|
TUBE ET UNCUFFED 3.5mm MS-23335
|
Facility
|
IP
|
$140.00
|
|
| Hospital Charge Code |
2963554
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$68.60 |
| Max. Negotiated Rate |
$128.80 |
| Rate for Payer: Aetna Commercial |
$126.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$120.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$74.20
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cigna Commercial |
$128.80
|
| Rate for Payer: Health EOS Commercial |
$124.60
|
| Rate for Payer: HFN Commercial |
$128.80
|
| Rate for Payer: Multiplan Commercial |
$112.00
|
| Rate for Payer: NAPHCARE Commercial |
$84.00
|
| Rate for Payer: Preferred Network Access Commercial |
$128.80
|
| Rate for Payer: Quartz Beloit One Network |
$68.60
|
| Rate for Payer: Quartz Commercial |
$84.00
|
| Rate for Payer: WEA Trust Commercial |
$77.00
|
| Rate for Payer: WPS Commercial |
$103.70
|
|
|
TUBE ET UNCUFFED 3.5mm MS-23335
|
Facility
|
OP
|
$140.00
|
|
| Hospital Charge Code |
2963554
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$39.20 |
| Max. Negotiated Rate |
$560.00 |
| Rate for Payer: Aetna Commercial |
$126.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$120.40
|
| Rate for Payer: Aetna Managed Medicare |
$39.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$91.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$70.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$67.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$74.20
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cigna Commercial |
$128.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$78.34
|
| Rate for Payer: Health EOS Commercial |
$124.60
|
| Rate for Payer: HFN Commercial |
$128.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$105.00
|
| Rate for Payer: Multiplan Commercial |
$112.00
|
| Rate for Payer: NAPHCARE Commercial |
$84.00
|
| Rate for Payer: Preferred Network Access Commercial |
$128.80
|
| Rate for Payer: Quartz Beloit One Network |
$68.60
|
| Rate for Payer: Quartz Commercial |
$91.00
|
| Rate for Payer: Quartz Medicare Advantage |
$84.00
|
| Rate for Payer: The Alliance Commercial |
$560.00
|
| Rate for Payer: WEA Trust Commercial |
$77.00
|
| Rate for Payer: WPS Commercial |
$103.70
|
|
|
TUBE ET UNCUFFED 4.0mm
|
Facility
|
IP
|
$57.00
|
|
| Hospital Charge Code |
2963911
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$27.93 |
| Max. Negotiated Rate |
$52.44 |
| Rate for Payer: Aetna Commercial |
$51.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$49.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$30.21
|
| Rate for Payer: Cash Price |
$17.10
|
| Rate for Payer: Cigna Commercial |
$52.44
|
| Rate for Payer: Health EOS Commercial |
$50.73
|
| Rate for Payer: HFN Commercial |
$52.44
|
| Rate for Payer: Multiplan Commercial |
$45.60
|
| Rate for Payer: NAPHCARE Commercial |
$34.20
|
| Rate for Payer: Preferred Network Access Commercial |
$52.44
|
| Rate for Payer: Quartz Beloit One Network |
$27.93
|
| Rate for Payer: Quartz Commercial |
$34.20
|
| Rate for Payer: WEA Trust Commercial |
$31.35
|
| Rate for Payer: WPS Commercial |
$42.22
|
|
|
TUBE ET UNCUFFED 4.0mm
|
Facility
|
OP
|
$57.00
|
|
| Hospital Charge Code |
2963911
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.96 |
| Max. Negotiated Rate |
$228.00 |
| Rate for Payer: Aetna Commercial |
$51.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$49.02
|
| Rate for Payer: Aetna Managed Medicare |
$15.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$37.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$28.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$27.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$30.21
|
| Rate for Payer: Cash Price |
$17.10
|
| Rate for Payer: Cigna Commercial |
$52.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$31.90
|
| Rate for Payer: Health EOS Commercial |
$50.73
|
| Rate for Payer: HFN Commercial |
$52.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$42.75
|
| Rate for Payer: Multiplan Commercial |
$45.60
|
| Rate for Payer: NAPHCARE Commercial |
$34.20
|
| Rate for Payer: Preferred Network Access Commercial |
$52.44
|
| Rate for Payer: Quartz Beloit One Network |
$27.93
|
| Rate for Payer: Quartz Commercial |
$37.05
|
| Rate for Payer: Quartz Medicare Advantage |
$34.20
|
| Rate for Payer: The Alliance Commercial |
$228.00
|
| Rate for Payer: WEA Trust Commercial |
$31.35
|
| Rate for Payer: WPS Commercial |
$42.22
|
|
|
TUBE ET UNCUFFED W/STYLET 2.5mm 506525
|
Facility
|
IP
|
$517.00
|
|
| Hospital Charge Code |
4455568
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$253.33 |
| Max. Negotiated Rate |
$475.64 |
| Rate for Payer: Aetna Commercial |
$465.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$444.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$274.01
|
| Rate for Payer: Cash Price |
$155.10
|
| Rate for Payer: Cigna Commercial |
$475.64
|
| Rate for Payer: Health EOS Commercial |
$460.13
|
| Rate for Payer: HFN Commercial |
$475.64
|
| Rate for Payer: Multiplan Commercial |
$413.60
|
| Rate for Payer: NAPHCARE Commercial |
$310.20
|
| Rate for Payer: Preferred Network Access Commercial |
$475.64
|
| Rate for Payer: Quartz Beloit One Network |
$253.33
|
| Rate for Payer: Quartz Commercial |
$310.20
|
| Rate for Payer: WEA Trust Commercial |
$284.35
|
| Rate for Payer: WPS Commercial |
$382.94
|
|
|
TUBE ET UNCUFFED W/STYLET 2.5mm 506525
|
Facility
|
OP
|
$517.00
|
|
| Hospital Charge Code |
4455568
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$144.76 |
| Max. Negotiated Rate |
$2,068.00 |
| Rate for Payer: Aetna Commercial |
$465.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$444.62
|
| Rate for Payer: Aetna Managed Medicare |
$144.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$336.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$258.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$248.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$274.01
|
| Rate for Payer: Cash Price |
$155.10
|
| Rate for Payer: Cigna Commercial |
$475.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$289.31
|
| Rate for Payer: Health EOS Commercial |
$460.13
|
| Rate for Payer: HFN Commercial |
$475.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$387.75
|
| Rate for Payer: Multiplan Commercial |
$413.60
|
| Rate for Payer: NAPHCARE Commercial |
$310.20
|
| Rate for Payer: Preferred Network Access Commercial |
$475.64
|
| Rate for Payer: Quartz Beloit One Network |
$253.33
|
| Rate for Payer: Quartz Commercial |
$336.05
|
| Rate for Payer: Quartz Medicare Advantage |
$310.20
|
| Rate for Payer: The Alliance Commercial |
$2,068.00
|
| Rate for Payer: WEA Trust Commercial |
$284.35
|
| Rate for Payer: WPS Commercial |
$382.94
|
|
|
TUBE ET UNIVENT 6.5 1202628
|
Facility
|
IP
|
$2,551.00
|
|
| Hospital Charge Code |
4055456
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,249.99 |
| Max. Negotiated Rate |
$2,346.92 |
| Rate for Payer: Aetna Commercial |
$2,295.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,193.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,352.03
|
| Rate for Payer: Cash Price |
$765.30
|
| Rate for Payer: Cigna Commercial |
$2,346.92
|
| Rate for Payer: Health EOS Commercial |
$2,270.39
|
| Rate for Payer: HFN Commercial |
$2,346.92
|
| Rate for Payer: Multiplan Commercial |
$2,040.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,530.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,346.92
|
| Rate for Payer: Quartz Beloit One Network |
$1,249.99
|
| Rate for Payer: Quartz Commercial |
$1,530.60
|
| Rate for Payer: WEA Trust Commercial |
$1,403.05
|
| Rate for Payer: WPS Commercial |
$1,889.53
|
|
|
TUBE ET UNIVENT 6.5 1202628
|
Facility
|
OP
|
$2,551.00
|
|
| Hospital Charge Code |
4055456
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$714.28 |
| Max. Negotiated Rate |
$10,204.00 |
| Rate for Payer: Aetna Commercial |
$2,295.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,193.86
|
| Rate for Payer: Aetna Managed Medicare |
$714.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,658.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,275.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,224.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,352.03
|
| Rate for Payer: Cash Price |
$765.30
|
| Rate for Payer: Cigna Commercial |
$2,346.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,427.54
|
| Rate for Payer: Health EOS Commercial |
$2,270.39
|
| Rate for Payer: HFN Commercial |
$2,346.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,913.25
|
| Rate for Payer: Multiplan Commercial |
$2,040.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,530.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,346.92
|
| Rate for Payer: Quartz Beloit One Network |
$1,249.99
|
| Rate for Payer: Quartz Commercial |
$1,658.15
|
| Rate for Payer: Quartz Medicare Advantage |
$1,530.60
|
| Rate for Payer: The Alliance Commercial |
$10,204.00
|
| Rate for Payer: WEA Trust Commercial |
$1,403.05
|
| Rate for Payer: WPS Commercial |
$1,889.53
|
|
|
TUBE ET UNIVENT 7.0 1202630
|
Facility
|
IP
|
$2,551.00
|
|
| Hospital Charge Code |
4055457
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,249.99 |
| Max. Negotiated Rate |
$2,346.92 |
| Rate for Payer: Aetna Commercial |
$2,295.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,193.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,352.03
|
| Rate for Payer: Cash Price |
$765.30
|
| Rate for Payer: Cigna Commercial |
$2,346.92
|
| Rate for Payer: Health EOS Commercial |
$2,270.39
|
| Rate for Payer: HFN Commercial |
$2,346.92
|
| Rate for Payer: Multiplan Commercial |
$2,040.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,530.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,346.92
|
| Rate for Payer: Quartz Beloit One Network |
$1,249.99
|
| Rate for Payer: Quartz Commercial |
$1,530.60
|
| Rate for Payer: WEA Trust Commercial |
$1,403.05
|
| Rate for Payer: WPS Commercial |
$1,889.53
|
|
|
TUBE ET UNIVENT 7.0 1202630
|
Facility
|
OP
|
$2,551.00
|
|
| Hospital Charge Code |
4055457
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$714.28 |
| Max. Negotiated Rate |
$10,204.00 |
| Rate for Payer: Aetna Commercial |
$2,295.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,193.86
|
| Rate for Payer: Aetna Managed Medicare |
$714.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,658.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,275.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,224.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,352.03
|
| Rate for Payer: Cash Price |
$765.30
|
| Rate for Payer: Cigna Commercial |
$2,346.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,427.54
|
| Rate for Payer: Health EOS Commercial |
$2,270.39
|
| Rate for Payer: HFN Commercial |
$2,346.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,913.25
|
| Rate for Payer: Multiplan Commercial |
$2,040.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,530.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,346.92
|
| Rate for Payer: Quartz Beloit One Network |
$1,249.99
|
| Rate for Payer: Quartz Commercial |
$1,658.15
|
| Rate for Payer: Quartz Medicare Advantage |
$1,530.60
|
| Rate for Payer: The Alliance Commercial |
$10,204.00
|
| Rate for Payer: WEA Trust Commercial |
$1,403.05
|
| Rate for Payer: WPS Commercial |
$1,889.53
|
|
|
TUBE EXTENSION ADLT DISP W/ADAPTER 60 #487000"
|
Facility
|
IP
|
$85.00
|
|
| Hospital Charge Code |
2974543
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$41.65 |
| Max. Negotiated Rate |
$78.20 |
| Rate for Payer: Aetna Commercial |
$76.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$73.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$45.05
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Cigna Commercial |
$78.20
|
| Rate for Payer: Health EOS Commercial |
$75.65
|
| Rate for Payer: HFN Commercial |
$78.20
|
| Rate for Payer: Multiplan Commercial |
$68.00
|
| Rate for Payer: NAPHCARE Commercial |
$51.00
|
| Rate for Payer: Preferred Network Access Commercial |
$78.20
|
| Rate for Payer: Quartz Beloit One Network |
$41.65
|
| Rate for Payer: Quartz Commercial |
$51.00
|
| Rate for Payer: WEA Trust Commercial |
$46.75
|
| Rate for Payer: WPS Commercial |
$62.96
|
|
|
TUBE EXTENSION ADLT DISP W/ADAPTER 60 #487000"
|
Facility
|
OP
|
$85.00
|
|
| Hospital Charge Code |
2974543
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$23.80 |
| Max. Negotiated Rate |
$340.00 |
| Rate for Payer: Aetna Commercial |
$76.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$73.10
|
| Rate for Payer: Aetna Managed Medicare |
$23.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$55.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$42.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$40.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$45.05
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Cigna Commercial |
$78.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$47.57
|
| Rate for Payer: Health EOS Commercial |
$75.65
|
| Rate for Payer: HFN Commercial |
$78.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$63.75
|
| Rate for Payer: Multiplan Commercial |
$68.00
|
| Rate for Payer: NAPHCARE Commercial |
$51.00
|
| Rate for Payer: Preferred Network Access Commercial |
$78.20
|
| Rate for Payer: Quartz Beloit One Network |
$41.65
|
| Rate for Payer: Quartz Commercial |
$55.25
|
| Rate for Payer: Quartz Medicare Advantage |
$51.00
|
| Rate for Payer: The Alliance Commercial |
$340.00
|
| Rate for Payer: WEA Trust Commercial |
$46.75
|
| Rate for Payer: WPS Commercial |
$62.96
|
|
|
TUBE FEEDING 3 1/2 FR
|
Facility
|
OP
|
$56.00
|
|
| Hospital Charge Code |
2963839
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.68 |
| Max. Negotiated Rate |
$224.00 |
| Rate for Payer: Aetna Commercial |
$50.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$48.16
|
| Rate for Payer: Aetna Managed Medicare |
$15.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$36.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$28.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$26.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$29.68
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Cigna Commercial |
$51.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$31.34
|
| Rate for Payer: Health EOS Commercial |
$49.84
|
| Rate for Payer: HFN Commercial |
$51.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$42.00
|
| Rate for Payer: Multiplan Commercial |
$44.80
|
| Rate for Payer: NAPHCARE Commercial |
$33.60
|
| Rate for Payer: Preferred Network Access Commercial |
$51.52
|
| Rate for Payer: Quartz Beloit One Network |
$27.44
|
| Rate for Payer: Quartz Commercial |
$36.40
|
| Rate for Payer: Quartz Medicare Advantage |
$33.60
|
| Rate for Payer: The Alliance Commercial |
$224.00
|
| Rate for Payer: WEA Trust Commercial |
$30.80
|
| Rate for Payer: WPS Commercial |
$41.48
|
|
|
TUBE FEEDING 3 1/2 FR
|
Facility
|
IP
|
$56.00
|
|
| Hospital Charge Code |
2963839
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$27.44 |
| Max. Negotiated Rate |
$51.52 |
| Rate for Payer: Aetna Commercial |
$50.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$48.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$29.68
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Cigna Commercial |
$51.52
|
| Rate for Payer: Health EOS Commercial |
$49.84
|
| Rate for Payer: HFN Commercial |
$51.52
|
| Rate for Payer: Multiplan Commercial |
$44.80
|
| Rate for Payer: NAPHCARE Commercial |
$33.60
|
| Rate for Payer: Preferred Network Access Commercial |
$51.52
|
| Rate for Payer: Quartz Beloit One Network |
$27.44
|
| Rate for Payer: Quartz Commercial |
$33.60
|
| Rate for Payer: WEA Trust Commercial |
$30.80
|
| Rate for Payer: WPS Commercial |
$41.48
|
|
|
TUBE FEEDING ADULT 10FRX55/ENFIT 8884721055E
|
Facility
|
OP
|
$205.00
|
|
| Hospital Charge Code |
2975040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$57.40 |
| Max. Negotiated Rate |
$820.00 |
| Rate for Payer: Aetna Commercial |
$184.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$176.30
|
| Rate for Payer: Aetna Managed Medicare |
$57.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$133.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$102.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$98.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$108.65
|
| Rate for Payer: Cash Price |
$61.50
|
| Rate for Payer: Cigna Commercial |
$188.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$114.72
|
| Rate for Payer: Health EOS Commercial |
$182.45
|
| Rate for Payer: HFN Commercial |
$188.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$153.75
|
| Rate for Payer: Multiplan Commercial |
$164.00
|
| Rate for Payer: NAPHCARE Commercial |
$123.00
|
| Rate for Payer: Preferred Network Access Commercial |
$188.60
|
| Rate for Payer: Quartz Beloit One Network |
$100.45
|
| Rate for Payer: Quartz Commercial |
$133.25
|
| Rate for Payer: Quartz Medicare Advantage |
$123.00
|
| Rate for Payer: The Alliance Commercial |
$820.00
|
| Rate for Payer: WEA Trust Commercial |
$112.75
|
| Rate for Payer: WPS Commercial |
$151.84
|
|
|
TUBE FEEDING ADULT 10FRX55/ENFIT 8884721055E
|
Facility
|
IP
|
$205.00
|
|
| Hospital Charge Code |
2975040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$100.45 |
| Max. Negotiated Rate |
$188.60 |
| Rate for Payer: Aetna Commercial |
$184.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$176.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$108.65
|
| Rate for Payer: Cash Price |
$61.50
|
| Rate for Payer: Cigna Commercial |
$188.60
|
| Rate for Payer: Health EOS Commercial |
$182.45
|
| Rate for Payer: HFN Commercial |
$188.60
|
| Rate for Payer: Multiplan Commercial |
$164.00
|
| Rate for Payer: NAPHCARE Commercial |
$123.00
|
| Rate for Payer: Preferred Network Access Commercial |
$188.60
|
| Rate for Payer: Quartz Beloit One Network |
$100.45
|
| Rate for Payer: Quartz Commercial |
$123.00
|
| Rate for Payer: WEA Trust Commercial |
$112.75
|
| Rate for Payer: WPS Commercial |
$151.84
|
|
|
TUBE FEEDING PREMATURE INFANT 5FR 0036400
|
Facility
|
IP
|
$28.00
|
|
| Hospital Charge Code |
2963303
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.72 |
| Max. Negotiated Rate |
$25.76 |
| Rate for Payer: Aetna Commercial |
$25.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$24.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$14.84
|
| Rate for Payer: Cash Price |
$8.40
|
| Rate for Payer: Cigna Commercial |
$25.76
|
| Rate for Payer: Health EOS Commercial |
$24.92
|
| Rate for Payer: HFN Commercial |
$25.76
|
| Rate for Payer: Multiplan Commercial |
$22.40
|
| Rate for Payer: NAPHCARE Commercial |
$16.80
|
| Rate for Payer: Preferred Network Access Commercial |
$25.76
|
| Rate for Payer: Quartz Beloit One Network |
$13.72
|
| Rate for Payer: Quartz Commercial |
$16.80
|
| Rate for Payer: WEA Trust Commercial |
$15.40
|
| Rate for Payer: WPS Commercial |
$20.74
|
|
|
TUBE FEEDING PREMATURE INFANT 5FR 0036400
|
Facility
|
OP
|
$28.00
|
|
| Hospital Charge Code |
2963303
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.84 |
| Max. Negotiated Rate |
$112.00 |
| Rate for Payer: Aetna Commercial |
$25.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$24.08
|
| Rate for Payer: Aetna Managed Medicare |
$7.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$18.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$14.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$13.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$14.84
|
| Rate for Payer: Cash Price |
$8.40
|
| Rate for Payer: Cigna Commercial |
$25.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$15.67
|
| Rate for Payer: Health EOS Commercial |
$24.92
|
| Rate for Payer: HFN Commercial |
$25.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$21.00
|
| Rate for Payer: Multiplan Commercial |
$22.40
|
| Rate for Payer: NAPHCARE Commercial |
$16.80
|
| Rate for Payer: Preferred Network Access Commercial |
$25.76
|
| Rate for Payer: Quartz Beloit One Network |
$13.72
|
| Rate for Payer: Quartz Commercial |
$18.20
|
| Rate for Payer: Quartz Medicare Advantage |
$16.80
|
| Rate for Payer: The Alliance Commercial |
$112.00
|
| Rate for Payer: WEA Trust Commercial |
$15.40
|
| Rate for Payer: WPS Commercial |
$20.74
|
|
|
TUBE GASTRO ENTERIC MIC FEEDING 0210-24
|
Facility
|
OP
|
$2,599.00
|
|
| Hospital Charge Code |
4595874
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$727.72 |
| Max. Negotiated Rate |
$10,396.00 |
| Rate for Payer: Aetna Commercial |
$2,339.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,235.14
|
| Rate for Payer: Aetna Managed Medicare |
$727.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,689.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,299.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,247.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,377.47
|
| Rate for Payer: Cash Price |
$779.70
|
| Rate for Payer: Cigna Commercial |
$2,391.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,454.40
|
| Rate for Payer: Health EOS Commercial |
$2,313.11
|
| Rate for Payer: HFN Commercial |
$2,391.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,949.25
|
| Rate for Payer: Multiplan Commercial |
$2,079.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,559.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,391.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,273.51
|
| Rate for Payer: Quartz Commercial |
$1,689.35
|
| Rate for Payer: Quartz Medicare Advantage |
$1,559.40
|
| Rate for Payer: The Alliance Commercial |
$10,396.00
|
| Rate for Payer: WEA Trust Commercial |
$1,429.45
|
| Rate for Payer: WPS Commercial |
$1,925.08
|
|
|
TUBE GASTRO ENTERIC MIC FEEDING 0210-24
|
Facility
|
IP
|
$2,599.00
|
|
| Hospital Charge Code |
4595874
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,273.51 |
| Max. Negotiated Rate |
$2,391.08 |
| Rate for Payer: Aetna Commercial |
$2,339.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,235.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,377.47
|
| Rate for Payer: Cash Price |
$779.70
|
| Rate for Payer: Cigna Commercial |
$2,391.08
|
| Rate for Payer: Health EOS Commercial |
$2,313.11
|
| Rate for Payer: HFN Commercial |
$2,391.08
|
| Rate for Payer: Multiplan Commercial |
$2,079.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,559.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,391.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,273.51
|
| Rate for Payer: Quartz Commercial |
$1,559.40
|
| Rate for Payer: WEA Trust Commercial |
$1,429.45
|
| Rate for Payer: WPS Commercial |
$1,925.08
|
|
|
TUBE GASTROSTOMY MIC 24FR BAA010024
|
Facility
|
IP
|
$708.00
|
|
| Hospital Charge Code |
5349272
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$346.92 |
| Max. Negotiated Rate |
$651.36 |
| Rate for Payer: Aetna Commercial |
$637.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$608.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$375.24
|
| Rate for Payer: Cash Price |
$212.40
|
| Rate for Payer: Cigna Commercial |
$651.36
|
| Rate for Payer: Health EOS Commercial |
$630.12
|
| Rate for Payer: HFN Commercial |
$651.36
|
| Rate for Payer: Multiplan Commercial |
$566.40
|
| Rate for Payer: NAPHCARE Commercial |
$424.80
|
| Rate for Payer: Preferred Network Access Commercial |
$651.36
|
| Rate for Payer: Quartz Beloit One Network |
$346.92
|
| Rate for Payer: Quartz Commercial |
$424.80
|
| Rate for Payer: WEA Trust Commercial |
$389.40
|
| Rate for Payer: WPS Commercial |
$524.42
|
|
|
TUBE GASTROSTOMY MIC 24FR BAA010024
|
Facility
|
OP
|
$708.00
|
|
| Hospital Charge Code |
5349272
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$198.24 |
| Max. Negotiated Rate |
$2,832.00 |
| Rate for Payer: Aetna Commercial |
$637.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$608.88
|
| Rate for Payer: Aetna Managed Medicare |
$198.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$460.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$354.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$339.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$375.24
|
| Rate for Payer: Cash Price |
$212.40
|
| Rate for Payer: Cigna Commercial |
$651.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$396.20
|
| Rate for Payer: Health EOS Commercial |
$630.12
|
| Rate for Payer: HFN Commercial |
$651.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$531.00
|
| Rate for Payer: Multiplan Commercial |
$566.40
|
| Rate for Payer: NAPHCARE Commercial |
$424.80
|
| Rate for Payer: Preferred Network Access Commercial |
$651.36
|
| Rate for Payer: Quartz Beloit One Network |
$346.92
|
| Rate for Payer: Quartz Commercial |
$460.20
|
| Rate for Payer: Quartz Medicare Advantage |
$424.80
|
| Rate for Payer: The Alliance Commercial |
$2,832.00
|
| Rate for Payer: WEA Trust Commercial |
$389.40
|
| Rate for Payer: WPS Commercial |
$524.42
|
|
|
TUBE GASTROSTOMY PEG 26FR 8884720265
|
Facility
|
OP
|
$758.00
|
|
| Hospital Charge Code |
4020642
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$212.24 |
| Max. Negotiated Rate |
$3,032.00 |
| Rate for Payer: Aetna Commercial |
$682.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$651.88
|
| Rate for Payer: Aetna Managed Medicare |
$212.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$492.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$379.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$363.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$401.74
|
| Rate for Payer: Cash Price |
$227.40
|
| Rate for Payer: Cigna Commercial |
$697.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$424.18
|
| Rate for Payer: Health EOS Commercial |
$674.62
|
| Rate for Payer: HFN Commercial |
$697.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$568.50
|
| Rate for Payer: Multiplan Commercial |
$606.40
|
| Rate for Payer: NAPHCARE Commercial |
$454.80
|
| Rate for Payer: Preferred Network Access Commercial |
$697.36
|
| Rate for Payer: Quartz Beloit One Network |
$371.42
|
| Rate for Payer: Quartz Commercial |
$492.70
|
| Rate for Payer: Quartz Medicare Advantage |
$454.80
|
| Rate for Payer: The Alliance Commercial |
$3,032.00
|
| Rate for Payer: WEA Trust Commercial |
$416.90
|
| Rate for Payer: WPS Commercial |
$561.45
|
|
|
TUBE GASTROSTOMY PEG 26FR 8884720265
|
Facility
|
IP
|
$758.00
|
|
| Hospital Charge Code |
4020642
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$371.42 |
| Max. Negotiated Rate |
$697.36 |
| Rate for Payer: Aetna Commercial |
$682.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$651.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$401.74
|
| Rate for Payer: Cash Price |
$227.40
|
| Rate for Payer: Cigna Commercial |
$697.36
|
| Rate for Payer: Health EOS Commercial |
$674.62
|
| Rate for Payer: HFN Commercial |
$697.36
|
| Rate for Payer: Multiplan Commercial |
$606.40
|
| Rate for Payer: NAPHCARE Commercial |
$454.80
|
| Rate for Payer: Preferred Network Access Commercial |
$697.36
|
| Rate for Payer: Quartz Beloit One Network |
$371.42
|
| Rate for Payer: Quartz Commercial |
$454.80
|
| Rate for Payer: WEA Trust Commercial |
$416.90
|
| Rate for Payer: WPS Commercial |
$561.45
|
|
|
TUBE GASTROSTOMY PEG 28FR 8884720285
|
Facility
|
OP
|
$758.00
|
|
| Hospital Charge Code |
4020643
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$212.24 |
| Max. Negotiated Rate |
$3,032.00 |
| Rate for Payer: Aetna Commercial |
$682.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$651.88
|
| Rate for Payer: Aetna Managed Medicare |
$212.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$492.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$379.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$363.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$401.74
|
| Rate for Payer: Cash Price |
$227.40
|
| Rate for Payer: Cigna Commercial |
$697.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$424.18
|
| Rate for Payer: Health EOS Commercial |
$674.62
|
| Rate for Payer: HFN Commercial |
$697.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$568.50
|
| Rate for Payer: Multiplan Commercial |
$606.40
|
| Rate for Payer: NAPHCARE Commercial |
$454.80
|
| Rate for Payer: Preferred Network Access Commercial |
$697.36
|
| Rate for Payer: Quartz Beloit One Network |
$371.42
|
| Rate for Payer: Quartz Commercial |
$492.70
|
| Rate for Payer: Quartz Medicare Advantage |
$454.80
|
| Rate for Payer: The Alliance Commercial |
$3,032.00
|
| Rate for Payer: WEA Trust Commercial |
$416.90
|
| Rate for Payer: WPS Commercial |
$561.45
|
|
