|
TUBE SURGICAL IRRIGATION PD-IT
|
Facility
|
OP
|
$945.00
|
|
| Hospital Charge Code |
6172008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$275.18 |
| Max. Negotiated Rate |
$904.18 |
| Rate for Payer: Aetna Commercial |
$884.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$845.21
|
| Rate for Payer: Aetna Managed Medicare |
$275.18
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$638.82
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$491.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$471.74
|
| 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: Dean Health DHI/DHP/ASO |
$549.99
|
| Rate for Payer: Health EOS Commercial |
$874.69
|
| Rate for Payer: HFN Commercial |
$904.18
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$737.10
|
| Rate for Payer: Multiplan Commercial |
$786.24
|
| Rate for Payer: NAPHCARE Commercial |
$589.68
|
| Rate for Payer: Preferred Network Access Commercial |
$904.18
|
| Rate for Payer: Quartz Beloit One Network |
$481.57
|
| Rate for Payer: Quartz Commercial |
$638.82
|
| Rate for Payer: Quartz Medicare Advantage |
$589.68
|
| Rate for Payer: The Alliance Commercial |
$491.40
|
| Rate for Payer: WEA Trust Commercial |
$540.54
|
| Rate for Payer: WPS Commercial |
$727.93
|
|
|
TUBE TEFLON T2 HUMERUS SYSTEM STERILE 1806-0073S
|
Facility
|
OP
|
$1,809.00
|
|
| Hospital Charge Code |
5611631
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$526.78 |
| Max. Negotiated Rate |
$1,730.85 |
| Rate for Payer: Aetna Commercial |
$1,693.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,617.97
|
| Rate for Payer: Aetna Managed Medicare |
$526.78
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,222.88
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$940.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$903.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$997.12
|
| Rate for Payer: Cash Price |
$542.70
|
| Rate for Payer: Cigna Commercial |
$1,730.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,052.84
|
| Rate for Payer: Health EOS Commercial |
$1,674.41
|
| Rate for Payer: HFN Commercial |
$1,730.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,411.02
|
| Rate for Payer: Multiplan Commercial |
$1,505.09
|
| Rate for Payer: NAPHCARE Commercial |
$1,128.82
|
| Rate for Payer: Preferred Network Access Commercial |
$1,730.85
|
| Rate for Payer: Quartz Beloit One Network |
$921.87
|
| Rate for Payer: Quartz Commercial |
$1,222.88
|
| Rate for Payer: Quartz Medicare Advantage |
$1,128.82
|
| Rate for Payer: The Alliance Commercial |
$940.68
|
| Rate for Payer: WEA Trust Commercial |
$1,034.75
|
| Rate for Payer: WPS Commercial |
$1,393.47
|
|
|
TUBE TEFLON T2 HUMERUS SYSTEM STERILE 1806-0073S
|
Facility
|
IP
|
$1,809.00
|
|
| Hospital Charge Code |
5611631
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$921.87 |
| Max. Negotiated Rate |
$1,730.85 |
| Rate for Payer: Aetna Commercial |
$1,693.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,617.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$997.12
|
| Rate for Payer: Cash Price |
$542.70
|
| Rate for Payer: Cigna Commercial |
$1,730.85
|
| Rate for Payer: Health EOS Commercial |
$1,674.41
|
| Rate for Payer: HFN Commercial |
$1,730.85
|
| Rate for Payer: Multiplan Commercial |
$1,505.09
|
| Rate for Payer: Preferred Network Access Commercial |
$1,730.85
|
| Rate for Payer: Quartz Beloit One Network |
$921.87
|
| Rate for Payer: Quartz Commercial |
$1,128.82
|
| Rate for Payer: WEA Trust Commercial |
$1,034.75
|
| Rate for Payer: WPS Commercial |
$1,393.47
|
|
|
TUBE TRACH 6.0 BIVONA W/AIRE-
|
Facility
|
IP
|
$2,572.00
|
|
| Hospital Charge Code |
2966062
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,310.69 |
| Max. Negotiated Rate |
$2,460.89 |
| Rate for Payer: Aetna Commercial |
$2,407.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,300.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,417.69
|
| Rate for Payer: Cash Price |
$771.60
|
| Rate for Payer: Cigna Commercial |
$2,460.89
|
| Rate for Payer: Health EOS Commercial |
$2,380.64
|
| Rate for Payer: HFN Commercial |
$2,460.89
|
| Rate for Payer: Multiplan Commercial |
$2,139.90
|
| Rate for Payer: Preferred Network Access Commercial |
$2,460.89
|
| Rate for Payer: Quartz Beloit One Network |
$1,310.69
|
| Rate for Payer: Quartz Commercial |
$1,604.93
|
| Rate for Payer: WEA Trust Commercial |
$1,471.18
|
| Rate for Payer: WPS Commercial |
$1,981.21
|
|
|
TUBE TRACH 6.0 BIVONA W/AIRE-
|
Facility
|
OP
|
$2,572.00
|
|
| Hospital Charge Code |
2966062
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$748.97 |
| Max. Negotiated Rate |
$2,460.89 |
| Rate for Payer: Aetna Commercial |
$2,407.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,300.40
|
| Rate for Payer: Aetna Managed Medicare |
$748.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,738.67
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,337.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,283.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,417.69
|
| Rate for Payer: Cash Price |
$771.60
|
| Rate for Payer: Cigna Commercial |
$2,460.89
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,496.90
|
| Rate for Payer: Health EOS Commercial |
$2,380.64
|
| Rate for Payer: HFN Commercial |
$2,460.89
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,006.16
|
| Rate for Payer: Multiplan Commercial |
$2,139.90
|
| Rate for Payer: NAPHCARE Commercial |
$1,604.93
|
| Rate for Payer: Preferred Network Access Commercial |
$2,460.89
|
| Rate for Payer: Quartz Beloit One Network |
$1,310.69
|
| Rate for Payer: Quartz Commercial |
$1,738.67
|
| Rate for Payer: Quartz Medicare Advantage |
$1,604.93
|
| Rate for Payer: The Alliance Commercial |
$1,337.44
|
| Rate for Payer: WEA Trust Commercial |
$1,471.18
|
| Rate for Payer: WPS Commercial |
$1,981.21
|
|
|
TUBE TRACH 6.0MM #100/875/060
|
Facility
|
OP
|
$1,464.00
|
|
| Hospital Charge Code |
2972293
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$426.32 |
| Max. Negotiated Rate |
$1,400.76 |
| Rate for Payer: Aetna Commercial |
$1,370.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,309.40
|
| Rate for Payer: Aetna Managed Medicare |
$426.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$989.66
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$761.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$730.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$806.96
|
| Rate for Payer: Cash Price |
$439.20
|
| Rate for Payer: Cigna Commercial |
$1,400.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$852.05
|
| Rate for Payer: Health EOS Commercial |
$1,355.08
|
| Rate for Payer: HFN Commercial |
$1,400.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,141.92
|
| Rate for Payer: Multiplan Commercial |
$1,218.05
|
| Rate for Payer: NAPHCARE Commercial |
$913.54
|
| Rate for Payer: Preferred Network Access Commercial |
$1,400.76
|
| Rate for Payer: Quartz Beloit One Network |
$746.05
|
| Rate for Payer: Quartz Commercial |
$989.66
|
| Rate for Payer: Quartz Medicare Advantage |
$913.54
|
| Rate for Payer: The Alliance Commercial |
$761.28
|
| Rate for Payer: WEA Trust Commercial |
$837.41
|
| Rate for Payer: WPS Commercial |
$1,127.72
|
|
|
TUBE TRACH 6.0MM #100/875/060
|
Facility
|
IP
|
$1,464.00
|
|
| Hospital Charge Code |
2972293
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$746.05 |
| Max. Negotiated Rate |
$1,400.76 |
| Rate for Payer: Aetna Commercial |
$1,370.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,309.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$806.96
|
| Rate for Payer: Cash Price |
$439.20
|
| Rate for Payer: Cigna Commercial |
$1,400.76
|
| Rate for Payer: Health EOS Commercial |
$1,355.08
|
| Rate for Payer: HFN Commercial |
$1,400.76
|
| Rate for Payer: Multiplan Commercial |
$1,218.05
|
| Rate for Payer: Preferred Network Access Commercial |
$1,400.76
|
| Rate for Payer: Quartz Beloit One Network |
$746.05
|
| Rate for Payer: Quartz Commercial |
$913.54
|
| Rate for Payer: WEA Trust Commercial |
$837.41
|
| Rate for Payer: WPS Commercial |
$1,127.72
|
|
|
TUBE TRACH 6 CFD FEN 6DFEN
|
Facility
|
OP
|
$1,669.00
|
|
| Hospital Charge Code |
5415163
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$486.01 |
| Max. Negotiated Rate |
$1,596.90 |
| Rate for Payer: Aetna Commercial |
$1,562.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,492.75
|
| Rate for Payer: Aetna Managed Medicare |
$486.01
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,128.24
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$867.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$833.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$919.95
|
| Rate for Payer: Cash Price |
$500.70
|
| Rate for Payer: Cigna Commercial |
$1,596.90
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$971.36
|
| Rate for Payer: Health EOS Commercial |
$1,544.83
|
| Rate for Payer: HFN Commercial |
$1,596.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,301.82
|
| Rate for Payer: Multiplan Commercial |
$1,388.61
|
| Rate for Payer: NAPHCARE Commercial |
$1,041.46
|
| Rate for Payer: Preferred Network Access Commercial |
$1,596.90
|
| Rate for Payer: Quartz Beloit One Network |
$850.52
|
| Rate for Payer: Quartz Commercial |
$1,128.24
|
| Rate for Payer: Quartz Medicare Advantage |
$1,041.46
|
| Rate for Payer: The Alliance Commercial |
$867.88
|
| Rate for Payer: WEA Trust Commercial |
$954.67
|
| Rate for Payer: WPS Commercial |
$1,285.63
|
|
|
TUBE TRACH 6 CFD FEN 6DFEN
|
Facility
|
IP
|
$1,669.00
|
|
| Hospital Charge Code |
5415163
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$850.52 |
| Max. Negotiated Rate |
$1,596.90 |
| Rate for Payer: Aetna Commercial |
$1,562.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,492.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$919.95
|
| Rate for Payer: Cash Price |
$500.70
|
| Rate for Payer: Cigna Commercial |
$1,596.90
|
| Rate for Payer: Health EOS Commercial |
$1,544.83
|
| Rate for Payer: HFN Commercial |
$1,596.90
|
| Rate for Payer: Multiplan Commercial |
$1,388.61
|
| Rate for Payer: Preferred Network Access Commercial |
$1,596.90
|
| Rate for Payer: Quartz Beloit One Network |
$850.52
|
| Rate for Payer: Quartz Commercial |
$1,041.46
|
| Rate for Payer: WEA Trust Commercial |
$954.67
|
| Rate for Payer: WPS Commercial |
$1,285.63
|
|
|
TUBE TRACH 6 CFD NON-FEN 6DCT***DEDE 10/23
|
Facility
|
OP
|
$991.00
|
|
| Hospital Charge Code |
2965801
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$288.58 |
| Max. Negotiated Rate |
$948.19 |
| Rate for Payer: Aetna Commercial |
$927.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$886.35
|
| Rate for Payer: Aetna Managed Medicare |
$288.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$669.92
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$515.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$494.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$546.24
|
| Rate for Payer: Cash Price |
$297.30
|
| Rate for Payer: Cigna Commercial |
$948.19
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$576.76
|
| Rate for Payer: Health EOS Commercial |
$917.27
|
| Rate for Payer: HFN Commercial |
$948.19
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$772.98
|
| Rate for Payer: Multiplan Commercial |
$824.51
|
| Rate for Payer: NAPHCARE Commercial |
$618.38
|
| Rate for Payer: Preferred Network Access Commercial |
$948.19
|
| Rate for Payer: Quartz Beloit One Network |
$505.01
|
| Rate for Payer: Quartz Commercial |
$669.92
|
| Rate for Payer: Quartz Medicare Advantage |
$618.38
|
| Rate for Payer: The Alliance Commercial |
$515.32
|
| Rate for Payer: WEA Trust Commercial |
$566.85
|
| Rate for Payer: WPS Commercial |
$763.37
|
|
|
TUBE TRACH 6 CFD NON-FEN 6DCT***DEDE 10/23
|
Facility
|
IP
|
$991.00
|
|
| Hospital Charge Code |
2965801
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$505.01 |
| Max. Negotiated Rate |
$948.19 |
| Rate for Payer: Aetna Commercial |
$927.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$886.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$546.24
|
| Rate for Payer: Cash Price |
$297.30
|
| Rate for Payer: Cigna Commercial |
$948.19
|
| Rate for Payer: Health EOS Commercial |
$917.27
|
| Rate for Payer: HFN Commercial |
$948.19
|
| Rate for Payer: Multiplan Commercial |
$824.51
|
| Rate for Payer: Preferred Network Access Commercial |
$948.19
|
| Rate for Payer: Quartz Beloit One Network |
$505.01
|
| Rate for Payer: Quartz Commercial |
$618.38
|
| Rate for Payer: WEA Trust Commercial |
$566.85
|
| Rate for Payer: WPS Commercial |
$763.37
|
|
|
TUBE TRACH 8 CFD FEN 8DFEN
|
Facility
|
IP
|
$1,607.00
|
|
| Hospital Charge Code |
5415164
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$818.93 |
| Max. Negotiated Rate |
$1,537.58 |
| Rate for Payer: Aetna Commercial |
$1,504.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,437.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$885.78
|
| Rate for Payer: Cash Price |
$482.10
|
| Rate for Payer: Cigna Commercial |
$1,537.58
|
| Rate for Payer: Health EOS Commercial |
$1,487.44
|
| Rate for Payer: HFN Commercial |
$1,537.58
|
| Rate for Payer: Multiplan Commercial |
$1,337.02
|
| Rate for Payer: Preferred Network Access Commercial |
$1,537.58
|
| Rate for Payer: Quartz Beloit One Network |
$818.93
|
| Rate for Payer: Quartz Commercial |
$1,002.77
|
| Rate for Payer: WEA Trust Commercial |
$919.20
|
| Rate for Payer: WPS Commercial |
$1,237.87
|
|
|
TUBE TRACH 8 CFD FEN 8DFEN
|
Facility
|
OP
|
$1,607.00
|
|
| Hospital Charge Code |
5415164
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$467.96 |
| Max. Negotiated Rate |
$1,537.58 |
| Rate for Payer: Aetna Commercial |
$1,504.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,437.30
|
| Rate for Payer: Aetna Managed Medicare |
$467.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,086.33
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$835.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$802.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$885.78
|
| Rate for Payer: Cash Price |
$482.10
|
| Rate for Payer: Cigna Commercial |
$1,537.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$935.27
|
| Rate for Payer: Health EOS Commercial |
$1,487.44
|
| Rate for Payer: HFN Commercial |
$1,537.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,253.46
|
| Rate for Payer: Multiplan Commercial |
$1,337.02
|
| Rate for Payer: NAPHCARE Commercial |
$1,002.77
|
| Rate for Payer: Preferred Network Access Commercial |
$1,537.58
|
| Rate for Payer: Quartz Beloit One Network |
$818.93
|
| Rate for Payer: Quartz Commercial |
$1,086.33
|
| Rate for Payer: Quartz Medicare Advantage |
$1,002.77
|
| Rate for Payer: The Alliance Commercial |
$835.64
|
| Rate for Payer: WEA Trust Commercial |
$919.20
|
| Rate for Payer: WPS Commercial |
$1,237.87
|
|
|
TUBE TRACH 8 CFD NON-FEN 8DCT***DEDE 9/23
|
Facility
|
IP
|
$991.00
|
|
| Hospital Charge Code |
2965802
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$505.01 |
| Max. Negotiated Rate |
$948.19 |
| Rate for Payer: Aetna Commercial |
$927.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$886.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$546.24
|
| Rate for Payer: Cash Price |
$297.30
|
| Rate for Payer: Cigna Commercial |
$948.19
|
| Rate for Payer: Health EOS Commercial |
$917.27
|
| Rate for Payer: HFN Commercial |
$948.19
|
| Rate for Payer: Multiplan Commercial |
$824.51
|
| Rate for Payer: Preferred Network Access Commercial |
$948.19
|
| Rate for Payer: Quartz Beloit One Network |
$505.01
|
| Rate for Payer: Quartz Commercial |
$618.38
|
| Rate for Payer: WEA Trust Commercial |
$566.85
|
| Rate for Payer: WPS Commercial |
$763.37
|
|
|
TUBE TRACH 8 CFD NON-FEN 8DCT***DEDE 9/23
|
Facility
|
OP
|
$991.00
|
|
| Hospital Charge Code |
2965802
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$288.58 |
| Max. Negotiated Rate |
$948.19 |
| Rate for Payer: Aetna Commercial |
$927.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$886.35
|
| Rate for Payer: Aetna Managed Medicare |
$288.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$669.92
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$515.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$494.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$546.24
|
| Rate for Payer: Cash Price |
$297.30
|
| Rate for Payer: Cigna Commercial |
$948.19
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$576.76
|
| Rate for Payer: Health EOS Commercial |
$917.27
|
| Rate for Payer: HFN Commercial |
$948.19
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$772.98
|
| Rate for Payer: Multiplan Commercial |
$824.51
|
| Rate for Payer: NAPHCARE Commercial |
$618.38
|
| Rate for Payer: Preferred Network Access Commercial |
$948.19
|
| Rate for Payer: Quartz Beloit One Network |
$505.01
|
| Rate for Payer: Quartz Commercial |
$669.92
|
| Rate for Payer: Quartz Medicare Advantage |
$618.38
|
| Rate for Payer: The Alliance Commercial |
$515.32
|
| Rate for Payer: WEA Trust Commercial |
$566.85
|
| Rate for Payer: WPS Commercial |
$763.37
|
|
|
TUBE TRACH BIVONA 5.0MM 670150
|
Facility
|
OP
|
$1,159.00
|
|
| Hospital Charge Code |
5385011
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$337.50 |
| Max. Negotiated Rate |
$1,108.93 |
| Rate for Payer: Aetna Commercial |
$1,084.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,036.61
|
| Rate for Payer: Aetna Managed Medicare |
$337.50
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$783.48
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$602.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$578.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$638.84
|
| Rate for Payer: Cash Price |
$347.70
|
| Rate for Payer: Cigna Commercial |
$1,108.93
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$674.54
|
| Rate for Payer: Health EOS Commercial |
$1,072.77
|
| Rate for Payer: HFN Commercial |
$1,108.93
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$904.02
|
| Rate for Payer: Multiplan Commercial |
$964.29
|
| Rate for Payer: NAPHCARE Commercial |
$723.22
|
| Rate for Payer: Preferred Network Access Commercial |
$1,108.93
|
| Rate for Payer: Quartz Beloit One Network |
$590.63
|
| Rate for Payer: Quartz Commercial |
$783.48
|
| Rate for Payer: Quartz Medicare Advantage |
$723.22
|
| Rate for Payer: The Alliance Commercial |
$602.68
|
| Rate for Payer: WEA Trust Commercial |
$662.95
|
| Rate for Payer: WPS Commercial |
$892.78
|
|
|
TUBE TRACH BIVONA 5.0MM 670150
|
Facility
|
IP
|
$1,159.00
|
|
| Hospital Charge Code |
5385011
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$590.63 |
| Max. Negotiated Rate |
$1,108.93 |
| Rate for Payer: Aetna Commercial |
$1,084.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,036.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$638.84
|
| Rate for Payer: Cash Price |
$347.70
|
| Rate for Payer: Cigna Commercial |
$1,108.93
|
| Rate for Payer: Health EOS Commercial |
$1,072.77
|
| Rate for Payer: HFN Commercial |
$1,108.93
|
| Rate for Payer: Multiplan Commercial |
$964.29
|
| Rate for Payer: Preferred Network Access Commercial |
$1,108.93
|
| Rate for Payer: Quartz Beloit One Network |
$590.63
|
| Rate for Payer: Quartz Commercial |
$723.22
|
| Rate for Payer: WEA Trust Commercial |
$662.95
|
| Rate for Payer: WPS Commercial |
$892.78
|
|
|
TUBE TRACH BIVONA 6.0MM 670160
|
Facility
|
OP
|
$1,216.00
|
|
| Hospital Charge Code |
4494190
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$354.10 |
| Max. Negotiated Rate |
$1,163.47 |
| Rate for Payer: Aetna Commercial |
$1,138.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,087.59
|
| Rate for Payer: Aetna Managed Medicare |
$354.10
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$822.02
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$632.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$607.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$670.26
|
| Rate for Payer: Cash Price |
$364.80
|
| Rate for Payer: Cigna Commercial |
$1,163.47
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$707.71
|
| Rate for Payer: Health EOS Commercial |
$1,125.53
|
| Rate for Payer: HFN Commercial |
$1,163.47
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$948.48
|
| Rate for Payer: Multiplan Commercial |
$1,011.71
|
| Rate for Payer: NAPHCARE Commercial |
$758.78
|
| Rate for Payer: Preferred Network Access Commercial |
$1,163.47
|
| Rate for Payer: Quartz Beloit One Network |
$619.67
|
| Rate for Payer: Quartz Commercial |
$822.02
|
| Rate for Payer: Quartz Medicare Advantage |
$758.78
|
| Rate for Payer: The Alliance Commercial |
$632.32
|
| Rate for Payer: WEA Trust Commercial |
$695.55
|
| Rate for Payer: WPS Commercial |
$936.68
|
|
|
TUBE TRACH BIVONA 6.0MM 670160
|
Facility
|
IP
|
$1,216.00
|
|
| Hospital Charge Code |
4494190
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$619.67 |
| Max. Negotiated Rate |
$1,163.47 |
| Rate for Payer: Aetna Commercial |
$1,138.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,087.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$670.26
|
| Rate for Payer: Cash Price |
$364.80
|
| Rate for Payer: Cigna Commercial |
$1,163.47
|
| Rate for Payer: Health EOS Commercial |
$1,125.53
|
| Rate for Payer: HFN Commercial |
$1,163.47
|
| Rate for Payer: Multiplan Commercial |
$1,011.71
|
| Rate for Payer: Preferred Network Access Commercial |
$1,163.47
|
| Rate for Payer: Quartz Beloit One Network |
$619.67
|
| Rate for Payer: Quartz Commercial |
$758.78
|
| Rate for Payer: WEA Trust Commercial |
$695.55
|
| Rate for Payer: WPS Commercial |
$936.68
|
|
|
TUBE TRACH BIVONA 7.0MM 670170
|
Facility
|
IP
|
$1,216.00
|
|
| Hospital Charge Code |
4494191
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$619.67 |
| Max. Negotiated Rate |
$1,163.47 |
| Rate for Payer: Aetna Commercial |
$1,138.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,087.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$670.26
|
| Rate for Payer: Cash Price |
$364.80
|
| Rate for Payer: Cigna Commercial |
$1,163.47
|
| Rate for Payer: Health EOS Commercial |
$1,125.53
|
| Rate for Payer: HFN Commercial |
$1,163.47
|
| Rate for Payer: Multiplan Commercial |
$1,011.71
|
| Rate for Payer: Preferred Network Access Commercial |
$1,163.47
|
| Rate for Payer: Quartz Beloit One Network |
$619.67
|
| Rate for Payer: Quartz Commercial |
$758.78
|
| Rate for Payer: WEA Trust Commercial |
$695.55
|
| Rate for Payer: WPS Commercial |
$936.68
|
|
|
TUBE TRACH BIVONA 7.0MM 670170
|
Facility
|
OP
|
$1,216.00
|
|
| Hospital Charge Code |
4494191
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$354.10 |
| Max. Negotiated Rate |
$1,163.47 |
| Rate for Payer: Aetna Commercial |
$1,138.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,087.59
|
| Rate for Payer: Aetna Managed Medicare |
$354.10
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$822.02
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$632.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$607.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$670.26
|
| Rate for Payer: Cash Price |
$364.80
|
| Rate for Payer: Cigna Commercial |
$1,163.47
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$707.71
|
| Rate for Payer: Health EOS Commercial |
$1,125.53
|
| Rate for Payer: HFN Commercial |
$1,163.47
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$948.48
|
| Rate for Payer: Multiplan Commercial |
$1,011.71
|
| Rate for Payer: NAPHCARE Commercial |
$758.78
|
| Rate for Payer: Preferred Network Access Commercial |
$1,163.47
|
| Rate for Payer: Quartz Beloit One Network |
$619.67
|
| Rate for Payer: Quartz Commercial |
$822.02
|
| Rate for Payer: Quartz Medicare Advantage |
$758.78
|
| Rate for Payer: The Alliance Commercial |
$632.32
|
| Rate for Payer: WEA Trust Commercial |
$695.55
|
| Rate for Payer: WPS Commercial |
$936.68
|
|
|
TUBE TRACH BIVONA 8.0MM 670180
|
Facility
|
OP
|
$1,216.00
|
|
| Hospital Charge Code |
4494192
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$354.10 |
| Max. Negotiated Rate |
$1,163.47 |
| Rate for Payer: Aetna Commercial |
$1,138.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,087.59
|
| Rate for Payer: Aetna Managed Medicare |
$354.10
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$822.02
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$632.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$607.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$670.26
|
| Rate for Payer: Cash Price |
$364.80
|
| Rate for Payer: Cigna Commercial |
$1,163.47
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$707.71
|
| Rate for Payer: Health EOS Commercial |
$1,125.53
|
| Rate for Payer: HFN Commercial |
$1,163.47
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$948.48
|
| Rate for Payer: Multiplan Commercial |
$1,011.71
|
| Rate for Payer: NAPHCARE Commercial |
$758.78
|
| Rate for Payer: Preferred Network Access Commercial |
$1,163.47
|
| Rate for Payer: Quartz Beloit One Network |
$619.67
|
| Rate for Payer: Quartz Commercial |
$822.02
|
| Rate for Payer: Quartz Medicare Advantage |
$758.78
|
| Rate for Payer: The Alliance Commercial |
$632.32
|
| Rate for Payer: WEA Trust Commercial |
$695.55
|
| Rate for Payer: WPS Commercial |
$936.68
|
|
|
TUBE TRACH BIVONA 8.0MM 670180
|
Facility
|
IP
|
$1,216.00
|
|
| Hospital Charge Code |
4494192
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$619.67 |
| Max. Negotiated Rate |
$1,163.47 |
| Rate for Payer: Aetna Commercial |
$1,138.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,087.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$670.26
|
| Rate for Payer: Cash Price |
$364.80
|
| Rate for Payer: Cigna Commercial |
$1,163.47
|
| Rate for Payer: Health EOS Commercial |
$1,125.53
|
| Rate for Payer: HFN Commercial |
$1,163.47
|
| Rate for Payer: Multiplan Commercial |
$1,011.71
|
| Rate for Payer: Preferred Network Access Commercial |
$1,163.47
|
| Rate for Payer: Quartz Beloit One Network |
$619.67
|
| Rate for Payer: Quartz Commercial |
$758.78
|
| Rate for Payer: WEA Trust Commercial |
$695.55
|
| Rate for Payer: WPS Commercial |
$936.68
|
|
|
TUBE TRACH BIVONA 9.0MM 670190
|
Facility
|
IP
|
$1,216.00
|
|
| Hospital Charge Code |
4494193
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$619.67 |
| Max. Negotiated Rate |
$1,163.47 |
| Rate for Payer: Aetna Commercial |
$1,138.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,087.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$670.26
|
| Rate for Payer: Cash Price |
$364.80
|
| Rate for Payer: Cigna Commercial |
$1,163.47
|
| Rate for Payer: Health EOS Commercial |
$1,125.53
|
| Rate for Payer: HFN Commercial |
$1,163.47
|
| Rate for Payer: Multiplan Commercial |
$1,011.71
|
| Rate for Payer: Preferred Network Access Commercial |
$1,163.47
|
| Rate for Payer: Quartz Beloit One Network |
$619.67
|
| Rate for Payer: Quartz Commercial |
$758.78
|
| Rate for Payer: WEA Trust Commercial |
$695.55
|
| Rate for Payer: WPS Commercial |
$936.68
|
|
|
TUBE TRACH BIVONA 9.0MM 670190
|
Facility
|
OP
|
$1,216.00
|
|
| Hospital Charge Code |
4494193
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$354.10 |
| Max. Negotiated Rate |
$1,163.47 |
| Rate for Payer: Aetna Commercial |
$1,138.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,087.59
|
| Rate for Payer: Aetna Managed Medicare |
$354.10
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$822.02
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$632.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$607.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$670.26
|
| Rate for Payer: Cash Price |
$364.80
|
| Rate for Payer: Cigna Commercial |
$1,163.47
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$707.71
|
| Rate for Payer: Health EOS Commercial |
$1,125.53
|
| Rate for Payer: HFN Commercial |
$1,163.47
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$948.48
|
| Rate for Payer: Multiplan Commercial |
$1,011.71
|
| Rate for Payer: NAPHCARE Commercial |
$758.78
|
| Rate for Payer: Preferred Network Access Commercial |
$1,163.47
|
| Rate for Payer: Quartz Beloit One Network |
$619.67
|
| Rate for Payer: Quartz Commercial |
$822.02
|
| Rate for Payer: Quartz Medicare Advantage |
$758.78
|
| Rate for Payer: The Alliance Commercial |
$632.32
|
| Rate for Payer: WEA Trust Commercial |
$695.55
|
| Rate for Payer: WPS Commercial |
$936.68
|
|
