|
TUBING LIFESHIELD CP PRIMARY
|
Facility
OP
|
$55.00
|
|
| Hospital Charge Code |
2963231
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.40 |
| Max. Negotiated Rate |
$220.00 |
| Rate for Payer: Aetna Commercial |
$49.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$47.30
|
| Rate for Payer: Aetna Managed Medicare |
$15.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$35.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$27.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$26.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$29.15
|
| Rate for Payer: Cash Price |
$16.50
|
| Rate for Payer: Cigna Commercial |
$50.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$30.78
|
| Rate for Payer: Health EOS Commercial |
$48.95
|
| Rate for Payer: HFN Commercial |
$50.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$41.25
|
| Rate for Payer: Multiplan Commercial |
$44.00
|
| Rate for Payer: NAPHCARE Commercial |
$33.00
|
| Rate for Payer: Preferred Network Access Commercial |
$50.60
|
| Rate for Payer: Quartz Beloit One Network |
$26.95
|
| Rate for Payer: Quartz Commercial |
$35.75
|
| Rate for Payer: Quartz Medicare Advantage |
$33.00
|
| Rate for Payer: The Alliance Commercial |
$220.00
|
| Rate for Payer: WEA Trust Commercial |
$30.25
|
| Rate for Payer: WPS Commercial |
$40.74
|
|
|
TUBING MIDAS REX IRRIGATION IRD300
|
Facility
IP
|
$1,513.00
|
|
| Hospital Charge Code |
3613495
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$741.37 |
| Max. Negotiated Rate |
$1,391.96 |
| Rate for Payer: Aetna Commercial |
$1,361.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$801.89
|
| Rate for Payer: Cash Price |
$453.90
|
| Rate for Payer: Cigna Commercial |
$1,391.96
|
| Rate for Payer: Health EOS Commercial |
$1,346.57
|
| Rate for Payer: HFN Commercial |
$1,391.96
|
| Rate for Payer: Multiplan Commercial |
$1,210.40
|
| Rate for Payer: NAPHCARE Commercial |
$907.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,391.96
|
| Rate for Payer: Quartz Beloit One Network |
$741.37
|
| Rate for Payer: Quartz Commercial |
$907.80
|
| Rate for Payer: WEA Trust Commercial |
$832.15
|
| Rate for Payer: WPS Commercial |
$1,120.68
|
|
|
TUBING MIDAS REX IRRIGATION IRD300
|
Facility
OP
|
$1,513.00
|
|
| Hospital Charge Code |
3613495
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$423.64 |
| Max. Negotiated Rate |
$6,052.00 |
| Rate for Payer: Aetna Commercial |
$1,361.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,301.18
|
| Rate for Payer: Aetna Managed Medicare |
$423.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$983.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$756.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$726.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$801.89
|
| Rate for Payer: Cash Price |
$453.90
|
| Rate for Payer: Cigna Commercial |
$1,391.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$846.67
|
| Rate for Payer: Health EOS Commercial |
$1,346.57
|
| Rate for Payer: HFN Commercial |
$1,391.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,134.75
|
| Rate for Payer: Multiplan Commercial |
$1,210.40
|
| Rate for Payer: NAPHCARE Commercial |
$907.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,391.96
|
| Rate for Payer: Quartz Beloit One Network |
$741.37
|
| Rate for Payer: Quartz Commercial |
$983.45
|
| Rate for Payer: Quartz Medicare Advantage |
$907.80
|
| Rate for Payer: The Alliance Commercial |
$6,052.00
|
| Rate for Payer: WEA Trust Commercial |
$832.15
|
| Rate for Payer: WPS Commercial |
$1,120.68
|
|
|
TUBING PACK 1/2x3/32x120 SHC10
|
Facility
IP
|
$490.00
|
|
| Hospital Charge Code |
2965788
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$240.10 |
| Max. Negotiated Rate |
$450.80 |
| Rate for Payer: Aetna Commercial |
$441.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$259.70
|
| Rate for Payer: Cash Price |
$147.00
|
| Rate for Payer: Cigna Commercial |
$450.80
|
| Rate for Payer: Health EOS Commercial |
$436.10
|
| Rate for Payer: HFN Commercial |
$450.80
|
| Rate for Payer: Multiplan Commercial |
$392.00
|
| Rate for Payer: NAPHCARE Commercial |
$294.00
|
| Rate for Payer: Preferred Network Access Commercial |
$450.80
|
| Rate for Payer: Quartz Beloit One Network |
$240.10
|
| Rate for Payer: Quartz Commercial |
$294.00
|
| Rate for Payer: WEA Trust Commercial |
$269.50
|
| Rate for Payer: WPS Commercial |
$362.94
|
|
|
TUBING PACK 1/2x3/32x120 SHC10
|
Facility
OP
|
$490.00
|
|
| Hospital Charge Code |
2965788
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$137.20 |
| Max. Negotiated Rate |
$1,960.00 |
| Rate for Payer: Aetna Commercial |
$441.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$421.40
|
| Rate for Payer: Aetna Managed Medicare |
$137.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$318.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$245.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$235.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$259.70
|
| Rate for Payer: Cash Price |
$147.00
|
| Rate for Payer: Cigna Commercial |
$450.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$274.20
|
| Rate for Payer: Health EOS Commercial |
$436.10
|
| Rate for Payer: HFN Commercial |
$450.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$367.50
|
| Rate for Payer: Multiplan Commercial |
$392.00
|
| Rate for Payer: NAPHCARE Commercial |
$294.00
|
| Rate for Payer: Preferred Network Access Commercial |
$450.80
|
| Rate for Payer: Quartz Beloit One Network |
$240.10
|
| Rate for Payer: Quartz Commercial |
$318.50
|
| Rate for Payer: Quartz Medicare Advantage |
$294.00
|
| Rate for Payer: The Alliance Commercial |
$1,960.00
|
| Rate for Payer: WEA Trust Commercial |
$269.50
|
| Rate for Payer: WPS Commercial |
$362.94
|
|
|
TUBING PACK 1/4 IN ID x 1/16 IN WALL X 10 FT CARDIOVASCULAR PROCEDURE KIT 70346
|
Facility
IP
|
$490.00
|
|
| Hospital Charge Code |
2965161
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$240.10 |
| Max. Negotiated Rate |
$450.80 |
| Rate for Payer: Aetna Commercial |
$441.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$259.70
|
| Rate for Payer: Cash Price |
$147.00
|
| Rate for Payer: Cigna Commercial |
$450.80
|
| Rate for Payer: Health EOS Commercial |
$436.10
|
| Rate for Payer: HFN Commercial |
$450.80
|
| Rate for Payer: Multiplan Commercial |
$392.00
|
| Rate for Payer: NAPHCARE Commercial |
$294.00
|
| Rate for Payer: Preferred Network Access Commercial |
$450.80
|
| Rate for Payer: Quartz Beloit One Network |
$240.10
|
| Rate for Payer: Quartz Commercial |
$294.00
|
| Rate for Payer: WEA Trust Commercial |
$269.50
|
| Rate for Payer: WPS Commercial |
$362.94
|
|
|
TUBING PACK 1/4 IN ID x 1/16 IN WALL X 10 FT CARDIOVASCULAR PROCEDURE KIT 70346
|
Facility
OP
|
$490.00
|
|
| Hospital Charge Code |
2965161
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$137.20 |
| Max. Negotiated Rate |
$1,960.00 |
| Rate for Payer: Aetna Commercial |
$441.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$421.40
|
| Rate for Payer: Aetna Managed Medicare |
$137.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$318.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$245.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$235.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$259.70
|
| Rate for Payer: Cash Price |
$147.00
|
| Rate for Payer: Cigna Commercial |
$450.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$274.20
|
| Rate for Payer: Health EOS Commercial |
$436.10
|
| Rate for Payer: HFN Commercial |
$450.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$367.50
|
| Rate for Payer: Multiplan Commercial |
$392.00
|
| Rate for Payer: NAPHCARE Commercial |
$294.00
|
| Rate for Payer: Preferred Network Access Commercial |
$450.80
|
| Rate for Payer: Quartz Beloit One Network |
$240.10
|
| Rate for Payer: Quartz Commercial |
$318.50
|
| Rate for Payer: Quartz Medicare Advantage |
$294.00
|
| Rate for Payer: The Alliance Commercial |
$1,960.00
|
| Rate for Payer: WEA Trust Commercial |
$269.50
|
| Rate for Payer: WPS Commercial |
$362.94
|
|
|
TUBING PACK 1/4 IN ID x 1/16 IN WALL X 7 FT CARDIOVASCULAR PROCEDURE KIT 60050
|
Facility
OP
|
$202.00
|
|
| Hospital Charge Code |
6200961
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$56.56 |
| Max. Negotiated Rate |
$808.00 |
| Rate for Payer: Aetna Commercial |
$181.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$173.72
|
| Rate for Payer: Aetna Managed Medicare |
$56.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$131.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$101.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$96.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$107.06
|
| Rate for Payer: Cash Price |
$60.60
|
| Rate for Payer: Cigna Commercial |
$185.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$113.04
|
| Rate for Payer: Health EOS Commercial |
$179.78
|
| Rate for Payer: HFN Commercial |
$185.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$151.50
|
| Rate for Payer: Multiplan Commercial |
$161.60
|
| Rate for Payer: NAPHCARE Commercial |
$121.20
|
| Rate for Payer: Preferred Network Access Commercial |
$185.84
|
| Rate for Payer: Quartz Beloit One Network |
$98.98
|
| Rate for Payer: Quartz Commercial |
$131.30
|
| Rate for Payer: Quartz Medicare Advantage |
$121.20
|
| Rate for Payer: The Alliance Commercial |
$808.00
|
| Rate for Payer: WEA Trust Commercial |
$111.10
|
| Rate for Payer: WPS Commercial |
$149.62
|
|
|
TUBING PACK 1/4 IN ID x 1/16 IN WALL X 7 FT CARDIOVASCULAR PROCEDURE KIT 60050
|
Facility
IP
|
$202.00
|
|
| Hospital Charge Code |
6200961
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$98.98 |
| Max. Negotiated Rate |
$185.84 |
| Rate for Payer: Aetna Commercial |
$181.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$107.06
|
| Rate for Payer: Cash Price |
$60.60
|
| Rate for Payer: Cigna Commercial |
$185.84
|
| Rate for Payer: Health EOS Commercial |
$179.78
|
| Rate for Payer: HFN Commercial |
$185.84
|
| Rate for Payer: Multiplan Commercial |
$161.60
|
| Rate for Payer: NAPHCARE Commercial |
$121.20
|
| Rate for Payer: Preferred Network Access Commercial |
$185.84
|
| Rate for Payer: Quartz Beloit One Network |
$98.98
|
| Rate for Payer: Quartz Commercial |
$121.20
|
| Rate for Payer: WEA Trust Commercial |
$111.10
|
| Rate for Payer: WPS Commercial |
$149.62
|
|
|
TUBING PACK 3/8x3/32x120 SFC10
|
Facility
OP
|
$490.00
|
|
| Hospital Charge Code |
2965789
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$137.20 |
| Max. Negotiated Rate |
$1,960.00 |
| Rate for Payer: Aetna Commercial |
$441.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$421.40
|
| Rate for Payer: Aetna Managed Medicare |
$137.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$318.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$245.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$235.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$259.70
|
| Rate for Payer: Cash Price |
$147.00
|
| Rate for Payer: Cigna Commercial |
$450.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$274.20
|
| Rate for Payer: Health EOS Commercial |
$436.10
|
| Rate for Payer: HFN Commercial |
$450.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$367.50
|
| Rate for Payer: Multiplan Commercial |
$392.00
|
| Rate for Payer: NAPHCARE Commercial |
$294.00
|
| Rate for Payer: Preferred Network Access Commercial |
$450.80
|
| Rate for Payer: Quartz Beloit One Network |
$240.10
|
| Rate for Payer: Quartz Commercial |
$318.50
|
| Rate for Payer: Quartz Medicare Advantage |
$294.00
|
| Rate for Payer: The Alliance Commercial |
$1,960.00
|
| Rate for Payer: WEA Trust Commercial |
$269.50
|
| Rate for Payer: WPS Commercial |
$362.94
|
|
|
TUBING PACK 3/8x3/32x120 SFC10
|
Facility
IP
|
$490.00
|
|
| Hospital Charge Code |
2965789
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$240.10 |
| Max. Negotiated Rate |
$450.80 |
| Rate for Payer: Aetna Commercial |
$441.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$259.70
|
| Rate for Payer: Cash Price |
$147.00
|
| Rate for Payer: Cigna Commercial |
$450.80
|
| Rate for Payer: Health EOS Commercial |
$436.10
|
| Rate for Payer: HFN Commercial |
$450.80
|
| Rate for Payer: Multiplan Commercial |
$392.00
|
| Rate for Payer: NAPHCARE Commercial |
$294.00
|
| Rate for Payer: Preferred Network Access Commercial |
$450.80
|
| Rate for Payer: Quartz Beloit One Network |
$240.10
|
| Rate for Payer: Quartz Commercial |
$294.00
|
| Rate for Payer: WEA Trust Commercial |
$269.50
|
| Rate for Payer: WPS Commercial |
$362.94
|
|
|
TUBING PCA COMBINATION SET 14279-28
|
Facility
OP
|
$135.00
|
|
| Hospital Charge Code |
2963210
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$37.80 |
| Max. Negotiated Rate |
$540.00 |
| Rate for Payer: Aetna Commercial |
$121.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$116.10
|
| Rate for Payer: Aetna Managed Medicare |
$37.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$87.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$67.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$64.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$71.55
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cigna Commercial |
$124.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$75.55
|
| Rate for Payer: Health EOS Commercial |
$120.15
|
| Rate for Payer: HFN Commercial |
$124.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$101.25
|
| Rate for Payer: Multiplan Commercial |
$108.00
|
| Rate for Payer: NAPHCARE Commercial |
$81.00
|
| Rate for Payer: Preferred Network Access Commercial |
$124.20
|
| Rate for Payer: Quartz Beloit One Network |
$66.15
|
| Rate for Payer: Quartz Commercial |
$87.75
|
| Rate for Payer: Quartz Medicare Advantage |
$81.00
|
| Rate for Payer: The Alliance Commercial |
$540.00
|
| Rate for Payer: WEA Trust Commercial |
$74.25
|
| Rate for Payer: WPS Commercial |
$99.99
|
|
|
TUBING PCA COMBINATION SET 14279-28
|
Facility
IP
|
$135.00
|
|
| Hospital Charge Code |
2963210
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$66.15 |
| Max. Negotiated Rate |
$124.20 |
| Rate for Payer: Aetna Commercial |
$121.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$71.55
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cigna Commercial |
$124.20
|
| Rate for Payer: Health EOS Commercial |
$120.15
|
| Rate for Payer: HFN Commercial |
$124.20
|
| Rate for Payer: Multiplan Commercial |
$108.00
|
| Rate for Payer: NAPHCARE Commercial |
$81.00
|
| Rate for Payer: Preferred Network Access Commercial |
$124.20
|
| Rate for Payer: Quartz Beloit One Network |
$66.15
|
| Rate for Payer: Quartz Commercial |
$81.00
|
| Rate for Payer: WEA Trust Commercial |
$74.25
|
| Rate for Payer: WPS Commercial |
$99.99
|
|
|
TUBING PERFUSION PACK 02946300
|
Facility
OP
|
$638.00
|
|
| Hospital Charge Code |
2966064
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$178.64 |
| Max. Negotiated Rate |
$2,552.00 |
| Rate for Payer: Aetna Commercial |
$574.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$548.68
|
| Rate for Payer: Aetna Managed Medicare |
$178.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$414.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$319.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$306.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$338.14
|
| Rate for Payer: Cash Price |
$191.40
|
| Rate for Payer: Cigna Commercial |
$586.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$357.02
|
| Rate for Payer: Health EOS Commercial |
$567.82
|
| Rate for Payer: HFN Commercial |
$586.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$478.50
|
| Rate for Payer: Multiplan Commercial |
$510.40
|
| Rate for Payer: NAPHCARE Commercial |
$382.80
|
| Rate for Payer: Preferred Network Access Commercial |
$586.96
|
| Rate for Payer: Quartz Beloit One Network |
$312.62
|
| Rate for Payer: Quartz Commercial |
$414.70
|
| Rate for Payer: Quartz Medicare Advantage |
$382.80
|
| Rate for Payer: The Alliance Commercial |
$2,552.00
|
| Rate for Payer: WEA Trust Commercial |
$350.90
|
| Rate for Payer: WPS Commercial |
$472.57
|
|
|
TUBING PERFUSION PACK 02946300
|
Facility
IP
|
$638.00
|
|
| Hospital Charge Code |
2966064
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$312.62 |
| Max. Negotiated Rate |
$586.96 |
| Rate for Payer: Aetna Commercial |
$574.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$338.14
|
| Rate for Payer: Cash Price |
$191.40
|
| Rate for Payer: Cigna Commercial |
$586.96
|
| Rate for Payer: Health EOS Commercial |
$567.82
|
| Rate for Payer: HFN Commercial |
$586.96
|
| Rate for Payer: Multiplan Commercial |
$510.40
|
| Rate for Payer: NAPHCARE Commercial |
$382.80
|
| Rate for Payer: Preferred Network Access Commercial |
$586.96
|
| Rate for Payer: Quartz Beloit One Network |
$312.62
|
| Rate for Payer: Quartz Commercial |
$382.80
|
| Rate for Payer: WEA Trust Commercial |
$350.90
|
| Rate for Payer: WPS Commercial |
$472.57
|
|
|
TUBING PRESSURE MONITOR LINE 029456000
|
Facility
IP
|
$1,262.00
|
|
| Hospital Charge Code |
2965816
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$618.38 |
| Max. Negotiated Rate |
$1,161.04 |
| Rate for Payer: Aetna Commercial |
$1,135.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$668.86
|
| Rate for Payer: Cash Price |
$378.60
|
| Rate for Payer: Cigna Commercial |
$1,161.04
|
| Rate for Payer: Health EOS Commercial |
$1,123.18
|
| Rate for Payer: HFN Commercial |
$1,161.04
|
| Rate for Payer: Multiplan Commercial |
$1,009.60
|
| Rate for Payer: NAPHCARE Commercial |
$757.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,161.04
|
| Rate for Payer: Quartz Beloit One Network |
$618.38
|
| Rate for Payer: Quartz Commercial |
$757.20
|
| Rate for Payer: WEA Trust Commercial |
$694.10
|
| Rate for Payer: WPS Commercial |
$934.76
|
|
|
TUBING PRESSURE MONITOR LINE 029456000
|
Facility
OP
|
$1,262.00
|
|
| Hospital Charge Code |
2965816
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$353.36 |
| Max. Negotiated Rate |
$5,048.00 |
| Rate for Payer: Aetna Commercial |
$1,135.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,085.32
|
| Rate for Payer: Aetna Managed Medicare |
$353.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$820.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$631.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$605.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$668.86
|
| Rate for Payer: Cash Price |
$378.60
|
| Rate for Payer: Cigna Commercial |
$1,161.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$706.22
|
| Rate for Payer: Health EOS Commercial |
$1,123.18
|
| Rate for Payer: HFN Commercial |
$1,161.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$946.50
|
| Rate for Payer: Multiplan Commercial |
$1,009.60
|
| Rate for Payer: NAPHCARE Commercial |
$757.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,161.04
|
| Rate for Payer: Quartz Beloit One Network |
$618.38
|
| Rate for Payer: Quartz Commercial |
$820.30
|
| Rate for Payer: Quartz Medicare Advantage |
$757.20
|
| Rate for Payer: The Alliance Commercial |
$5,048.00
|
| Rate for Payer: WEA Trust Commercial |
$694.10
|
| Rate for Payer: WPS Commercial |
$934.76
|
|
|
TUBING PROBE PLUS PRESSURIZED EPT03
|
Facility
OP
|
$762.00
|
|
| Hospital Charge Code |
2963012
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$213.36 |
| Max. Negotiated Rate |
$3,048.00 |
| Rate for Payer: Quartz Commercial |
$495.30
|
| Rate for Payer: Aetna Commercial |
$685.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$655.32
|
| Rate for Payer: Aetna Managed Medicare |
$213.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$495.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$381.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$365.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$403.86
|
| Rate for Payer: Cash Price |
$228.60
|
| Rate for Payer: Cigna Commercial |
$701.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$426.42
|
| Rate for Payer: Health EOS Commercial |
$678.18
|
| Rate for Payer: HFN Commercial |
$701.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$571.50
|
| Rate for Payer: Multiplan Commercial |
$609.60
|
| Rate for Payer: NAPHCARE Commercial |
$457.20
|
| Rate for Payer: Preferred Network Access Commercial |
$701.04
|
| Rate for Payer: Quartz Beloit One Network |
$373.38
|
| Rate for Payer: Quartz Medicare Advantage |
$457.20
|
| Rate for Payer: The Alliance Commercial |
$3,048.00
|
| Rate for Payer: WEA Trust Commercial |
$419.10
|
| Rate for Payer: WPS Commercial |
$564.41
|
|
|
TUBING PROBE PLUS PRESSURIZED EPT03
|
Facility
IP
|
$762.00
|
|
| Hospital Charge Code |
2963012
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$373.38 |
| Max. Negotiated Rate |
$701.04 |
| Rate for Payer: Aetna Commercial |
$685.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$403.86
|
| Rate for Payer: Cash Price |
$228.60
|
| Rate for Payer: Cigna Commercial |
$701.04
|
| Rate for Payer: Health EOS Commercial |
$678.18
|
| Rate for Payer: HFN Commercial |
$701.04
|
| Rate for Payer: Multiplan Commercial |
$609.60
|
| Rate for Payer: NAPHCARE Commercial |
$457.20
|
| Rate for Payer: Preferred Network Access Commercial |
$701.04
|
| Rate for Payer: Quartz Beloit One Network |
$373.38
|
| Rate for Payer: Quartz Commercial |
$457.20
|
| Rate for Payer: WEA Trust Commercial |
$419.10
|
| Rate for Payer: WPS Commercial |
$564.41
|
|
|
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
|
Facility
IP
|
$7.00
|
|
| Hospital Charge Code |
3040295
|
|
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
|
|
|
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: 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 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 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: 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 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
|
|
