|
TRAY LUMBAR PUNCTURE INFANT 22G QUINCKE
|
Facility
|
IP
|
$292.00
|
|
| Hospital Charge Code |
2963248
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$148.80 |
| Max. Negotiated Rate |
$279.39 |
| Rate for Payer: Aetna Commercial |
$273.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$261.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$160.95
|
| Rate for Payer: Cash Price |
$87.60
|
| Rate for Payer: Cigna Commercial |
$279.39
|
| Rate for Payer: Health EOS Commercial |
$270.28
|
| Rate for Payer: HFN Commercial |
$279.39
|
| Rate for Payer: Multiplan Commercial |
$242.94
|
| Rate for Payer: Preferred Network Access Commercial |
$279.39
|
| Rate for Payer: Quartz Beloit One Network |
$148.80
|
| Rate for Payer: Quartz Commercial |
$182.21
|
| Rate for Payer: WEA Trust Commercial |
$167.02
|
| Rate for Payer: WPS Commercial |
$224.93
|
|
|
TRAY LUMBAR PUNCTURE INFANT 22G QUINCKE
|
Facility
|
OP
|
$292.00
|
|
| Hospital Charge Code |
2963248
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$85.03 |
| Max. Negotiated Rate |
$279.39 |
| Rate for Payer: Aetna Commercial |
$273.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$261.16
|
| Rate for Payer: Aetna Managed Medicare |
$85.03
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$197.39
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$151.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$145.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$160.95
|
| Rate for Payer: Cash Price |
$87.60
|
| Rate for Payer: Cigna Commercial |
$279.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$169.94
|
| Rate for Payer: Health EOS Commercial |
$270.28
|
| Rate for Payer: HFN Commercial |
$279.39
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$227.76
|
| Rate for Payer: Multiplan Commercial |
$242.94
|
| Rate for Payer: NAPHCARE Commercial |
$182.21
|
| Rate for Payer: Preferred Network Access Commercial |
$279.39
|
| Rate for Payer: Quartz Beloit One Network |
$148.80
|
| Rate for Payer: Quartz Commercial |
$197.39
|
| Rate for Payer: Quartz Medicare Advantage |
$182.21
|
| Rate for Payer: The Alliance Commercial |
$151.84
|
| Rate for Payer: WEA Trust Commercial |
$167.02
|
| Rate for Payer: WPS Commercial |
$224.93
|
|
|
TRAY PARACERV PUDENDAL BLK. DYNJRA9046
|
Facility
|
OP
|
$240.00
|
|
| Hospital Charge Code |
2963046
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$69.89 |
| Max. Negotiated Rate |
$229.63 |
| Rate for Payer: Aetna Commercial |
$224.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$214.66
|
| Rate for Payer: Aetna Managed Medicare |
$69.89
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$162.24
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$124.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$119.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$132.29
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cigna Commercial |
$229.63
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$139.68
|
| Rate for Payer: Health EOS Commercial |
$222.14
|
| Rate for Payer: HFN Commercial |
$229.63
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$187.20
|
| Rate for Payer: Multiplan Commercial |
$199.68
|
| Rate for Payer: NAPHCARE Commercial |
$149.76
|
| Rate for Payer: Preferred Network Access Commercial |
$229.63
|
| Rate for Payer: Quartz Beloit One Network |
$122.30
|
| Rate for Payer: Quartz Commercial |
$162.24
|
| Rate for Payer: Quartz Medicare Advantage |
$149.76
|
| Rate for Payer: The Alliance Commercial |
$124.80
|
| Rate for Payer: WEA Trust Commercial |
$137.28
|
| Rate for Payer: WPS Commercial |
$184.87
|
|
|
TRAY PARACERV PUDENDAL BLK. DYNJRA9046
|
Facility
|
IP
|
$240.00
|
|
| Hospital Charge Code |
2963046
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$122.30 |
| Max. Negotiated Rate |
$229.63 |
| Rate for Payer: Aetna Commercial |
$224.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$214.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$132.29
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cigna Commercial |
$229.63
|
| Rate for Payer: Health EOS Commercial |
$222.14
|
| Rate for Payer: HFN Commercial |
$229.63
|
| Rate for Payer: Multiplan Commercial |
$199.68
|
| Rate for Payer: Preferred Network Access Commercial |
$229.63
|
| Rate for Payer: Quartz Beloit One Network |
$122.30
|
| Rate for Payer: Quartz Commercial |
$149.76
|
| Rate for Payer: WEA Trust Commercial |
$137.28
|
| Rate for Payer: WPS Commercial |
$184.87
|
|
|
TRAY PD CATHETER PRE-STERNAL 8888111132
|
Facility
|
OP
|
$5,699.00
|
|
|
Service Code
|
HCPCS C1750
|
| Hospital Charge Code |
4520299
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,659.55 |
| Max. Negotiated Rate |
$5,452.80 |
| Rate for Payer: Aetna Commercial |
$5,334.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,097.19
|
| Rate for Payer: Aetna Managed Medicare |
$1,659.55
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,852.52
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,963.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,844.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,141.29
|
| Rate for Payer: Cash Price |
$1,709.70
|
| Rate for Payer: Cigna Commercial |
$5,452.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,316.82
|
| Rate for Payer: Health EOS Commercial |
$5,274.99
|
| Rate for Payer: HFN Commercial |
$5,452.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,445.22
|
| Rate for Payer: Multiplan Commercial |
$4,741.57
|
| Rate for Payer: NAPHCARE Commercial |
$3,556.18
|
| Rate for Payer: Preferred Network Access Commercial |
$5,452.80
|
| Rate for Payer: Quartz Beloit One Network |
$2,904.21
|
| Rate for Payer: Quartz Commercial |
$3,852.52
|
| Rate for Payer: Quartz Medicare Advantage |
$3,556.18
|
| Rate for Payer: The Alliance Commercial |
$2,963.48
|
| Rate for Payer: WEA Trust Commercial |
$3,259.83
|
| Rate for Payer: WPS Commercial |
$4,389.94
|
|
|
TRAY PD CATHETER PRE-STERNAL 8888111132
|
Facility
|
IP
|
$5,699.00
|
|
|
Service Code
|
HCPCS C1750
|
| Hospital Charge Code |
4520299
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,904.21 |
| Max. Negotiated Rate |
$5,452.80 |
| Rate for Payer: Aetna Commercial |
$5,334.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,097.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,141.29
|
| Rate for Payer: Cash Price |
$1,709.70
|
| Rate for Payer: Cigna Commercial |
$5,452.80
|
| Rate for Payer: Health EOS Commercial |
$5,274.99
|
| Rate for Payer: HFN Commercial |
$5,452.80
|
| Rate for Payer: Multiplan Commercial |
$4,741.57
|
| Rate for Payer: Preferred Network Access Commercial |
$5,452.80
|
| Rate for Payer: Quartz Beloit One Network |
$2,904.21
|
| Rate for Payer: Quartz Commercial |
$3,556.18
|
| Rate for Payer: WEA Trust Commercial |
$3,259.83
|
| Rate for Payer: WPS Commercial |
$4,389.94
|
|
|
TRAY PERIFIX COMPLETE 18GX3.5 332236"
|
Facility
|
IP
|
$404.00
|
|
| Hospital Charge Code |
4595228
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$205.88 |
| Max. Negotiated Rate |
$386.55 |
| Rate for Payer: Aetna Commercial |
$378.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$361.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$222.68
|
| Rate for Payer: Cash Price |
$121.20
|
| Rate for Payer: Cigna Commercial |
$386.55
|
| Rate for Payer: Health EOS Commercial |
$373.94
|
| Rate for Payer: HFN Commercial |
$386.55
|
| Rate for Payer: Multiplan Commercial |
$336.13
|
| Rate for Payer: Preferred Network Access Commercial |
$386.55
|
| Rate for Payer: Quartz Beloit One Network |
$205.88
|
| Rate for Payer: Quartz Commercial |
$252.10
|
| Rate for Payer: WEA Trust Commercial |
$231.09
|
| Rate for Payer: WPS Commercial |
$311.20
|
|
|
TRAY PERIFIX COMPLETE 18GX3.5 332236"
|
Facility
|
OP
|
$404.00
|
|
| Hospital Charge Code |
4595228
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$117.64 |
| Max. Negotiated Rate |
$386.55 |
| Rate for Payer: Aetna Commercial |
$378.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$361.34
|
| Rate for Payer: Aetna Managed Medicare |
$117.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$273.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$210.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$201.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$222.68
|
| Rate for Payer: Cash Price |
$121.20
|
| Rate for Payer: Cigna Commercial |
$386.55
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$235.13
|
| Rate for Payer: Health EOS Commercial |
$373.94
|
| Rate for Payer: HFN Commercial |
$386.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$315.12
|
| Rate for Payer: Multiplan Commercial |
$336.13
|
| Rate for Payer: NAPHCARE Commercial |
$252.10
|
| Rate for Payer: Preferred Network Access Commercial |
$386.55
|
| Rate for Payer: Quartz Beloit One Network |
$205.88
|
| Rate for Payer: Quartz Commercial |
$273.10
|
| Rate for Payer: Quartz Medicare Advantage |
$252.10
|
| Rate for Payer: The Alliance Commercial |
$210.08
|
| Rate for Payer: WEA Trust Commercial |
$231.09
|
| Rate for Payer: WPS Commercial |
$311.20
|
|
|
TRAY PERITONEAL DIALYSIS #5C4150A
|
Facility
|
OP
|
$108.00
|
|
| Hospital Charge Code |
2972154
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.45 |
| Max. Negotiated Rate |
$103.33 |
| Rate for Payer: Aetna Commercial |
$101.09
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$96.60
|
| Rate for Payer: Aetna Managed Medicare |
$31.45
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$73.01
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$56.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$53.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$59.53
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cigna Commercial |
$103.33
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$62.86
|
| Rate for Payer: Health EOS Commercial |
$99.96
|
| Rate for Payer: HFN Commercial |
$103.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$84.24
|
| Rate for Payer: Multiplan Commercial |
$89.86
|
| Rate for Payer: NAPHCARE Commercial |
$67.39
|
| Rate for Payer: Preferred Network Access Commercial |
$103.33
|
| Rate for Payer: Quartz Beloit One Network |
$55.04
|
| Rate for Payer: Quartz Commercial |
$73.01
|
| Rate for Payer: Quartz Medicare Advantage |
$67.39
|
| Rate for Payer: The Alliance Commercial |
$56.16
|
| Rate for Payer: WEA Trust Commercial |
$61.78
|
| Rate for Payer: WPS Commercial |
$83.19
|
|
|
TRAY PERITONEAL DIALYSIS #5C4150A
|
Facility
|
IP
|
$108.00
|
|
| Hospital Charge Code |
2972154
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$55.04 |
| Max. Negotiated Rate |
$103.33 |
| Rate for Payer: Aetna Commercial |
$101.09
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$96.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$59.53
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cigna Commercial |
$103.33
|
| Rate for Payer: Health EOS Commercial |
$99.96
|
| Rate for Payer: HFN Commercial |
$103.33
|
| Rate for Payer: Multiplan Commercial |
$89.86
|
| Rate for Payer: Preferred Network Access Commercial |
$103.33
|
| Rate for Payer: Quartz Beloit One Network |
$55.04
|
| Rate for Payer: Quartz Commercial |
$67.39
|
| Rate for Payer: WEA Trust Commercial |
$61.78
|
| Rate for Payer: WPS Commercial |
$83.19
|
|
|
TRAY PNEUMOTHORAX WAYNE G56537
|
Facility
|
IP
|
$2,630.00
|
|
| Hospital Charge Code |
3453504
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,340.25 |
| Max. Negotiated Rate |
$2,516.38 |
| Rate for Payer: Aetna Commercial |
$2,461.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,352.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,449.66
|
| Rate for Payer: Cash Price |
$789.00
|
| Rate for Payer: Cigna Commercial |
$2,516.38
|
| Rate for Payer: Health EOS Commercial |
$2,434.33
|
| Rate for Payer: HFN Commercial |
$2,516.38
|
| Rate for Payer: Multiplan Commercial |
$2,188.16
|
| Rate for Payer: Preferred Network Access Commercial |
$2,516.38
|
| Rate for Payer: Quartz Beloit One Network |
$1,340.25
|
| Rate for Payer: Quartz Commercial |
$1,641.12
|
| Rate for Payer: WEA Trust Commercial |
$1,504.36
|
| Rate for Payer: WPS Commercial |
$2,025.89
|
|
|
TRAY PNEUMOTHORAX WAYNE G56537
|
Facility
|
OP
|
$2,630.00
|
|
| Hospital Charge Code |
3453504
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$765.86 |
| Max. Negotiated Rate |
$2,516.38 |
| Rate for Payer: Aetna Commercial |
$2,461.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,352.27
|
| Rate for Payer: Aetna Managed Medicare |
$765.86
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,777.88
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,367.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,312.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,449.66
|
| Rate for Payer: Cash Price |
$789.00
|
| Rate for Payer: Cigna Commercial |
$2,516.38
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,530.66
|
| Rate for Payer: Health EOS Commercial |
$2,434.33
|
| Rate for Payer: HFN Commercial |
$2,516.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,051.40
|
| Rate for Payer: Multiplan Commercial |
$2,188.16
|
| Rate for Payer: NAPHCARE Commercial |
$1,641.12
|
| Rate for Payer: Preferred Network Access Commercial |
$2,516.38
|
| Rate for Payer: Quartz Beloit One Network |
$1,340.25
|
| Rate for Payer: Quartz Commercial |
$1,777.88
|
| Rate for Payer: Quartz Medicare Advantage |
$1,641.12
|
| Rate for Payer: The Alliance Commercial |
$1,367.60
|
| Rate for Payer: WEA Trust Commercial |
$1,504.36
|
| Rate for Payer: WPS Commercial |
$2,025.89
|
|
|
TRAY SINGLE DOSE EPIDURAL 18ga 11992-20
|
Facility
|
IP
|
$356.00
|
|
| Hospital Charge Code |
2969063
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$181.42 |
| Max. Negotiated Rate |
$340.62 |
| Rate for Payer: Aetna Commercial |
$333.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$318.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$196.23
|
| Rate for Payer: Cash Price |
$106.80
|
| Rate for Payer: Cigna Commercial |
$340.62
|
| Rate for Payer: Health EOS Commercial |
$329.51
|
| Rate for Payer: HFN Commercial |
$340.62
|
| Rate for Payer: Multiplan Commercial |
$296.19
|
| Rate for Payer: Preferred Network Access Commercial |
$340.62
|
| Rate for Payer: Quartz Beloit One Network |
$181.42
|
| Rate for Payer: Quartz Commercial |
$222.14
|
| Rate for Payer: WEA Trust Commercial |
$203.63
|
| Rate for Payer: WPS Commercial |
$274.23
|
|
|
TRAY SINGLE DOSE EPIDURAL 18ga 11992-20
|
Facility
|
OP
|
$356.00
|
|
| Hospital Charge Code |
2969063
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$103.67 |
| Max. Negotiated Rate |
$340.62 |
| Rate for Payer: Aetna Commercial |
$333.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$318.41
|
| Rate for Payer: Aetna Managed Medicare |
$103.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$240.66
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$185.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$177.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$196.23
|
| Rate for Payer: Cash Price |
$106.80
|
| Rate for Payer: Cigna Commercial |
$340.62
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$207.19
|
| Rate for Payer: Health EOS Commercial |
$329.51
|
| Rate for Payer: HFN Commercial |
$340.62
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$277.68
|
| Rate for Payer: Multiplan Commercial |
$296.19
|
| Rate for Payer: NAPHCARE Commercial |
$222.14
|
| Rate for Payer: Preferred Network Access Commercial |
$340.62
|
| Rate for Payer: Quartz Beloit One Network |
$181.42
|
| Rate for Payer: Quartz Commercial |
$240.66
|
| Rate for Payer: Quartz Medicare Advantage |
$222.14
|
| Rate for Payer: The Alliance Commercial |
$185.12
|
| Rate for Payer: WEA Trust Commercial |
$203.63
|
| Rate for Payer: WPS Commercial |
$274.23
|
|
|
TRAY SKIN SCRUB PREP CHG 4489
|
Facility
|
IP
|
$115.00
|
|
| Hospital Charge Code |
2962820
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$58.60 |
| Max. Negotiated Rate |
$110.03 |
| Rate for Payer: Aetna Commercial |
$107.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$102.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$63.39
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cigna Commercial |
$110.03
|
| Rate for Payer: Health EOS Commercial |
$106.44
|
| Rate for Payer: HFN Commercial |
$110.03
|
| Rate for Payer: Multiplan Commercial |
$95.68
|
| Rate for Payer: Preferred Network Access Commercial |
$110.03
|
| Rate for Payer: Quartz Beloit One Network |
$58.60
|
| Rate for Payer: Quartz Commercial |
$71.76
|
| Rate for Payer: WEA Trust Commercial |
$65.78
|
| Rate for Payer: WPS Commercial |
$88.58
|
|
|
TRAY SKIN SCRUB PREP CHG 4489
|
Facility
|
OP
|
$115.00
|
|
| Hospital Charge Code |
2962820
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$33.49 |
| Max. Negotiated Rate |
$110.03 |
| Rate for Payer: Aetna Commercial |
$107.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$102.86
|
| Rate for Payer: Aetna Managed Medicare |
$33.49
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$77.74
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$59.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$57.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$63.39
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cigna Commercial |
$110.03
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$66.93
|
| Rate for Payer: Health EOS Commercial |
$106.44
|
| Rate for Payer: HFN Commercial |
$110.03
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$89.70
|
| Rate for Payer: Multiplan Commercial |
$95.68
|
| Rate for Payer: NAPHCARE Commercial |
$71.76
|
| Rate for Payer: Preferred Network Access Commercial |
$110.03
|
| Rate for Payer: Quartz Beloit One Network |
$58.60
|
| Rate for Payer: Quartz Commercial |
$77.74
|
| Rate for Payer: Quartz Medicare Advantage |
$71.76
|
| Rate for Payer: The Alliance Commercial |
$59.80
|
| Rate for Payer: WEA Trust Commercial |
$65.78
|
| Rate for Payer: WPS Commercial |
$88.58
|
|
|
TRAY SKIN SCRUB PREP PROVIDINE IODINE 4468
|
Facility
|
OP
|
$131.00
|
|
| Hospital Charge Code |
2963477
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$38.15 |
| Max. Negotiated Rate |
$125.34 |
| Rate for Payer: Aetna Commercial |
$122.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$117.17
|
| Rate for Payer: Aetna Managed Medicare |
$38.15
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$88.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$68.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$65.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$72.21
|
| Rate for Payer: Cash Price |
$39.30
|
| Rate for Payer: Cigna Commercial |
$125.34
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$76.24
|
| Rate for Payer: Health EOS Commercial |
$121.25
|
| Rate for Payer: HFN Commercial |
$125.34
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$102.18
|
| Rate for Payer: Multiplan Commercial |
$108.99
|
| Rate for Payer: NAPHCARE Commercial |
$81.74
|
| Rate for Payer: Preferred Network Access Commercial |
$125.34
|
| Rate for Payer: Quartz Beloit One Network |
$66.76
|
| Rate for Payer: Quartz Commercial |
$88.56
|
| Rate for Payer: Quartz Medicare Advantage |
$81.74
|
| Rate for Payer: The Alliance Commercial |
$68.12
|
| Rate for Payer: WEA Trust Commercial |
$74.93
|
| Rate for Payer: WPS Commercial |
$100.91
|
|
|
TRAY SKIN SCRUB PREP PROVIDINE IODINE 4468
|
Facility
|
IP
|
$131.00
|
|
| Hospital Charge Code |
2963477
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$66.76 |
| Max. Negotiated Rate |
$125.34 |
| Rate for Payer: Aetna Commercial |
$122.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$117.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$72.21
|
| Rate for Payer: Cash Price |
$39.30
|
| Rate for Payer: Cigna Commercial |
$125.34
|
| Rate for Payer: Health EOS Commercial |
$121.25
|
| Rate for Payer: HFN Commercial |
$125.34
|
| Rate for Payer: Multiplan Commercial |
$108.99
|
| Rate for Payer: Preferred Network Access Commercial |
$125.34
|
| Rate for Payer: Quartz Beloit One Network |
$66.76
|
| Rate for Payer: Quartz Commercial |
$81.74
|
| Rate for Payer: WEA Trust Commercial |
$74.93
|
| Rate for Payer: WPS Commercial |
$100.91
|
|
|
Tray Spinal Anesthesia
|
Facility
|
IP
|
$575.00
|
|
| Hospital Charge Code |
3101767
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$293.02 |
| Max. Negotiated Rate |
$550.16 |
| Rate for Payer: Aetna Commercial |
$538.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$514.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$316.94
|
| Rate for Payer: Cash Price |
$172.50
|
| Rate for Payer: Cigna Commercial |
$550.16
|
| Rate for Payer: Health EOS Commercial |
$532.22
|
| Rate for Payer: HFN Commercial |
$550.16
|
| Rate for Payer: Multiplan Commercial |
$478.40
|
| Rate for Payer: Preferred Network Access Commercial |
$550.16
|
| Rate for Payer: Quartz Beloit One Network |
$293.02
|
| Rate for Payer: Quartz Commercial |
$358.80
|
| Rate for Payer: WEA Trust Commercial |
$328.90
|
| Rate for Payer: WPS Commercial |
$442.92
|
|
|
Tray Spinal Anesthesia
|
Facility
|
OP
|
$575.00
|
|
| Hospital Charge Code |
3101767
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$167.44 |
| Max. Negotiated Rate |
$550.16 |
| Rate for Payer: Aetna Commercial |
$538.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$514.28
|
| Rate for Payer: Aetna Managed Medicare |
$167.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$388.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$299.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$287.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$316.94
|
| Rate for Payer: Cash Price |
$172.50
|
| Rate for Payer: Cigna Commercial |
$550.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$334.65
|
| Rate for Payer: Health EOS Commercial |
$532.22
|
| Rate for Payer: HFN Commercial |
$550.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$448.50
|
| Rate for Payer: Multiplan Commercial |
$478.40
|
| Rate for Payer: NAPHCARE Commercial |
$358.80
|
| Rate for Payer: Preferred Network Access Commercial |
$550.16
|
| Rate for Payer: Quartz Beloit One Network |
$293.02
|
| Rate for Payer: Quartz Commercial |
$388.70
|
| Rate for Payer: Quartz Medicare Advantage |
$358.80
|
| Rate for Payer: The Alliance Commercial |
$299.00
|
| Rate for Payer: WEA Trust Commercial |
$328.90
|
| Rate for Payer: WPS Commercial |
$442.92
|
|
|
TRAY SPINAL ANESTHESIA B
|
Facility
|
IP
|
$261.00
|
|
| Hospital Charge Code |
2969065
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$133.01 |
| Max. Negotiated Rate |
$249.72 |
| Rate for Payer: Aetna Commercial |
$244.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$233.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$143.86
|
| Rate for Payer: Cash Price |
$78.30
|
| Rate for Payer: Cigna Commercial |
$249.72
|
| Rate for Payer: Health EOS Commercial |
$241.58
|
| Rate for Payer: HFN Commercial |
$249.72
|
| Rate for Payer: Multiplan Commercial |
$217.15
|
| Rate for Payer: Preferred Network Access Commercial |
$249.72
|
| Rate for Payer: Quartz Beloit One Network |
$133.01
|
| Rate for Payer: Quartz Commercial |
$162.86
|
| Rate for Payer: WEA Trust Commercial |
$149.29
|
| Rate for Payer: WPS Commercial |
$201.05
|
|
|
TRAY SPINAL ANESTHESIA B
|
Facility
|
OP
|
$261.00
|
|
| Hospital Charge Code |
2969065
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$76.00 |
| Max. Negotiated Rate |
$249.72 |
| Rate for Payer: Aetna Commercial |
$244.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$233.44
|
| Rate for Payer: Aetna Managed Medicare |
$76.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$176.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$135.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$130.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$143.86
|
| Rate for Payer: Cash Price |
$78.30
|
| Rate for Payer: Cigna Commercial |
$249.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$151.90
|
| Rate for Payer: Health EOS Commercial |
$241.58
|
| Rate for Payer: HFN Commercial |
$249.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$203.58
|
| Rate for Payer: Multiplan Commercial |
$217.15
|
| Rate for Payer: NAPHCARE Commercial |
$162.86
|
| Rate for Payer: Preferred Network Access Commercial |
$249.72
|
| Rate for Payer: Quartz Beloit One Network |
$133.01
|
| Rate for Payer: Quartz Commercial |
$176.44
|
| Rate for Payer: Quartz Medicare Advantage |
$162.86
|
| Rate for Payer: The Alliance Commercial |
$135.72
|
| Rate for Payer: WEA Trust Commercial |
$149.29
|
| Rate for Payer: WPS Commercial |
$201.05
|
|
|
TRAY SPINAL/EPIDURAL COMBINED NEPI-12093-20
|
Facility
|
OP
|
$656.00
|
|
| Hospital Charge Code |
4373908
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$191.03 |
| Max. Negotiated Rate |
$627.66 |
| Rate for Payer: Aetna Commercial |
$614.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$586.73
|
| Rate for Payer: Aetna Managed Medicare |
$191.03
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$443.46
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$341.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$327.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$361.59
|
| Rate for Payer: Cash Price |
$196.80
|
| Rate for Payer: Cigna Commercial |
$627.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$381.79
|
| Rate for Payer: Health EOS Commercial |
$607.19
|
| Rate for Payer: HFN Commercial |
$627.66
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$511.68
|
| Rate for Payer: Multiplan Commercial |
$545.79
|
| Rate for Payer: NAPHCARE Commercial |
$409.34
|
| Rate for Payer: Preferred Network Access Commercial |
$627.66
|
| Rate for Payer: Quartz Beloit One Network |
$334.30
|
| Rate for Payer: Quartz Commercial |
$443.46
|
| Rate for Payer: Quartz Medicare Advantage |
$409.34
|
| Rate for Payer: The Alliance Commercial |
$341.12
|
| Rate for Payer: WEA Trust Commercial |
$375.23
|
| Rate for Payer: WPS Commercial |
$505.32
|
|
|
TRAY SPINAL/EPIDURAL COMBINED NEPI-12093-20
|
Facility
|
IP
|
$656.00
|
|
| Hospital Charge Code |
4373908
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$334.30 |
| Max. Negotiated Rate |
$627.66 |
| Rate for Payer: Aetna Commercial |
$614.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$586.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$361.59
|
| Rate for Payer: Cash Price |
$196.80
|
| Rate for Payer: Cigna Commercial |
$627.66
|
| Rate for Payer: Health EOS Commercial |
$607.19
|
| Rate for Payer: HFN Commercial |
$627.66
|
| Rate for Payer: Multiplan Commercial |
$545.79
|
| Rate for Payer: Preferred Network Access Commercial |
$627.66
|
| Rate for Payer: Quartz Beloit One Network |
$334.30
|
| Rate for Payer: Quartz Commercial |
$409.34
|
| Rate for Payer: WEA Trust Commercial |
$375.23
|
| Rate for Payer: WPS Commercial |
$505.32
|
|
|
TRAY THAL QUICK 12F CHEST TUBE G05464
|
Facility
|
IP
|
$2,311.00
|
|
| Hospital Charge Code |
6202989
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,177.69 |
| Max. Negotiated Rate |
$2,211.16 |
| Rate for Payer: Aetna Commercial |
$2,163.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,066.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,273.82
|
| Rate for Payer: Cash Price |
$693.30
|
| Rate for Payer: Cigna Commercial |
$2,211.16
|
| Rate for Payer: Health EOS Commercial |
$2,139.06
|
| Rate for Payer: HFN Commercial |
$2,211.16
|
| Rate for Payer: Multiplan Commercial |
$1,922.75
|
| Rate for Payer: Preferred Network Access Commercial |
$2,211.16
|
| Rate for Payer: Quartz Beloit One Network |
$1,177.69
|
| Rate for Payer: Quartz Commercial |
$1,442.06
|
| Rate for Payer: WEA Trust Commercial |
$1,321.89
|
| Rate for Payer: WPS Commercial |
$1,780.16
|
|
