercial |
$729.60
|
| Rate for Payer: WEA Trust Commercial |
$668.80
|
| Rate for Payer: WPS Commercial |
$900.69
|
|
|
TUBE TRACH BIVONA 7.0MM 670170
|
Facility
IP
|
$1,216.00
|
|
| Hospital Charge Code |
4494191
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$595.84 |
| Max. Negotiated Rate |
$1,118.72 |
| Rate for Payer: Aetna Commercial |
$1,094.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$644.48
|
| Rate for Payer: Cash Price |
$364.80
|
| Rate for Payer: Cigna Commercial |
$1,118.72
|
| Rate for Payer: Health EOS Commercial |
$1,082.24
|
| Rate for Payer: HFN Commercial |
$1,118.72
|
| Rate for Payer: Multiplan Commercial |
$972.80
|
| Rate for Payer: NAPHCARE Commercial |
$729.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,118.72
|
| Rate for Payer: Quartz Beloit One Network |
$595.84
|
| Rate for Payer: Quartz Commercial |
$729.60
|
| Rate for Payer: WEA Trust Commercial |
$668.80
|
| Rate for Payer: WPS Commercial |
$900.69
|
|
|
TUBE TRACH BIVONA 7.0MM 670170
|
Facility
OP
|
$1,216.00
|
|
| Hospital Charge Code |
4494191
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$340.48 |
| Max. Negotiated Rate |
$4,864.00 |
| Rate for Payer: Aetna Commercial |
$1,094.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,045.76
|
| Rate for Payer: Aetna Managed Medicare |
$340.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$790.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$608.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$583.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$644.48
|
| Rate for Payer: Cash Price |
$364.80
|
| Rate for Payer: Cigna Commercial |
$1,118.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$680.47
|
| Rate for Payer: Health EOS Commercial |
$1,082.24
|
| Rate for Payer: HFN Commercial |
$1,118.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$912.00
|
| Rate for Payer: Multiplan Commercial |
$972.80
|
| Rate for Payer: NAPHCARE Commercial |
$729.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,118.72
|
| Rate for Payer: Quartz Beloit One Network |
$595.84
|
| Rate for Payer: Quartz Commercial |
$790.40
|
| Rate for Payer: Quartz Medicare Advantage |
$729.60
|
| Rate for Payer: The Alliance Commercial |
$4,864.00
|
| Rate for Payer: WEA Trust Commercial |
$668.80
|
| Rate for Payer: WPS Commercial |
$900.69
|
|
|
TUBE TRACH BIVONA 8.0MM 670180
|
Facility
IP
|
$1,216.00
|
|
| Hospital Charge Code |
4494192
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$595.84 |
| Max. Negotiated Rate |
$1,118.72 |
| Rate for Payer: Aetna Commercial |
$1,094.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$644.48
|
| Rate for Payer: Cash Price |
$364.80
|
| Rate for Payer: Cigna Commercial |
$1,118.72
|
| Rate for Payer: Health EOS Commercial |
$1,082.24
|
| Rate for Payer: HFN Commercial |
$1,118.72
|
| Rate for Payer: Multiplan Commercial |
$972.80
|
| Rate for Payer: NAPHCARE Commercial |
$729.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,118.72
|
| Rate for Payer: Quartz Beloit One Network |
$595.84
|
| Rate for Payer: Quartz Commercial |
$729.60
|
| Rate for Payer: WEA Trust Commercial |
$668.80
|
| Rate for Payer: WPS Commercial |
$900.69
|
|
|
TUBE TRACH BIVONA 8.0MM 670180
|
Facility
OP
|
$1,216.00
|
|
| Hospital Charge Code |
4494192
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$340.48 |
| Max. Negotiated Rate |
$4,864.00 |
| Rate for Payer: Aetna Commercial |
$1,094.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,045.76
|
| Rate for Payer: Aetna Managed Medicare |
$340.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$790.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$608.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$583.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$644.48
|
| Rate for Payer: Cash Price |
$364.80
|
| Rate for Payer: Cigna Commercial |
$1,118.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$680.47
|
| Rate for Payer: Health EOS Commercial |
$1,082.24
|
| Rate for Payer: HFN Commercial |
$1,118.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$912.00
|
| Rate for Payer: Multiplan Commercial |
$972.80
|
| Rate for Payer: NAPHCARE Commercial |
$729.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,118.72
|
| Rate for Payer: Quartz Beloit One Network |
$595.84
|
| Rate for Payer: Quartz Commercial |
$790.40
|
| Rate for Payer: Quartz Medicare Advantage |
$729.60
|
| Rate for Payer: The Alliance Commercial |
$4,864.00
|
| Rate for Payer: WEA Trust Commercial |
$668.80
|
| Rate for Payer: WPS Commercial |
$900.69
|
|
|
TUBE TRACH BIVONA 9.0MM 670190
|
Facility
OP
|
$1,216.00
|
|
| Hospital Charge Code |
4494193
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$340.48 |
| Max. Negotiated Rate |
$4,864.00 |
| Rate for Payer: Aetna Commercial |
$1,094.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,045.76
|
| Rate for Payer: Aetna Managed Medicare |
$340.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$790.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$608.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$583.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$644.48
|
| Rate for Payer: Cash Price |
$364.80
|
| Rate for Payer: Cigna Commercial |
$1,118.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$680.47
|
| Rate for Payer: Health EOS Commercial |
$1,082.24
|
| Rate for Payer: HFN Commercial |
$1,118.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$912.00
|
| Rate for Payer: Multiplan Commercial |
$972.80
|
| Rate for Payer: NAPHCARE Commercial |
$729.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,118.72
|
| Rate for Payer: Quartz Beloit One Network |
$595.84
|
| Rate for Payer: Quartz Commercial |
$790.40
|
| Rate for Payer: Quartz Medicare Advantage |
$729.60
|
| Rate for Payer: The Alliance Commercial |
$4,864.00
|
| Rate for Payer: WEA Trust Commercial |
$668.80
|
| Rate for Payer: WPS Commercial |
$900.69
|
|
|
TUBE TRACH BIVONA 9.0MM 670190
|
Facility
IP
|
$1,216.00
|
|
| Hospital Charge Code |
4494193
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$595.84 |
| Max. Negotiated Rate |
$1,118.72 |
| Rate for Payer: Aetna Commercial |
$1,094.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$644.48
|
| Rate for Payer: Cash Price |
$364.80
|
| Rate for Payer: Cigna Commercial |
$1,118.72
|
| Rate for Payer: Health EOS Commercial |
$1,082.24
|
| Rate for Payer: HFN Commercial |
$1,118.72
|
| Rate for Payer: Multiplan Commercial |
$972.80
|
| Rate for Payer: NAPHCARE Commercial |
$729.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,118.72
|
| Rate for Payer: Quartz Beloit One Network |
$595.84
|
| Rate for Payer: Quartz Commercial |
$729.60
|
| Rate for Payer: WEA Trust Commercial |
$668.80
|
| Rate for Payer: WPS Commercial |
$900.69
|
|
|
TUBE TRACHEAL 4.5 CUFFED #5-10109
|
Facility
OP
|
$72.00
|
|
| Hospital Charge Code |
2970144
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$20.16 |
| Max. Negotiated Rate |
$288.00 |
| Rate for Payer: Aetna Commercial |
$64.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$61.92
|
| Rate for Payer: Aetna Managed Medicare |
$20.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$46.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$36.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$34.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$38.16
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cigna Commercial |
$66.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$40.29
|
| Rate for Payer: Health EOS Commercial |
$64.08
|
| Rate for Payer: HFN Commercial |
$66.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$54.00
|
| Rate for Payer: Multiplan Commercial |
$57.60
|
| Rate for Payer: NAPHCARE Commercial |
$43.20
|
| Rate for Payer: Preferred Network Access Commercial |
$66.24
|
| Rate for Payer: Quartz Beloit One Network |
$35.28
|
| Rate for Payer: Quartz Commercial |
$46.80
|
| Rate for Payer: Quartz Medicare Advantage |
$43.20
|
| Rate for Payer: The Alliance Commercial |
$288.00
|
| Rate for Payer: WEA Trust Commercial |
$39.60
|
| Rate for Payer: WPS Commercial |
$53.33
|
|
|
TUBE TRACHEAL 4.5 CUFFED #5-10109
|
Facility
IP
|
$72.00
|
|
| Hospital Charge Code |
2970144
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$35.28 |
| Max. Negotiated Rate |
$66.24 |
| Rate for Payer: Aetna Commercial |
$64.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$38.16
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cigna Commercial |
$66.24
|
| Rate for Payer: Health EOS Commercial |
$64.08
|
| Rate for Payer: HFN Commercial |
$66.24
|
| Rate for Payer: Multiplan Commercial |
$57.60
|
| Rate for Payer: NAPHCARE Commercial |
$43.20
|
| Rate for Payer: Preferred Network Access Commercial |
$66.24
|
| Rate for Payer: Quartz Beloit One Network |
$35.28
|
| Rate for Payer: Quartz Commercial |
$43.20
|
| Rate for Payer: WEA Trust Commercial |
$39.60
|
| Rate for Payer: WPS Commercial |
$53.33
|
|
|
TUBE TRACHEAL 5.0 UNCUFFED #86238
|
Facility
IP
|
$75.00
|
|
| Hospital Charge Code |
2974404
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$36.75 |
| Max. Negotiated Rate |
$69.00 |
| Rate for Payer: Aetna Commercial |
$67.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$39.75
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cigna Commercial |
$69.00
|
| Rate for Payer: Health EOS Commercial |
$66.75
|
| Rate for Payer: HFN Commercial |
$69.00
|
| Rate for Payer: Multiplan Commercial |
$60.00
|
| Rate for Payer: NAPHCARE Commercial |
$45.00
|
| Rate for Payer: Preferred Network Access Commercial |
$69.00
|
| Rate for Payer: Quartz Beloit One Network |
$36.75
|
| Rate for Payer: Quartz Commercial |
$45.00
|
| Rate for Payer: WEA Trust Commercial |
$41.25
|
| Rate for Payer: WPS Commercial |
$55.55
|
|
|
TUBE TRACHEAL 5.0 UNCUFFED #86238
|
Facility
OP
|
$75.00
|
|
| Hospital Charge Code |
2974404
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.00 |
| Max. Negotiated Rate |
$300.00 |
| Rate for Payer: Aetna Commercial |
$67.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$64.50
|
| Rate for Payer: Aetna Managed Medicare |
$21.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$48.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$37.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$36.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$39.75
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cigna Commercial |
$69.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$41.97
|
| Rate for Payer: Health EOS Commercial |
$66.75
|
| Rate for Payer: HFN Commercial |
$69.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$56.25
|
| Rate for Payer: Multiplan Commercial |
$60.00
|
| Rate for Payer: NAPHCARE Commercial |
$45.00
|
| Rate for Payer: Preferred Network Access Commercial |
$69.00
|
| Rate for Payer: Quartz Beloit One Network |
$36.75
|
| Rate for Payer: Quartz Commercial |
$48.75
|
| Rate for Payer: Quartz Medicare Advantage |
$45.00
|
| Rate for Payer: The Alliance Commercial |
$300.00
|
| Rate for Payer: WEA Trust Commercial |
$41.25
|
| Rate for Payer: WPS Commercial |
$55.55
|
|
|
TUBE TRACHEAL 6.0 UNCUFFED #5-10412
|
Facility
IP
|
$48.00
|
|
| Hospital Charge Code |
2974360
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$23.52 |
| Max. Negotiated Rate |
$44.16 |
| Rate for Payer: Aetna Commercial |
$43.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$25.44
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cigna Commercial |
$44.16
|
| Rate for Payer: Health EOS Commercial |
$42.72
|
| Rate for Payer: HFN Commercial |
$44.16
|
| Rate for Payer: Multiplan Commercial |
$38.40
|
| Rate for Payer: NAPHCARE Commercial |
$28.80
|
| Rate for Payer: Preferred Network Access Commercial |
$44.16
|
| Rate for Payer: Quartz Beloit One Network |
$23.52
|
| Rate for Payer: Quartz Commercial |
$28.80
|
| Rate for Payer: WEA Trust Commercial |
$26.40
|
| Rate for Payer: WPS Commercial |
$35.55
|
|
|
TUBE TRACHEAL 6.0 UNCUFFED #5-10412
|
Facility
OP
|
$48.00
|
|
| Hospital Charge Code |
2974360
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.44 |
| Max. Negotiated Rate |
$192.00 |
| Rate for Payer: Aetna Commercial |
$43.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$41.28
|
| Rate for Payer: Aetna Managed Medicare |
$13.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$31.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$24.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$23.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$25.44
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cigna Commercial |
$44.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$26.86
|
| Rate for Payer: Health EOS Commercial |
$42.72
|
| Rate for Payer: HFN Commercial |
$44.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$36.00
|
| Rate for Payer: Multiplan Commercial |
$38.40
|
| Rate for Payer: NAPHCARE Commercial |
$28.80
|
| Rate for Payer: Preferred Network Access Commercial |
$44.16
|
| Rate for Payer: Quartz Beloit One Network |
$23.52
|
| Rate for Payer: Quartz Commercial |
$31.20
|
| Rate for Payer: Quartz Medicare Advantage |
$28.80
|
| Rate for Payer: The Alliance Commercial |
$192.00
|
| Rate for Payer: WEA Trust Commercial |
$26.40
|
| Rate for Payer: WPS Commercial |
$35.55
|
|
|
TUBE TRACH SHILEY 4 CFD NON-FEN 4CN65H
|
Facility
OP
|
$788.00
|
|
| Hospital Charge Code |
5641668
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$220.64 |
| Max. Negotiated Rate |
$3,152.00 |
| Rate for Payer: Aetna Commercial |
$709.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$677.68
|
| Rate for Payer: Aetna Managed Medicare |
$220.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$512.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$394.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$378.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$417.64
|
| Rate for Payer: Cash Price |
$236.40
|
| Rate for Payer: Cigna Commercial |
$724.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$440.96
|
| Rate for Payer: Health EOS Commercial |
$701.32
|
| Rate for Payer: HFN Commercial |
$724.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$591.00
|
| Rate for Payer: Multiplan Commercial |
$630.40
|
| Rate for Payer: NAPHCARE Commercial |
$472.80
|
| Rate for Payer: Preferred Network Access Commercial |
$724.96
|
| Rate for Payer: Quartz Beloit One Network |
$386.12
|
| Rate for Payer: Quartz Commercial |
$512.20
|
| Rate for Payer: Quartz Medicare Advantage |
$472.80
|
| Rate for Payer: The Alliance Commercial |
$3,152.00
|
| Rate for Payer: WEA Trust Commercial |
$433.40
|
| Rate for Payer: WPS Commercial |
$583.67
|
|
|
TUBE TRACH SHILEY 4 CFD NON-FEN 4CN65H
|
Facility
IP
|
$788.00
|
|
| Hospital Charge Code |
5641668
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$386.12 |
| Max. Negotiated Rate |
$724.96 |
| Rate for Payer: Aetna Commercial |
$709.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$417.64
|
| Rate for Payer: Cash Price |
$236.40
|
| Rate for Payer: Cigna Commercial |
$724.96
|
| Rate for Payer: Health EOS Commercial |
$701.32
|
| Rate for Payer: HFN Commercial |
$724.96
|
| Rate for Payer: Multiplan Commercial |
$630.40
|
| Rate for Payer: NAPHCARE Commercial |
$472.80
|
| Rate for Payer: Preferred Network Access Commercial |
$724.96
|
| Rate for Payer: Quartz Beloit One Network |
$386.12
|
| Rate for Payer: Quartz Commercial |
$472.80
|
| Rate for Payer: WEA Trust Commercial |
$433.40
|
| Rate for Payer: WPS Commercial |
$583.67
|
|
|
Tube Y-Type Wfilter
|
Facility
OP
|
$138.00
|
|
| Hospital Charge Code |
3101773
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$38.64 |
| Max. Negotiated Rate |
$552.00 |
| Rate for Payer: Aetna Commercial |
$124.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$118.68
|
| Rate for Payer: Aetna Managed Medicare |
$38.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$89.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$69.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$66.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$73.14
|
| Rate for Payer: Cash Price |
$41.40
|
| Rate for Payer: Cigna Commercial |
$126.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$77.22
|
| Rate for Payer: Health EOS Commercial |
$122.82
|
| Rate for Payer: HFN Commercial |
$126.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$103.50
|
| Rate for Payer: Multiplan Commercial |
$110.40
|
| Rate for Payer: NAPHCARE Commercial |
$82.80
|
| Rate for Payer: Preferred Network Access Commercial |
$126.96
|
| Rate for Payer: Quartz Beloit One Network |
$67.62
|
| Rate for Payer: Quartz Commercial |
$89.70
|
| Rate for Payer: Quartz Medicare Advantage |
$82.80
|
| Rate for Payer: The Alliance Commercial |
$552.00
|
| Rate for Payer: WEA Trust Commercial |
$75.90
|
| Rate for Payer: WPS Commercial |
$102.22
|
|
|
Tube Y-Type Wfilter
|
Facility
IP
|
$138.00
|
|
| Hospital Charge Code |
3101773
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$67.62 |
| Max. Negotiated Rate |
$126.96 |
| Rate for Payer: Aetna Commercial |
$124.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$73.14
|
| Rate for Payer: Cash Price |
$41.40
|
| Rate for Payer: Cigna Commercial |
$126.96
|
| Rate for Payer: Health EOS Commercial |
$122.82
|
| Rate for Payer: HFN Commercial |
$126.96
|
| Rate for Payer: Multiplan Commercial |
$110.40
|
| Rate for Payer: NAPHCARE Commercial |
$82.80
|
| Rate for Payer: Preferred Network Access Commercial |
$126.96
|
| Rate for Payer: Quartz Beloit One Network |
$67.62
|
| Rate for Payer: Quartz Commercial |
$82.80
|
| Rate for Payer: WEA Trust Commercial |
$75.90
|
| Rate for Payer: WPS Commercial |
$102.22
|
|
|
TUBIGRIP SIZE B (BEIGE) 1449
|
Facility
IP
|
$569.00
|
|
| Hospital Charge Code |
2974507
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$278.81 |
| Max. Negotiated Rate |
$523.48 |
| Rate for Payer: Aetna Commercial |
$512.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$301.57
|
| Rate for Payer: Cash Price |
$170.70
|
| Rate for Payer: Cigna Commercial |
$523.48
|
| Rate for Payer: Health EOS Commercial |
$506.41
|
| Rate for Payer: HFN Commercial |
$523.48
|
| Rate for Payer: Multiplan Commercial |
$455.20
|
| Rate for Payer: NAPHCARE Commercial |
$341.40
|
| Rate for Payer: Preferred Network Access Commercial |
$523.48
|
| Rate for Payer: Quartz Beloit One Network |
$278.81
|
| Rate for Payer: Quartz Commercial |
$341.40
|
| Rate for Payer: WEA Trust Commercial |
$312.95
|
| Rate for Payer: WPS Commercial |
$421.46
|
|
|
TUBIGRIP SIZE B (BEIGE) 1449
|
Facility
OP
|
$569.00
|
|
| Hospital Charge Code |
2974507
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$159.32 |
| Max. Negotiated Rate |
$2,276.00 |
| Rate for Payer: Aetna Commercial |
$512.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$489.34
|
| Rate for Payer: Aetna Managed Medicare |
$159.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$369.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$284.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$273.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$301.57
|
| Rate for Payer: Cash Price |
$170.70
|
| Rate for Payer: Cigna Commercial |
$523.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$318.41
|
| Rate for Payer: Health EOS Commercial |
$506.41
|
| Rate for Payer: HFN Commercial |
$523.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$426.75
|
| Rate for Payer: Multiplan Commercial |
$455.20
|
| Rate for Payer: NAPHCARE Commercial |
$341.40
|
| Rate for Payer: Preferred Network Access Commercial |
$523.48
|
| Rate for Payer: Quartz Beloit One Network |
$278.81
|
| Rate for Payer: Quartz Commercial |
$369.85
|
| Rate for Payer: Quartz Medicare Advantage |
$341.40
|
| Rate for Payer: The Alliance Commercial |
$2,276.00
|
| Rate for Payer: WEA Trust Commercial |
$312.95
|
| Rate for Payer: WPS Commercial |
$421.46
|
|
|
TUBIGRIP SIZE C #1450
|
Facility
IP
|
$652.00
|
|
| Hospital Charge Code |
2969639
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$319.48 |
| Max. Negotiated Rate |
$599.84 |
| Rate for Payer: Aetna Commercial |
$586.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$345.56
|
| Rate for Payer: Cash Price |
$195.60
|
| Rate for Payer: Cigna Commercial |
$599.84
|
| Rate for Payer: Health EOS Commercial |
$580.28
|
| Rate for Payer: HFN Commercial |
$599.84
|
| Rate for Payer: Multiplan Commercial |
$521.60
|
| Rate for Payer: NAPHCARE Commercial |
$391.20
|
| Rate for Payer: Preferred Network Access Commercial |
$599.84
|
| Rate for Payer: Quartz Beloit One Network |
$319.48
|
| Rate for Payer: Quartz Commercial |
$391.20
|
| Rate for Payer: WEA Trust Commercial |
$358.60
|
| Rate for Payer: WPS Commercial |
$482.94
|
|
|
TUBIGRIP SIZE C #1450
|
Facility
OP
|
$652.00
|
|
| Hospital Charge Code |
2969639
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$182.56 |
| Max. Negotiated Rate |
$2,608.00 |
| Rate for Payer: Aetna Commercial |
$586.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$560.72
|
| Rate for Payer: Aetna Managed Medicare |
$182.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$423.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$326.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$312.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$345.56
|
| Rate for Payer: Cash Price |
$195.60
|
| Rate for Payer: Cigna Commercial |
$599.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$364.86
|
| Rate for Payer: Health EOS Commercial |
$580.28
|
| Rate for Payer: HFN Commercial |
$599.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$489.00
|
| Rate for Payer: Multiplan Commercial |
$521.60
|
| Rate for Payer: NAPHCARE Commercial |
$391.20
|
| Rate for Payer: Preferred Network Access Commercial |
$599.84
|
| Rate for Payer: Quartz Beloit One Network |
$319.48
|
| Rate for Payer: Quartz Commercial |
$423.80
|
| Rate for Payer: Quartz Medicare Advantage |
$391.20
|
| Rate for Payer: The Alliance Commercial |
$2,608.00
|
| Rate for Payer: WEA Trust Commercial |
$358.60
|
| Rate for Payer: WPS Commercial |
$482.94
|
|
|
TUBIGRIP SIZE D #1451
|
Facility
OP
|
$749.00
|
|
| Hospital Charge Code |
2969634
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$209.72 |
| Max. Negotiated Rate |
$2,996.00 |
| Rate for Payer: Aetna Commercial |
$674.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$644.14
|
| Rate for Payer: Aetna Managed Medicare |
$209.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$486.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$374.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$359.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$396.97
|
| Rate for Payer: Cash Price |
$224.70
|
| Rate for Payer: Cigna Commercial |
$689.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$419.14
|
| Rate for Payer: Health EOS Commercial |
$666.61
|
| Rate for Payer: HFN Commercial |
$689.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$561.75
|
| Rate for Payer: Multiplan Commercial |
$599.20
|
| Rate for Payer: NAPHCARE Commercial |
$449.40
|
| Rate for Payer: Preferred Network Access Commercial |
$689.08
|
| Rate for Payer: Quartz Beloit One Network |
$367.01
|
| Rate for Payer: Quartz Commercial |
$486.85
|
| Rate for Payer: Quartz Medicare Advantage |
$449.40
|
| Rate for Payer: The Alliance Commercial |
$2,996.00
|
| Rate for Payer: WEA Trust Commercial |
$411.95
|
| Rate for Payer: WPS Commercial |
$554.78
|
|
