|
TRAY CATHETER DRAINAGE SAFE-T PIG1260TSP
|
Facility
|
IP
|
$1,326.00
|
|
| Hospital Charge Code |
2973715
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$649.74 |
| Max. Negotiated Rate |
$1,219.92 |
| Rate for Payer: Aetna Commercial |
$1,193.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,140.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$702.78
|
| Rate for Payer: Cash Price |
$397.80
|
| Rate for Payer: Cigna Commercial |
$1,219.92
|
| Rate for Payer: Health EOS Commercial |
$1,180.14
|
| Rate for Payer: HFN Commercial |
$1,219.92
|
| Rate for Payer: Multiplan Commercial |
$1,060.80
|
| Rate for Payer: NAPHCARE Commercial |
$795.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,219.92
|
| Rate for Payer: Quartz Beloit One Network |
$649.74
|
| Rate for Payer: Quartz Commercial |
$795.60
|
| Rate for Payer: WEA Trust Commercial |
$729.30
|
| Rate for Payer: WPS Commercial |
$982.17
|
|
|
TRAY CATHETER DRAINAGE SAFE-T PIG1260TSP
|
Facility
|
OP
|
$1,326.00
|
|
| Hospital Charge Code |
2973715
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$371.28 |
| Max. Negotiated Rate |
$5,304.00 |
| Rate for Payer: Aetna Commercial |
$1,193.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,140.36
|
| Rate for Payer: Aetna Managed Medicare |
$371.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$861.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$663.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$636.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$702.78
|
| Rate for Payer: Cash Price |
$397.80
|
| Rate for Payer: Cigna Commercial |
$1,219.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$742.03
|
| Rate for Payer: Health EOS Commercial |
$1,180.14
|
| Rate for Payer: HFN Commercial |
$1,219.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$994.50
|
| Rate for Payer: Multiplan Commercial |
$1,060.80
|
| Rate for Payer: NAPHCARE Commercial |
$795.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,219.92
|
| Rate for Payer: Quartz Beloit One Network |
$649.74
|
| Rate for Payer: Quartz Commercial |
$861.90
|
| Rate for Payer: Quartz Medicare Advantage |
$795.60
|
| Rate for Payer: The Alliance Commercial |
$5,304.00
|
| Rate for Payer: WEA Trust Commercial |
$729.30
|
| Rate for Payer: WPS Commercial |
$982.17
|
|
|
TRAY CENTRAL LINE DRESSING DYND75229
|
Facility
|
OP
|
$98.00
|
|
| Hospital Charge Code |
2963393
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$27.44 |
| Max. Negotiated Rate |
$392.00 |
| Rate for Payer: Aetna Commercial |
$88.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$84.28
|
| Rate for Payer: Aetna Managed Medicare |
$27.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$63.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$49.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$47.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$51.94
|
| Rate for Payer: Cash Price |
$29.40
|
| Rate for Payer: Cigna Commercial |
$90.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$54.84
|
| Rate for Payer: Health EOS Commercial |
$87.22
|
| Rate for Payer: HFN Commercial |
$90.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$73.50
|
| Rate for Payer: Multiplan Commercial |
$78.40
|
| Rate for Payer: NAPHCARE Commercial |
$58.80
|
| Rate for Payer: Preferred Network Access Commercial |
$90.16
|
| Rate for Payer: Quartz Beloit One Network |
$48.02
|
| Rate for Payer: Quartz Commercial |
$63.70
|
| Rate for Payer: Quartz Medicare Advantage |
$58.80
|
| Rate for Payer: The Alliance Commercial |
$392.00
|
| Rate for Payer: WEA Trust Commercial |
$53.90
|
| Rate for Payer: WPS Commercial |
$72.59
|
|
|
TRAY CENTRAL LINE DRESSING DYND75229
|
Facility
|
IP
|
$98.00
|
|
| Hospital Charge Code |
2963393
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$48.02 |
| Max. Negotiated Rate |
$90.16 |
| Rate for Payer: Aetna Commercial |
$88.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$84.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$51.94
|
| Rate for Payer: Cash Price |
$29.40
|
| Rate for Payer: Cigna Commercial |
$90.16
|
| Rate for Payer: Health EOS Commercial |
$87.22
|
| Rate for Payer: HFN Commercial |
$90.16
|
| Rate for Payer: Multiplan Commercial |
$78.40
|
| Rate for Payer: NAPHCARE Commercial |
$58.80
|
| Rate for Payer: Preferred Network Access Commercial |
$90.16
|
| Rate for Payer: Quartz Beloit One Network |
$48.02
|
| Rate for Payer: Quartz Commercial |
$58.80
|
| Rate for Payer: WEA Trust Commercial |
$53.90
|
| Rate for Payer: WPS Commercial |
$72.59
|
|
|
TRAY CIRCUMCISION 5295
|
Facility
|
OP
|
$488.00
|
|
| Hospital Charge Code |
2963011
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$136.64 |
| Max. Negotiated Rate |
$1,952.00 |
| Rate for Payer: Aetna Commercial |
$439.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$419.68
|
| Rate for Payer: Aetna Managed Medicare |
$136.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$317.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$244.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$234.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$258.64
|
| Rate for Payer: Cash Price |
$146.40
|
| Rate for Payer: Cigna Commercial |
$448.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$273.08
|
| Rate for Payer: Health EOS Commercial |
$434.32
|
| Rate for Payer: HFN Commercial |
$448.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$366.00
|
| Rate for Payer: Multiplan Commercial |
$390.40
|
| Rate for Payer: NAPHCARE Commercial |
$292.80
|
| Rate for Payer: Preferred Network Access Commercial |
$448.96
|
| Rate for Payer: Quartz Beloit One Network |
$239.12
|
| Rate for Payer: Quartz Commercial |
$317.20
|
| Rate for Payer: Quartz Medicare Advantage |
$292.80
|
| Rate for Payer: The Alliance Commercial |
$1,952.00
|
| Rate for Payer: WEA Trust Commercial |
$268.40
|
| Rate for Payer: WPS Commercial |
$361.46
|
|
|
TRAY CIRCUMCISION 5295
|
Facility
|
IP
|
$488.00
|
|
| Hospital Charge Code |
2963011
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$239.12 |
| Max. Negotiated Rate |
$448.96 |
| Rate for Payer: Aetna Commercial |
$439.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$419.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$258.64
|
| Rate for Payer: Cash Price |
$146.40
|
| Rate for Payer: Cigna Commercial |
$448.96
|
| Rate for Payer: Health EOS Commercial |
$434.32
|
| Rate for Payer: HFN Commercial |
$448.96
|
| Rate for Payer: Multiplan Commercial |
$390.40
|
| Rate for Payer: NAPHCARE Commercial |
$292.80
|
| Rate for Payer: Preferred Network Access Commercial |
$448.96
|
| Rate for Payer: Quartz Beloit One Network |
$239.12
|
| Rate for Payer: Quartz Commercial |
$292.80
|
| Rate for Payer: WEA Trust Commercial |
$268.40
|
| Rate for Payer: WPS Commercial |
$361.46
|
|
|
TRAY CIRCUMCISION MEDLINE DYNDA1353
|
Facility
|
OP
|
$358.00
|
|
| Hospital Charge Code |
3976389
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$100.24 |
| Max. Negotiated Rate |
$1,432.00 |
| Rate for Payer: Aetna Commercial |
$322.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$307.88
|
| Rate for Payer: Aetna Managed Medicare |
$100.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$232.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$179.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$171.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$189.74
|
| Rate for Payer: Cash Price |
$107.40
|
| Rate for Payer: Cigna Commercial |
$329.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$200.34
|
| Rate for Payer: Health EOS Commercial |
$318.62
|
| Rate for Payer: HFN Commercial |
$329.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$268.50
|
| Rate for Payer: Multiplan Commercial |
$286.40
|
| Rate for Payer: NAPHCARE Commercial |
$214.80
|
| Rate for Payer: Preferred Network Access Commercial |
$329.36
|
| Rate for Payer: Quartz Beloit One Network |
$175.42
|
| Rate for Payer: Quartz Commercial |
$232.70
|
| Rate for Payer: Quartz Medicare Advantage |
$214.80
|
| Rate for Payer: The Alliance Commercial |
$1,432.00
|
| Rate for Payer: WEA Trust Commercial |
$196.90
|
| Rate for Payer: WPS Commercial |
$265.17
|
|
|
TRAY CIRCUMCISION MEDLINE DYNDA1353
|
Facility
|
IP
|
$358.00
|
|
| Hospital Charge Code |
3976389
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$175.42 |
| Max. Negotiated Rate |
$329.36 |
| Rate for Payer: Aetna Commercial |
$322.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$307.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$189.74
|
| Rate for Payer: Cash Price |
$107.40
|
| Rate for Payer: Cigna Commercial |
$329.36
|
| Rate for Payer: Health EOS Commercial |
$318.62
|
| Rate for Payer: HFN Commercial |
$329.36
|
| Rate for Payer: Multiplan Commercial |
$286.40
|
| Rate for Payer: NAPHCARE Commercial |
$214.80
|
| Rate for Payer: Preferred Network Access Commercial |
$329.36
|
| Rate for Payer: Quartz Beloit One Network |
$175.42
|
| Rate for Payer: Quartz Commercial |
$214.80
|
| Rate for Payer: WEA Trust Commercial |
$196.90
|
| Rate for Payer: WPS Commercial |
$265.17
|
|
|
TRAY CONT EPIDURAL PERIFIX 18GX3-1/2 TUOHYN
|
Facility
|
OP
|
$511.00
|
|
| Hospital Charge Code |
2969062
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$143.08 |
| Max. Negotiated Rate |
$2,044.00 |
| Rate for Payer: Aetna Commercial |
$459.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$439.46
|
| Rate for Payer: Aetna Managed Medicare |
$143.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$332.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$255.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$245.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$270.83
|
| Rate for Payer: Cash Price |
$153.30
|
| Rate for Payer: Cigna Commercial |
$470.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$285.96
|
| Rate for Payer: Health EOS Commercial |
$454.79
|
| Rate for Payer: HFN Commercial |
$470.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$383.25
|
| Rate for Payer: Multiplan Commercial |
$408.80
|
| Rate for Payer: NAPHCARE Commercial |
$306.60
|
| Rate for Payer: Preferred Network Access Commercial |
$470.12
|
| Rate for Payer: Quartz Beloit One Network |
$250.39
|
| Rate for Payer: Quartz Commercial |
$332.15
|
| Rate for Payer: Quartz Medicare Advantage |
$306.60
|
| Rate for Payer: The Alliance Commercial |
$2,044.00
|
| Rate for Payer: WEA Trust Commercial |
$281.05
|
| Rate for Payer: WPS Commercial |
$378.50
|
|
|
TRAY CONT EPIDURAL PERIFIX 18GX3-1/2 TUOHYN
|
Facility
|
IP
|
$511.00
|
|
| Hospital Charge Code |
2969062
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$250.39 |
| Max. Negotiated Rate |
$470.12 |
| Rate for Payer: Aetna Commercial |
$459.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$439.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$270.83
|
| Rate for Payer: Cash Price |
$153.30
|
| Rate for Payer: Cigna Commercial |
$470.12
|
| Rate for Payer: Health EOS Commercial |
$454.79
|
| Rate for Payer: HFN Commercial |
$470.12
|
| Rate for Payer: Multiplan Commercial |
$408.80
|
| Rate for Payer: NAPHCARE Commercial |
$306.60
|
| Rate for Payer: Preferred Network Access Commercial |
$470.12
|
| Rate for Payer: Quartz Beloit One Network |
$250.39
|
| Rate for Payer: Quartz Commercial |
$306.60
|
| Rate for Payer: WEA Trust Commercial |
$281.05
|
| Rate for Payer: WPS Commercial |
$378.50
|
|
|
TRAY CRITICORE W/FOLEY SURESTEP A900216
|
Facility
|
IP
|
$664.00
|
|
| Hospital Charge Code |
2963660
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$325.36 |
| Max. Negotiated Rate |
$610.88 |
| Rate for Payer: Aetna Commercial |
$597.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$571.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$351.92
|
| Rate for Payer: Cash Price |
$199.20
|
| Rate for Payer: Cigna Commercial |
$610.88
|
| Rate for Payer: Health EOS Commercial |
$590.96
|
| Rate for Payer: HFN Commercial |
$610.88
|
| Rate for Payer: Multiplan Commercial |
$531.20
|
| Rate for Payer: NAPHCARE Commercial |
$398.40
|
| Rate for Payer: Preferred Network Access Commercial |
$610.88
|
| Rate for Payer: Quartz Beloit One Network |
$325.36
|
| Rate for Payer: Quartz Commercial |
$398.40
|
| Rate for Payer: WEA Trust Commercial |
$365.20
|
| Rate for Payer: WPS Commercial |
$491.82
|
|
|
TRAY CRITICORE W/FOLEY SURESTEP A900216
|
Facility
|
OP
|
$664.00
|
|
| Hospital Charge Code |
2963660
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$185.92 |
| Max. Negotiated Rate |
$2,656.00 |
| Rate for Payer: Aetna Commercial |
$597.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$571.04
|
| Rate for Payer: Aetna Managed Medicare |
$185.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$431.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$332.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$318.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$351.92
|
| Rate for Payer: Cash Price |
$199.20
|
| Rate for Payer: Cigna Commercial |
$610.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$371.57
|
| Rate for Payer: Health EOS Commercial |
$590.96
|
| Rate for Payer: HFN Commercial |
$610.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$498.00
|
| Rate for Payer: Multiplan Commercial |
$531.20
|
| Rate for Payer: NAPHCARE Commercial |
$398.40
|
| Rate for Payer: Preferred Network Access Commercial |
$610.88
|
| Rate for Payer: Quartz Beloit One Network |
$325.36
|
| Rate for Payer: Quartz Commercial |
$431.60
|
| Rate for Payer: Quartz Medicare Advantage |
$398.40
|
| Rate for Payer: The Alliance Commercial |
$2,656.00
|
| Rate for Payer: WEA Trust Commercial |
$365.20
|
| Rate for Payer: WPS Commercial |
$491.82
|
|
|
Tray Epidural Anes Cont
|
Facility
|
OP
|
$786.00
|
|
| Hospital Charge Code |
3101764
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$220.08 |
| Max. Negotiated Rate |
$3,144.00 |
| Rate for Payer: Aetna Commercial |
$707.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$675.96
|
| Rate for Payer: Aetna Managed Medicare |
$220.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$510.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$393.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$377.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$416.58
|
| Rate for Payer: Cash Price |
$235.80
|
| Rate for Payer: Cigna Commercial |
$723.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$439.85
|
| Rate for Payer: Health EOS Commercial |
$699.54
|
| Rate for Payer: HFN Commercial |
$723.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$589.50
|
| Rate for Payer: Multiplan Commercial |
$628.80
|
| Rate for Payer: NAPHCARE Commercial |
$471.60
|
| Rate for Payer: Preferred Network Access Commercial |
$723.12
|
| Rate for Payer: Quartz Beloit One Network |
$385.14
|
| Rate for Payer: Quartz Commercial |
$510.90
|
| Rate for Payer: Quartz Medicare Advantage |
$471.60
|
| Rate for Payer: The Alliance Commercial |
$3,144.00
|
| Rate for Payer: WEA Trust Commercial |
$432.30
|
| Rate for Payer: WPS Commercial |
$582.19
|
|
|
Tray Epidural Anes Cont
|
Facility
|
IP
|
$786.00
|
|
| Hospital Charge Code |
3101764
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$385.14 |
| Max. Negotiated Rate |
$723.12 |
| Rate for Payer: Aetna Commercial |
$707.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$675.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$416.58
|
| Rate for Payer: Cash Price |
$235.80
|
| Rate for Payer: Cigna Commercial |
$723.12
|
| Rate for Payer: Health EOS Commercial |
$699.54
|
| Rate for Payer: HFN Commercial |
$723.12
|
| Rate for Payer: Multiplan Commercial |
$628.80
|
| Rate for Payer: NAPHCARE Commercial |
$471.60
|
| Rate for Payer: Preferred Network Access Commercial |
$723.12
|
| Rate for Payer: Quartz Beloit One Network |
$385.14
|
| Rate for Payer: Quartz Commercial |
$471.60
|
| Rate for Payer: WEA Trust Commercial |
$432.30
|
| Rate for Payer: WPS Commercial |
$582.19
|
|
|
TRAY EPIDURAL SINGLE SHOT 20GA 4947-20
|
Facility
|
IP
|
$405.00
|
|
| Hospital Charge Code |
2969064
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$198.45 |
| Max. Negotiated Rate |
$372.60 |
| Rate for Payer: Aetna Commercial |
$364.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$348.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$214.65
|
| Rate for Payer: Cash Price |
$121.50
|
| Rate for Payer: Cigna Commercial |
$372.60
|
| Rate for Payer: Health EOS Commercial |
$360.45
|
| Rate for Payer: HFN Commercial |
$372.60
|
| Rate for Payer: Multiplan Commercial |
$324.00
|
| Rate for Payer: NAPHCARE Commercial |
$243.00
|
| Rate for Payer: Preferred Network Access Commercial |
$372.60
|
| Rate for Payer: Quartz Beloit One Network |
$198.45
|
| Rate for Payer: Quartz Commercial |
$243.00
|
| Rate for Payer: WEA Trust Commercial |
$222.75
|
| Rate for Payer: WPS Commercial |
$299.98
|
|
|
TRAY EPIDURAL SINGLE SHOT 20GA 4947-20
|
Facility
|
OP
|
$405.00
|
|
| Hospital Charge Code |
2969064
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$113.40 |
| Max. Negotiated Rate |
$1,620.00 |
| Rate for Payer: Aetna Commercial |
$364.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$348.30
|
| Rate for Payer: Aetna Managed Medicare |
$113.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$263.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$202.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$194.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$214.65
|
| Rate for Payer: Cash Price |
$121.50
|
| Rate for Payer: Cigna Commercial |
$372.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$226.64
|
| Rate for Payer: Health EOS Commercial |
$360.45
|
| Rate for Payer: HFN Commercial |
$372.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$303.75
|
| Rate for Payer: Multiplan Commercial |
$324.00
|
| Rate for Payer: NAPHCARE Commercial |
$243.00
|
| Rate for Payer: Preferred Network Access Commercial |
$372.60
|
| Rate for Payer: Quartz Beloit One Network |
$198.45
|
| Rate for Payer: Quartz Commercial |
$263.25
|
| Rate for Payer: Quartz Medicare Advantage |
$243.00
|
| Rate for Payer: The Alliance Commercial |
$1,620.00
|
| Rate for Payer: WEA Trust Commercial |
$222.75
|
| Rate for Payer: WPS Commercial |
$299.98
|
|
|
TRAY EXCHANGE TRANSFUSION
|
Facility
|
IP
|
$1,254.00
|
|
| Hospital Charge Code |
2963389
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$614.46 |
| Max. Negotiated Rate |
$1,153.68 |
| Rate for Payer: Aetna Commercial |
$1,128.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,078.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$664.62
|
| Rate for Payer: Cash Price |
$376.20
|
| Rate for Payer: Cigna Commercial |
$1,153.68
|
| Rate for Payer: Health EOS Commercial |
$1,116.06
|
| Rate for Payer: HFN Commercial |
$1,153.68
|
| Rate for Payer: Multiplan Commercial |
$1,003.20
|
| Rate for Payer: NAPHCARE Commercial |
$752.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,153.68
|
| Rate for Payer: Quartz Beloit One Network |
$614.46
|
| Rate for Payer: Quartz Commercial |
$752.40
|
| Rate for Payer: WEA Trust Commercial |
$689.70
|
| Rate for Payer: WPS Commercial |
$928.84
|
|
|
TRAY EXCHANGE TRANSFUSION
|
Facility
|
OP
|
$1,254.00
|
|
| Hospital Charge Code |
2963389
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$351.12 |
| Max. Negotiated Rate |
$5,016.00 |
| Rate for Payer: Aetna Commercial |
$1,128.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,078.44
|
| Rate for Payer: Aetna Managed Medicare |
$351.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$815.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$627.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$601.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$664.62
|
| Rate for Payer: Cash Price |
$376.20
|
| Rate for Payer: Cigna Commercial |
$1,153.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$701.74
|
| Rate for Payer: Health EOS Commercial |
$1,116.06
|
| Rate for Payer: HFN Commercial |
$1,153.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$940.50
|
| Rate for Payer: Multiplan Commercial |
$1,003.20
|
| Rate for Payer: NAPHCARE Commercial |
$752.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,153.68
|
| Rate for Payer: Quartz Beloit One Network |
$614.46
|
| Rate for Payer: Quartz Commercial |
$815.10
|
| Rate for Payer: Quartz Medicare Advantage |
$752.40
|
| Rate for Payer: The Alliance Commercial |
$5,016.00
|
| Rate for Payer: WEA Trust Commercial |
$689.70
|
| Rate for Payer: WPS Commercial |
$928.84
|
|
|
TRAY EXCHANGE TRANSFUSION 275.00
|
Facility
|
OP
|
$1,331.00
|
|
| Hospital Charge Code |
3802746
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$372.68 |
| Max. Negotiated Rate |
$5,324.00 |
| Rate for Payer: Aetna Commercial |
$1,197.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,144.66
|
| Rate for Payer: Aetna Managed Medicare |
$372.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$865.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$665.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$638.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$705.43
|
| Rate for Payer: Cash Price |
$399.30
|
| Rate for Payer: Cigna Commercial |
$1,224.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$744.83
|
| Rate for Payer: Health EOS Commercial |
$1,184.59
|
| Rate for Payer: HFN Commercial |
$1,224.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$998.25
|
| Rate for Payer: Multiplan Commercial |
$1,064.80
|
| Rate for Payer: NAPHCARE Commercial |
$798.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,224.52
|
| Rate for Payer: Quartz Beloit One Network |
$652.19
|
| Rate for Payer: Quartz Commercial |
$865.15
|
| Rate for Payer: Quartz Medicare Advantage |
$798.60
|
| Rate for Payer: The Alliance Commercial |
$5,324.00
|
| Rate for Payer: WEA Trust Commercial |
$732.05
|
| Rate for Payer: WPS Commercial |
$985.87
|
|
|
TRAY EXCHANGE TRANSFUSION 275.00
|
Facility
|
IP
|
$1,331.00
|
|
| Hospital Charge Code |
3802746
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$652.19 |
| Max. Negotiated Rate |
$1,224.52 |
| Rate for Payer: Aetna Commercial |
$1,197.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,144.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$705.43
|
| Rate for Payer: Cash Price |
$399.30
|
| Rate for Payer: Cigna Commercial |
$1,224.52
|
| Rate for Payer: Health EOS Commercial |
$1,184.59
|
| Rate for Payer: HFN Commercial |
$1,224.52
|
| Rate for Payer: Multiplan Commercial |
$1,064.80
|
| Rate for Payer: NAPHCARE Commercial |
$798.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,224.52
|
| Rate for Payer: Quartz Beloit One Network |
$652.19
|
| Rate for Payer: Quartz Commercial |
$798.60
|
| Rate for Payer: WEA Trust Commercial |
$732.05
|
| Rate for Payer: WPS Commercial |
$985.87
|
|
|
TRAY FOLEY 16FR SURESTEP LATEX A300316A
|
Facility
|
OP
|
$154.00
|
|
| Hospital Charge Code |
2963134
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$43.12 |
| Max. Negotiated Rate |
$616.00 |
| Rate for Payer: Aetna Commercial |
$138.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$132.44
|
| Rate for Payer: Aetna Managed Medicare |
$43.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$100.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$77.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$73.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$81.62
|
| Rate for Payer: Cash Price |
$46.20
|
| Rate for Payer: Cigna Commercial |
$141.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$86.18
|
| Rate for Payer: Health EOS Commercial |
$137.06
|
| Rate for Payer: HFN Commercial |
$141.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$115.50
|
| Rate for Payer: Multiplan Commercial |
$123.20
|
| Rate for Payer: NAPHCARE Commercial |
$92.40
|
| Rate for Payer: Preferred Network Access Commercial |
$141.68
|
| Rate for Payer: Quartz Beloit One Network |
$75.46
|
| Rate for Payer: Quartz Commercial |
$100.10
|
| Rate for Payer: Quartz Medicare Advantage |
$92.40
|
| Rate for Payer: The Alliance Commercial |
$616.00
|
| Rate for Payer: WEA Trust Commercial |
$84.70
|
| Rate for Payer: WPS Commercial |
$114.07
|
|
|
TRAY FOLEY 16FR SURESTEP LATEX A300316A
|
Facility
|
IP
|
$154.00
|
|
| Hospital Charge Code |
2963134
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$75.46 |
| Max. Negotiated Rate |
$141.68 |
| Rate for Payer: Aetna Commercial |
$138.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$132.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$81.62
|
| Rate for Payer: Cash Price |
$46.20
|
| Rate for Payer: Cigna Commercial |
$141.68
|
| Rate for Payer: Health EOS Commercial |
$137.06
|
| Rate for Payer: HFN Commercial |
$141.68
|
| Rate for Payer: Multiplan Commercial |
$123.20
|
| Rate for Payer: NAPHCARE Commercial |
$92.40
|
| Rate for Payer: Preferred Network Access Commercial |
$141.68
|
| Rate for Payer: Quartz Beloit One Network |
$75.46
|
| Rate for Payer: Quartz Commercial |
$92.40
|
| Rate for Payer: WEA Trust Commercial |
$84.70
|
| Rate for Payer: WPS Commercial |
$114.07
|
|
|
TRAY FOLEY 16FR SURESTEP LF A300416A
|
Facility
|
IP
|
$321.00
|
|
| Hospital Charge Code |
2963118
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$157.29 |
| Max. Negotiated Rate |
$295.32 |
| Rate for Payer: Aetna Commercial |
$288.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$276.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$170.13
|
| Rate for Payer: Cash Price |
$96.30
|
| Rate for Payer: Cigna Commercial |
$295.32
|
| Rate for Payer: Health EOS Commercial |
$285.69
|
| Rate for Payer: HFN Commercial |
$295.32
|
| Rate for Payer: Multiplan Commercial |
$256.80
|
| Rate for Payer: NAPHCARE Commercial |
$192.60
|
| Rate for Payer: Preferred Network Access Commercial |
$295.32
|
| Rate for Payer: Quartz Beloit One Network |
$157.29
|
| Rate for Payer: Quartz Commercial |
$192.60
|
| Rate for Payer: WEA Trust Commercial |
$176.55
|
| Rate for Payer: WPS Commercial |
$237.76
|
|
|
TRAY FOLEY 16FR SURESTEP LF A300416A
|
Facility
|
OP
|
$321.00
|
|
| Hospital Charge Code |
2963118
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$89.88 |
| Max. Negotiated Rate |
$1,284.00 |
| Rate for Payer: Aetna Commercial |
$288.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$276.06
|
| Rate for Payer: Aetna Managed Medicare |
$89.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$208.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$160.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$154.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$170.13
|
| Rate for Payer: Cash Price |
$96.30
|
| Rate for Payer: Cigna Commercial |
$295.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$179.63
|
| Rate for Payer: Health EOS Commercial |
$285.69
|
| Rate for Payer: HFN Commercial |
$295.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$240.75
|
| Rate for Payer: Multiplan Commercial |
$256.80
|
| Rate for Payer: NAPHCARE Commercial |
$192.60
|
| Rate for Payer: Preferred Network Access Commercial |
$295.32
|
| Rate for Payer: Quartz Beloit One Network |
$157.29
|
| Rate for Payer: Quartz Commercial |
$208.65
|
| Rate for Payer: Quartz Medicare Advantage |
$192.60
|
| Rate for Payer: The Alliance Commercial |
$1,284.00
|
| Rate for Payer: WEA Trust Commercial |
$176.55
|
| Rate for Payer: WPS Commercial |
$237.76
|
|
|
TRAY FOLEY 18FR SURESTEP LATEX A300318A
|
Facility
|
IP
|
$154.00
|
|
|
Service Code
|
HCPCS A4314
|
| Hospital Charge Code |
2969251
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$75.46 |
| Max. Negotiated Rate |
$141.68 |
| Rate for Payer: Aetna Commercial |
$138.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$132.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$81.62
|
| Rate for Payer: Cash Price |
$46.20
|
| Rate for Payer: Cigna Commercial |
$141.68
|
| Rate for Payer: Health EOS Commercial |
$137.06
|
| Rate for Payer: HFN Commercial |
$141.68
|
| Rate for Payer: Multiplan Commercial |
$123.20
|
| Rate for Payer: NAPHCARE Commercial |
$92.40
|
| Rate for Payer: Preferred Network Access Commercial |
$141.68
|
| Rate for Payer: Quartz Beloit One Network |
$75.46
|
| Rate for Payer: Quartz Commercial |
$92.40
|
| Rate for Payer: WEA Trust Commercial |
$84.70
|
| Rate for Payer: WPS Commercial |
$114.07
|
|
