|
TUBE DIGIT EXT.DYNAMIC SMALL #9272-55-02
|
Facility
|
OP
|
$363.00
|
|
| Hospital Charge Code |
2969531
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$105.71 |
| Max. Negotiated Rate |
$347.32 |
| Rate for Payer: Aetna Commercial |
$339.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$324.67
|
| Rate for Payer: Aetna Managed Medicare |
$105.71
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$245.39
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$188.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$181.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$200.09
|
| Rate for Payer: Cash Price |
$108.90
|
| Rate for Payer: Cigna Commercial |
$347.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$211.27
|
| Rate for Payer: Health EOS Commercial |
$335.99
|
| Rate for Payer: HFN Commercial |
$347.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$283.14
|
| Rate for Payer: Multiplan Commercial |
$302.02
|
| Rate for Payer: NAPHCARE Commercial |
$226.51
|
| Rate for Payer: Preferred Network Access Commercial |
$347.32
|
| Rate for Payer: Quartz Beloit One Network |
$184.98
|
| Rate for Payer: Quartz Commercial |
$245.39
|
| Rate for Payer: Quartz Medicare Advantage |
$226.51
|
| Rate for Payer: The Alliance Commercial |
$188.76
|
| Rate for Payer: WEA Trust Commercial |
$207.64
|
| Rate for Payer: WPS Commercial |
$279.62
|
|
|
TUBE DIGIT EXT.DYNAMIC SMALL #9272-55-02
|
Facility
|
IP
|
$363.00
|
|
| Hospital Charge Code |
2969531
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$184.98 |
| Max. Negotiated Rate |
$347.32 |
| Rate for Payer: Aetna Commercial |
$339.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$324.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$200.09
|
| Rate for Payer: Cash Price |
$108.90
|
| Rate for Payer: Cigna Commercial |
$347.32
|
| Rate for Payer: Health EOS Commercial |
$335.99
|
| Rate for Payer: HFN Commercial |
$347.32
|
| Rate for Payer: Multiplan Commercial |
$302.02
|
| Rate for Payer: Preferred Network Access Commercial |
$347.32
|
| Rate for Payer: Quartz Beloit One Network |
$184.98
|
| Rate for Payer: Quartz Commercial |
$226.51
|
| Rate for Payer: WEA Trust Commercial |
$207.64
|
| Rate for Payer: WPS Commercial |
$279.62
|
|
|
TUBE DIGIT EXTENSION LARGE #92725505
|
Facility
|
IP
|
$233.00
|
|
| Hospital Charge Code |
2969643
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$118.74 |
| Max. Negotiated Rate |
$222.93 |
| Rate for Payer: Aetna Commercial |
$218.09
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$208.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$128.43
|
| Rate for Payer: Cash Price |
$69.90
|
| Rate for Payer: Cigna Commercial |
$222.93
|
| Rate for Payer: Health EOS Commercial |
$215.66
|
| Rate for Payer: HFN Commercial |
$222.93
|
| Rate for Payer: Multiplan Commercial |
$193.86
|
| Rate for Payer: Preferred Network Access Commercial |
$222.93
|
| Rate for Payer: Quartz Beloit One Network |
$118.74
|
| Rate for Payer: Quartz Commercial |
$145.39
|
| Rate for Payer: WEA Trust Commercial |
$133.28
|
| Rate for Payer: WPS Commercial |
$179.48
|
|
|
TUBE DIGIT EXTENSION LARGE #92725505
|
Facility
|
OP
|
$233.00
|
|
| Hospital Charge Code |
2969643
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$67.85 |
| Max. Negotiated Rate |
$222.93 |
| Rate for Payer: Aetna Commercial |
$218.09
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$208.40
|
| Rate for Payer: Aetna Managed Medicare |
$67.85
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$157.51
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$121.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$116.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$128.43
|
| Rate for Payer: Cash Price |
$69.90
|
| Rate for Payer: Cigna Commercial |
$222.93
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$135.61
|
| Rate for Payer: Health EOS Commercial |
$215.66
|
| Rate for Payer: HFN Commercial |
$222.93
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$181.74
|
| Rate for Payer: Multiplan Commercial |
$193.86
|
| Rate for Payer: NAPHCARE Commercial |
$145.39
|
| Rate for Payer: Preferred Network Access Commercial |
$222.93
|
| Rate for Payer: Quartz Beloit One Network |
$118.74
|
| Rate for Payer: Quartz Commercial |
$157.51
|
| Rate for Payer: Quartz Medicare Advantage |
$145.39
|
| Rate for Payer: The Alliance Commercial |
$121.16
|
| Rate for Payer: WEA Trust Commercial |
$133.28
|
| Rate for Payer: WPS Commercial |
$179.48
|
|
|
TUBE DYNAMIC DIGIT EXT MEDIUM #9272-55-03
|
Facility
|
IP
|
$339.00
|
|
| Hospital Charge Code |
2969622
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$172.75 |
| Max. Negotiated Rate |
$324.36 |
| Rate for Payer: Aetna Commercial |
$317.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$303.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$186.86
|
| Rate for Payer: Cash Price |
$101.70
|
| Rate for Payer: Cigna Commercial |
$324.36
|
| Rate for Payer: Health EOS Commercial |
$313.78
|
| Rate for Payer: HFN Commercial |
$324.36
|
| Rate for Payer: Multiplan Commercial |
$282.05
|
| Rate for Payer: Preferred Network Access Commercial |
$324.36
|
| Rate for Payer: Quartz Beloit One Network |
$172.75
|
| Rate for Payer: Quartz Commercial |
$211.54
|
| Rate for Payer: WEA Trust Commercial |
$193.91
|
| Rate for Payer: WPS Commercial |
$261.13
|
|
|
TUBE DYNAMIC DIGIT EXT MEDIUM #9272-55-03
|
Facility
|
OP
|
$339.00
|
|
| Hospital Charge Code |
2969622
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$98.72 |
| Max. Negotiated Rate |
$324.36 |
| Rate for Payer: Aetna Commercial |
$317.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$303.20
|
| Rate for Payer: Aetna Managed Medicare |
$98.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$229.16
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$176.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$169.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$186.86
|
| Rate for Payer: Cash Price |
$101.70
|
| Rate for Payer: Cigna Commercial |
$324.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$197.30
|
| Rate for Payer: Health EOS Commercial |
$313.78
|
| Rate for Payer: HFN Commercial |
$324.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$264.42
|
| Rate for Payer: Multiplan Commercial |
$282.05
|
| Rate for Payer: NAPHCARE Commercial |
$211.54
|
| Rate for Payer: Preferred Network Access Commercial |
$324.36
|
| Rate for Payer: Quartz Beloit One Network |
$172.75
|
| Rate for Payer: Quartz Commercial |
$229.16
|
| Rate for Payer: Quartz Medicare Advantage |
$211.54
|
| Rate for Payer: The Alliance Commercial |
$176.28
|
| Rate for Payer: WEA Trust Commercial |
$193.91
|
| Rate for Payer: WPS Commercial |
$261.13
|
|
|
TUBE DYNAMIC MONOTUBE TRIAX BLUE 20MM 5150-0-470
|
Facility
|
IP
|
$7,006.00
|
|
| Hospital Charge Code |
5685881
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,570.26 |
| Max. Negotiated Rate |
$6,703.34 |
| Rate for Payer: Aetna Commercial |
$6,557.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,266.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,861.71
|
| Rate for Payer: Cash Price |
$2,101.80
|
| Rate for Payer: Cigna Commercial |
$6,703.34
|
| Rate for Payer: Health EOS Commercial |
$6,484.75
|
| Rate for Payer: HFN Commercial |
$6,703.34
|
| Rate for Payer: Multiplan Commercial |
$5,828.99
|
| Rate for Payer: Preferred Network Access Commercial |
$6,703.34
|
| Rate for Payer: Quartz Beloit One Network |
$3,570.26
|
| Rate for Payer: Quartz Commercial |
$4,371.74
|
| Rate for Payer: WEA Trust Commercial |
$4,007.43
|
| Rate for Payer: WPS Commercial |
$5,396.72
|
|
|
TUBE DYNAMIC MONOTUBE TRIAX BLUE 20MM 5150-0-470
|
Facility
|
OP
|
$7,006.00
|
|
| Hospital Charge Code |
5685881
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,040.15 |
| Max. Negotiated Rate |
$6,703.34 |
| Rate for Payer: Aetna Commercial |
$6,557.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,266.17
|
| Rate for Payer: Aetna Managed Medicare |
$2,040.15
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,736.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,643.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,497.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,861.71
|
| Rate for Payer: Cash Price |
$2,101.80
|
| Rate for Payer: Cigna Commercial |
$6,703.34
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,077.49
|
| Rate for Payer: Health EOS Commercial |
$6,484.75
|
| Rate for Payer: HFN Commercial |
$6,703.34
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,464.68
|
| Rate for Payer: Multiplan Commercial |
$5,828.99
|
| Rate for Payer: NAPHCARE Commercial |
$4,371.74
|
| Rate for Payer: Preferred Network Access Commercial |
$6,703.34
|
| Rate for Payer: Quartz Beloit One Network |
$3,570.26
|
| Rate for Payer: Quartz Commercial |
$4,736.06
|
| Rate for Payer: Quartz Medicare Advantage |
$4,371.74
|
| Rate for Payer: The Alliance Commercial |
$3,643.12
|
| Rate for Payer: WEA Trust Commercial |
$4,007.43
|
| Rate for Payer: WPS Commercial |
$5,396.72
|
|
|
TUBE EAR 240050
|
Facility
|
OP
|
$378.00
|
|
| Hospital Charge Code |
2965423
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$110.07 |
| Max. Negotiated Rate |
$361.67 |
| Rate for Payer: Aetna Commercial |
$353.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$338.08
|
| Rate for Payer: Aetna Managed Medicare |
$110.07
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$255.53
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$196.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$188.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$208.35
|
| Rate for Payer: Cash Price |
$113.40
|
| Rate for Payer: Cigna Commercial |
$361.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$220.00
|
| Rate for Payer: Health EOS Commercial |
$349.88
|
| Rate for Payer: HFN Commercial |
$361.67
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$294.84
|
| Rate for Payer: Multiplan Commercial |
$314.50
|
| Rate for Payer: NAPHCARE Commercial |
$235.87
|
| Rate for Payer: Preferred Network Access Commercial |
$361.67
|
| Rate for Payer: Quartz Beloit One Network |
$192.63
|
| Rate for Payer: Quartz Commercial |
$255.53
|
| Rate for Payer: Quartz Medicare Advantage |
$235.87
|
| Rate for Payer: The Alliance Commercial |
$196.56
|
| Rate for Payer: WEA Trust Commercial |
$216.22
|
| Rate for Payer: WPS Commercial |
$291.17
|
|
|
TUBE EAR 240050
|
Facility
|
IP
|
$378.00
|
|
| Hospital Charge Code |
2965423
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$192.63 |
| Max. Negotiated Rate |
$361.67 |
| Rate for Payer: Aetna Commercial |
$353.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$338.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$208.35
|
| Rate for Payer: Cash Price |
$113.40
|
| Rate for Payer: Cigna Commercial |
$361.67
|
| Rate for Payer: Health EOS Commercial |
$349.88
|
| Rate for Payer: HFN Commercial |
$361.67
|
| Rate for Payer: Multiplan Commercial |
$314.50
|
| Rate for Payer: Preferred Network Access Commercial |
$361.67
|
| Rate for Payer: Quartz Beloit One Network |
$192.63
|
| Rate for Payer: Quartz Commercial |
$235.87
|
| Rate for Payer: WEA Trust Commercial |
$216.22
|
| Rate for Payer: WPS Commercial |
$291.17
|
|
|
TUBE ENDOTRACHEAL 2.5MM CUFFED
|
Facility
|
OP
|
$88.00
|
|
| Hospital Charge Code |
2974570
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$25.63 |
| Max. Negotiated Rate |
$84.20 |
| Rate for Payer: Aetna Commercial |
$82.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$78.71
|
| Rate for Payer: Aetna Managed Medicare |
$25.63
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$59.49
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$45.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$43.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$48.51
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cigna Commercial |
$84.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$51.22
|
| Rate for Payer: Health EOS Commercial |
$81.45
|
| Rate for Payer: HFN Commercial |
$84.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$68.64
|
| Rate for Payer: Multiplan Commercial |
$73.22
|
| Rate for Payer: NAPHCARE Commercial |
$54.91
|
| Rate for Payer: Preferred Network Access Commercial |
$84.20
|
| Rate for Payer: Quartz Beloit One Network |
$44.84
|
| Rate for Payer: Quartz Commercial |
$59.49
|
| Rate for Payer: Quartz Medicare Advantage |
$54.91
|
| Rate for Payer: The Alliance Commercial |
$45.76
|
| Rate for Payer: WEA Trust Commercial |
$50.34
|
| Rate for Payer: WPS Commercial |
$67.79
|
|
|
TUBE ENDOTRACHEAL 2.5MM CUFFED
|
Facility
|
IP
|
$88.00
|
|
| Hospital Charge Code |
2974570
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$44.84 |
| Max. Negotiated Rate |
$84.20 |
| Rate for Payer: Aetna Commercial |
$82.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$78.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$48.51
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cigna Commercial |
$84.20
|
| Rate for Payer: Health EOS Commercial |
$81.45
|
| Rate for Payer: HFN Commercial |
$84.20
|
| Rate for Payer: Multiplan Commercial |
$73.22
|
| Rate for Payer: Preferred Network Access Commercial |
$84.20
|
| Rate for Payer: Quartz Beloit One Network |
$44.84
|
| Rate for Payer: Quartz Commercial |
$54.91
|
| Rate for Payer: WEA Trust Commercial |
$50.34
|
| Rate for Payer: WPS Commercial |
$67.79
|
|
|
TUBE ENDOTRACHEAL 3.0MM CUFFED 112480030
|
Facility
|
OP
|
$88.00
|
|
| Hospital Charge Code |
2974444
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$25.63 |
| Max. Negotiated Rate |
$84.20 |
| Rate for Payer: Aetna Commercial |
$82.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$78.71
|
| Rate for Payer: Aetna Managed Medicare |
$25.63
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$59.49
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$45.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$43.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$48.51
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cigna Commercial |
$84.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$51.22
|
| Rate for Payer: Health EOS Commercial |
$81.45
|
| Rate for Payer: HFN Commercial |
$84.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$68.64
|
| Rate for Payer: Multiplan Commercial |
$73.22
|
| Rate for Payer: NAPHCARE Commercial |
$54.91
|
| Rate for Payer: Preferred Network Access Commercial |
$84.20
|
| Rate for Payer: Quartz Beloit One Network |
$44.84
|
| Rate for Payer: Quartz Commercial |
$59.49
|
| Rate for Payer: Quartz Medicare Advantage |
$54.91
|
| Rate for Payer: The Alliance Commercial |
$45.76
|
| Rate for Payer: WEA Trust Commercial |
$50.34
|
| Rate for Payer: WPS Commercial |
$67.79
|
|
|
TUBE ENDOTRACHEAL 3.0MM CUFFED 112480030
|
Facility
|
IP
|
$88.00
|
|
| Hospital Charge Code |
2974444
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$44.84 |
| Max. Negotiated Rate |
$84.20 |
| Rate for Payer: Aetna Commercial |
$82.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$78.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$48.51
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cigna Commercial |
$84.20
|
| Rate for Payer: Health EOS Commercial |
$81.45
|
| Rate for Payer: HFN Commercial |
$84.20
|
| Rate for Payer: Multiplan Commercial |
$73.22
|
| Rate for Payer: Preferred Network Access Commercial |
$84.20
|
| Rate for Payer: Quartz Beloit One Network |
$44.84
|
| Rate for Payer: Quartz Commercial |
$54.91
|
| Rate for Payer: WEA Trust Commercial |
$50.34
|
| Rate for Payer: WPS Commercial |
$67.79
|
|
|
TUBE ENDOTRACHEAL 4.0MM CUFFED
|
Facility
|
OP
|
$96.00
|
|
| Hospital Charge Code |
2974445
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$27.96 |
| Max. Negotiated Rate |
$91.85 |
| Rate for Payer: Aetna Commercial |
$89.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$85.86
|
| Rate for Payer: Aetna Managed Medicare |
$27.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$64.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$49.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$47.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$52.92
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cigna Commercial |
$91.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$55.87
|
| Rate for Payer: Health EOS Commercial |
$88.86
|
| Rate for Payer: HFN Commercial |
$91.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$74.88
|
| Rate for Payer: Multiplan Commercial |
$79.87
|
| Rate for Payer: NAPHCARE Commercial |
$59.90
|
| Rate for Payer: Preferred Network Access Commercial |
$91.85
|
| Rate for Payer: Quartz Beloit One Network |
$48.92
|
| Rate for Payer: Quartz Commercial |
$64.90
|
| Rate for Payer: Quartz Medicare Advantage |
$59.90
|
| Rate for Payer: The Alliance Commercial |
$49.92
|
| Rate for Payer: WEA Trust Commercial |
$54.91
|
| Rate for Payer: WPS Commercial |
$73.95
|
|
|
TUBE ENDOTRACHEAL 4.0MM CUFFED
|
Facility
|
IP
|
$96.00
|
|
| Hospital Charge Code |
2974445
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$48.92 |
| Max. Negotiated Rate |
$91.85 |
| Rate for Payer: Aetna Commercial |
$89.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$85.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$52.92
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cigna Commercial |
$91.85
|
| Rate for Payer: Health EOS Commercial |
$88.86
|
| Rate for Payer: HFN Commercial |
$91.85
|
| Rate for Payer: Multiplan Commercial |
$79.87
|
| Rate for Payer: Preferred Network Access Commercial |
$91.85
|
| Rate for Payer: Quartz Beloit One Network |
$48.92
|
| Rate for Payer: Quartz Commercial |
$59.90
|
| Rate for Payer: WEA Trust Commercial |
$54.91
|
| Rate for Payer: WPS Commercial |
$73.95
|
|
|
TUBE ENDOTRACHEAL 4.5 W/O CUFF 86237
|
Facility
|
OP
|
$64.00
|
|
| Hospital Charge Code |
2974405
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$18.64 |
| Max. Negotiated Rate |
$61.24 |
| Rate for Payer: Aetna Commercial |
$59.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$57.24
|
| Rate for Payer: Aetna Managed Medicare |
$18.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$43.26
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$33.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$31.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$35.28
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Cigna Commercial |
$61.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$37.25
|
| Rate for Payer: Health EOS Commercial |
$59.24
|
| Rate for Payer: HFN Commercial |
$61.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$49.92
|
| Rate for Payer: Multiplan Commercial |
$53.25
|
| Rate for Payer: NAPHCARE Commercial |
$39.94
|
| Rate for Payer: Preferred Network Access Commercial |
$61.24
|
| Rate for Payer: Quartz Beloit One Network |
$32.61
|
| Rate for Payer: Quartz Commercial |
$43.26
|
| Rate for Payer: Quartz Medicare Advantage |
$39.94
|
| Rate for Payer: The Alliance Commercial |
$33.28
|
| Rate for Payer: WEA Trust Commercial |
$36.61
|
| Rate for Payer: WPS Commercial |
$49.30
|
|
|
TUBE ENDOTRACHEAL 4.5 W/O CUFF 86237
|
Facility
|
IP
|
$64.00
|
|
| Hospital Charge Code |
2974405
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$32.61 |
| Max. Negotiated Rate |
$61.24 |
| Rate for Payer: Aetna Commercial |
$59.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$57.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$35.28
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Cigna Commercial |
$61.24
|
| Rate for Payer: Health EOS Commercial |
$59.24
|
| Rate for Payer: HFN Commercial |
$61.24
|
| Rate for Payer: Multiplan Commercial |
$53.25
|
| Rate for Payer: Preferred Network Access Commercial |
$61.24
|
| Rate for Payer: Quartz Beloit One Network |
$32.61
|
| Rate for Payer: Quartz Commercial |
$39.94
|
| Rate for Payer: WEA Trust Commercial |
$36.61
|
| Rate for Payer: WPS Commercial |
$49.30
|
|
|
TUBE ENDOTRACHEAL 5.5 W/O CUFF #5-10411
|
Facility
|
IP
|
$44.00
|
|
| Hospital Charge Code |
2974332
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$22.42 |
| Max. Negotiated Rate |
$42.10 |
| Rate for Payer: Aetna Commercial |
$41.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$39.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$24.25
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Cigna Commercial |
$42.10
|
| Rate for Payer: Health EOS Commercial |
$40.73
|
| Rate for Payer: HFN Commercial |
$42.10
|
| Rate for Payer: Multiplan Commercial |
$36.61
|
| Rate for Payer: Preferred Network Access Commercial |
$42.10
|
| Rate for Payer: Quartz Beloit One Network |
$22.42
|
| Rate for Payer: Quartz Commercial |
$27.46
|
| Rate for Payer: WEA Trust Commercial |
$25.17
|
| Rate for Payer: WPS Commercial |
$33.89
|
|
|
TUBE ENDOTRACHEAL 5.5 W/O CUFF #5-10411
|
Facility
|
OP
|
$44.00
|
|
| Hospital Charge Code |
2974332
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$12.81 |
| Max. Negotiated Rate |
$42.10 |
| Rate for Payer: Aetna Commercial |
$41.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$39.35
|
| Rate for Payer: Aetna Managed Medicare |
$12.81
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$29.74
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$22.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$21.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$24.25
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Cigna Commercial |
$42.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$25.61
|
| Rate for Payer: Health EOS Commercial |
$40.73
|
| Rate for Payer: HFN Commercial |
$42.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$34.32
|
| Rate for Payer: Multiplan Commercial |
$36.61
|
| Rate for Payer: NAPHCARE Commercial |
$27.46
|
| Rate for Payer: Preferred Network Access Commercial |
$42.10
|
| Rate for Payer: Quartz Beloit One Network |
$22.42
|
| Rate for Payer: Quartz Commercial |
$29.74
|
| Rate for Payer: Quartz Medicare Advantage |
$27.46
|
| Rate for Payer: The Alliance Commercial |
$22.88
|
| Rate for Payer: WEA Trust Commercial |
$25.17
|
| Rate for Payer: WPS Commercial |
$33.89
|
|
|
TUBE ENDOTRACHEAL 9MM
|
Facility
|
IP
|
$51.00
|
|
| Hospital Charge Code |
2963825
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$25.99 |
| Max. Negotiated Rate |
$48.80 |
| Rate for Payer: Aetna Commercial |
$47.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$45.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$28.11
|
| Rate for Payer: Cash Price |
$15.30
|
| Rate for Payer: Cigna Commercial |
$48.80
|
| Rate for Payer: Health EOS Commercial |
$47.21
|
| Rate for Payer: HFN Commercial |
$48.80
|
| Rate for Payer: Multiplan Commercial |
$42.43
|
| Rate for Payer: Preferred Network Access Commercial |
$48.80
|
| Rate for Payer: Quartz Beloit One Network |
$25.99
|
| Rate for Payer: Quartz Commercial |
$31.82
|
| Rate for Payer: WEA Trust Commercial |
$29.17
|
| Rate for Payer: WPS Commercial |
$39.29
|
|
|
TUBE ENDOTRACHEAL 9MM
|
Facility
|
OP
|
$51.00
|
|
| Hospital Charge Code |
2963825
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.85 |
| Max. Negotiated Rate |
$48.80 |
| Rate for Payer: Aetna Commercial |
$47.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$45.61
|
| Rate for Payer: Aetna Managed Medicare |
$14.85
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$34.48
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$26.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$25.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$28.11
|
| Rate for Payer: Cash Price |
$15.30
|
| Rate for Payer: Cigna Commercial |
$48.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$29.68
|
| Rate for Payer: Health EOS Commercial |
$47.21
|
| Rate for Payer: HFN Commercial |
$48.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$39.78
|
| Rate for Payer: Multiplan Commercial |
$42.43
|
| Rate for Payer: NAPHCARE Commercial |
$31.82
|
| Rate for Payer: Preferred Network Access Commercial |
$48.80
|
| Rate for Payer: Quartz Beloit One Network |
$25.99
|
| Rate for Payer: Quartz Commercial |
$34.48
|
| Rate for Payer: Quartz Medicare Advantage |
$31.82
|
| Rate for Payer: The Alliance Commercial |
$26.52
|
| Rate for Payer: WEA Trust Commercial |
$29.17
|
| Rate for Payer: WPS Commercial |
$39.29
|
|
|
Tube Endotracheal All Size
|
Facility
|
IP
|
$3.00
|
|
| Hospital Charge Code |
3040309
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.53 |
| Max. Negotiated Rate |
$2.87 |
| Rate for Payer: Aetna Commercial |
$2.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1.65
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Cigna Commercial |
$2.87
|
| Rate for Payer: Health EOS Commercial |
$2.78
|
| Rate for Payer: HFN Commercial |
$2.87
|
| Rate for Payer: Multiplan Commercial |
$2.50
|
| Rate for Payer: Preferred Network Access Commercial |
$2.87
|
| Rate for Payer: Quartz Beloit One Network |
$1.53
|
| Rate for Payer: Quartz Commercial |
$1.87
|
| Rate for Payer: WEA Trust Commercial |
$1.72
|
| Rate for Payer: WPS Commercial |
$2.31
|
|
|
Tube Endotracheal All Size
|
Facility
|
OP
|
$3.00
|
|
| Hospital Charge Code |
3040309
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.87 |
| Max. Negotiated Rate |
$2.87 |
| Rate for Payer: Aetna Commercial |
$2.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2.68
|
| Rate for Payer: Aetna Managed Medicare |
$0.87
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2.03
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1.65
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Cigna Commercial |
$2.87
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1.75
|
| Rate for Payer: Health EOS Commercial |
$2.78
|
| Rate for Payer: HFN Commercial |
$2.87
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2.34
|
| Rate for Payer: Multiplan Commercial |
$2.50
|
| Rate for Payer: NAPHCARE Commercial |
$1.87
|
| Rate for Payer: Preferred Network Access Commercial |
$2.87
|
| Rate for Payer: Quartz Beloit One Network |
$1.53
|
| Rate for Payer: Quartz Commercial |
$2.03
|
| Rate for Payer: Quartz Medicare Advantage |
$1.87
|
| Rate for Payer: The Alliance Commercial |
$1.56
|
| Rate for Payer: WEA Trust Commercial |
$1.72
|
| Rate for Payer: WPS Commercial |
$2.31
|
|
|
Tube Endotracheal All Sizes
|
Facility
|
IP
|
$162.00
|
|
| Hospital Charge Code |
3101740
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$82.56 |
| Max. Negotiated Rate |
$155.00 |
| Rate for Payer: Aetna Commercial |
$151.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$144.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$89.29
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Cigna Commercial |
$155.00
|
| Rate for Payer: Health EOS Commercial |
$149.95
|
| Rate for Payer: HFN Commercial |
$155.00
|
| Rate for Payer: Multiplan Commercial |
$134.78
|
| Rate for Payer: Preferred Network Access Commercial |
$155.00
|
| Rate for Payer: Quartz Beloit One Network |
$82.56
|
| Rate for Payer: Quartz Commercial |
$101.09
|
| Rate for Payer: WEA Trust Commercial |
$92.66
|
| Rate for Payer: WPS Commercial |
$124.79
|
|
