|
TUBE ORAL/NASAL CO2 FOR PEDS #2013067-002
|
Facility
|
OP
|
$261.00
|
|
| Hospital Charge Code |
2969791
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$73.08 |
| Max. Negotiated Rate |
$1,044.00 |
| Rate for Payer: Aetna Commercial |
$234.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$224.46
|
| Rate for Payer: Aetna Managed Medicare |
$73.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$169.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$130.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$125.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$138.33
|
| Rate for Payer: Cash Price |
$78.30
|
| Rate for Payer: Cigna Commercial |
$240.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$146.06
|
| Rate for Payer: Health EOS Commercial |
$232.29
|
| Rate for Payer: HFN Commercial |
$240.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$195.75
|
| Rate for Payer: Multiplan Commercial |
$208.80
|
| Rate for Payer: NAPHCARE Commercial |
$156.60
|
| Rate for Payer: Preferred Network Access Commercial |
$240.12
|
| Rate for Payer: Quartz Beloit One Network |
$127.89
|
| Rate for Payer: Quartz Commercial |
$169.65
|
| Rate for Payer: Quartz Medicare Advantage |
$156.60
|
| Rate for Payer: The Alliance Commercial |
$1,044.00
|
| Rate for Payer: WEA Trust Commercial |
$143.55
|
| Rate for Payer: WPS Commercial |
$193.32
|
|
|
TUBE ORAL/NASAL CO2 FOR PEDS #2013067-002
|
Facility
|
IP
|
$261.00
|
|
| Hospital Charge Code |
2969791
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$127.89 |
| Max. Negotiated Rate |
$240.12 |
| Rate for Payer: Aetna Commercial |
$234.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$224.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$138.33
|
| Rate for Payer: Cash Price |
$78.30
|
| Rate for Payer: Cigna Commercial |
$240.12
|
| Rate for Payer: Health EOS Commercial |
$232.29
|
| Rate for Payer: HFN Commercial |
$240.12
|
| Rate for Payer: Multiplan Commercial |
$208.80
|
| Rate for Payer: NAPHCARE Commercial |
$156.60
|
| Rate for Payer: Preferred Network Access Commercial |
$240.12
|
| Rate for Payer: Quartz Beloit One Network |
$127.89
|
| Rate for Payer: Quartz Commercial |
$156.60
|
| Rate for Payer: WEA Trust Commercial |
$143.55
|
| Rate for Payer: WPS Commercial |
$193.32
|
|
|
TUBE RUSCH DBL LMN LT 37FR #116100370
|
Facility
|
IP
|
$1,023.00
|
|
| Hospital Charge Code |
2962805
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$501.27 |
| Max. Negotiated Rate |
$941.16 |
| Rate for Payer: Aetna Commercial |
$920.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$879.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$542.19
|
| Rate for Payer: Cash Price |
$306.90
|
| Rate for Payer: Cigna Commercial |
$941.16
|
| Rate for Payer: Health EOS Commercial |
$910.47
|
| Rate for Payer: HFN Commercial |
$941.16
|
| Rate for Payer: Multiplan Commercial |
$818.40
|
| Rate for Payer: NAPHCARE Commercial |
$613.80
|
| Rate for Payer: Preferred Network Access Commercial |
$941.16
|
| Rate for Payer: Quartz Beloit One Network |
$501.27
|
| Rate for Payer: Quartz Commercial |
$613.80
|
| Rate for Payer: WEA Trust Commercial |
$562.65
|
| Rate for Payer: WPS Commercial |
$757.74
|
|
|
TUBE RUSCH DBL LMN LT 37FR #116100370
|
Facility
|
OP
|
$1,023.00
|
|
| Hospital Charge Code |
2962805
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$286.44 |
| Max. Negotiated Rate |
$4,092.00 |
| Rate for Payer: Aetna Commercial |
$920.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$879.78
|
| Rate for Payer: Aetna Managed Medicare |
$286.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$664.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$511.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$491.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$542.19
|
| Rate for Payer: Cash Price |
$306.90
|
| Rate for Payer: Cigna Commercial |
$941.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$572.47
|
| Rate for Payer: Health EOS Commercial |
$910.47
|
| Rate for Payer: HFN Commercial |
$941.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$767.25
|
| Rate for Payer: Multiplan Commercial |
$818.40
|
| Rate for Payer: NAPHCARE Commercial |
$613.80
|
| Rate for Payer: Preferred Network Access Commercial |
$941.16
|
| Rate for Payer: Quartz Beloit One Network |
$501.27
|
| Rate for Payer: Quartz Commercial |
$664.95
|
| Rate for Payer: Quartz Medicare Advantage |
$613.80
|
| Rate for Payer: The Alliance Commercial |
$4,092.00
|
| Rate for Payer: WEA Trust Commercial |
$562.65
|
| Rate for Payer: WPS Commercial |
$757.74
|
|
|
TUBE RUSCH DBL LMN LT 39FR #11610039
|
Facility
|
IP
|
$1,023.00
|
|
| Hospital Charge Code |
2974627
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$501.27 |
| Max. Negotiated Rate |
$941.16 |
| Rate for Payer: Aetna Commercial |
$920.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$879.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$542.19
|
| Rate for Payer: Cash Price |
$306.90
|
| Rate for Payer: Cigna Commercial |
$941.16
|
| Rate for Payer: Health EOS Commercial |
$910.47
|
| Rate for Payer: HFN Commercial |
$941.16
|
| Rate for Payer: Multiplan Commercial |
$818.40
|
| Rate for Payer: NAPHCARE Commercial |
$613.80
|
| Rate for Payer: Preferred Network Access Commercial |
$941.16
|
| Rate for Payer: Quartz Beloit One Network |
$501.27
|
| Rate for Payer: Quartz Commercial |
$613.80
|
| Rate for Payer: WEA Trust Commercial |
$562.65
|
| Rate for Payer: WPS Commercial |
$757.74
|
|
|
TUBE RUSCH DBL LMN LT 39FR #11610039
|
Facility
|
OP
|
$1,023.00
|
|
| Hospital Charge Code |
2974627
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$286.44 |
| Max. Negotiated Rate |
$4,092.00 |
| Rate for Payer: Aetna Commercial |
$920.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$879.78
|
| Rate for Payer: Aetna Managed Medicare |
$286.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$664.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$511.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$491.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$542.19
|
| Rate for Payer: Cash Price |
$306.90
|
| Rate for Payer: Cigna Commercial |
$941.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$572.47
|
| Rate for Payer: Health EOS Commercial |
$910.47
|
| Rate for Payer: HFN Commercial |
$941.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$767.25
|
| Rate for Payer: Multiplan Commercial |
$818.40
|
| Rate for Payer: NAPHCARE Commercial |
$613.80
|
| Rate for Payer: Preferred Network Access Commercial |
$941.16
|
| Rate for Payer: Quartz Beloit One Network |
$501.27
|
| Rate for Payer: Quartz Commercial |
$664.95
|
| Rate for Payer: Quartz Medicare Advantage |
$613.80
|
| Rate for Payer: The Alliance Commercial |
$4,092.00
|
| Rate for Payer: WEA Trust Commercial |
$562.65
|
| Rate for Payer: WPS Commercial |
$757.74
|
|
|
TUBE RUSCH DBL LMN LT 41FR #116100041
|
Facility
|
OP
|
$1,063.00
|
|
| Hospital Charge Code |
2974628
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$297.64 |
| Max. Negotiated Rate |
$4,252.00 |
| Rate for Payer: Aetna Commercial |
$956.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$914.18
|
| Rate for Payer: Aetna Managed Medicare |
$297.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$690.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$531.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$510.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$563.39
|
| Rate for Payer: Cash Price |
$318.90
|
| Rate for Payer: Cigna Commercial |
$977.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$594.85
|
| Rate for Payer: Health EOS Commercial |
$946.07
|
| Rate for Payer: HFN Commercial |
$977.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$797.25
|
| Rate for Payer: Multiplan Commercial |
$850.40
|
| Rate for Payer: NAPHCARE Commercial |
$637.80
|
| Rate for Payer: Preferred Network Access Commercial |
$977.96
|
| Rate for Payer: Quartz Beloit One Network |
$520.87
|
| Rate for Payer: Quartz Commercial |
$690.95
|
| Rate for Payer: Quartz Medicare Advantage |
$637.80
|
| Rate for Payer: The Alliance Commercial |
$4,252.00
|
| Rate for Payer: WEA Trust Commercial |
$584.65
|
| Rate for Payer: WPS Commercial |
$787.36
|
|
|
TUBE RUSCH DBL LMN LT 41FR #116100041
|
Facility
|
IP
|
$1,063.00
|
|
| Hospital Charge Code |
2974628
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$520.87 |
| Max. Negotiated Rate |
$977.96 |
| Rate for Payer: Aetna Commercial |
$956.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$914.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$563.39
|
| Rate for Payer: Cash Price |
$318.90
|
| Rate for Payer: Cigna Commercial |
$977.96
|
| Rate for Payer: Health EOS Commercial |
$946.07
|
| Rate for Payer: HFN Commercial |
$977.96
|
| Rate for Payer: Multiplan Commercial |
$850.40
|
| Rate for Payer: NAPHCARE Commercial |
$637.80
|
| Rate for Payer: Preferred Network Access Commercial |
$977.96
|
| Rate for Payer: Quartz Beloit One Network |
$520.87
|
| Rate for Payer: Quartz Commercial |
$637.80
|
| Rate for Payer: WEA Trust Commercial |
$584.65
|
| Rate for Payer: WPS Commercial |
$787.36
|
|
|
TUBE RUSCH DBL LMN RT 35FR #116200035
|
Facility
|
IP
|
$1,319.00
|
|
| Hospital Charge Code |
2974714
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$646.31 |
| Max. Negotiated Rate |
$1,213.48 |
| Rate for Payer: Aetna Commercial |
$1,187.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,134.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$699.07
|
| Rate for Payer: Cash Price |
$395.70
|
| Rate for Payer: Cigna Commercial |
$1,213.48
|
| Rate for Payer: Health EOS Commercial |
$1,173.91
|
| Rate for Payer: HFN Commercial |
$1,213.48
|
| Rate for Payer: Multiplan Commercial |
$1,055.20
|
| Rate for Payer: NAPHCARE Commercial |
$791.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,213.48
|
| Rate for Payer: Quartz Beloit One Network |
$646.31
|
| Rate for Payer: Quartz Commercial |
$791.40
|
| Rate for Payer: WEA Trust Commercial |
$725.45
|
| Rate for Payer: WPS Commercial |
$976.98
|
|
|
TUBE RUSCH DBL LMN RT 35FR #116200035
|
Facility
|
OP
|
$1,319.00
|
|
| Hospital Charge Code |
2974714
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$369.32 |
| Max. Negotiated Rate |
$5,276.00 |
| Rate for Payer: Aetna Commercial |
$1,187.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,134.34
|
| Rate for Payer: Aetna Managed Medicare |
$369.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$857.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$659.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$633.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$699.07
|
| Rate for Payer: Cash Price |
$395.70
|
| Rate for Payer: Cigna Commercial |
$1,213.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$738.11
|
| Rate for Payer: Health EOS Commercial |
$1,173.91
|
| Rate for Payer: HFN Commercial |
$1,213.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$989.25
|
| Rate for Payer: Multiplan Commercial |
$1,055.20
|
| Rate for Payer: NAPHCARE Commercial |
$791.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,213.48
|
| Rate for Payer: Quartz Beloit One Network |
$646.31
|
| Rate for Payer: Quartz Commercial |
$857.35
|
| Rate for Payer: Quartz Medicare Advantage |
$791.40
|
| Rate for Payer: The Alliance Commercial |
$5,276.00
|
| Rate for Payer: WEA Trust Commercial |
$725.45
|
| Rate for Payer: WPS Commercial |
$976.98
|
|
|
TUBE RUSCH DBL LMN RT 37fr. #116200037
|
Facility
|
IP
|
$1,319.00
|
|
| Hospital Charge Code |
2974713
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$646.31 |
| Max. Negotiated Rate |
$1,213.48 |
| Rate for Payer: Aetna Commercial |
$1,187.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,134.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$699.07
|
| Rate for Payer: Cash Price |
$395.70
|
| Rate for Payer: Cigna Commercial |
$1,213.48
|
| Rate for Payer: Health EOS Commercial |
$1,173.91
|
| Rate for Payer: HFN Commercial |
$1,213.48
|
| Rate for Payer: Multiplan Commercial |
$1,055.20
|
| Rate for Payer: NAPHCARE Commercial |
$791.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,213.48
|
| Rate for Payer: Quartz Beloit One Network |
$646.31
|
| Rate for Payer: Quartz Commercial |
$791.40
|
| Rate for Payer: WEA Trust Commercial |
$725.45
|
| Rate for Payer: WPS Commercial |
$976.98
|
|
|
TUBE RUSCH DBL LMN RT 37fr. #116200037
|
Facility
|
OP
|
$1,319.00
|
|
| Hospital Charge Code |
2974713
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$369.32 |
| Max. Negotiated Rate |
$5,276.00 |
| Rate for Payer: Aetna Commercial |
$1,187.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,134.34
|
| Rate for Payer: Aetna Managed Medicare |
$369.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$857.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$659.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$633.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$699.07
|
| Rate for Payer: Cash Price |
$395.70
|
| Rate for Payer: Cigna Commercial |
$1,213.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$738.11
|
| Rate for Payer: Health EOS Commercial |
$1,173.91
|
| Rate for Payer: HFN Commercial |
$1,213.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$989.25
|
| Rate for Payer: Multiplan Commercial |
$1,055.20
|
| Rate for Payer: NAPHCARE Commercial |
$791.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,213.48
|
| Rate for Payer: Quartz Beloit One Network |
$646.31
|
| Rate for Payer: Quartz Commercial |
$857.35
|
| Rate for Payer: Quartz Medicare Advantage |
$791.40
|
| Rate for Payer: The Alliance Commercial |
$5,276.00
|
| Rate for Payer: WEA Trust Commercial |
$725.45
|
| Rate for Payer: WPS Commercial |
$976.98
|
|
|
TUBE RUSCH DBL LMN RT 39FR #116200039
|
Facility
|
IP
|
$1,308.00
|
|
| Hospital Charge Code |
2974712
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$640.92 |
| Max. Negotiated Rate |
$1,203.36 |
| Rate for Payer: Aetna Commercial |
$1,177.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,124.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$693.24
|
| Rate for Payer: Cash Price |
$392.40
|
| Rate for Payer: Cigna Commercial |
$1,203.36
|
| Rate for Payer: Health EOS Commercial |
$1,164.12
|
| Rate for Payer: HFN Commercial |
$1,203.36
|
| Rate for Payer: Multiplan Commercial |
$1,046.40
|
| Rate for Payer: NAPHCARE Commercial |
$784.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,203.36
|
| Rate for Payer: Quartz Beloit One Network |
$640.92
|
| Rate for Payer: Quartz Commercial |
$784.80
|
| Rate for Payer: WEA Trust Commercial |
$719.40
|
| Rate for Payer: WPS Commercial |
$968.84
|
|
|
TUBE RUSCH DBL LMN RT 39FR #116200039
|
Facility
|
OP
|
$1,308.00
|
|
| Hospital Charge Code |
2974712
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$366.24 |
| Max. Negotiated Rate |
$5,232.00 |
| Rate for Payer: Aetna Commercial |
$1,177.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,124.88
|
| Rate for Payer: Aetna Managed Medicare |
$366.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$850.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$654.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$627.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$693.24
|
| Rate for Payer: Cash Price |
$392.40
|
| Rate for Payer: Cigna Commercial |
$1,203.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$731.96
|
| Rate for Payer: Health EOS Commercial |
$1,164.12
|
| Rate for Payer: HFN Commercial |
$1,203.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$981.00
|
| Rate for Payer: Multiplan Commercial |
$1,046.40
|
| Rate for Payer: NAPHCARE Commercial |
$784.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,203.36
|
| Rate for Payer: Quartz Beloit One Network |
$640.92
|
| Rate for Payer: Quartz Commercial |
$850.20
|
| Rate for Payer: Quartz Medicare Advantage |
$784.80
|
| Rate for Payer: The Alliance Commercial |
$5,232.00
|
| Rate for Payer: WEA Trust Commercial |
$719.40
|
| Rate for Payer: WPS Commercial |
$968.84
|
|
|
TUBE RUSCH DBL LMN RT 41FR #116200041
|
Facility
|
IP
|
$1,319.00
|
|
| Hospital Charge Code |
2974711
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$646.31 |
| Max. Negotiated Rate |
$1,213.48 |
| Rate for Payer: Aetna Commercial |
$1,187.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,134.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$699.07
|
| Rate for Payer: Cash Price |
$395.70
|
| Rate for Payer: Cigna Commercial |
$1,213.48
|
| Rate for Payer: Health EOS Commercial |
$1,173.91
|
| Rate for Payer: HFN Commercial |
$1,213.48
|
| Rate for Payer: Multiplan Commercial |
$1,055.20
|
| Rate for Payer: NAPHCARE Commercial |
$791.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,213.48
|
| Rate for Payer: Quartz Beloit One Network |
$646.31
|
| Rate for Payer: Quartz Commercial |
$791.40
|
| Rate for Payer: WEA Trust Commercial |
$725.45
|
| Rate for Payer: WPS Commercial |
$976.98
|
|
|
TUBE RUSCH DBL LMN RT 41FR #116200041
|
Facility
|
OP
|
$1,319.00
|
|
| Hospital Charge Code |
2974711
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$369.32 |
| Max. Negotiated Rate |
$5,276.00 |
| Rate for Payer: Aetna Commercial |
$1,187.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,134.34
|
| Rate for Payer: Aetna Managed Medicare |
$369.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$857.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$659.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$633.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$699.07
|
| Rate for Payer: Cash Price |
$395.70
|
| Rate for Payer: Cigna Commercial |
$1,213.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$738.11
|
| Rate for Payer: Health EOS Commercial |
$1,173.91
|
| Rate for Payer: HFN Commercial |
$1,213.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$989.25
|
| Rate for Payer: Multiplan Commercial |
$1,055.20
|
| Rate for Payer: NAPHCARE Commercial |
$791.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,213.48
|
| Rate for Payer: Quartz Beloit One Network |
$646.31
|
| Rate for Payer: Quartz Commercial |
$857.35
|
| Rate for Payer: Quartz Medicare Advantage |
$791.40
|
| Rate for Payer: The Alliance Commercial |
$5,276.00
|
| Rate for Payer: WEA Trust Commercial |
$725.45
|
| Rate for Payer: WPS Commercial |
$976.98
|
|
|
TUBE SALEM SUMP 14FR.W/ANTI
|
Facility
|
OP
|
$134.00
|
|
| Hospital Charge Code |
2963080
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$37.52 |
| Max. Negotiated Rate |
$536.00 |
| Rate for Payer: Aetna Commercial |
$120.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$115.24
|
| Rate for Payer: Aetna Managed Medicare |
$37.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$87.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$67.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$64.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$71.02
|
| Rate for Payer: Cash Price |
$40.20
|
| Rate for Payer: Cigna Commercial |
$123.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$74.99
|
| Rate for Payer: Health EOS Commercial |
$119.26
|
| Rate for Payer: HFN Commercial |
$123.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$100.50
|
| Rate for Payer: Multiplan Commercial |
$107.20
|
| Rate for Payer: NAPHCARE Commercial |
$80.40
|
| Rate for Payer: Preferred Network Access Commercial |
$123.28
|
| Rate for Payer: Quartz Beloit One Network |
$65.66
|
| Rate for Payer: Quartz Commercial |
$87.10
|
| Rate for Payer: Quartz Medicare Advantage |
$80.40
|
| Rate for Payer: The Alliance Commercial |
$536.00
|
| Rate for Payer: WEA Trust Commercial |
$73.70
|
| Rate for Payer: WPS Commercial |
$99.25
|
|
|
TUBE SALEM SUMP 14FR.W/ANTI
|
Facility
|
IP
|
$134.00
|
|
| Hospital Charge Code |
2963080
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$65.66 |
| Max. Negotiated Rate |
$123.28 |
| Rate for Payer: Aetna Commercial |
$120.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$115.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$71.02
|
| Rate for Payer: Cash Price |
$40.20
|
| Rate for Payer: Cigna Commercial |
$123.28
|
| Rate for Payer: Health EOS Commercial |
$119.26
|
| Rate for Payer: HFN Commercial |
$123.28
|
| Rate for Payer: Multiplan Commercial |
$107.20
|
| Rate for Payer: NAPHCARE Commercial |
$80.40
|
| Rate for Payer: Preferred Network Access Commercial |
$123.28
|
| Rate for Payer: Quartz Beloit One Network |
$65.66
|
| Rate for Payer: Quartz Commercial |
$80.40
|
| Rate for Payer: WEA Trust Commercial |
$73.70
|
| Rate for Payer: WPS Commercial |
$99.25
|
|
|
TUBE SALEM SUMP 16 FR. W
|
Facility
|
OP
|
$98.00
|
|
| Hospital Charge Code |
2963079
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$27.44 |
| Max. Negotiated Rate |
$392.00 |
| Rate for Payer: Aetna Commercial |
$88.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$84.28
|
| Rate for Payer: Aetna Managed Medicare |
$27.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$63.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$49.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$47.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$51.94
|
| Rate for Payer: Cash Price |
$29.40
|
| Rate for Payer: Cigna Commercial |
$90.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$54.84
|
| Rate for Payer: Health EOS Commercial |
$87.22
|
| Rate for Payer: HFN Commercial |
$90.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$73.50
|
| Rate for Payer: Multiplan Commercial |
$78.40
|
| Rate for Payer: NAPHCARE Commercial |
$58.80
|
| Rate for Payer: Preferred Network Access Commercial |
$90.16
|
| Rate for Payer: Quartz Beloit One Network |
$48.02
|
| Rate for Payer: Quartz Commercial |
$63.70
|
| Rate for Payer: Quartz Medicare Advantage |
$58.80
|
| Rate for Payer: The Alliance Commercial |
$392.00
|
| Rate for Payer: WEA Trust Commercial |
$53.90
|
| Rate for Payer: WPS Commercial |
$72.59
|
|
|
TUBE SALEM SUMP 16 FR. W
|
Facility
|
IP
|
$98.00
|
|
| Hospital Charge Code |
2963079
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$48.02 |
| Max. Negotiated Rate |
$90.16 |
| Rate for Payer: Aetna Commercial |
$88.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$84.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$51.94
|
| Rate for Payer: Cash Price |
$29.40
|
| Rate for Payer: Cigna Commercial |
$90.16
|
| Rate for Payer: Health EOS Commercial |
$87.22
|
| Rate for Payer: HFN Commercial |
$90.16
|
| Rate for Payer: Multiplan Commercial |
$78.40
|
| Rate for Payer: NAPHCARE Commercial |
$58.80
|
| Rate for Payer: Preferred Network Access Commercial |
$90.16
|
| Rate for Payer: Quartz Beloit One Network |
$48.02
|
| Rate for Payer: Quartz Commercial |
$58.80
|
| Rate for Payer: WEA Trust Commercial |
$53.90
|
| Rate for Payer: WPS Commercial |
$72.59
|
|
|
Tube Salem Sump16F W/Anti-Refl
|
Facility
|
OP
|
$173.00
|
|
| Hospital Charge Code |
3101762
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$48.44 |
| Max. Negotiated Rate |
$692.00 |
| Rate for Payer: Aetna Commercial |
$155.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$148.78
|
| Rate for Payer: Aetna Managed Medicare |
$48.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$112.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$86.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$83.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$91.69
|
| Rate for Payer: Cash Price |
$51.90
|
| Rate for Payer: Cigna Commercial |
$159.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$96.81
|
| Rate for Payer: Health EOS Commercial |
$153.97
|
| Rate for Payer: HFN Commercial |
$159.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$129.75
|
| Rate for Payer: Multiplan Commercial |
$138.40
|
| Rate for Payer: NAPHCARE Commercial |
$103.80
|
| Rate for Payer: Preferred Network Access Commercial |
$159.16
|
| Rate for Payer: Quartz Beloit One Network |
$84.77
|
| Rate for Payer: Quartz Commercial |
$112.45
|
| Rate for Payer: Quartz Medicare Advantage |
$103.80
|
| Rate for Payer: The Alliance Commercial |
$692.00
|
| Rate for Payer: WEA Trust Commercial |
$95.15
|
| Rate for Payer: WPS Commercial |
$128.14
|
|
|
Tube Salem Sump16F W/Anti-Refl
|
Facility
|
IP
|
$173.00
|
|
| Hospital Charge Code |
3101762
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$84.77 |
| Max. Negotiated Rate |
$159.16 |
| Rate for Payer: Aetna Commercial |
$155.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$148.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$91.69
|
| Rate for Payer: Cash Price |
$51.90
|
| Rate for Payer: Cigna Commercial |
$159.16
|
| Rate for Payer: Health EOS Commercial |
$153.97
|
| Rate for Payer: HFN Commercial |
$159.16
|
| Rate for Payer: Multiplan Commercial |
$138.40
|
| Rate for Payer: NAPHCARE Commercial |
$103.80
|
| Rate for Payer: Preferred Network Access Commercial |
$159.16
|
| Rate for Payer: Quartz Beloit One Network |
$84.77
|
| Rate for Payer: Quartz Commercial |
$103.80
|
| Rate for Payer: WEA Trust Commercial |
$95.15
|
| Rate for Payer: WPS Commercial |
$128.14
|
|
|
TUBE SALEM SUMP 18FR.W/ANTI. 8888266148
|
Facility
|
IP
|
$111.00
|
|
| Hospital Charge Code |
2963078
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$54.39 |
| Max. Negotiated Rate |
$102.12 |
| Rate for Payer: Aetna Commercial |
$99.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$95.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$58.83
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cigna Commercial |
$102.12
|
| Rate for Payer: Health EOS Commercial |
$98.79
|
| Rate for Payer: HFN Commercial |
$102.12
|
| Rate for Payer: Multiplan Commercial |
$88.80
|
| Rate for Payer: NAPHCARE Commercial |
$66.60
|
| Rate for Payer: Preferred Network Access Commercial |
$102.12
|
| Rate for Payer: Quartz Beloit One Network |
$54.39
|
| Rate for Payer: Quartz Commercial |
$66.60
|
| Rate for Payer: WEA Trust Commercial |
$61.05
|
| Rate for Payer: WPS Commercial |
$82.22
|
|
|
TUBE SALEM SUMP 18FR.W/ANTI. 8888266148
|
Facility
|
OP
|
$111.00
|
|
| Hospital Charge Code |
2963078
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.08 |
| Max. Negotiated Rate |
$444.00 |
| Rate for Payer: Aetna Commercial |
$99.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$95.46
|
| Rate for Payer: Aetna Managed Medicare |
$31.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$72.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$55.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$53.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$58.83
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cigna Commercial |
$102.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$62.12
|
| Rate for Payer: Health EOS Commercial |
$98.79
|
| Rate for Payer: HFN Commercial |
$102.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$83.25
|
| Rate for Payer: Multiplan Commercial |
$88.80
|
| Rate for Payer: NAPHCARE Commercial |
$66.60
|
| Rate for Payer: Preferred Network Access Commercial |
$102.12
|
| Rate for Payer: Quartz Beloit One Network |
$54.39
|
| Rate for Payer: Quartz Commercial |
$72.15
|
| Rate for Payer: Quartz Medicare Advantage |
$66.60
|
| Rate for Payer: The Alliance Commercial |
$444.00
|
| Rate for Payer: WEA Trust Commercial |
$61.05
|
| Rate for Payer: WPS Commercial |
$82.22
|
|
|
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 |
$668.36 |
| Max. Negotiated Rate |
$1,254.88 |
| Rate for Payer: Aetna Commercial |
$1,227.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,173.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$722.92
|
| Rate for Payer: Cash Price |
$409.20
|
| Rate for Payer: Cigna Commercial |
$1,254.88
|
| Rate for Payer: Health EOS Commercial |
$1,213.96
|
| Rate for Payer: HFN Commercial |
$1,254.88
|
| Rate for Payer: Multiplan Commercial |
$1,091.20
|
| Rate for Payer: NAPHCARE Commercial |
$818.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,254.88
|
| Rate for Payer: Quartz Beloit One Network |
$668.36
|
| Rate for Payer: Quartz Commercial |
$818.40
|
| Rate for Payer: WEA Trust Commercial |
$750.20
|
| Rate for Payer: WPS Commercial |
$1,010.31
|
|
