|
TUBE FEEDING ADULT 10FRX55/ENFIT 8884721055E
|
Facility
|
OP
|
$205.00
|
|
| Hospital Charge Code |
2975040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$59.70 |
| Max. Negotiated Rate |
$196.14 |
| Rate for Payer: Aetna Commercial |
$191.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$183.35
|
| Rate for Payer: Aetna Managed Medicare |
$59.70
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$138.58
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$106.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$102.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$113.00
|
| Rate for Payer: Cash Price |
$61.50
|
| Rate for Payer: Cigna Commercial |
$196.14
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$119.31
|
| Rate for Payer: Health EOS Commercial |
$189.75
|
| Rate for Payer: HFN Commercial |
$196.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$159.90
|
| Rate for Payer: Multiplan Commercial |
$170.56
|
| Rate for Payer: NAPHCARE Commercial |
$127.92
|
| Rate for Payer: Preferred Network Access Commercial |
$196.14
|
| Rate for Payer: Quartz Beloit One Network |
$104.47
|
| Rate for Payer: Quartz Commercial |
$138.58
|
| Rate for Payer: Quartz Medicare Advantage |
$127.92
|
| Rate for Payer: The Alliance Commercial |
$106.60
|
| Rate for Payer: WEA Trust Commercial |
$117.26
|
| Rate for Payer: WPS Commercial |
$157.91
|
|
|
TUBE FEEDING PREMATURE INFANT 5FR 0036400
|
Facility
|
IP
|
$28.00
|
|
| Hospital Charge Code |
2963303
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.27 |
| Max. Negotiated Rate |
$26.79 |
| Rate for Payer: Aetna Commercial |
$26.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$25.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$15.43
|
| Rate for Payer: Cash Price |
$8.40
|
| Rate for Payer: Cigna Commercial |
$26.79
|
| Rate for Payer: Health EOS Commercial |
$25.92
|
| Rate for Payer: HFN Commercial |
$26.79
|
| Rate for Payer: Multiplan Commercial |
$23.30
|
| Rate for Payer: Preferred Network Access Commercial |
$26.79
|
| Rate for Payer: Quartz Beloit One Network |
$14.27
|
| Rate for Payer: Quartz Commercial |
$17.47
|
| Rate for Payer: WEA Trust Commercial |
$16.02
|
| Rate for Payer: WPS Commercial |
$21.57
|
|
|
TUBE FEEDING PREMATURE INFANT 5FR 0036400
|
Facility
|
OP
|
$28.00
|
|
| Hospital Charge Code |
2963303
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.15 |
| Max. Negotiated Rate |
$26.79 |
| Rate for Payer: Aetna Commercial |
$26.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$25.04
|
| Rate for Payer: Aetna Managed Medicare |
$8.15
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$18.93
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$14.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$13.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$15.43
|
| Rate for Payer: Cash Price |
$8.40
|
| Rate for Payer: Cigna Commercial |
$26.79
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$16.30
|
| Rate for Payer: Health EOS Commercial |
$25.92
|
| Rate for Payer: HFN Commercial |
$26.79
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$21.84
|
| Rate for Payer: Multiplan Commercial |
$23.30
|
| Rate for Payer: NAPHCARE Commercial |
$17.47
|
| Rate for Payer: Preferred Network Access Commercial |
$26.79
|
| Rate for Payer: Quartz Beloit One Network |
$14.27
|
| Rate for Payer: Quartz Commercial |
$18.93
|
| Rate for Payer: Quartz Medicare Advantage |
$17.47
|
| Rate for Payer: The Alliance Commercial |
$14.56
|
| Rate for Payer: WEA Trust Commercial |
$16.02
|
| Rate for Payer: WPS Commercial |
$21.57
|
|
|
TUBE GASTRO ENTERIC MIC FEEDING 0210-24
|
Facility
|
IP
|
$2,599.00
|
|
| Hospital Charge Code |
4595874
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,324.45 |
| Max. Negotiated Rate |
$2,486.72 |
| Rate for Payer: Aetna Commercial |
$2,432.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,324.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,432.57
|
| Rate for Payer: Cash Price |
$779.70
|
| Rate for Payer: Cigna Commercial |
$2,486.72
|
| Rate for Payer: Health EOS Commercial |
$2,405.63
|
| Rate for Payer: HFN Commercial |
$2,486.72
|
| Rate for Payer: Multiplan Commercial |
$2,162.37
|
| Rate for Payer: Preferred Network Access Commercial |
$2,486.72
|
| Rate for Payer: Quartz Beloit One Network |
$1,324.45
|
| Rate for Payer: Quartz Commercial |
$1,621.78
|
| Rate for Payer: WEA Trust Commercial |
$1,486.63
|
| Rate for Payer: WPS Commercial |
$2,002.01
|
|
|
TUBE GASTRO ENTERIC MIC FEEDING 0210-24
|
Facility
|
OP
|
$2,599.00
|
|
| Hospital Charge Code |
4595874
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$756.83 |
| Max. Negotiated Rate |
$2,486.72 |
| Rate for Payer: Aetna Commercial |
$2,432.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,324.55
|
| Rate for Payer: Aetna Managed Medicare |
$756.83
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,756.92
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,351.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,297.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,432.57
|
| Rate for Payer: Cash Price |
$779.70
|
| Rate for Payer: Cigna Commercial |
$2,486.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,512.62
|
| Rate for Payer: Health EOS Commercial |
$2,405.63
|
| Rate for Payer: HFN Commercial |
$2,486.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,027.22
|
| Rate for Payer: Multiplan Commercial |
$2,162.37
|
| Rate for Payer: NAPHCARE Commercial |
$1,621.78
|
| Rate for Payer: Preferred Network Access Commercial |
$2,486.72
|
| Rate for Payer: Quartz Beloit One Network |
$1,324.45
|
| Rate for Payer: Quartz Commercial |
$1,756.92
|
| Rate for Payer: Quartz Medicare Advantage |
$1,621.78
|
| Rate for Payer: The Alliance Commercial |
$1,351.48
|
| Rate for Payer: WEA Trust Commercial |
$1,486.63
|
| Rate for Payer: WPS Commercial |
$2,002.01
|
|
|
TUBE GASTROSTOMY MIC 24FR BAA010024
|
Facility
|
IP
|
$708.00
|
|
| Hospital Charge Code |
5349272
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$360.80 |
| Max. Negotiated Rate |
$677.41 |
| Rate for Payer: Aetna Commercial |
$662.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$633.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$390.25
|
| Rate for Payer: Cash Price |
$212.40
|
| Rate for Payer: Cigna Commercial |
$677.41
|
| Rate for Payer: Health EOS Commercial |
$655.32
|
| Rate for Payer: HFN Commercial |
$677.41
|
| Rate for Payer: Multiplan Commercial |
$589.06
|
| Rate for Payer: Preferred Network Access Commercial |
$677.41
|
| Rate for Payer: Quartz Beloit One Network |
$360.80
|
| Rate for Payer: Quartz Commercial |
$441.79
|
| Rate for Payer: WEA Trust Commercial |
$404.98
|
| Rate for Payer: WPS Commercial |
$545.37
|
|
|
TUBE GASTROSTOMY MIC 24FR BAA010024
|
Facility
|
OP
|
$708.00
|
|
| Hospital Charge Code |
5349272
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$206.17 |
| Max. Negotiated Rate |
$677.41 |
| Rate for Payer: Aetna Commercial |
$662.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$633.24
|
| Rate for Payer: Aetna Managed Medicare |
$206.17
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$478.61
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$368.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$353.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$390.25
|
| Rate for Payer: Cash Price |
$212.40
|
| Rate for Payer: Cigna Commercial |
$677.41
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$412.06
|
| Rate for Payer: Health EOS Commercial |
$655.32
|
| Rate for Payer: HFN Commercial |
$677.41
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$552.24
|
| Rate for Payer: Multiplan Commercial |
$589.06
|
| Rate for Payer: NAPHCARE Commercial |
$441.79
|
| Rate for Payer: Preferred Network Access Commercial |
$677.41
|
| Rate for Payer: Quartz Beloit One Network |
$360.80
|
| Rate for Payer: Quartz Commercial |
$478.61
|
| Rate for Payer: Quartz Medicare Advantage |
$441.79
|
| Rate for Payer: The Alliance Commercial |
$368.16
|
| Rate for Payer: WEA Trust Commercial |
$404.98
|
| Rate for Payer: WPS Commercial |
$545.37
|
|
|
TUBE GASTROSTOMY PEG 26FR 8884720265
|
Facility
|
IP
|
$758.00
|
|
| Hospital Charge Code |
4020642
|
|
Hospital Revenue Code
|
278
|
| 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
|
|
|
TUBE GASTROSTOMY PEG 26FR 8884720265
|
Facility
|
OP
|
$758.00
|
|
| Hospital Charge Code |
4020642
|
|
Hospital Revenue Code
|
278
|
| 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
|
|
|
TUBE GASTROSTOMY PEG 28FR 8884720285
|
Facility
|
IP
|
$758.00
|
|
| Hospital Charge Code |
4020643
|
|
Hospital Revenue Code
|
272
|
| 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
|
|
|
TUBE GASTROSTOMY PEG 28FR 8884720285
|
Facility
|
OP
|
$758.00
|
|
| Hospital Charge Code |
4020643
|
|
Hospital Revenue Code
|
272
|
| 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
|
|
|
TUBE GASTROSTOMY PEG ENFIT 14FR 8100-14LV
|
Facility
|
OP
|
$687.00
|
|
|
Service Code
|
HCPCS B4087
|
| Hospital Charge Code |
5563441
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$200.05 |
| Max. Negotiated Rate |
$657.32 |
| Rate for Payer: Aetna Commercial |
$643.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$614.45
|
| Rate for Payer: Aetna Managed Medicare |
$200.05
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$464.41
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$357.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$342.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$378.67
|
| Rate for Payer: Cash Price |
$206.10
|
| Rate for Payer: Cigna Commercial |
$657.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$399.83
|
| Rate for Payer: Health EOS Commercial |
$635.89
|
| Rate for Payer: HFN Commercial |
$657.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$535.86
|
| Rate for Payer: Multiplan Commercial |
$571.58
|
| Rate for Payer: NAPHCARE Commercial |
$428.69
|
| Rate for Payer: Preferred Network Access Commercial |
$657.32
|
| Rate for Payer: Quartz Beloit One Network |
$350.10
|
| Rate for Payer: Quartz Commercial |
$464.41
|
| Rate for Payer: Quartz Medicare Advantage |
$428.69
|
| Rate for Payer: The Alliance Commercial |
$357.24
|
| Rate for Payer: WEA Trust Commercial |
$392.96
|
| Rate for Payer: WPS Commercial |
$529.20
|
|
|
TUBE GASTROSTOMY PEG ENFIT 14FR 8100-14LV
|
Facility
|
IP
|
$687.00
|
|
|
Service Code
|
HCPCS B4087
|
| Hospital Charge Code |
5563441
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$350.10 |
| Max. Negotiated Rate |
$657.32 |
| Rate for Payer: Aetna Commercial |
$643.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$614.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$378.67
|
| Rate for Payer: Cash Price |
$206.10
|
| Rate for Payer: Cigna Commercial |
$657.32
|
| Rate for Payer: Health EOS Commercial |
$635.89
|
| Rate for Payer: HFN Commercial |
$657.32
|
| Rate for Payer: Multiplan Commercial |
$571.58
|
| Rate for Payer: Preferred Network Access Commercial |
$657.32
|
| Rate for Payer: Quartz Beloit One Network |
$350.10
|
| Rate for Payer: Quartz Commercial |
$428.69
|
| Rate for Payer: WEA Trust Commercial |
$392.96
|
| Rate for Payer: WPS Commercial |
$529.20
|
|
|
Tube inserted - Tracheostomy Tube Activity
|
Facility
|
IP
|
$1,191.00
|
|
|
Service Code
|
CPT 31603
|
| Hospital Charge Code |
3000324
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$606.93 |
| Max. Negotiated Rate |
$1,139.55 |
| Rate for Payer: Aetna Commercial |
$1,114.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,065.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$656.48
|
| Rate for Payer: Cash Price |
$357.30
|
| Rate for Payer: Cigna Commercial |
$1,139.55
|
| Rate for Payer: Health EOS Commercial |
$1,102.39
|
| Rate for Payer: HFN Commercial |
$1,139.55
|
| Rate for Payer: Multiplan Commercial |
$990.91
|
| Rate for Payer: Preferred Network Access Commercial |
$1,139.55
|
| Rate for Payer: Quartz Beloit One Network |
$606.93
|
| Rate for Payer: Quartz Commercial |
$743.18
|
| Rate for Payer: WEA Trust Commercial |
$681.25
|
| Rate for Payer: WPS Commercial |
$917.43
|
|
|
Tube inserted - Tracheostomy Tube Activity
|
Facility
|
OP
|
$1,191.00
|
|
|
Service Code
|
CPT 31603
|
| Hospital Charge Code |
3000324
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$313.04 |
| Max. Negotiated Rate |
$6,531.49 |
| Rate for Payer: Aetna Commercial |
$1,114.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,065.23
|
| Rate for Payer: Aetna Managed Medicare |
$1,632.87
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$805.12
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$619.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$594.55
|
| Rate for Payer: Anthem Medicare Advantage |
$1,632.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$656.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,632.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,632.87
|
| Rate for Payer: Cash Price |
$357.30
|
| Rate for Payer: Cash Price |
$357.30
|
| Rate for Payer: Cash Price |
$357.30
|
| Rate for Payer: Cigna Commercial |
$1,139.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,632.87
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,632.87
|
| Rate for Payer: Health EOS Commercial |
$1,102.39
|
| Rate for Payer: HFN Commercial |
$1,139.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,074.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,632.87
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,632.87
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,632.87
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,632.87
|
| Rate for Payer: Multiplan Commercial |
$990.91
|
| Rate for Payer: NAPHCARE Commercial |
$2,449.31
|
| Rate for Payer: Preferred Network Access Commercial |
$1,139.55
|
| Rate for Payer: Quartz Beloit One Network |
$606.93
|
| Rate for Payer: Quartz Commercial |
$805.12
|
| Rate for Payer: Quartz Medicare Advantage |
$1,632.87
|
| Rate for Payer: The Alliance Commercial |
$6,531.49
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,632.87
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$681.25
|
| Rate for Payer: Wellcare Medicare |
$1,632.87
|
| Rate for Payer: WPS Commercial |
$917.43
|
|
|
TUBE LUKI STER.SPECIMEN TRAP 8886864604
|
Facility
|
IP
|
$158.00
|
|
| Hospital Charge Code |
2963419
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$80.52 |
| Max. Negotiated Rate |
$151.17 |
| Rate for Payer: Aetna Commercial |
$147.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$141.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$87.09
|
| Rate for Payer: Cash Price |
$47.40
|
| Rate for Payer: Cigna Commercial |
$151.17
|
| Rate for Payer: Health EOS Commercial |
$146.24
|
| Rate for Payer: HFN Commercial |
$151.17
|
| Rate for Payer: Multiplan Commercial |
$131.46
|
| Rate for Payer: Preferred Network Access Commercial |
$151.17
|
| Rate for Payer: Quartz Beloit One Network |
$80.52
|
| Rate for Payer: Quartz Commercial |
$98.59
|
| Rate for Payer: WEA Trust Commercial |
$90.38
|
| Rate for Payer: WPS Commercial |
$121.71
|
|
|
TUBE LUKI STER.SPECIMEN TRAP 8886864604
|
Facility
|
OP
|
$158.00
|
|
| Hospital Charge Code |
2963419
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$46.01 |
| Max. Negotiated Rate |
$151.17 |
| Rate for Payer: Aetna Commercial |
$147.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$141.32
|
| Rate for Payer: Aetna Managed Medicare |
$46.01
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$106.81
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$82.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$78.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$87.09
|
| Rate for Payer: Cash Price |
$47.40
|
| Rate for Payer: Cigna Commercial |
$151.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$91.96
|
| Rate for Payer: Health EOS Commercial |
$146.24
|
| Rate for Payer: HFN Commercial |
$151.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$123.24
|
| Rate for Payer: Multiplan Commercial |
$131.46
|
| Rate for Payer: NAPHCARE Commercial |
$98.59
|
| Rate for Payer: Preferred Network Access Commercial |
$151.17
|
| Rate for Payer: Quartz Beloit One Network |
$80.52
|
| Rate for Payer: Quartz Commercial |
$106.81
|
| Rate for Payer: Quartz Medicare Advantage |
$98.59
|
| Rate for Payer: The Alliance Commercial |
$82.16
|
| Rate for Payer: WEA Trust Commercial |
$90.38
|
| Rate for Payer: WPS Commercial |
$121.71
|
|
|
TUBE MAGIL ENDOTRACHEAL 3.5MM CUFFED
|
Facility
|
IP
|
$73.00
|
|
| Hospital Charge Code |
2974407
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$37.20 |
| Max. Negotiated Rate |
$69.85 |
| Rate for Payer: Aetna Commercial |
$68.33
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$65.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$40.24
|
| Rate for Payer: Cash Price |
$21.90
|
| Rate for Payer: Cigna Commercial |
$69.85
|
| Rate for Payer: Health EOS Commercial |
$67.57
|
| Rate for Payer: HFN Commercial |
$69.85
|
| Rate for Payer: Multiplan Commercial |
$60.74
|
| Rate for Payer: Preferred Network Access Commercial |
$69.85
|
| Rate for Payer: Quartz Beloit One Network |
$37.20
|
| Rate for Payer: Quartz Commercial |
$45.55
|
| Rate for Payer: WEA Trust Commercial |
$41.76
|
| Rate for Payer: WPS Commercial |
$56.23
|
|
|
TUBE MAGIL ENDOTRACHEAL 3.5MM CUFFED
|
Facility
|
OP
|
$73.00
|
|
| Hospital Charge Code |
2974407
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.26 |
| Max. Negotiated Rate |
$69.85 |
| Rate for Payer: Aetna Commercial |
$68.33
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$65.29
|
| Rate for Payer: Aetna Managed Medicare |
$21.26
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$49.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$37.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$36.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$40.24
|
| Rate for Payer: Cash Price |
$21.90
|
| Rate for Payer: Cigna Commercial |
$69.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$42.49
|
| Rate for Payer: Health EOS Commercial |
$67.57
|
| Rate for Payer: HFN Commercial |
$69.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$56.94
|
| Rate for Payer: Multiplan Commercial |
$60.74
|
| Rate for Payer: NAPHCARE Commercial |
$45.55
|
| Rate for Payer: Preferred Network Access Commercial |
$69.85
|
| Rate for Payer: Quartz Beloit One Network |
$37.20
|
| Rate for Payer: Quartz Commercial |
$49.35
|
| Rate for Payer: Quartz Medicare Advantage |
$45.55
|
| Rate for Payer: The Alliance Commercial |
$37.96
|
| Rate for Payer: WEA Trust Commercial |
$41.76
|
| Rate for Payer: WPS Commercial |
$56.23
|
|
|
TUBE MICROLARYNGEAL 5.0mm #5-11110
|
Facility
|
IP
|
$160.00
|
|
| Hospital Charge Code |
2974659
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$81.54 |
| Max. Negotiated Rate |
$153.09 |
| Rate for Payer: Aetna Commercial |
$149.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$143.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$88.19
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cigna Commercial |
$153.09
|
| Rate for Payer: Health EOS Commercial |
$148.10
|
| Rate for Payer: HFN Commercial |
$153.09
|
| Rate for Payer: Multiplan Commercial |
$133.12
|
| Rate for Payer: Preferred Network Access Commercial |
$153.09
|
| Rate for Payer: Quartz Beloit One Network |
$81.54
|
| Rate for Payer: Quartz Commercial |
$99.84
|
| Rate for Payer: WEA Trust Commercial |
$91.52
|
| Rate for Payer: WPS Commercial |
$123.25
|
|
|
TUBE MICROLARYNGEAL 5.0mm #5-11110
|
Facility
|
OP
|
$160.00
|
|
| Hospital Charge Code |
2974659
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$46.59 |
| Max. Negotiated Rate |
$153.09 |
| Rate for Payer: Aetna Commercial |
$149.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$143.10
|
| Rate for Payer: Aetna Managed Medicare |
$46.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$108.16
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$83.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$79.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$88.19
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cigna Commercial |
$153.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$93.12
|
| Rate for Payer: Health EOS Commercial |
$148.10
|
| Rate for Payer: HFN Commercial |
$153.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$124.80
|
| Rate for Payer: Multiplan Commercial |
$133.12
|
| Rate for Payer: NAPHCARE Commercial |
$99.84
|
| Rate for Payer: Preferred Network Access Commercial |
$153.09
|
| Rate for Payer: Quartz Beloit One Network |
$81.54
|
| Rate for Payer: Quartz Commercial |
$108.16
|
| Rate for Payer: Quartz Medicare Advantage |
$99.84
|
| Rate for Payer: The Alliance Commercial |
$83.20
|
| Rate for Payer: WEA Trust Commercial |
$91.52
|
| Rate for Payer: WPS Commercial |
$123.25
|
|
|
TUBE MICROLARYNGEAL 6.0MM #5-11112
|
Facility
|
IP
|
$1,069.00
|
|
| Hospital Charge Code |
2974660
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$544.76 |
| Max. Negotiated Rate |
$1,022.82 |
| Rate for Payer: Aetna Commercial |
$1,000.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$956.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$589.23
|
| Rate for Payer: Cash Price |
$320.70
|
| Rate for Payer: Cigna Commercial |
$1,022.82
|
| Rate for Payer: Health EOS Commercial |
$989.47
|
| Rate for Payer: HFN Commercial |
$1,022.82
|
| Rate for Payer: Multiplan Commercial |
$889.41
|
| Rate for Payer: Preferred Network Access Commercial |
$1,022.82
|
| Rate for Payer: Quartz Beloit One Network |
$544.76
|
| Rate for Payer: Quartz Commercial |
$667.06
|
| Rate for Payer: WEA Trust Commercial |
$611.47
|
| Rate for Payer: WPS Commercial |
$823.45
|
|
|
TUBE MICROLARYNGEAL 6.0MM #5-11112
|
Facility
|
OP
|
$1,069.00
|
|
| Hospital Charge Code |
2974660
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$311.29 |
| Max. Negotiated Rate |
$1,022.82 |
| Rate for Payer: Aetna Commercial |
$1,000.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$956.11
|
| Rate for Payer: Aetna Managed Medicare |
$311.29
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$722.64
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$555.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$533.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$589.23
|
| Rate for Payer: Cash Price |
$320.70
|
| Rate for Payer: Cigna Commercial |
$1,022.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$622.16
|
| Rate for Payer: Health EOS Commercial |
$989.47
|
| Rate for Payer: HFN Commercial |
$1,022.82
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$833.82
|
| Rate for Payer: Multiplan Commercial |
$889.41
|
| Rate for Payer: NAPHCARE Commercial |
$667.06
|
| Rate for Payer: Preferred Network Access Commercial |
$1,022.82
|
| Rate for Payer: Quartz Beloit One Network |
$544.76
|
| Rate for Payer: Quartz Commercial |
$722.64
|
| Rate for Payer: Quartz Medicare Advantage |
$667.06
|
| Rate for Payer: The Alliance Commercial |
$555.88
|
| Rate for Payer: WEA Trust Commercial |
$611.47
|
| Rate for Payer: WPS Commercial |
$823.45
|
|
|
Tube-Minidrip
|
Facility
|
IP
|
$7.00
|
|
| Hospital Charge Code |
3040291
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$3.57 |
| Max. Negotiated Rate |
$6.70 |
| Rate for Payer: Aetna Commercial |
$6.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3.86
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: Cigna Commercial |
$6.70
|
| Rate for Payer: Health EOS Commercial |
$6.48
|
| Rate for Payer: HFN Commercial |
$6.70
|
| Rate for Payer: Multiplan Commercial |
$5.82
|
| Rate for Payer: Preferred Network Access Commercial |
$6.70
|
| Rate for Payer: Quartz Beloit One Network |
$3.57
|
| Rate for Payer: Quartz Commercial |
$4.37
|
| Rate for Payer: WEA Trust Commercial |
$4.00
|
| Rate for Payer: WPS Commercial |
$5.39
|
|
|
Tube-Minidrip
|
Facility
|
OP
|
$7.00
|
|
| Hospital Charge Code |
3040291
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$2.04 |
| Max. Negotiated Rate |
$6.70 |
| Rate for Payer: Aetna Commercial |
$6.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6.26
|
| Rate for Payer: Aetna Managed Medicare |
$2.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4.73
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3.86
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: Cigna Commercial |
$6.70
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4.07
|
| Rate for Payer: Health EOS Commercial |
$6.48
|
| Rate for Payer: HFN Commercial |
$6.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5.46
|
| Rate for Payer: Multiplan Commercial |
$5.82
|
| Rate for Payer: NAPHCARE Commercial |
$4.37
|
| Rate for Payer: Preferred Network Access Commercial |
$6.70
|
| Rate for Payer: Quartz Beloit One Network |
$3.57
|
| Rate for Payer: Quartz Commercial |
$4.73
|
| Rate for Payer: Quartz Medicare Advantage |
$4.37
|
| Rate for Payer: The Alliance Commercial |
$3.64
|
| Rate for Payer: WEA Trust Commercial |
$4.00
|
| Rate for Payer: WPS Commercial |
$5.39
|
|
