|
TUBING MIDAS REX IRRIGATION IRD300
|
Facility
|
OP
|
$1,513.00
|
|
| Hospital Charge Code |
3613495
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$440.59 |
| Max. Negotiated Rate |
$1,447.64 |
| Rate for Payer: Aetna Commercial |
$1,416.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,353.23
|
| Rate for Payer: Aetna Managed Medicare |
$440.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,022.79
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$786.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$755.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$833.97
|
| Rate for Payer: Cash Price |
$453.90
|
| Rate for Payer: Cigna Commercial |
$1,447.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$880.57
|
| Rate for Payer: Health EOS Commercial |
$1,400.43
|
| Rate for Payer: HFN Commercial |
$1,447.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,180.14
|
| Rate for Payer: Multiplan Commercial |
$1,258.82
|
| Rate for Payer: NAPHCARE Commercial |
$944.11
|
| Rate for Payer: Preferred Network Access Commercial |
$1,447.64
|
| Rate for Payer: Quartz Beloit One Network |
$771.02
|
| Rate for Payer: Quartz Commercial |
$1,022.79
|
| Rate for Payer: Quartz Medicare Advantage |
$944.11
|
| Rate for Payer: The Alliance Commercial |
$786.76
|
| Rate for Payer: WEA Trust Commercial |
$865.44
|
| Rate for Payer: WPS Commercial |
$1,165.46
|
|
|
TUBING PACK 1/2x3/32x120 SHC10
|
Facility
|
IP
|
$490.00
|
|
| Hospital Charge Code |
2965788
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$249.70 |
| Max. Negotiated Rate |
$468.83 |
| Rate for Payer: Aetna Commercial |
$458.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$438.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$270.09
|
| Rate for Payer: Cash Price |
$147.00
|
| Rate for Payer: Cigna Commercial |
$468.83
|
| Rate for Payer: Health EOS Commercial |
$453.54
|
| Rate for Payer: HFN Commercial |
$468.83
|
| Rate for Payer: Multiplan Commercial |
$407.68
|
| Rate for Payer: Preferred Network Access Commercial |
$468.83
|
| Rate for Payer: Quartz Beloit One Network |
$249.70
|
| Rate for Payer: Quartz Commercial |
$305.76
|
| Rate for Payer: WEA Trust Commercial |
$280.28
|
| Rate for Payer: WPS Commercial |
$377.45
|
|
|
TUBING PACK 1/2x3/32x120 SHC10
|
Facility
|
OP
|
$490.00
|
|
| Hospital Charge Code |
2965788
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$142.69 |
| Max. Negotiated Rate |
$468.83 |
| Rate for Payer: Aetna Commercial |
$458.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$438.26
|
| Rate for Payer: Aetna Managed Medicare |
$142.69
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$331.24
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$254.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$244.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$270.09
|
| Rate for Payer: Cash Price |
$147.00
|
| Rate for Payer: Cigna Commercial |
$468.83
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$285.18
|
| Rate for Payer: Health EOS Commercial |
$453.54
|
| Rate for Payer: HFN Commercial |
$468.83
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$382.20
|
| Rate for Payer: Multiplan Commercial |
$407.68
|
| Rate for Payer: NAPHCARE Commercial |
$305.76
|
| Rate for Payer: Preferred Network Access Commercial |
$468.83
|
| Rate for Payer: Quartz Beloit One Network |
$249.70
|
| Rate for Payer: Quartz Commercial |
$331.24
|
| Rate for Payer: Quartz Medicare Advantage |
$305.76
|
| Rate for Payer: The Alliance Commercial |
$254.80
|
| Rate for Payer: WEA Trust Commercial |
$280.28
|
| Rate for Payer: WPS Commercial |
$377.45
|
|
|
TUBING PACK 1/4 IN ID x 1/16 IN WALL X 10 FT CARDIOVASCULAR PROCEDURE KIT 70346
|
Facility
|
IP
|
$490.00
|
|
| Hospital Charge Code |
2965161
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$249.70 |
| Max. Negotiated Rate |
$468.83 |
| Rate for Payer: Aetna Commercial |
$458.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$438.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$270.09
|
| Rate for Payer: Cash Price |
$147.00
|
| Rate for Payer: Cigna Commercial |
$468.83
|
| Rate for Payer: Health EOS Commercial |
$453.54
|
| Rate for Payer: HFN Commercial |
$468.83
|
| Rate for Payer: Multiplan Commercial |
$407.68
|
| Rate for Payer: Preferred Network Access Commercial |
$468.83
|
| Rate for Payer: Quartz Beloit One Network |
$249.70
|
| Rate for Payer: Quartz Commercial |
$305.76
|
| Rate for Payer: WEA Trust Commercial |
$280.28
|
| Rate for Payer: WPS Commercial |
$377.45
|
|
|
TUBING PACK 1/4 IN ID x 1/16 IN WALL X 10 FT CARDIOVASCULAR PROCEDURE KIT 70346
|
Facility
|
OP
|
$490.00
|
|
| Hospital Charge Code |
2965161
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$142.69 |
| Max. Negotiated Rate |
$468.83 |
| Rate for Payer: Aetna Commercial |
$458.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$438.26
|
| Rate for Payer: Aetna Managed Medicare |
$142.69
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$331.24
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$254.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$244.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$270.09
|
| Rate for Payer: Cash Price |
$147.00
|
| Rate for Payer: Cigna Commercial |
$468.83
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$285.18
|
| Rate for Payer: Health EOS Commercial |
$453.54
|
| Rate for Payer: HFN Commercial |
$468.83
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$382.20
|
| Rate for Payer: Multiplan Commercial |
$407.68
|
| Rate for Payer: NAPHCARE Commercial |
$305.76
|
| Rate for Payer: Preferred Network Access Commercial |
$468.83
|
| Rate for Payer: Quartz Beloit One Network |
$249.70
|
| Rate for Payer: Quartz Commercial |
$331.24
|
| Rate for Payer: Quartz Medicare Advantage |
$305.76
|
| Rate for Payer: The Alliance Commercial |
$254.80
|
| Rate for Payer: WEA Trust Commercial |
$280.28
|
| Rate for Payer: WPS Commercial |
$377.45
|
|
|
TUBING PACK 1/4 IN ID x 1/16 IN WALL X 7 FT CARDIOVASCULAR PROCEDURE KIT 60050
|
Facility
|
OP
|
$202.00
|
|
| Hospital Charge Code |
6200961
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$58.82 |
| Max. Negotiated Rate |
$193.27 |
| Rate for Payer: Aetna Commercial |
$189.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$180.67
|
| Rate for Payer: Aetna Managed Medicare |
$58.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$136.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$105.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$100.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$111.34
|
| Rate for Payer: Cash Price |
$60.60
|
| Rate for Payer: Cigna Commercial |
$193.27
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$117.56
|
| Rate for Payer: Health EOS Commercial |
$186.97
|
| Rate for Payer: HFN Commercial |
$193.27
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$157.56
|
| Rate for Payer: Multiplan Commercial |
$168.06
|
| Rate for Payer: NAPHCARE Commercial |
$126.05
|
| Rate for Payer: Preferred Network Access Commercial |
$193.27
|
| Rate for Payer: Quartz Beloit One Network |
$102.94
|
| Rate for Payer: Quartz Commercial |
$136.55
|
| Rate for Payer: Quartz Medicare Advantage |
$126.05
|
| Rate for Payer: The Alliance Commercial |
$105.04
|
| Rate for Payer: WEA Trust Commercial |
$115.54
|
| Rate for Payer: WPS Commercial |
$155.60
|
|
|
TUBING PACK 1/4 IN ID x 1/16 IN WALL X 7 FT CARDIOVASCULAR PROCEDURE KIT 60050
|
Facility
|
IP
|
$202.00
|
|
| Hospital Charge Code |
6200961
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$102.94 |
| Max. Negotiated Rate |
$193.27 |
| Rate for Payer: Aetna Commercial |
$189.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$180.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$111.34
|
| Rate for Payer: Cash Price |
$60.60
|
| Rate for Payer: Cigna Commercial |
$193.27
|
| Rate for Payer: Health EOS Commercial |
$186.97
|
| Rate for Payer: HFN Commercial |
$193.27
|
| Rate for Payer: Multiplan Commercial |
$168.06
|
| Rate for Payer: Preferred Network Access Commercial |
$193.27
|
| Rate for Payer: Quartz Beloit One Network |
$102.94
|
| Rate for Payer: Quartz Commercial |
$126.05
|
| Rate for Payer: WEA Trust Commercial |
$115.54
|
| Rate for Payer: WPS Commercial |
$155.60
|
|
|
TUBING PACK 3/8x3/32x120 SFC10
|
Facility
|
OP
|
$490.00
|
|
| Hospital Charge Code |
2965789
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$142.69 |
| Max. Negotiated Rate |
$468.83 |
| Rate for Payer: Aetna Commercial |
$458.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$438.26
|
| Rate for Payer: Aetna Managed Medicare |
$142.69
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$331.24
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$254.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$244.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$270.09
|
| Rate for Payer: Cash Price |
$147.00
|
| Rate for Payer: Cigna Commercial |
$468.83
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$285.18
|
| Rate for Payer: Health EOS Commercial |
$453.54
|
| Rate for Payer: HFN Commercial |
$468.83
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$382.20
|
| Rate for Payer: Multiplan Commercial |
$407.68
|
| Rate for Payer: NAPHCARE Commercial |
$305.76
|
| Rate for Payer: Preferred Network Access Commercial |
$468.83
|
| Rate for Payer: Quartz Beloit One Network |
$249.70
|
| Rate for Payer: Quartz Commercial |
$331.24
|
| Rate for Payer: Quartz Medicare Advantage |
$305.76
|
| Rate for Payer: The Alliance Commercial |
$254.80
|
| Rate for Payer: WEA Trust Commercial |
$280.28
|
| Rate for Payer: WPS Commercial |
$377.45
|
|
|
TUBING PACK 3/8x3/32x120 SFC10
|
Facility
|
IP
|
$490.00
|
|
| Hospital Charge Code |
2965789
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$249.70 |
| Max. Negotiated Rate |
$468.83 |
| Rate for Payer: Aetna Commercial |
$458.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$438.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$270.09
|
| Rate for Payer: Cash Price |
$147.00
|
| Rate for Payer: Cigna Commercial |
$468.83
|
| Rate for Payer: Health EOS Commercial |
$453.54
|
| Rate for Payer: HFN Commercial |
$468.83
|
| Rate for Payer: Multiplan Commercial |
$407.68
|
| Rate for Payer: Preferred Network Access Commercial |
$468.83
|
| Rate for Payer: Quartz Beloit One Network |
$249.70
|
| Rate for Payer: Quartz Commercial |
$305.76
|
| Rate for Payer: WEA Trust Commercial |
$280.28
|
| Rate for Payer: WPS Commercial |
$377.45
|
|
|
TUBING PCA COMBINATION SET 14279-28
|
Facility
|
IP
|
$135.00
|
|
| Hospital Charge Code |
2963210
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$68.80 |
| Max. Negotiated Rate |
$129.17 |
| Rate for Payer: Aetna Commercial |
$126.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$120.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$74.41
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cigna Commercial |
$129.17
|
| Rate for Payer: Health EOS Commercial |
$124.96
|
| Rate for Payer: HFN Commercial |
$129.17
|
| Rate for Payer: Multiplan Commercial |
$112.32
|
| Rate for Payer: Preferred Network Access Commercial |
$129.17
|
| Rate for Payer: Quartz Beloit One Network |
$68.80
|
| Rate for Payer: Quartz Commercial |
$84.24
|
| Rate for Payer: WEA Trust Commercial |
$77.22
|
| Rate for Payer: WPS Commercial |
$103.99
|
|
|
TUBING PCA COMBINATION SET 14279-28
|
Facility
|
OP
|
$135.00
|
|
| Hospital Charge Code |
2963210
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$39.31 |
| Max. Negotiated Rate |
$129.17 |
| Rate for Payer: Aetna Commercial |
$126.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$120.74
|
| Rate for Payer: Aetna Managed Medicare |
$39.31
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$91.26
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$70.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$67.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$74.41
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cigna Commercial |
$129.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$78.57
|
| Rate for Payer: Health EOS Commercial |
$124.96
|
| Rate for Payer: HFN Commercial |
$129.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$105.30
|
| Rate for Payer: Multiplan Commercial |
$112.32
|
| Rate for Payer: NAPHCARE Commercial |
$84.24
|
| Rate for Payer: Preferred Network Access Commercial |
$129.17
|
| Rate for Payer: Quartz Beloit One Network |
$68.80
|
| Rate for Payer: Quartz Commercial |
$91.26
|
| Rate for Payer: Quartz Medicare Advantage |
$84.24
|
| Rate for Payer: The Alliance Commercial |
$70.20
|
| Rate for Payer: WEA Trust Commercial |
$77.22
|
| Rate for Payer: WPS Commercial |
$103.99
|
|
|
TUBING PERFUSION PACK 02946300
|
Facility
|
IP
|
$638.00
|
|
| Hospital Charge Code |
2966064
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$325.12 |
| Max. Negotiated Rate |
$610.44 |
| Rate for Payer: Aetna Commercial |
$597.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$570.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$351.67
|
| Rate for Payer: Cash Price |
$191.40
|
| Rate for Payer: Cigna Commercial |
$610.44
|
| Rate for Payer: Health EOS Commercial |
$590.53
|
| Rate for Payer: HFN Commercial |
$610.44
|
| Rate for Payer: Multiplan Commercial |
$530.82
|
| Rate for Payer: Preferred Network Access Commercial |
$610.44
|
| Rate for Payer: Quartz Beloit One Network |
$325.12
|
| Rate for Payer: Quartz Commercial |
$398.11
|
| Rate for Payer: WEA Trust Commercial |
$364.94
|
| Rate for Payer: WPS Commercial |
$491.45
|
|
|
TUBING PERFUSION PACK 02946300
|
Facility
|
OP
|
$638.00
|
|
| Hospital Charge Code |
2966064
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$185.79 |
| Max. Negotiated Rate |
$610.44 |
| Rate for Payer: Aetna Commercial |
$597.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$570.63
|
| Rate for Payer: Aetna Managed Medicare |
$185.79
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$431.29
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$331.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$318.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$351.67
|
| Rate for Payer: Cash Price |
$191.40
|
| Rate for Payer: Cigna Commercial |
$610.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$371.32
|
| Rate for Payer: Health EOS Commercial |
$590.53
|
| Rate for Payer: HFN Commercial |
$610.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$497.64
|
| Rate for Payer: Multiplan Commercial |
$530.82
|
| Rate for Payer: NAPHCARE Commercial |
$398.11
|
| Rate for Payer: Preferred Network Access Commercial |
$610.44
|
| Rate for Payer: Quartz Beloit One Network |
$325.12
|
| Rate for Payer: Quartz Commercial |
$431.29
|
| Rate for Payer: Quartz Medicare Advantage |
$398.11
|
| Rate for Payer: The Alliance Commercial |
$331.76
|
| Rate for Payer: WEA Trust Commercial |
$364.94
|
| Rate for Payer: WPS Commercial |
$491.45
|
|
|
TUBING PRESSURE MONITOR LINE 029456000
|
Facility
|
IP
|
$1,262.00
|
|
| Hospital Charge Code |
2965816
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$643.12 |
| Max. Negotiated Rate |
$1,207.48 |
| Rate for Payer: Aetna Commercial |
$1,181.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,128.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$695.61
|
| Rate for Payer: Cash Price |
$378.60
|
| Rate for Payer: Cigna Commercial |
$1,207.48
|
| Rate for Payer: Health EOS Commercial |
$1,168.11
|
| Rate for Payer: HFN Commercial |
$1,207.48
|
| Rate for Payer: Multiplan Commercial |
$1,049.98
|
| Rate for Payer: Preferred Network Access Commercial |
$1,207.48
|
| Rate for Payer: Quartz Beloit One Network |
$643.12
|
| Rate for Payer: Quartz Commercial |
$787.49
|
| Rate for Payer: WEA Trust Commercial |
$721.86
|
| Rate for Payer: WPS Commercial |
$972.12
|
|
|
TUBING PRESSURE MONITOR LINE 029456000
|
Facility
|
OP
|
$1,262.00
|
|
| Hospital Charge Code |
2965816
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$367.49 |
| Max. Negotiated Rate |
$1,207.48 |
| Rate for Payer: Aetna Commercial |
$1,181.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,128.73
|
| Rate for Payer: Aetna Managed Medicare |
$367.49
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$853.11
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$656.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$629.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$695.61
|
| Rate for Payer: Cash Price |
$378.60
|
| Rate for Payer: Cigna Commercial |
$1,207.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$734.48
|
| Rate for Payer: Health EOS Commercial |
$1,168.11
|
| Rate for Payer: HFN Commercial |
$1,207.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$984.36
|
| Rate for Payer: Multiplan Commercial |
$1,049.98
|
| Rate for Payer: NAPHCARE Commercial |
$787.49
|
| Rate for Payer: Preferred Network Access Commercial |
$1,207.48
|
| Rate for Payer: Quartz Beloit One Network |
$643.12
|
| Rate for Payer: Quartz Commercial |
$853.11
|
| Rate for Payer: Quartz Medicare Advantage |
$787.49
|
| Rate for Payer: The Alliance Commercial |
$656.24
|
| Rate for Payer: WEA Trust Commercial |
$721.86
|
| Rate for Payer: WPS Commercial |
$972.12
|
|
|
TUBING PROBE PLUS PRESSURIZED EPT03
|
Facility
|
OP
|
$762.00
|
|
| Hospital Charge Code |
2963012
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$221.89 |
| Max. Negotiated Rate |
$729.08 |
| Rate for Payer: Aetna Commercial |
$713.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$681.53
|
| Rate for Payer: Aetna Managed Medicare |
$221.89
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$515.11
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$396.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$380.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$420.01
|
| Rate for Payer: Cash Price |
$228.60
|
| Rate for Payer: Cigna Commercial |
$729.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$443.48
|
| Rate for Payer: Health EOS Commercial |
$705.31
|
| Rate for Payer: HFN Commercial |
$729.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$594.36
|
| Rate for Payer: Multiplan Commercial |
$633.98
|
| Rate for Payer: NAPHCARE Commercial |
$475.49
|
| Rate for Payer: Preferred Network Access Commercial |
$729.08
|
| Rate for Payer: Quartz Beloit One Network |
$388.32
|
| Rate for Payer: Quartz Commercial |
$515.11
|
| Rate for Payer: Quartz Medicare Advantage |
$475.49
|
| Rate for Payer: The Alliance Commercial |
$396.24
|
| Rate for Payer: WEA Trust Commercial |
$435.86
|
| Rate for Payer: WPS Commercial |
$586.97
|
|
|
TUBING PROBE PLUS PRESSURIZED EPT03
|
Facility
|
IP
|
$762.00
|
|
| Hospital Charge Code |
2963012
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$388.32 |
| Max. Negotiated Rate |
$729.08 |
| Rate for Payer: Aetna Commercial |
$713.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$681.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$420.01
|
| Rate for Payer: Cash Price |
$228.60
|
| Rate for Payer: Cigna Commercial |
$729.08
|
| Rate for Payer: Health EOS Commercial |
$705.31
|
| Rate for Payer: HFN Commercial |
$729.08
|
| Rate for Payer: Multiplan Commercial |
$633.98
|
| Rate for Payer: Preferred Network Access Commercial |
$729.08
|
| Rate for Payer: Quartz Beloit One Network |
$388.32
|
| Rate for Payer: Quartz Commercial |
$475.49
|
| Rate for Payer: WEA Trust Commercial |
$435.86
|
| Rate for Payer: WPS Commercial |
$586.97
|
|
|
Tubing Rapid Flow
|
Facility
|
IP
|
$7.00
|
|
| Hospital Charge Code |
3040295
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$3.57 |
| Max. Negotiated Rate |
$6.70 |
| Rate for Payer: Aetna Commercial |
$6.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3.86
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: Cigna Commercial |
$6.70
|
| Rate for Payer: Health EOS Commercial |
$6.48
|
| Rate for Payer: HFN Commercial |
$6.70
|
| Rate for Payer: Multiplan Commercial |
$5.82
|
| Rate for Payer: Preferred Network Access Commercial |
$6.70
|
| Rate for Payer: Quartz Beloit One Network |
$3.57
|
| Rate for Payer: Quartz Commercial |
$4.37
|
| Rate for Payer: WEA Trust Commercial |
$4.00
|
| Rate for Payer: WPS Commercial |
$5.39
|
|
|
Tubing Rapid Flow
|
Facility
|
OP
|
$7.00
|
|
| Hospital Charge Code |
3040295
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$2.04 |
| Max. Negotiated Rate |
$6.70 |
| Rate for Payer: Aetna Commercial |
$6.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6.26
|
| Rate for Payer: Aetna Managed Medicare |
$2.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4.73
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3.86
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: Cigna Commercial |
$6.70
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4.07
|
| Rate for Payer: Health EOS Commercial |
$6.48
|
| Rate for Payer: HFN Commercial |
$6.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5.46
|
| Rate for Payer: Multiplan Commercial |
$5.82
|
| Rate for Payer: NAPHCARE Commercial |
$4.37
|
| Rate for Payer: Preferred Network Access Commercial |
$6.70
|
| Rate for Payer: Quartz Beloit One Network |
$3.57
|
| Rate for Payer: Quartz Commercial |
$4.73
|
| Rate for Payer: Quartz Medicare Advantage |
$4.37
|
| Rate for Payer: The Alliance Commercial |
$3.64
|
| Rate for Payer: WEA Trust Commercial |
$4.00
|
| Rate for Payer: WPS Commercial |
$5.39
|
|
|
TUBING RAPID FLOW BLOOD TRAUMA
|
Facility
|
OP
|
$823.00
|
|
| Hospital Charge Code |
2963093
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$239.66 |
| Max. Negotiated Rate |
$787.45 |
| Rate for Payer: Aetna Commercial |
$770.33
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$736.09
|
| Rate for Payer: Aetna Managed Medicare |
$239.66
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$556.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$427.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$410.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$453.64
|
| Rate for Payer: Cash Price |
$246.90
|
| Rate for Payer: Cigna Commercial |
$787.45
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$478.99
|
| Rate for Payer: Health EOS Commercial |
$761.77
|
| Rate for Payer: HFN Commercial |
$787.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$641.94
|
| Rate for Payer: Multiplan Commercial |
$684.74
|
| Rate for Payer: NAPHCARE Commercial |
$513.55
|
| Rate for Payer: Preferred Network Access Commercial |
$787.45
|
| Rate for Payer: Quartz Beloit One Network |
$419.40
|
| Rate for Payer: Quartz Commercial |
$556.35
|
| Rate for Payer: Quartz Medicare Advantage |
$513.55
|
| Rate for Payer: The Alliance Commercial |
$427.96
|
| Rate for Payer: WEA Trust Commercial |
$470.76
|
| Rate for Payer: WPS Commercial |
$633.96
|
|
|
TUBING RAPID FLOW BLOOD TRAUMA
|
Facility
|
IP
|
$823.00
|
|
| Hospital Charge Code |
2963093
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$419.40 |
| Max. Negotiated Rate |
$787.45 |
| Rate for Payer: Aetna Commercial |
$770.33
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$736.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$453.64
|
| Rate for Payer: Cash Price |
$246.90
|
| Rate for Payer: Cigna Commercial |
$787.45
|
| Rate for Payer: Health EOS Commercial |
$761.77
|
| Rate for Payer: HFN Commercial |
$787.45
|
| Rate for Payer: Multiplan Commercial |
$684.74
|
| Rate for Payer: Preferred Network Access Commercial |
$787.45
|
| Rate for Payer: Quartz Beloit One Network |
$419.40
|
| Rate for Payer: Quartz Commercial |
$513.55
|
| Rate for Payer: WEA Trust Commercial |
$470.76
|
| Rate for Payer: WPS Commercial |
$633.96
|
|
|
TUBING REPLACEMENT KIT 94.0010
|
Facility
|
OP
|
$769.00
|
|
| Hospital Charge Code |
2971617
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$223.93 |
| Max. Negotiated Rate |
$735.78 |
| Rate for Payer: Aetna Commercial |
$719.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$687.79
|
| Rate for Payer: Aetna Managed Medicare |
$223.93
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$519.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$399.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$383.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$423.87
|
| Rate for Payer: Cash Price |
$230.70
|
| Rate for Payer: Cigna Commercial |
$735.78
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$447.56
|
| Rate for Payer: Health EOS Commercial |
$711.79
|
| Rate for Payer: HFN Commercial |
$735.78
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$599.82
|
| Rate for Payer: Multiplan Commercial |
$639.81
|
| Rate for Payer: NAPHCARE Commercial |
$479.86
|
| Rate for Payer: Preferred Network Access Commercial |
$735.78
|
| Rate for Payer: Quartz Beloit One Network |
$391.88
|
| Rate for Payer: Quartz Commercial |
$519.84
|
| Rate for Payer: Quartz Medicare Advantage |
$479.86
|
| Rate for Payer: The Alliance Commercial |
$399.88
|
| Rate for Payer: WEA Trust Commercial |
$439.87
|
| Rate for Payer: WPS Commercial |
$592.36
|
|
|
TUBING REPLACEMENT KIT 94.0010
|
Facility
|
IP
|
$769.00
|
|
| Hospital Charge Code |
2971617
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$391.88 |
| Max. Negotiated Rate |
$735.78 |
| Rate for Payer: Aetna Commercial |
$719.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$687.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$423.87
|
| Rate for Payer: Cash Price |
$230.70
|
| Rate for Payer: Cigna Commercial |
$735.78
|
| Rate for Payer: Health EOS Commercial |
$711.79
|
| Rate for Payer: HFN Commercial |
$735.78
|
| Rate for Payer: Multiplan Commercial |
$639.81
|
| Rate for Payer: Preferred Network Access Commercial |
$735.78
|
| Rate for Payer: Quartz Beloit One Network |
$391.88
|
| Rate for Payer: Quartz Commercial |
$479.86
|
| Rate for Payer: WEA Trust Commercial |
$439.87
|
| Rate for Payer: WPS Commercial |
$592.36
|
|
|
TUBING SECONDARY LF 14230-28
|
Facility
|
IP
|
$44.00
|
|
| Hospital Charge Code |
2963563
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$22.42 |
| Max. Negotiated Rate |
$42.10 |
| Rate for Payer: Aetna Commercial |
$41.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$39.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$24.25
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Cigna Commercial |
$42.10
|
| Rate for Payer: Health EOS Commercial |
$40.73
|
| Rate for Payer: HFN Commercial |
$42.10
|
| Rate for Payer: Multiplan Commercial |
$36.61
|
| Rate for Payer: Preferred Network Access Commercial |
$42.10
|
| Rate for Payer: Quartz Beloit One Network |
$22.42
|
| Rate for Payer: Quartz Commercial |
$27.46
|
| Rate for Payer: WEA Trust Commercial |
$25.17
|
| Rate for Payer: WPS Commercial |
$33.89
|
|
|
TUBING SECONDARY LF 14230-28
|
Facility
|
OP
|
$44.00
|
|
| Hospital Charge Code |
2963563
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.81 |
| Max. Negotiated Rate |
$42.10 |
| Rate for Payer: Aetna Commercial |
$41.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$39.35
|
| Rate for Payer: Aetna Managed Medicare |
$12.81
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$29.74
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$22.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$21.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$24.25
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Cigna Commercial |
$42.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$25.61
|
| Rate for Payer: Health EOS Commercial |
$40.73
|
| Rate for Payer: HFN Commercial |
$42.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$34.32
|
| Rate for Payer: Multiplan Commercial |
$36.61
|
| Rate for Payer: NAPHCARE Commercial |
$27.46
|
| Rate for Payer: Preferred Network Access Commercial |
$42.10
|
| Rate for Payer: Quartz Beloit One Network |
$22.42
|
| Rate for Payer: Quartz Commercial |
$29.74
|
| Rate for Payer: Quartz Medicare Advantage |
$27.46
|
| Rate for Payer: The Alliance Commercial |
$22.88
|
| Rate for Payer: WEA Trust Commercial |
$25.17
|
| Rate for Payer: WPS Commercial |
$33.89
|
|
