|
TRAY AMNIOCENTESIS 20 x 3.5
|
Facility
|
IP
|
$328.00
|
|
| Hospital Charge Code |
2963119
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$167.15 |
| Max. Negotiated Rate |
$313.83 |
| Rate for Payer: Aetna Commercial |
$307.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$293.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$180.79
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cigna Commercial |
$313.83
|
| Rate for Payer: Health EOS Commercial |
$303.60
|
| Rate for Payer: HFN Commercial |
$313.83
|
| Rate for Payer: Multiplan Commercial |
$272.90
|
| Rate for Payer: Preferred Network Access Commercial |
$313.83
|
| Rate for Payer: Quartz Beloit One Network |
$167.15
|
| Rate for Payer: Quartz Commercial |
$204.67
|
| Rate for Payer: WEA Trust Commercial |
$187.62
|
| Rate for Payer: WPS Commercial |
$252.66
|
|
|
TRAY AMNIOCENTESIS 20 x 3.5
|
Facility
|
OP
|
$328.00
|
|
| Hospital Charge Code |
2963119
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$95.51 |
| Max. Negotiated Rate |
$313.83 |
| Rate for Payer: Aetna Commercial |
$307.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$293.36
|
| Rate for Payer: Aetna Managed Medicare |
$95.51
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$221.73
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$170.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$163.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$180.79
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cigna Commercial |
$313.83
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$190.90
|
| Rate for Payer: Health EOS Commercial |
$303.60
|
| Rate for Payer: HFN Commercial |
$313.83
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$255.84
|
| Rate for Payer: Multiplan Commercial |
$272.90
|
| Rate for Payer: NAPHCARE Commercial |
$204.67
|
| Rate for Payer: Preferred Network Access Commercial |
$313.83
|
| Rate for Payer: Quartz Beloit One Network |
$167.15
|
| Rate for Payer: Quartz Commercial |
$221.73
|
| Rate for Payer: Quartz Medicare Advantage |
$204.67
|
| Rate for Payer: The Alliance Commercial |
$170.56
|
| Rate for Payer: WEA Trust Commercial |
$187.62
|
| Rate for Payer: WPS Commercial |
$252.66
|
|
|
Tray Anest Single 19Ga622G
|
Facility
|
IP
|
$758.00
|
|
| Hospital Charge Code |
3101765
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$386.28 |
| Max. Negotiated Rate |
$725.25 |
| Rate for Payer: Aetna Commercial |
$709.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$677.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$417.81
|
| Rate for Payer: Cash Price |
$227.40
|
| Rate for Payer: Cigna Commercial |
$725.25
|
| Rate for Payer: Health EOS Commercial |
$701.60
|
| Rate for Payer: HFN Commercial |
$725.25
|
| Rate for Payer: Multiplan Commercial |
$630.66
|
| Rate for Payer: Preferred Network Access Commercial |
$725.25
|
| Rate for Payer: Quartz Beloit One Network |
$386.28
|
| Rate for Payer: Quartz Commercial |
$472.99
|
| Rate for Payer: WEA Trust Commercial |
$433.58
|
| Rate for Payer: WPS Commercial |
$583.89
|
|
|
Tray Anest Single 19Ga622G
|
Facility
|
OP
|
$758.00
|
|
| Hospital Charge Code |
3101765
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$220.73 |
| Max. Negotiated Rate |
$725.25 |
| Rate for Payer: Aetna Commercial |
$709.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$677.96
|
| Rate for Payer: Aetna Managed Medicare |
$220.73
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$512.41
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$394.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$378.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$417.81
|
| Rate for Payer: Cash Price |
$227.40
|
| Rate for Payer: Cigna Commercial |
$725.25
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$441.16
|
| Rate for Payer: Health EOS Commercial |
$701.60
|
| Rate for Payer: HFN Commercial |
$725.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$591.24
|
| Rate for Payer: Multiplan Commercial |
$630.66
|
| Rate for Payer: NAPHCARE Commercial |
$472.99
|
| Rate for Payer: Preferred Network Access Commercial |
$725.25
|
| Rate for Payer: Quartz Beloit One Network |
$386.28
|
| Rate for Payer: Quartz Commercial |
$512.41
|
| Rate for Payer: Quartz Medicare Advantage |
$472.99
|
| Rate for Payer: The Alliance Commercial |
$394.16
|
| Rate for Payer: WEA Trust Commercial |
$433.58
|
| Rate for Payer: WPS Commercial |
$583.89
|
|
|
TRAY ARTHROSCOPY KNEE DYNJS0810
|
Facility
|
OP
|
$747.00
|
|
| Hospital Charge Code |
6153642
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$217.53 |
| Max. Negotiated Rate |
$714.73 |
| Rate for Payer: Aetna Commercial |
$699.19
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$668.12
|
| Rate for Payer: Aetna Managed Medicare |
$217.53
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$504.97
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$388.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$372.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$411.75
|
| Rate for Payer: Cash Price |
$224.10
|
| Rate for Payer: Cigna Commercial |
$714.73
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$434.75
|
| Rate for Payer: Health EOS Commercial |
$691.42
|
| Rate for Payer: HFN Commercial |
$714.73
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$582.66
|
| Rate for Payer: Multiplan Commercial |
$621.50
|
| Rate for Payer: NAPHCARE Commercial |
$466.13
|
| Rate for Payer: Preferred Network Access Commercial |
$714.73
|
| Rate for Payer: Quartz Beloit One Network |
$380.67
|
| Rate for Payer: Quartz Commercial |
$504.97
|
| Rate for Payer: Quartz Medicare Advantage |
$466.13
|
| Rate for Payer: The Alliance Commercial |
$388.44
|
| Rate for Payer: WEA Trust Commercial |
$427.28
|
| Rate for Payer: WPS Commercial |
$575.41
|
|
|
TRAY ARTHROSCOPY KNEE DYNJS0810
|
Facility
|
IP
|
$747.00
|
|
| Hospital Charge Code |
6153642
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$380.67 |
| Max. Negotiated Rate |
$714.73 |
| Rate for Payer: Aetna Commercial |
$699.19
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$668.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$411.75
|
| Rate for Payer: Cash Price |
$224.10
|
| Rate for Payer: Cigna Commercial |
$714.73
|
| Rate for Payer: Health EOS Commercial |
$691.42
|
| Rate for Payer: HFN Commercial |
$714.73
|
| Rate for Payer: Multiplan Commercial |
$621.50
|
| Rate for Payer: Preferred Network Access Commercial |
$714.73
|
| Rate for Payer: Quartz Beloit One Network |
$380.67
|
| Rate for Payer: Quartz Commercial |
$466.13
|
| Rate for Payer: WEA Trust Commercial |
$427.28
|
| Rate for Payer: WPS Commercial |
$575.41
|
|
|
TRAY BONE BIOPSY & MARROW JAMSHIDI NEEDLE 11G BAK4511
|
Facility
|
IP
|
$780.00
|
|
| Hospital Charge Code |
2962868
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$397.49 |
| Max. Negotiated Rate |
$746.30 |
| Rate for Payer: Aetna Commercial |
$730.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$697.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$429.94
|
| Rate for Payer: Cash Price |
$234.00
|
| Rate for Payer: Cigna Commercial |
$746.30
|
| Rate for Payer: Health EOS Commercial |
$721.97
|
| Rate for Payer: HFN Commercial |
$746.30
|
| Rate for Payer: Multiplan Commercial |
$648.96
|
| Rate for Payer: Preferred Network Access Commercial |
$746.30
|
| Rate for Payer: Quartz Beloit One Network |
$397.49
|
| Rate for Payer: Quartz Commercial |
$486.72
|
| Rate for Payer: WEA Trust Commercial |
$446.16
|
| Rate for Payer: WPS Commercial |
$600.83
|
|
|
TRAY BONE BIOPSY & MARROW JAMSHIDI NEEDLE 11G BAK4511
|
Facility
|
OP
|
$780.00
|
|
| Hospital Charge Code |
2962868
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$227.14 |
| Max. Negotiated Rate |
$746.30 |
| Rate for Payer: Aetna Commercial |
$730.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$697.63
|
| Rate for Payer: Aetna Managed Medicare |
$227.14
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$527.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$405.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$389.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$429.94
|
| Rate for Payer: Cash Price |
$234.00
|
| Rate for Payer: Cigna Commercial |
$746.30
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$453.96
|
| Rate for Payer: Health EOS Commercial |
$721.97
|
| Rate for Payer: HFN Commercial |
$746.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$608.40
|
| Rate for Payer: Multiplan Commercial |
$648.96
|
| Rate for Payer: NAPHCARE Commercial |
$486.72
|
| Rate for Payer: Preferred Network Access Commercial |
$746.30
|
| Rate for Payer: Quartz Beloit One Network |
$397.49
|
| Rate for Payer: Quartz Commercial |
$527.28
|
| Rate for Payer: Quartz Medicare Advantage |
$486.72
|
| Rate for Payer: The Alliance Commercial |
$405.60
|
| Rate for Payer: WEA Trust Commercial |
$446.16
|
| Rate for Payer: WPS Commercial |
$600.83
|
|
|
TRAY CATH 16FR SURE STEP LF INTS16
|
Facility
|
IP
|
$102.00
|
|
| Hospital Charge Code |
2963586
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$51.98 |
| Max. Negotiated Rate |
$97.59 |
| Rate for Payer: Aetna Commercial |
$95.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$91.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$56.22
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cigna Commercial |
$97.59
|
| Rate for Payer: Health EOS Commercial |
$94.41
|
| Rate for Payer: HFN Commercial |
$97.59
|
| Rate for Payer: Multiplan Commercial |
$84.86
|
| Rate for Payer: Preferred Network Access Commercial |
$97.59
|
| Rate for Payer: Quartz Beloit One Network |
$51.98
|
| Rate for Payer: Quartz Commercial |
$63.65
|
| Rate for Payer: WEA Trust Commercial |
$58.34
|
| Rate for Payer: WPS Commercial |
$78.57
|
|
|
TRAY CATH 16FR SURE STEP LF INTS16
|
Facility
|
OP
|
$102.00
|
|
| Hospital Charge Code |
2963586
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$29.70 |
| Max. Negotiated Rate |
$97.59 |
| Rate for Payer: Aetna Commercial |
$95.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$91.23
|
| Rate for Payer: Aetna Managed Medicare |
$29.70
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$68.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$53.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$50.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$56.22
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cigna Commercial |
$97.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$59.36
|
| Rate for Payer: Health EOS Commercial |
$94.41
|
| Rate for Payer: HFN Commercial |
$97.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$79.56
|
| Rate for Payer: Multiplan Commercial |
$84.86
|
| Rate for Payer: NAPHCARE Commercial |
$63.65
|
| Rate for Payer: Preferred Network Access Commercial |
$97.59
|
| Rate for Payer: Quartz Beloit One Network |
$51.98
|
| Rate for Payer: Quartz Commercial |
$68.95
|
| Rate for Payer: Quartz Medicare Advantage |
$63.65
|
| Rate for Payer: The Alliance Commercial |
$53.04
|
| Rate for Payer: WEA Trust Commercial |
$58.34
|
| Rate for Payer: WPS Commercial |
$78.57
|
|
|
TRAY CATHETER DRAINAGE SAFE-T PIG1260TSP
|
Facility
|
IP
|
$1,326.00
|
|
| Hospital Charge Code |
2973715
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$675.73 |
| Max. Negotiated Rate |
$1,268.72 |
| Rate for Payer: Aetna Commercial |
$1,241.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,185.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$730.89
|
| Rate for Payer: Cash Price |
$397.80
|
| Rate for Payer: Cigna Commercial |
$1,268.72
|
| Rate for Payer: Health EOS Commercial |
$1,227.35
|
| Rate for Payer: HFN Commercial |
$1,268.72
|
| Rate for Payer: Multiplan Commercial |
$1,103.23
|
| Rate for Payer: Preferred Network Access Commercial |
$1,268.72
|
| Rate for Payer: Quartz Beloit One Network |
$675.73
|
| Rate for Payer: Quartz Commercial |
$827.42
|
| Rate for Payer: WEA Trust Commercial |
$758.47
|
| Rate for Payer: WPS Commercial |
$1,021.42
|
|
|
TRAY CATHETER DRAINAGE SAFE-T PIG1260TSP
|
Facility
|
OP
|
$1,326.00
|
|
| Hospital Charge Code |
2973715
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$386.13 |
| Max. Negotiated Rate |
$1,268.72 |
| Rate for Payer: Aetna Commercial |
$1,241.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,185.97
|
| Rate for Payer: Aetna Managed Medicare |
$386.13
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$896.38
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$689.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$661.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$730.89
|
| Rate for Payer: Cash Price |
$397.80
|
| Rate for Payer: Cigna Commercial |
$1,268.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$771.73
|
| Rate for Payer: Health EOS Commercial |
$1,227.35
|
| Rate for Payer: HFN Commercial |
$1,268.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,034.28
|
| Rate for Payer: Multiplan Commercial |
$1,103.23
|
| Rate for Payer: NAPHCARE Commercial |
$827.42
|
| Rate for Payer: Preferred Network Access Commercial |
$1,268.72
|
| Rate for Payer: Quartz Beloit One Network |
$675.73
|
| Rate for Payer: Quartz Commercial |
$896.38
|
| Rate for Payer: Quartz Medicare Advantage |
$827.42
|
| Rate for Payer: The Alliance Commercial |
$689.52
|
| Rate for Payer: WEA Trust Commercial |
$758.47
|
| Rate for Payer: WPS Commercial |
$1,021.42
|
|
|
TRAY CENTRAL LINE DRESSING DYND75229
|
Facility
|
OP
|
$98.00
|
|
| Hospital Charge Code |
2963393
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$28.54 |
| Max. Negotiated Rate |
$93.77 |
| Rate for Payer: Aetna Commercial |
$91.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$87.65
|
| Rate for Payer: Aetna Managed Medicare |
$28.54
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$66.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$50.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$48.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$54.02
|
| Rate for Payer: Cash Price |
$29.40
|
| Rate for Payer: Cigna Commercial |
$93.77
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$57.04
|
| Rate for Payer: Health EOS Commercial |
$90.71
|
| Rate for Payer: HFN Commercial |
$93.77
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$76.44
|
| Rate for Payer: Multiplan Commercial |
$81.54
|
| Rate for Payer: NAPHCARE Commercial |
$61.15
|
| Rate for Payer: Preferred Network Access Commercial |
$93.77
|
| Rate for Payer: Quartz Beloit One Network |
$49.94
|
| Rate for Payer: Quartz Commercial |
$66.25
|
| Rate for Payer: Quartz Medicare Advantage |
$61.15
|
| Rate for Payer: The Alliance Commercial |
$50.96
|
| Rate for Payer: WEA Trust Commercial |
$56.06
|
| Rate for Payer: WPS Commercial |
$75.49
|
|
|
TRAY CENTRAL LINE DRESSING DYND75229
|
Facility
|
IP
|
$98.00
|
|
| Hospital Charge Code |
2963393
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$49.94 |
| Max. Negotiated Rate |
$93.77 |
| Rate for Payer: Aetna Commercial |
$91.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$87.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$54.02
|
| Rate for Payer: Cash Price |
$29.40
|
| Rate for Payer: Cigna Commercial |
$93.77
|
| Rate for Payer: Health EOS Commercial |
$90.71
|
| Rate for Payer: HFN Commercial |
$93.77
|
| Rate for Payer: Multiplan Commercial |
$81.54
|
| Rate for Payer: Preferred Network Access Commercial |
$93.77
|
| Rate for Payer: Quartz Beloit One Network |
$49.94
|
| Rate for Payer: Quartz Commercial |
$61.15
|
| Rate for Payer: WEA Trust Commercial |
$56.06
|
| Rate for Payer: WPS Commercial |
$75.49
|
|
|
TRAY CIRCUMCISION 5295
|
Facility
|
OP
|
$488.00
|
|
| Hospital Charge Code |
2963011
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$142.11 |
| Max. Negotiated Rate |
$466.92 |
| Rate for Payer: Aetna Commercial |
$456.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$436.47
|
| Rate for Payer: Aetna Managed Medicare |
$142.11
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$329.89
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$253.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$243.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$268.99
|
| Rate for Payer: Cash Price |
$146.40
|
| Rate for Payer: Cigna Commercial |
$466.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$284.02
|
| Rate for Payer: Health EOS Commercial |
$451.69
|
| Rate for Payer: HFN Commercial |
$466.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$380.64
|
| Rate for Payer: Multiplan Commercial |
$406.02
|
| Rate for Payer: NAPHCARE Commercial |
$304.51
|
| Rate for Payer: Preferred Network Access Commercial |
$466.92
|
| Rate for Payer: Quartz Beloit One Network |
$248.68
|
| Rate for Payer: Quartz Commercial |
$329.89
|
| Rate for Payer: Quartz Medicare Advantage |
$304.51
|
| Rate for Payer: The Alliance Commercial |
$253.76
|
| Rate for Payer: WEA Trust Commercial |
$279.14
|
| Rate for Payer: WPS Commercial |
$375.91
|
|
|
TRAY CIRCUMCISION 5295
|
Facility
|
IP
|
$488.00
|
|
| Hospital Charge Code |
2963011
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$248.68 |
| Max. Negotiated Rate |
$466.92 |
| Rate for Payer: Aetna Commercial |
$456.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$436.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$268.99
|
| Rate for Payer: Cash Price |
$146.40
|
| Rate for Payer: Cigna Commercial |
$466.92
|
| Rate for Payer: Health EOS Commercial |
$451.69
|
| Rate for Payer: HFN Commercial |
$466.92
|
| Rate for Payer: Multiplan Commercial |
$406.02
|
| Rate for Payer: Preferred Network Access Commercial |
$466.92
|
| Rate for Payer: Quartz Beloit One Network |
$248.68
|
| Rate for Payer: Quartz Commercial |
$304.51
|
| Rate for Payer: WEA Trust Commercial |
$279.14
|
| Rate for Payer: WPS Commercial |
$375.91
|
|
|
TRAY CIRCUMCISION MEDLINE DYNDA1353
|
Facility
|
IP
|
$358.00
|
|
| Hospital Charge Code |
3976389
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$182.44 |
| Max. Negotiated Rate |
$342.53 |
| Rate for Payer: Aetna Commercial |
$335.09
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$320.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$197.33
|
| Rate for Payer: Cash Price |
$107.40
|
| Rate for Payer: Cigna Commercial |
$342.53
|
| Rate for Payer: Health EOS Commercial |
$331.36
|
| Rate for Payer: HFN Commercial |
$342.53
|
| Rate for Payer: Multiplan Commercial |
$297.86
|
| Rate for Payer: Preferred Network Access Commercial |
$342.53
|
| Rate for Payer: Quartz Beloit One Network |
$182.44
|
| Rate for Payer: Quartz Commercial |
$223.39
|
| Rate for Payer: WEA Trust Commercial |
$204.78
|
| Rate for Payer: WPS Commercial |
$275.77
|
|
|
TRAY CIRCUMCISION MEDLINE DYNDA1353
|
Facility
|
OP
|
$358.00
|
|
| Hospital Charge Code |
3976389
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$104.25 |
| Max. Negotiated Rate |
$342.53 |
| Rate for Payer: Aetna Commercial |
$335.09
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$320.20
|
| Rate for Payer: Aetna Managed Medicare |
$104.25
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$242.01
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$186.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$178.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$197.33
|
| Rate for Payer: Cash Price |
$107.40
|
| Rate for Payer: Cigna Commercial |
$342.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$208.36
|
| Rate for Payer: Health EOS Commercial |
$331.36
|
| Rate for Payer: HFN Commercial |
$342.53
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$279.24
|
| Rate for Payer: Multiplan Commercial |
$297.86
|
| Rate for Payer: NAPHCARE Commercial |
$223.39
|
| Rate for Payer: Preferred Network Access Commercial |
$342.53
|
| Rate for Payer: Quartz Beloit One Network |
$182.44
|
| Rate for Payer: Quartz Commercial |
$242.01
|
| Rate for Payer: Quartz Medicare Advantage |
$223.39
|
| Rate for Payer: The Alliance Commercial |
$186.16
|
| Rate for Payer: WEA Trust Commercial |
$204.78
|
| Rate for Payer: WPS Commercial |
$275.77
|
|
|
TRAY CONT EPIDURAL PERIFIX 18GX3-1/2 TUOHYN
|
Facility
|
OP
|
$511.00
|
|
| Hospital Charge Code |
2969062
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$148.80 |
| Max. Negotiated Rate |
$488.92 |
| Rate for Payer: Aetna Commercial |
$478.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$457.04
|
| Rate for Payer: Aetna Managed Medicare |
$148.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$345.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$265.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$255.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$281.66
|
| Rate for Payer: Cash Price |
$153.30
|
| Rate for Payer: Cigna Commercial |
$488.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$297.40
|
| Rate for Payer: Health EOS Commercial |
$472.98
|
| Rate for Payer: HFN Commercial |
$488.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$398.58
|
| Rate for Payer: Multiplan Commercial |
$425.15
|
| Rate for Payer: NAPHCARE Commercial |
$318.86
|
| Rate for Payer: Preferred Network Access Commercial |
$488.92
|
| Rate for Payer: Quartz Beloit One Network |
$260.41
|
| Rate for Payer: Quartz Commercial |
$345.44
|
| Rate for Payer: Quartz Medicare Advantage |
$318.86
|
| Rate for Payer: The Alliance Commercial |
$265.72
|
| Rate for Payer: WEA Trust Commercial |
$292.29
|
| Rate for Payer: WPS Commercial |
$393.62
|
|
|
TRAY CONT EPIDURAL PERIFIX 18GX3-1/2 TUOHYN
|
Facility
|
IP
|
$511.00
|
|
| Hospital Charge Code |
2969062
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$260.41 |
| Max. Negotiated Rate |
$488.92 |
| Rate for Payer: Aetna Commercial |
$478.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$457.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$281.66
|
| Rate for Payer: Cash Price |
$153.30
|
| Rate for Payer: Cigna Commercial |
$488.92
|
| Rate for Payer: Health EOS Commercial |
$472.98
|
| Rate for Payer: HFN Commercial |
$488.92
|
| Rate for Payer: Multiplan Commercial |
$425.15
|
| Rate for Payer: Preferred Network Access Commercial |
$488.92
|
| Rate for Payer: Quartz Beloit One Network |
$260.41
|
| Rate for Payer: Quartz Commercial |
$318.86
|
| Rate for Payer: WEA Trust Commercial |
$292.29
|
| Rate for Payer: WPS Commercial |
$393.62
|
|
|
TRAY CRITICORE W/FOLEY SURESTEP A900216
|
Facility
|
IP
|
$664.00
|
|
| Hospital Charge Code |
2963660
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$338.37 |
| Max. Negotiated Rate |
$635.32 |
| Rate for Payer: Aetna Commercial |
$621.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$593.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$366.00
|
| Rate for Payer: Cash Price |
$199.20
|
| Rate for Payer: Cigna Commercial |
$635.32
|
| Rate for Payer: Health EOS Commercial |
$614.60
|
| Rate for Payer: HFN Commercial |
$635.32
|
| Rate for Payer: Multiplan Commercial |
$552.45
|
| Rate for Payer: Preferred Network Access Commercial |
$635.32
|
| Rate for Payer: Quartz Beloit One Network |
$338.37
|
| Rate for Payer: Quartz Commercial |
$414.34
|
| Rate for Payer: WEA Trust Commercial |
$379.81
|
| Rate for Payer: WPS Commercial |
$511.48
|
|
|
TRAY CRITICORE W/FOLEY SURESTEP A900216
|
Facility
|
OP
|
$664.00
|
|
| Hospital Charge Code |
2963660
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$193.36 |
| Max. Negotiated Rate |
$635.32 |
| Rate for Payer: Aetna Commercial |
$621.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$593.88
|
| Rate for Payer: Aetna Managed Medicare |
$193.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$448.86
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$345.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$331.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$366.00
|
| Rate for Payer: Cash Price |
$199.20
|
| Rate for Payer: Cigna Commercial |
$635.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$386.45
|
| Rate for Payer: Health EOS Commercial |
$614.60
|
| Rate for Payer: HFN Commercial |
$635.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$517.92
|
| Rate for Payer: Multiplan Commercial |
$552.45
|
| Rate for Payer: NAPHCARE Commercial |
$414.34
|
| Rate for Payer: Preferred Network Access Commercial |
$635.32
|
| Rate for Payer: Quartz Beloit One Network |
$338.37
|
| Rate for Payer: Quartz Commercial |
$448.86
|
| Rate for Payer: Quartz Medicare Advantage |
$414.34
|
| Rate for Payer: The Alliance Commercial |
$345.28
|
| Rate for Payer: WEA Trust Commercial |
$379.81
|
| Rate for Payer: WPS Commercial |
$511.48
|
|
|
Tray Epidural Anes Cont
|
Facility
|
OP
|
$786.00
|
|
| Hospital Charge Code |
3101764
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$228.88 |
| Max. Negotiated Rate |
$752.04 |
| Rate for Payer: Aetna Commercial |
$735.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$703.00
|
| Rate for Payer: Aetna Managed Medicare |
$228.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$531.34
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$408.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$392.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$433.24
|
| Rate for Payer: Cash Price |
$235.80
|
| Rate for Payer: Cigna Commercial |
$752.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$457.45
|
| Rate for Payer: Health EOS Commercial |
$727.52
|
| Rate for Payer: HFN Commercial |
$752.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$613.08
|
| Rate for Payer: Multiplan Commercial |
$653.95
|
| Rate for Payer: NAPHCARE Commercial |
$490.46
|
| Rate for Payer: Preferred Network Access Commercial |
$752.04
|
| Rate for Payer: Quartz Beloit One Network |
$400.55
|
| Rate for Payer: Quartz Commercial |
$531.34
|
| Rate for Payer: Quartz Medicare Advantage |
$490.46
|
| Rate for Payer: The Alliance Commercial |
$408.72
|
| Rate for Payer: WEA Trust Commercial |
$449.59
|
| Rate for Payer: WPS Commercial |
$605.46
|
|
|
Tray Epidural Anes Cont
|
Facility
|
IP
|
$786.00
|
|
| Hospital Charge Code |
3101764
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$400.55 |
| Max. Negotiated Rate |
$752.04 |
| Rate for Payer: Aetna Commercial |
$735.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$703.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$433.24
|
| Rate for Payer: Cash Price |
$235.80
|
| Rate for Payer: Cigna Commercial |
$752.04
|
| Rate for Payer: Health EOS Commercial |
$727.52
|
| Rate for Payer: HFN Commercial |
$752.04
|
| Rate for Payer: Multiplan Commercial |
$653.95
|
| Rate for Payer: Preferred Network Access Commercial |
$752.04
|
| Rate for Payer: Quartz Beloit One Network |
$400.55
|
| Rate for Payer: Quartz Commercial |
$490.46
|
| Rate for Payer: WEA Trust Commercial |
$449.59
|
| Rate for Payer: WPS Commercial |
$605.46
|
|
|
TRAY EPIDURAL SINGLE SHOT 20GA 4947-20
|
Facility
|
OP
|
$405.00
|
|
| Hospital Charge Code |
2969064
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$117.94 |
| Max. Negotiated Rate |
$387.50 |
| Rate for Payer: Aetna Commercial |
$379.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$362.23
|
| Rate for Payer: Aetna Managed Medicare |
$117.94
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$273.78
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$210.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$202.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$223.24
|
| Rate for Payer: Cash Price |
$121.50
|
| Rate for Payer: Cigna Commercial |
$387.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$235.71
|
| Rate for Payer: Health EOS Commercial |
$374.87
|
| Rate for Payer: HFN Commercial |
$387.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$315.90
|
| Rate for Payer: Multiplan Commercial |
$336.96
|
| Rate for Payer: NAPHCARE Commercial |
$252.72
|
| Rate for Payer: Preferred Network Access Commercial |
$387.50
|
| Rate for Payer: Quartz Beloit One Network |
$206.39
|
| Rate for Payer: Quartz Commercial |
$273.78
|
| Rate for Payer: Quartz Medicare Advantage |
$252.72
|
| Rate for Payer: The Alliance Commercial |
$210.60
|
| Rate for Payer: WEA Trust Commercial |
$231.66
|
| Rate for Payer: WPS Commercial |
$311.97
|
|
