|
TUBE TRACH BIVONA AIRE-CUF 6.0MM 750160
|
Facility
|
IP
|
$1,135.00
|
|
| Hospital Charge Code |
5248721
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$578.40 |
| Max. Negotiated Rate |
$1,085.97 |
| Rate for Payer: Aetna Commercial |
$1,062.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,015.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$625.61
|
| Rate for Payer: Cash Price |
$340.50
|
| Rate for Payer: Cigna Commercial |
$1,085.97
|
| Rate for Payer: Health EOS Commercial |
$1,050.56
|
| Rate for Payer: HFN Commercial |
$1,085.97
|
| Rate for Payer: Multiplan Commercial |
$944.32
|
| Rate for Payer: Preferred Network Access Commercial |
$1,085.97
|
| Rate for Payer: Quartz Beloit One Network |
$578.40
|
| Rate for Payer: Quartz Commercial |
$708.24
|
| Rate for Payer: WEA Trust Commercial |
$649.22
|
| Rate for Payer: WPS Commercial |
$874.29
|
|
|
TUBE TRACH BIVONA AIRE-CUF 6.0MM 750160
|
Facility
|
OP
|
$1,135.00
|
|
| Hospital Charge Code |
5248721
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$330.51 |
| Max. Negotiated Rate |
$1,085.97 |
| Rate for Payer: Aetna Commercial |
$1,062.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,015.14
|
| Rate for Payer: Aetna Managed Medicare |
$330.51
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$767.26
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$590.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$566.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$625.61
|
| Rate for Payer: Cash Price |
$340.50
|
| Rate for Payer: Cigna Commercial |
$1,085.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$660.57
|
| Rate for Payer: Health EOS Commercial |
$1,050.56
|
| Rate for Payer: HFN Commercial |
$1,085.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$885.30
|
| Rate for Payer: Multiplan Commercial |
$944.32
|
| Rate for Payer: NAPHCARE Commercial |
$708.24
|
| Rate for Payer: Preferred Network Access Commercial |
$1,085.97
|
| Rate for Payer: Quartz Beloit One Network |
$578.40
|
| Rate for Payer: Quartz Commercial |
$767.26
|
| Rate for Payer: Quartz Medicare Advantage |
$708.24
|
| Rate for Payer: The Alliance Commercial |
$590.20
|
| Rate for Payer: WEA Trust Commercial |
$649.22
|
| Rate for Payer: WPS Commercial |
$874.29
|
|
|
TUBE TRACH BIVONA AIRE-CUF 7.0MM 750170
|
Facility
|
IP
|
$1,135.00
|
|
| Hospital Charge Code |
5248722
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$578.40 |
| Max. Negotiated Rate |
$1,085.97 |
| Rate for Payer: Aetna Commercial |
$1,062.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,015.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$625.61
|
| Rate for Payer: Cash Price |
$340.50
|
| Rate for Payer: Cigna Commercial |
$1,085.97
|
| Rate for Payer: Health EOS Commercial |
$1,050.56
|
| Rate for Payer: HFN Commercial |
$1,085.97
|
| Rate for Payer: Multiplan Commercial |
$944.32
|
| Rate for Payer: Preferred Network Access Commercial |
$1,085.97
|
| Rate for Payer: Quartz Beloit One Network |
$578.40
|
| Rate for Payer: Quartz Commercial |
$708.24
|
| Rate for Payer: WEA Trust Commercial |
$649.22
|
| Rate for Payer: WPS Commercial |
$874.29
|
|
|
TUBE TRACH BIVONA AIRE-CUF 7.0MM 750170
|
Facility
|
OP
|
$1,135.00
|
|
| Hospital Charge Code |
5248722
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$330.51 |
| Max. Negotiated Rate |
$1,085.97 |
| Rate for Payer: Aetna Commercial |
$1,062.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,015.14
|
| Rate for Payer: Aetna Managed Medicare |
$330.51
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$767.26
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$590.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$566.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$625.61
|
| Rate for Payer: Cash Price |
$340.50
|
| Rate for Payer: Cigna Commercial |
$1,085.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$660.57
|
| Rate for Payer: Health EOS Commercial |
$1,050.56
|
| Rate for Payer: HFN Commercial |
$1,085.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$885.30
|
| Rate for Payer: Multiplan Commercial |
$944.32
|
| Rate for Payer: NAPHCARE Commercial |
$708.24
|
| Rate for Payer: Preferred Network Access Commercial |
$1,085.97
|
| Rate for Payer: Quartz Beloit One Network |
$578.40
|
| Rate for Payer: Quartz Commercial |
$767.26
|
| Rate for Payer: Quartz Medicare Advantage |
$708.24
|
| Rate for Payer: The Alliance Commercial |
$590.20
|
| Rate for Payer: WEA Trust Commercial |
$649.22
|
| Rate for Payer: WPS Commercial |
$874.29
|
|
|
TUBE TRACHEAL 4.5 CUFFED #5-10109
|
Facility
|
IP
|
$72.00
|
|
| Hospital Charge Code |
2970144
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$36.69 |
| Max. Negotiated Rate |
$68.89 |
| Rate for Payer: Aetna Commercial |
$67.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$64.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$39.69
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cigna Commercial |
$68.89
|
| Rate for Payer: Health EOS Commercial |
$66.64
|
| Rate for Payer: HFN Commercial |
$68.89
|
| Rate for Payer: Multiplan Commercial |
$59.90
|
| Rate for Payer: Preferred Network Access Commercial |
$68.89
|
| Rate for Payer: Quartz Beloit One Network |
$36.69
|
| Rate for Payer: Quartz Commercial |
$44.93
|
| Rate for Payer: WEA Trust Commercial |
$41.18
|
| Rate for Payer: WPS Commercial |
$55.46
|
|
|
TUBE TRACHEAL 4.5 CUFFED #5-10109
|
Facility
|
OP
|
$72.00
|
|
| Hospital Charge Code |
2970144
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$20.97 |
| Max. Negotiated Rate |
$68.89 |
| Rate for Payer: Aetna Commercial |
$67.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$64.40
|
| Rate for Payer: Aetna Managed Medicare |
$20.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$48.67
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$37.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$35.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$39.69
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cigna Commercial |
$68.89
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$41.90
|
| Rate for Payer: Health EOS Commercial |
$66.64
|
| Rate for Payer: HFN Commercial |
$68.89
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$56.16
|
| Rate for Payer: Multiplan Commercial |
$59.90
|
| Rate for Payer: NAPHCARE Commercial |
$44.93
|
| Rate for Payer: Preferred Network Access Commercial |
$68.89
|
| Rate for Payer: Quartz Beloit One Network |
$36.69
|
| Rate for Payer: Quartz Commercial |
$48.67
|
| Rate for Payer: Quartz Medicare Advantage |
$44.93
|
| Rate for Payer: The Alliance Commercial |
$37.44
|
| Rate for Payer: WEA Trust Commercial |
$41.18
|
| Rate for Payer: WPS Commercial |
$55.46
|
|
|
TUBE TRACHEAL 5.0 UNCUFFED #86238
|
Facility
|
IP
|
$75.00
|
|
| Hospital Charge Code |
2974404
|
|
Hospital Revenue Code
|
272
|
| 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 TRACHEAL 5.0 UNCUFFED #86238
|
Facility
|
OP
|
$75.00
|
|
| Hospital Charge Code |
2974404
|
|
Hospital Revenue Code
|
272
|
| 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 TRACHEAL 6.0 UNCUFFED #5-10412
|
Facility
|
IP
|
$48.00
|
|
| Hospital Charge Code |
2974360
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$24.46 |
| Max. Negotiated Rate |
$45.93 |
| Rate for Payer: Aetna Commercial |
$44.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$42.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$26.46
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cigna Commercial |
$45.93
|
| Rate for Payer: Health EOS Commercial |
$44.43
|
| Rate for Payer: HFN Commercial |
$45.93
|
| Rate for Payer: Multiplan Commercial |
$39.94
|
| Rate for Payer: Preferred Network Access Commercial |
$45.93
|
| Rate for Payer: Quartz Beloit One Network |
$24.46
|
| Rate for Payer: Quartz Commercial |
$29.95
|
| Rate for Payer: WEA Trust Commercial |
$27.46
|
| Rate for Payer: WPS Commercial |
$36.97
|
|
|
TUBE TRACHEAL 6.0 UNCUFFED #5-10412
|
Facility
|
OP
|
$48.00
|
|
| Hospital Charge Code |
2974360
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.98 |
| Max. Negotiated Rate |
$45.93 |
| Rate for Payer: Aetna Commercial |
$44.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$42.93
|
| Rate for Payer: Aetna Managed Medicare |
$13.98
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$32.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$24.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$23.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$26.46
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cigna Commercial |
$45.93
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$27.94
|
| Rate for Payer: Health EOS Commercial |
$44.43
|
| Rate for Payer: HFN Commercial |
$45.93
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$37.44
|
| Rate for Payer: Multiplan Commercial |
$39.94
|
| Rate for Payer: NAPHCARE Commercial |
$29.95
|
| Rate for Payer: Preferred Network Access Commercial |
$45.93
|
| Rate for Payer: Quartz Beloit One Network |
$24.46
|
| Rate for Payer: Quartz Commercial |
$32.45
|
| Rate for Payer: Quartz Medicare Advantage |
$29.95
|
| Rate for Payer: The Alliance Commercial |
$24.96
|
| Rate for Payer: WEA Trust Commercial |
$27.46
|
| Rate for Payer: WPS Commercial |
$36.97
|
|
|
TUBE TRACH SHILEY 4 CFD NON-FEN 4CN65H
|
Facility
|
IP
|
$788.00
|
|
| Hospital Charge Code |
5641668
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$401.56 |
| Max. Negotiated Rate |
$753.96 |
| Rate for Payer: Aetna Commercial |
$737.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$704.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$434.35
|
| Rate for Payer: Cash Price |
$236.40
|
| Rate for Payer: Cigna Commercial |
$753.96
|
| Rate for Payer: Health EOS Commercial |
$729.37
|
| Rate for Payer: HFN Commercial |
$753.96
|
| Rate for Payer: Multiplan Commercial |
$655.62
|
| Rate for Payer: Preferred Network Access Commercial |
$753.96
|
| Rate for Payer: Quartz Beloit One Network |
$401.56
|
| Rate for Payer: Quartz Commercial |
$491.71
|
| Rate for Payer: WEA Trust Commercial |
$450.74
|
| Rate for Payer: WPS Commercial |
$607.00
|
|
|
TUBE TRACH SHILEY 4 CFD NON-FEN 4CN65H
|
Facility
|
OP
|
$788.00
|
|
| Hospital Charge Code |
5641668
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$229.47 |
| Max. Negotiated Rate |
$753.96 |
| Rate for Payer: Aetna Commercial |
$737.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$704.79
|
| Rate for Payer: Aetna Managed Medicare |
$229.47
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$532.69
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$409.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$393.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$434.35
|
| Rate for Payer: Cash Price |
$236.40
|
| Rate for Payer: Cigna Commercial |
$753.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$458.62
|
| Rate for Payer: Health EOS Commercial |
$729.37
|
| Rate for Payer: HFN Commercial |
$753.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$614.64
|
| Rate for Payer: Multiplan Commercial |
$655.62
|
| Rate for Payer: NAPHCARE Commercial |
$491.71
|
| Rate for Payer: Preferred Network Access Commercial |
$753.96
|
| Rate for Payer: Quartz Beloit One Network |
$401.56
|
| Rate for Payer: Quartz Commercial |
$532.69
|
| Rate for Payer: Quartz Medicare Advantage |
$491.71
|
| Rate for Payer: The Alliance Commercial |
$409.76
|
| Rate for Payer: WEA Trust Commercial |
$450.74
|
| Rate for Payer: WPS Commercial |
$607.00
|
|
|
Tube Y-Type Wfilter
|
Facility
|
OP
|
$138.00
|
|
| Hospital Charge Code |
3101773
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$40.19 |
| Max. Negotiated Rate |
$132.04 |
| Rate for Payer: Aetna Commercial |
$129.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$123.43
|
| Rate for Payer: Aetna Managed Medicare |
$40.19
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$93.29
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$71.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$68.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$76.07
|
| Rate for Payer: Cash Price |
$41.40
|
| Rate for Payer: Cigna Commercial |
$132.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$80.32
|
| Rate for Payer: Health EOS Commercial |
$127.73
|
| Rate for Payer: HFN Commercial |
$132.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$107.64
|
| Rate for Payer: Multiplan Commercial |
$114.82
|
| Rate for Payer: NAPHCARE Commercial |
$86.11
|
| Rate for Payer: Preferred Network Access Commercial |
$132.04
|
| Rate for Payer: Quartz Beloit One Network |
$70.32
|
| Rate for Payer: Quartz Commercial |
$93.29
|
| Rate for Payer: Quartz Medicare Advantage |
$86.11
|
| Rate for Payer: The Alliance Commercial |
$71.76
|
| Rate for Payer: WEA Trust Commercial |
$78.94
|
| Rate for Payer: WPS Commercial |
$106.30
|
|
|
Tube Y-Type Wfilter
|
Facility
|
IP
|
$138.00
|
|
| Hospital Charge Code |
3101773
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$70.32 |
| Max. Negotiated Rate |
$132.04 |
| Rate for Payer: Aetna Commercial |
$129.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$123.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$76.07
|
| Rate for Payer: Cash Price |
$41.40
|
| Rate for Payer: Cigna Commercial |
$132.04
|
| Rate for Payer: Health EOS Commercial |
$127.73
|
| Rate for Payer: HFN Commercial |
$132.04
|
| Rate for Payer: Multiplan Commercial |
$114.82
|
| Rate for Payer: Preferred Network Access Commercial |
$132.04
|
| Rate for Payer: Quartz Beloit One Network |
$70.32
|
| Rate for Payer: Quartz Commercial |
$86.11
|
| Rate for Payer: WEA Trust Commercial |
$78.94
|
| Rate for Payer: WPS Commercial |
$106.30
|
|
|
TUBIGRIP SIZE B (BEIGE) 1449
|
Facility
|
IP
|
$569.00
|
|
| Hospital Charge Code |
2974507
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$289.96 |
| Max. Negotiated Rate |
$544.42 |
| Rate for Payer: Aetna Commercial |
$532.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$508.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$313.63
|
| Rate for Payer: Cash Price |
$170.70
|
| Rate for Payer: Cigna Commercial |
$544.42
|
| Rate for Payer: Health EOS Commercial |
$526.67
|
| Rate for Payer: HFN Commercial |
$544.42
|
| Rate for Payer: Multiplan Commercial |
$473.41
|
| Rate for Payer: Preferred Network Access Commercial |
$544.42
|
| Rate for Payer: Quartz Beloit One Network |
$289.96
|
| Rate for Payer: Quartz Commercial |
$355.06
|
| Rate for Payer: WEA Trust Commercial |
$325.47
|
| Rate for Payer: WPS Commercial |
$438.30
|
|
|
TUBIGRIP SIZE B (BEIGE) 1449
|
Facility
|
OP
|
$569.00
|
|
| Hospital Charge Code |
2974507
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$165.69 |
| Max. Negotiated Rate |
$544.42 |
| Rate for Payer: Aetna Commercial |
$532.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$508.91
|
| Rate for Payer: Aetna Managed Medicare |
$165.69
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$384.64
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$295.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$284.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$313.63
|
| Rate for Payer: Cash Price |
$170.70
|
| Rate for Payer: Cigna Commercial |
$544.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$331.16
|
| Rate for Payer: Health EOS Commercial |
$526.67
|
| Rate for Payer: HFN Commercial |
$544.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$443.82
|
| Rate for Payer: Multiplan Commercial |
$473.41
|
| Rate for Payer: NAPHCARE Commercial |
$355.06
|
| Rate for Payer: Preferred Network Access Commercial |
$544.42
|
| Rate for Payer: Quartz Beloit One Network |
$289.96
|
| Rate for Payer: Quartz Commercial |
$384.64
|
| Rate for Payer: Quartz Medicare Advantage |
$355.06
|
| Rate for Payer: The Alliance Commercial |
$295.88
|
| Rate for Payer: WEA Trust Commercial |
$325.47
|
| Rate for Payer: WPS Commercial |
$438.30
|
|
|
TUBIGRIP SIZE C #1450
|
Facility
|
IP
|
$652.00
|
|
| Hospital Charge Code |
2969639
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$332.26 |
| Max. Negotiated Rate |
$623.83 |
| Rate for Payer: Aetna Commercial |
$610.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$583.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$359.38
|
| Rate for Payer: Cash Price |
$195.60
|
| Rate for Payer: Cigna Commercial |
$623.83
|
| Rate for Payer: Health EOS Commercial |
$603.49
|
| Rate for Payer: HFN Commercial |
$623.83
|
| Rate for Payer: Multiplan Commercial |
$542.46
|
| Rate for Payer: Preferred Network Access Commercial |
$623.83
|
| Rate for Payer: Quartz Beloit One Network |
$332.26
|
| Rate for Payer: Quartz Commercial |
$406.85
|
| Rate for Payer: WEA Trust Commercial |
$372.94
|
| Rate for Payer: WPS Commercial |
$502.24
|
|
|
TUBIGRIP SIZE C #1450
|
Facility
|
OP
|
$652.00
|
|
| Hospital Charge Code |
2969639
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$189.86 |
| Max. Negotiated Rate |
$623.83 |
| Rate for Payer: Aetna Commercial |
$610.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$583.15
|
| Rate for Payer: Aetna Managed Medicare |
$189.86
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$440.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$339.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$325.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$359.38
|
| Rate for Payer: Cash Price |
$195.60
|
| Rate for Payer: Cigna Commercial |
$623.83
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$379.46
|
| Rate for Payer: Health EOS Commercial |
$603.49
|
| Rate for Payer: HFN Commercial |
$623.83
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$508.56
|
| Rate for Payer: Multiplan Commercial |
$542.46
|
| Rate for Payer: NAPHCARE Commercial |
$406.85
|
| Rate for Payer: Preferred Network Access Commercial |
$623.83
|
| Rate for Payer: Quartz Beloit One Network |
$332.26
|
| Rate for Payer: Quartz Commercial |
$440.75
|
| Rate for Payer: Quartz Medicare Advantage |
$406.85
|
| Rate for Payer: The Alliance Commercial |
$339.04
|
| Rate for Payer: WEA Trust Commercial |
$372.94
|
| Rate for Payer: WPS Commercial |
$502.24
|
|
|
TUBIGRIP SIZE D #1451
|
Facility
|
OP
|
$749.00
|
|
| Hospital Charge Code |
2969634
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$218.11 |
| Max. Negotiated Rate |
$716.64 |
| Rate for Payer: Aetna Commercial |
$701.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$669.91
|
| Rate for Payer: Aetna Managed Medicare |
$218.11
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$506.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$389.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$373.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$412.85
|
| Rate for Payer: Cash Price |
$224.70
|
| Rate for Payer: Cigna Commercial |
$716.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$435.92
|
| Rate for Payer: Health EOS Commercial |
$693.27
|
| Rate for Payer: HFN Commercial |
$716.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$584.22
|
| Rate for Payer: Multiplan Commercial |
$623.17
|
| Rate for Payer: NAPHCARE Commercial |
$467.38
|
| Rate for Payer: Preferred Network Access Commercial |
$716.64
|
| Rate for Payer: Quartz Beloit One Network |
$381.69
|
| Rate for Payer: Quartz Commercial |
$506.32
|
| Rate for Payer: Quartz Medicare Advantage |
$467.38
|
| Rate for Payer: The Alliance Commercial |
$389.48
|
| Rate for Payer: WEA Trust Commercial |
$428.43
|
| Rate for Payer: WPS Commercial |
$576.95
|
|
|
TUBIGRIP SIZE D #1451
|
Facility
|
IP
|
$749.00
|
|
| Hospital Charge Code |
2969634
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$381.69 |
| Max. Negotiated Rate |
$716.64 |
| Rate for Payer: Aetna Commercial |
$701.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$669.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$412.85
|
| Rate for Payer: Cash Price |
$224.70
|
| Rate for Payer: Cigna Commercial |
$716.64
|
| Rate for Payer: Health EOS Commercial |
$693.27
|
| Rate for Payer: HFN Commercial |
$716.64
|
| Rate for Payer: Multiplan Commercial |
$623.17
|
| Rate for Payer: Preferred Network Access Commercial |
$716.64
|
| Rate for Payer: Quartz Beloit One Network |
$381.69
|
| Rate for Payer: Quartz Commercial |
$467.38
|
| Rate for Payer: WEA Trust Commercial |
$428.43
|
| Rate for Payer: WPS Commercial |
$576.95
|
|
|
TUBIGRIP SIZE E (BEIGE) #1448
|
Facility
|
OP
|
$839.00
|
|
| Hospital Charge Code |
2965777
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$244.32 |
| Max. Negotiated Rate |
$802.76 |
| Rate for Payer: Aetna Commercial |
$785.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$750.40
|
| Rate for Payer: Aetna Managed Medicare |
$244.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$567.16
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$436.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$418.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$462.46
|
| Rate for Payer: Cash Price |
$251.70
|
| Rate for Payer: Cigna Commercial |
$802.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$488.30
|
| Rate for Payer: Health EOS Commercial |
$776.58
|
| Rate for Payer: HFN Commercial |
$802.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$654.42
|
| Rate for Payer: Multiplan Commercial |
$698.05
|
| Rate for Payer: NAPHCARE Commercial |
$523.54
|
| Rate for Payer: Preferred Network Access Commercial |
$802.76
|
| Rate for Payer: Quartz Beloit One Network |
$427.55
|
| Rate for Payer: Quartz Commercial |
$567.16
|
| Rate for Payer: Quartz Medicare Advantage |
$523.54
|
| Rate for Payer: The Alliance Commercial |
$436.28
|
| Rate for Payer: WEA Trust Commercial |
$479.91
|
| Rate for Payer: WPS Commercial |
$646.28
|
|
|
TUBIGRIP SIZE E (BEIGE) #1448
|
Facility
|
IP
|
$839.00
|
|
| Hospital Charge Code |
2965777
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$427.55 |
| Max. Negotiated Rate |
$802.76 |
| Rate for Payer: Aetna Commercial |
$785.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$750.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$462.46
|
| Rate for Payer: Cash Price |
$251.70
|
| Rate for Payer: Cigna Commercial |
$802.76
|
| Rate for Payer: Health EOS Commercial |
$776.58
|
| Rate for Payer: HFN Commercial |
$802.76
|
| Rate for Payer: Multiplan Commercial |
$698.05
|
| Rate for Payer: Preferred Network Access Commercial |
$802.76
|
| Rate for Payer: Quartz Beloit One Network |
$427.55
|
| Rate for Payer: Quartz Commercial |
$523.54
|
| Rate for Payer: WEA Trust Commercial |
$479.91
|
| Rate for Payer: WPS Commercial |
$646.28
|
|
|
TUBIGRIP SIZE J #1440
|
Facility
|
IP
|
$542.00
|
|
| Hospital Charge Code |
2969699
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$276.20 |
| Max. Negotiated Rate |
$518.59 |
| Rate for Payer: Aetna Commercial |
$507.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$484.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$298.75
|
| Rate for Payer: Cash Price |
$162.60
|
| Rate for Payer: Cigna Commercial |
$518.59
|
| Rate for Payer: Health EOS Commercial |
$501.68
|
| Rate for Payer: HFN Commercial |
$518.59
|
| Rate for Payer: Multiplan Commercial |
$450.94
|
| Rate for Payer: Preferred Network Access Commercial |
$518.59
|
| Rate for Payer: Quartz Beloit One Network |
$276.20
|
| Rate for Payer: Quartz Commercial |
$338.21
|
| Rate for Payer: WEA Trust Commercial |
$310.02
|
| Rate for Payer: WPS Commercial |
$417.50
|
|
|
TUBIGRIP SIZE J #1440
|
Facility
|
OP
|
$542.00
|
|
| Hospital Charge Code |
2969699
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$157.83 |
| Max. Negotiated Rate |
$518.59 |
| Rate for Payer: Aetna Commercial |
$507.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$484.76
|
| Rate for Payer: Aetna Managed Medicare |
$157.83
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$366.39
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$281.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$270.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$298.75
|
| Rate for Payer: Cash Price |
$162.60
|
| Rate for Payer: Cigna Commercial |
$518.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$315.44
|
| Rate for Payer: Health EOS Commercial |
$501.68
|
| Rate for Payer: HFN Commercial |
$518.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$422.76
|
| Rate for Payer: Multiplan Commercial |
$450.94
|
| Rate for Payer: NAPHCARE Commercial |
$338.21
|
| Rate for Payer: Preferred Network Access Commercial |
$518.59
|
| Rate for Payer: Quartz Beloit One Network |
$276.20
|
| Rate for Payer: Quartz Commercial |
$366.39
|
| Rate for Payer: Quartz Medicare Advantage |
$338.21
|
| Rate for Payer: The Alliance Commercial |
$281.84
|
| Rate for Payer: WEA Trust Commercial |
$310.02
|
| Rate for Payer: WPS Commercial |
$417.50
|
|
|
TUBIGRIP SIZE K #1441
|
Facility
|
OP
|
$1,564.00
|
|
| Hospital Charge Code |
2974065
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$455.44 |
| Max. Negotiated Rate |
$1,496.44 |
| Rate for Payer: Aetna Commercial |
$1,463.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,398.84
|
| Rate for Payer: Aetna Managed Medicare |
$455.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,057.26
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$813.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$780.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$862.08
|
| Rate for Payer: Cash Price |
$469.20
|
| Rate for Payer: Cigna Commercial |
$1,496.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$910.25
|
| Rate for Payer: Health EOS Commercial |
$1,447.64
|
| Rate for Payer: HFN Commercial |
$1,496.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,219.92
|
| Rate for Payer: Multiplan Commercial |
$1,301.25
|
| Rate for Payer: NAPHCARE Commercial |
$975.94
|
| Rate for Payer: Preferred Network Access Commercial |
$1,496.44
|
| Rate for Payer: Quartz Beloit One Network |
$797.01
|
| Rate for Payer: Quartz Commercial |
$1,057.26
|
| Rate for Payer: Quartz Medicare Advantage |
$975.94
|
| Rate for Payer: The Alliance Commercial |
$813.28
|
| Rate for Payer: WEA Trust Commercial |
$894.61
|
| Rate for Payer: WPS Commercial |
$1,204.75
|
|
