|
TUBE RUSCH DBL LMN RT 41FR #116200041
|
Facility
|
IP
|
$1,319.00
|
|
| Hospital Charge Code |
2974711
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$672.16 |
| Max. Negotiated Rate |
$1,262.02 |
| Rate for Payer: Aetna Commercial |
$1,234.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,179.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$727.03
|
| Rate for Payer: Cash Price |
$395.70
|
| Rate for Payer: Cigna Commercial |
$1,262.02
|
| Rate for Payer: Health EOS Commercial |
$1,220.87
|
| Rate for Payer: HFN Commercial |
$1,262.02
|
| Rate for Payer: Multiplan Commercial |
$1,097.41
|
| Rate for Payer: Preferred Network Access Commercial |
$1,262.02
|
| Rate for Payer: Quartz Beloit One Network |
$672.16
|
| Rate for Payer: Quartz Commercial |
$823.06
|
| Rate for Payer: WEA Trust Commercial |
$754.47
|
| Rate for Payer: WPS Commercial |
$1,016.03
|
|
|
TUBE RUSCH DBL LMN RT 41FR #116200041
|
Facility
|
OP
|
$1,319.00
|
|
| Hospital Charge Code |
2974711
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$384.09 |
| Max. Negotiated Rate |
$1,262.02 |
| Rate for Payer: Aetna Commercial |
$1,234.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,179.71
|
| Rate for Payer: Aetna Managed Medicare |
$384.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$891.64
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$685.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$658.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$727.03
|
| Rate for Payer: Cash Price |
$395.70
|
| Rate for Payer: Cigna Commercial |
$1,262.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$767.66
|
| Rate for Payer: Health EOS Commercial |
$1,220.87
|
| Rate for Payer: HFN Commercial |
$1,262.02
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,028.82
|
| Rate for Payer: Multiplan Commercial |
$1,097.41
|
| Rate for Payer: NAPHCARE Commercial |
$823.06
|
| Rate for Payer: Preferred Network Access Commercial |
$1,262.02
|
| Rate for Payer: Quartz Beloit One Network |
$672.16
|
| Rate for Payer: Quartz Commercial |
$891.64
|
| Rate for Payer: Quartz Medicare Advantage |
$823.06
|
| Rate for Payer: The Alliance Commercial |
$685.88
|
| Rate for Payer: WEA Trust Commercial |
$754.47
|
| Rate for Payer: WPS Commercial |
$1,016.03
|
|
|
TUBE SALEM SUMP 14FR.W/ANTI
|
Facility
|
IP
|
$134.00
|
|
| Hospital Charge Code |
2963080
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$68.29 |
| Max. Negotiated Rate |
$128.21 |
| Rate for Payer: Aetna Commercial |
$125.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$119.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$73.86
|
| Rate for Payer: Cash Price |
$40.20
|
| Rate for Payer: Cigna Commercial |
$128.21
|
| Rate for Payer: Health EOS Commercial |
$124.03
|
| Rate for Payer: HFN Commercial |
$128.21
|
| Rate for Payer: Multiplan Commercial |
$111.49
|
| Rate for Payer: Preferred Network Access Commercial |
$128.21
|
| Rate for Payer: Quartz Beloit One Network |
$68.29
|
| Rate for Payer: Quartz Commercial |
$83.62
|
| Rate for Payer: WEA Trust Commercial |
$76.65
|
| Rate for Payer: WPS Commercial |
$103.22
|
|
|
TUBE SALEM SUMP 14FR.W/ANTI
|
Facility
|
OP
|
$134.00
|
|
| Hospital Charge Code |
2963080
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$39.02 |
| Max. Negotiated Rate |
$128.21 |
| Rate for Payer: Aetna Commercial |
$125.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$119.85
|
| Rate for Payer: Aetna Managed Medicare |
$39.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$90.58
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$69.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$66.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$73.86
|
| Rate for Payer: Cash Price |
$40.20
|
| Rate for Payer: Cigna Commercial |
$128.21
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$77.99
|
| Rate for Payer: Health EOS Commercial |
$124.03
|
| Rate for Payer: HFN Commercial |
$128.21
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$104.52
|
| Rate for Payer: Multiplan Commercial |
$111.49
|
| Rate for Payer: NAPHCARE Commercial |
$83.62
|
| Rate for Payer: Preferred Network Access Commercial |
$128.21
|
| Rate for Payer: Quartz Beloit One Network |
$68.29
|
| Rate for Payer: Quartz Commercial |
$90.58
|
| Rate for Payer: Quartz Medicare Advantage |
$83.62
|
| Rate for Payer: The Alliance Commercial |
$69.68
|
| Rate for Payer: WEA Trust Commercial |
$76.65
|
| Rate for Payer: WPS Commercial |
$103.22
|
|
|
TUBE SALEM SUMP 16 FR. W
|
Facility
|
OP
|
$98.00
|
|
| Hospital Charge Code |
2963079
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$28.54 |
| Max. Negotiated Rate |
$93.77 |
| Rate for Payer: Aetna Commercial |
$91.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$87.65
|
| Rate for Payer: Aetna Managed Medicare |
$28.54
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$66.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$50.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$48.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$54.02
|
| Rate for Payer: Cash Price |
$29.40
|
| Rate for Payer: Cigna Commercial |
$93.77
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$57.04
|
| Rate for Payer: Health EOS Commercial |
$90.71
|
| Rate for Payer: HFN Commercial |
$93.77
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$76.44
|
| Rate for Payer: Multiplan Commercial |
$81.54
|
| Rate for Payer: NAPHCARE Commercial |
$61.15
|
| Rate for Payer: Preferred Network Access Commercial |
$93.77
|
| Rate for Payer: Quartz Beloit One Network |
$49.94
|
| Rate for Payer: Quartz Commercial |
$66.25
|
| Rate for Payer: Quartz Medicare Advantage |
$61.15
|
| Rate for Payer: The Alliance Commercial |
$50.96
|
| Rate for Payer: WEA Trust Commercial |
$56.06
|
| Rate for Payer: WPS Commercial |
$75.49
|
|
|
TUBE SALEM SUMP 16 FR. W
|
Facility
|
IP
|
$98.00
|
|
| Hospital Charge Code |
2963079
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$49.94 |
| Max. Negotiated Rate |
$93.77 |
| Rate for Payer: Aetna Commercial |
$91.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$87.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$54.02
|
| Rate for Payer: Cash Price |
$29.40
|
| Rate for Payer: Cigna Commercial |
$93.77
|
| Rate for Payer: Health EOS Commercial |
$90.71
|
| Rate for Payer: HFN Commercial |
$93.77
|
| Rate for Payer: Multiplan Commercial |
$81.54
|
| Rate for Payer: Preferred Network Access Commercial |
$93.77
|
| Rate for Payer: Quartz Beloit One Network |
$49.94
|
| Rate for Payer: Quartz Commercial |
$61.15
|
| Rate for Payer: WEA Trust Commercial |
$56.06
|
| Rate for Payer: WPS Commercial |
$75.49
|
|
|
Tube Salem Sump16F W/Anti-Refl
|
Facility
|
OP
|
$173.00
|
|
| Hospital Charge Code |
3101762
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$50.38 |
| Max. Negotiated Rate |
$165.53 |
| Rate for Payer: Aetna Commercial |
$161.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$154.73
|
| Rate for Payer: Aetna Managed Medicare |
$50.38
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$116.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$89.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$86.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$95.36
|
| Rate for Payer: Cash Price |
$51.90
|
| Rate for Payer: Cigna Commercial |
$165.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$100.69
|
| Rate for Payer: Health EOS Commercial |
$160.13
|
| Rate for Payer: HFN Commercial |
$165.53
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$134.94
|
| Rate for Payer: Multiplan Commercial |
$143.94
|
| Rate for Payer: NAPHCARE Commercial |
$107.95
|
| Rate for Payer: Preferred Network Access Commercial |
$165.53
|
| Rate for Payer: Quartz Beloit One Network |
$88.16
|
| Rate for Payer: Quartz Commercial |
$116.95
|
| Rate for Payer: Quartz Medicare Advantage |
$107.95
|
| Rate for Payer: The Alliance Commercial |
$89.96
|
| Rate for Payer: WEA Trust Commercial |
$98.96
|
| Rate for Payer: WPS Commercial |
$133.26
|
|
|
Tube Salem Sump16F W/Anti-Refl
|
Facility
|
IP
|
$173.00
|
|
| Hospital Charge Code |
3101762
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$88.16 |
| Max. Negotiated Rate |
$165.53 |
| Rate for Payer: Aetna Commercial |
$161.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$154.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$95.36
|
| Rate for Payer: Cash Price |
$51.90
|
| Rate for Payer: Cigna Commercial |
$165.53
|
| Rate for Payer: Health EOS Commercial |
$160.13
|
| Rate for Payer: HFN Commercial |
$165.53
|
| Rate for Payer: Multiplan Commercial |
$143.94
|
| Rate for Payer: Preferred Network Access Commercial |
$165.53
|
| Rate for Payer: Quartz Beloit One Network |
$88.16
|
| Rate for Payer: Quartz Commercial |
$107.95
|
| Rate for Payer: WEA Trust Commercial |
$98.96
|
| Rate for Payer: WPS Commercial |
$133.26
|
|
|
TUBE SALEM SUMP 18FR.W/ANTI. 8888266148
|
Facility
|
OP
|
$111.00
|
|
| Hospital Charge Code |
2963078
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$32.32 |
| Max. Negotiated Rate |
$106.20 |
| Rate for Payer: Aetna Commercial |
$103.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$99.28
|
| Rate for Payer: Aetna Managed Medicare |
$32.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$75.04
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$57.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$55.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$61.18
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cigna Commercial |
$106.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$64.60
|
| Rate for Payer: Health EOS Commercial |
$102.74
|
| Rate for Payer: HFN Commercial |
$106.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$86.58
|
| Rate for Payer: Multiplan Commercial |
$92.35
|
| Rate for Payer: NAPHCARE Commercial |
$69.26
|
| Rate for Payer: Preferred Network Access Commercial |
$106.20
|
| Rate for Payer: Quartz Beloit One Network |
$56.57
|
| Rate for Payer: Quartz Commercial |
$75.04
|
| Rate for Payer: Quartz Medicare Advantage |
$69.26
|
| Rate for Payer: The Alliance Commercial |
$57.72
|
| Rate for Payer: WEA Trust Commercial |
$63.49
|
| Rate for Payer: WPS Commercial |
$85.50
|
|
|
TUBE SALEM SUMP 18FR.W/ANTI. 8888266148
|
Facility
|
IP
|
$111.00
|
|
| Hospital Charge Code |
2963078
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$56.57 |
| Max. Negotiated Rate |
$106.20 |
| Rate for Payer: Aetna Commercial |
$103.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$99.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$61.18
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cigna Commercial |
$106.20
|
| Rate for Payer: Health EOS Commercial |
$102.74
|
| Rate for Payer: HFN Commercial |
$106.20
|
| Rate for Payer: Multiplan Commercial |
$92.35
|
| Rate for Payer: Preferred Network Access Commercial |
$106.20
|
| Rate for Payer: Quartz Beloit One Network |
$56.57
|
| Rate for Payer: Quartz Commercial |
$69.26
|
| Rate for Payer: WEA Trust Commercial |
$63.49
|
| Rate for Payer: WPS Commercial |
$85.50
|
|
|
TUBE SET INSUFFLATION STRYKER PNEUMOCLEAR HEATED HUMIDIFIED SMOKE EVACUATION/CO2 CONDITIONING 062005
|
Facility
|
OP
|
$1,364.00
|
|
| Hospital Charge Code |
6181644
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$397.20 |
| Max. Negotiated Rate |
$1,305.08 |
| Rate for Payer: Aetna Commercial |
$1,276.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,219.96
|
| Rate for Payer: Aetna Managed Medicare |
$397.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$922.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$709.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$680.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$751.84
|
| Rate for Payer: Cash Price |
$409.20
|
| Rate for Payer: Cigna Commercial |
$1,305.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$793.85
|
| Rate for Payer: Health EOS Commercial |
$1,262.52
|
| Rate for Payer: HFN Commercial |
$1,305.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,063.92
|
| Rate for Payer: Multiplan Commercial |
$1,134.85
|
| Rate for Payer: NAPHCARE Commercial |
$851.14
|
| Rate for Payer: Preferred Network Access Commercial |
$1,305.08
|
| Rate for Payer: Quartz Beloit One Network |
$695.09
|
| Rate for Payer: Quartz Commercial |
$922.06
|
| Rate for Payer: Quartz Medicare Advantage |
$851.14
|
| Rate for Payer: The Alliance Commercial |
$709.28
|
| Rate for Payer: WEA Trust Commercial |
$780.21
|
| Rate for Payer: WPS Commercial |
$1,050.69
|
|
|
TUBE SET INSUFFLATION STRYKER PNEUMOCLEAR HEATED HUMIDIFIED SMOKE EVACUATION/CO2 CONDITIONING 062005
|
Facility
|
IP
|
$1,364.00
|
|
| Hospital Charge Code |
6181644
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$695.09 |
| Max. Negotiated Rate |
$1,305.08 |
| Rate for Payer: Aetna Commercial |
$1,276.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,219.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$751.84
|
| Rate for Payer: Cash Price |
$409.20
|
| Rate for Payer: Cigna Commercial |
$1,305.08
|
| Rate for Payer: Health EOS Commercial |
$1,262.52
|
| Rate for Payer: HFN Commercial |
$1,305.08
|
| Rate for Payer: Multiplan Commercial |
$1,134.85
|
| Rate for Payer: Preferred Network Access Commercial |
$1,305.08
|
| Rate for Payer: Quartz Beloit One Network |
$695.09
|
| Rate for Payer: Quartz Commercial |
$851.14
|
| Rate for Payer: WEA Trust Commercial |
$780.21
|
| Rate for Payer: WPS Commercial |
$1,050.69
|
|
|
TUBE SET INSUFFLATION STRYKER PNEUMOSURE HEATED WITH RTP (NO SMOKE EVAC) 0620040690
|
Facility
|
IP
|
$731.00
|
|
| Hospital Charge Code |
6200958
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$372.52 |
| Max. Negotiated Rate |
$699.42 |
| Rate for Payer: Aetna Commercial |
$684.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$653.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$402.93
|
| Rate for Payer: Cash Price |
$219.30
|
| Rate for Payer: Cigna Commercial |
$699.42
|
| Rate for Payer: Health EOS Commercial |
$676.61
|
| Rate for Payer: HFN Commercial |
$699.42
|
| Rate for Payer: Multiplan Commercial |
$608.19
|
| Rate for Payer: Preferred Network Access Commercial |
$699.42
|
| Rate for Payer: Quartz Beloit One Network |
$372.52
|
| Rate for Payer: Quartz Commercial |
$456.14
|
| Rate for Payer: WEA Trust Commercial |
$418.13
|
| Rate for Payer: WPS Commercial |
$563.09
|
|
|
TUBE SET INSUFFLATION STRYKER PNEUMOSURE HEATED WITH RTP (NO SMOKE EVAC) 0620040690
|
Facility
|
OP
|
$731.00
|
|
| Hospital Charge Code |
6200958
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$212.87 |
| Max. Negotiated Rate |
$699.42 |
| Rate for Payer: Aetna Commercial |
$684.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$653.81
|
| Rate for Payer: Aetna Managed Medicare |
$212.87
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$494.16
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$380.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$364.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$402.93
|
| Rate for Payer: Cash Price |
$219.30
|
| Rate for Payer: Cigna Commercial |
$699.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$425.44
|
| Rate for Payer: Health EOS Commercial |
$676.61
|
| Rate for Payer: HFN Commercial |
$699.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$570.18
|
| Rate for Payer: Multiplan Commercial |
$608.19
|
| Rate for Payer: NAPHCARE Commercial |
$456.14
|
| Rate for Payer: Preferred Network Access Commercial |
$699.42
|
| Rate for Payer: Quartz Beloit One Network |
$372.52
|
| Rate for Payer: Quartz Commercial |
$494.16
|
| Rate for Payer: Quartz Medicare Advantage |
$456.14
|
| Rate for Payer: The Alliance Commercial |
$380.12
|
| Rate for Payer: WEA Trust Commercial |
$418.13
|
| Rate for Payer: WPS Commercial |
$563.09
|
|
|
TUBE SUCTION CONNECTING 18
|
Facility
|
IP
|
$12.00
|
|
| Hospital Charge Code |
2969066
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.12 |
| Max. Negotiated Rate |
$11.48 |
| Rate for Payer: Aetna Commercial |
$11.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6.61
|
| Rate for Payer: Cash Price |
$3.60
|
| Rate for Payer: Cigna Commercial |
$11.48
|
| Rate for Payer: Health EOS Commercial |
$11.11
|
| Rate for Payer: HFN Commercial |
$11.48
|
| Rate for Payer: Multiplan Commercial |
$9.98
|
| Rate for Payer: Preferred Network Access Commercial |
$11.48
|
| Rate for Payer: Quartz Beloit One Network |
$6.12
|
| Rate for Payer: Quartz Commercial |
$7.49
|
| Rate for Payer: WEA Trust Commercial |
$6.86
|
| Rate for Payer: WPS Commercial |
$9.24
|
|
|
TUBE SUCTION CONNECTING 18
|
Facility
|
OP
|
$12.00
|
|
| Hospital Charge Code |
2969066
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.49 |
| Max. Negotiated Rate |
$11.48 |
| Rate for Payer: Aetna Commercial |
$11.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10.73
|
| Rate for Payer: Aetna Managed Medicare |
$3.49
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8.11
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6.61
|
| Rate for Payer: Cash Price |
$3.60
|
| Rate for Payer: Cigna Commercial |
$11.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6.98
|
| Rate for Payer: Health EOS Commercial |
$11.11
|
| Rate for Payer: HFN Commercial |
$11.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9.36
|
| Rate for Payer: Multiplan Commercial |
$9.98
|
| Rate for Payer: NAPHCARE Commercial |
$7.49
|
| Rate for Payer: Preferred Network Access Commercial |
$11.48
|
| Rate for Payer: Quartz Beloit One Network |
$6.12
|
| Rate for Payer: Quartz Commercial |
$8.11
|
| Rate for Payer: Quartz Medicare Advantage |
$7.49
|
| Rate for Payer: The Alliance Commercial |
$6.24
|
| Rate for Payer: WEA Trust Commercial |
$6.86
|
| Rate for Payer: WPS Commercial |
$9.24
|
|
|
Tube Suction Yankauer
|
Facility
|
IP
|
$75.00
|
|
| Hospital Charge Code |
3101759
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$38.22 |
| Max. Negotiated Rate |
$71.76 |
| Rate for Payer: Aetna Commercial |
$70.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$67.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$41.34
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cigna Commercial |
$71.76
|
| Rate for Payer: Health EOS Commercial |
$69.42
|
| Rate for Payer: HFN Commercial |
$71.76
|
| Rate for Payer: Multiplan Commercial |
$62.40
|
| Rate for Payer: Preferred Network Access Commercial |
$71.76
|
| Rate for Payer: Quartz Beloit One Network |
$38.22
|
| Rate for Payer: Quartz Commercial |
$46.80
|
| Rate for Payer: WEA Trust Commercial |
$42.90
|
| Rate for Payer: WPS Commercial |
$57.77
|
|
|
Tube Suction Yankauer
|
Facility
|
OP
|
$75.00
|
|
| Hospital Charge Code |
3101759
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$21.84 |
| Max. Negotiated Rate |
$71.76 |
| Rate for Payer: Aetna Commercial |
$70.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$67.08
|
| Rate for Payer: Aetna Managed Medicare |
$21.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$50.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$39.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$37.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$41.34
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cigna Commercial |
$71.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$43.65
|
| Rate for Payer: Health EOS Commercial |
$69.42
|
| Rate for Payer: HFN Commercial |
$71.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$58.50
|
| Rate for Payer: Multiplan Commercial |
$62.40
|
| Rate for Payer: NAPHCARE Commercial |
$46.80
|
| Rate for Payer: Preferred Network Access Commercial |
$71.76
|
| Rate for Payer: Quartz Beloit One Network |
$38.22
|
| Rate for Payer: Quartz Commercial |
$50.70
|
| Rate for Payer: Quartz Medicare Advantage |
$46.80
|
| Rate for Payer: The Alliance Commercial |
$39.00
|
| Rate for Payer: WEA Trust Commercial |
$42.90
|
| Rate for Payer: WPS Commercial |
$57.77
|
|
|
Tube-Sump 10F
|
Facility
|
OP
|
$173.00
|
|
| Hospital Charge Code |
3101760
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$50.38 |
| Max. Negotiated Rate |
$165.53 |
| Rate for Payer: Aetna Commercial |
$161.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$154.73
|
| Rate for Payer: Aetna Managed Medicare |
$50.38
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$116.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$89.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$86.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$95.36
|
| Rate for Payer: Cash Price |
$51.90
|
| Rate for Payer: Cigna Commercial |
$165.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$100.69
|
| Rate for Payer: Health EOS Commercial |
$160.13
|
| Rate for Payer: HFN Commercial |
$165.53
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$134.94
|
| Rate for Payer: Multiplan Commercial |
$143.94
|
| Rate for Payer: NAPHCARE Commercial |
$107.95
|
| Rate for Payer: Preferred Network Access Commercial |
$165.53
|
| Rate for Payer: Quartz Beloit One Network |
$88.16
|
| Rate for Payer: Quartz Commercial |
$116.95
|
| Rate for Payer: Quartz Medicare Advantage |
$107.95
|
| Rate for Payer: The Alliance Commercial |
$89.96
|
| Rate for Payer: WEA Trust Commercial |
$98.96
|
| Rate for Payer: WPS Commercial |
$133.26
|
|
|
Tube-Sump 10F
|
Facility
|
IP
|
$173.00
|
|
| Hospital Charge Code |
3101760
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$88.16 |
| Max. Negotiated Rate |
$165.53 |
| Rate for Payer: Aetna Commercial |
$161.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$154.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$95.36
|
| Rate for Payer: Cash Price |
$51.90
|
| Rate for Payer: Cigna Commercial |
$165.53
|
| Rate for Payer: Health EOS Commercial |
$160.13
|
| Rate for Payer: HFN Commercial |
$165.53
|
| Rate for Payer: Multiplan Commercial |
$143.94
|
| Rate for Payer: Preferred Network Access Commercial |
$165.53
|
| Rate for Payer: Quartz Beloit One Network |
$88.16
|
| Rate for Payer: Quartz Commercial |
$107.95
|
| Rate for Payer: WEA Trust Commercial |
$98.96
|
| Rate for Payer: WPS Commercial |
$133.26
|
|
|
Tube-Sump 14Fr
|
Facility
|
IP
|
$173.00
|
|
| Hospital Charge Code |
3101761
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$88.16 |
| Max. Negotiated Rate |
$165.53 |
| Rate for Payer: Aetna Commercial |
$161.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$154.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$95.36
|
| Rate for Payer: Cash Price |
$51.90
|
| Rate for Payer: Cigna Commercial |
$165.53
|
| Rate for Payer: Health EOS Commercial |
$160.13
|
| Rate for Payer: HFN Commercial |
$165.53
|
| Rate for Payer: Multiplan Commercial |
$143.94
|
| Rate for Payer: Preferred Network Access Commercial |
$165.53
|
| Rate for Payer: Quartz Beloit One Network |
$88.16
|
| Rate for Payer: Quartz Commercial |
$107.95
|
| Rate for Payer: WEA Trust Commercial |
$98.96
|
| Rate for Payer: WPS Commercial |
$133.26
|
|
|
Tube-Sump 14Fr
|
Facility
|
OP
|
$173.00
|
|
| Hospital Charge Code |
3101761
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$50.38 |
| Max. Negotiated Rate |
$165.53 |
| Rate for Payer: Aetna Commercial |
$161.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$154.73
|
| Rate for Payer: Aetna Managed Medicare |
$50.38
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$116.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$89.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$86.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$95.36
|
| Rate for Payer: Cash Price |
$51.90
|
| Rate for Payer: Cigna Commercial |
$165.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$100.69
|
| Rate for Payer: Health EOS Commercial |
$160.13
|
| Rate for Payer: HFN Commercial |
$165.53
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$134.94
|
| Rate for Payer: Multiplan Commercial |
$143.94
|
| Rate for Payer: NAPHCARE Commercial |
$107.95
|
| Rate for Payer: Preferred Network Access Commercial |
$165.53
|
| Rate for Payer: Quartz Beloit One Network |
$88.16
|
| Rate for Payer: Quartz Commercial |
$116.95
|
| Rate for Payer: Quartz Medicare Advantage |
$107.95
|
| Rate for Payer: The Alliance Commercial |
$89.96
|
| Rate for Payer: WEA Trust Commercial |
$98.96
|
| Rate for Payer: WPS Commercial |
$133.26
|
|
|
Tube-Sump 18Fr
|
Facility
|
IP
|
$173.00
|
|
| Hospital Charge Code |
3101763
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$88.16 |
| Max. Negotiated Rate |
$165.53 |
| Rate for Payer: Aetna Commercial |
$161.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$154.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$95.36
|
| Rate for Payer: Cash Price |
$51.90
|
| Rate for Payer: Cigna Commercial |
$165.53
|
| Rate for Payer: Health EOS Commercial |
$160.13
|
| Rate for Payer: HFN Commercial |
$165.53
|
| Rate for Payer: Multiplan Commercial |
$143.94
|
| Rate for Payer: Preferred Network Access Commercial |
$165.53
|
| Rate for Payer: Quartz Beloit One Network |
$88.16
|
| Rate for Payer: Quartz Commercial |
$107.95
|
| Rate for Payer: WEA Trust Commercial |
$98.96
|
| Rate for Payer: WPS Commercial |
$133.26
|
|
|
Tube-Sump 18Fr
|
Facility
|
OP
|
$173.00
|
|
| Hospital Charge Code |
3101763
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$50.38 |
| Max. Negotiated Rate |
$165.53 |
| Rate for Payer: Aetna Commercial |
$161.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$154.73
|
| Rate for Payer: Aetna Managed Medicare |
$50.38
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$116.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$89.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$86.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$95.36
|
| Rate for Payer: Cash Price |
$51.90
|
| Rate for Payer: Cigna Commercial |
$165.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$100.69
|
| Rate for Payer: Health EOS Commercial |
$160.13
|
| Rate for Payer: HFN Commercial |
$165.53
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$134.94
|
| Rate for Payer: Multiplan Commercial |
$143.94
|
| Rate for Payer: NAPHCARE Commercial |
$107.95
|
| Rate for Payer: Preferred Network Access Commercial |
$165.53
|
| Rate for Payer: Quartz Beloit One Network |
$88.16
|
| Rate for Payer: Quartz Commercial |
$116.95
|
| Rate for Payer: Quartz Medicare Advantage |
$107.95
|
| Rate for Payer: The Alliance Commercial |
$89.96
|
| Rate for Payer: WEA Trust Commercial |
$98.96
|
| Rate for Payer: WPS Commercial |
$133.26
|
|
|
TUBE SURGICAL IRRIGATION PD-IT
|
Facility
|
IP
|
$945.00
|
|
| Hospital Charge Code |
6172008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$481.57 |
| Max. Negotiated Rate |
$904.18 |
| Rate for Payer: Aetna Commercial |
$884.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$845.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$520.88
|
| Rate for Payer: Cash Price |
$283.50
|
| Rate for Payer: Cigna Commercial |
$904.18
|
| Rate for Payer: Health EOS Commercial |
$874.69
|
| Rate for Payer: HFN Commercial |
$904.18
|
| Rate for Payer: Multiplan Commercial |
$786.24
|
| Rate for Payer: Preferred Network Access Commercial |
$904.18
|
| Rate for Payer: Quartz Beloit One Network |
$481.57
|
| Rate for Payer: Quartz Commercial |
$589.68
|
| Rate for Payer: WEA Trust Commercial |
$540.54
|
| Rate for Payer: WPS Commercial |
$727.93
|
|
