|
TUBE SET INSUFFLATION STRYKER PNEUMOCLEAR HEATED HUMIDIFIED SMOKE EVACUATION/CO2 CONDITIONING 062005
|
Facility
|
OP
|
$1,364.00
|
|
| Hospital Charge Code |
6181644
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$381.92 |
| Max. Negotiated Rate |
$5,456.00 |
| Rate for Payer: Aetna Commercial |
$1,227.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,173.04
|
| Rate for Payer: Aetna Managed Medicare |
$381.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$886.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$682.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$654.72
|
| 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: Dean Health DHI/DHP/ASO |
$763.29
|
| Rate for Payer: Health EOS Commercial |
$1,213.96
|
| Rate for Payer: HFN Commercial |
$1,254.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,023.00
|
| 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 |
$886.60
|
| Rate for Payer: Quartz Medicare Advantage |
$818.40
|
| Rate for Payer: The Alliance Commercial |
$5,456.00
|
| Rate for Payer: WEA Trust Commercial |
$750.20
|
| Rate for Payer: WPS Commercial |
$1,010.31
|
|
|
TUBE SET INSUFFLATION STRYKER PNEUMOSURE HEATED WITH RTP (NO SMOKE EVAC) 0620040690
|
Facility
|
OP
|
$731.00
|
|
| Hospital Charge Code |
6200958
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$204.68 |
| Max. Negotiated Rate |
$2,924.00 |
| Rate for Payer: Aetna Commercial |
$657.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$628.66
|
| Rate for Payer: Aetna Managed Medicare |
$204.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$475.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$365.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$350.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$387.43
|
| Rate for Payer: Cash Price |
$219.30
|
| Rate for Payer: Cigna Commercial |
$672.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$409.07
|
| Rate for Payer: Health EOS Commercial |
$650.59
|
| Rate for Payer: HFN Commercial |
$672.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$548.25
|
| Rate for Payer: Multiplan Commercial |
$584.80
|
| Rate for Payer: NAPHCARE Commercial |
$438.60
|
| Rate for Payer: Preferred Network Access Commercial |
$672.52
|
| Rate for Payer: Quartz Beloit One Network |
$358.19
|
| Rate for Payer: Quartz Commercial |
$475.15
|
| Rate for Payer: Quartz Medicare Advantage |
$438.60
|
| Rate for Payer: The Alliance Commercial |
$2,924.00
|
| Rate for Payer: WEA Trust Commercial |
$402.05
|
| Rate for Payer: WPS Commercial |
$541.45
|
|
|
TUBE SET INSUFFLATION STRYKER PNEUMOSURE HEATED WITH RTP (NO SMOKE EVAC) 0620040690
|
Facility
|
IP
|
$731.00
|
|
| Hospital Charge Code |
6200958
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$358.19 |
| Max. Negotiated Rate |
$672.52 |
| Rate for Payer: Aetna Commercial |
$657.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$628.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$387.43
|
| Rate for Payer: Cash Price |
$219.30
|
| Rate for Payer: Cigna Commercial |
$672.52
|
| Rate for Payer: Health EOS Commercial |
$650.59
|
| Rate for Payer: HFN Commercial |
$672.52
|
| Rate for Payer: Multiplan Commercial |
$584.80
|
| Rate for Payer: NAPHCARE Commercial |
$438.60
|
| Rate for Payer: Preferred Network Access Commercial |
$672.52
|
| Rate for Payer: Quartz Beloit One Network |
$358.19
|
| Rate for Payer: Quartz Commercial |
$438.60
|
| Rate for Payer: WEA Trust Commercial |
$402.05
|
| Rate for Payer: WPS Commercial |
$541.45
|
|
|
TUBE SUCTION CONNECTING 18
|
Facility
|
IP
|
$12.00
|
|
| Hospital Charge Code |
2969066
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.88 |
| Max. Negotiated Rate |
$11.04 |
| Rate for Payer: Aetna Commercial |
$10.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6.36
|
| Rate for Payer: Cash Price |
$3.60
|
| Rate for Payer: Cigna Commercial |
$11.04
|
| Rate for Payer: Health EOS Commercial |
$10.68
|
| Rate for Payer: HFN Commercial |
$11.04
|
| Rate for Payer: Multiplan Commercial |
$9.60
|
| Rate for Payer: NAPHCARE Commercial |
$7.20
|
| Rate for Payer: Preferred Network Access Commercial |
$11.04
|
| Rate for Payer: Quartz Beloit One Network |
$5.88
|
| Rate for Payer: Quartz Commercial |
$7.20
|
| Rate for Payer: WEA Trust Commercial |
$6.60
|
| Rate for Payer: WPS Commercial |
$8.89
|
|
|
TUBE SUCTION CONNECTING 18
|
Facility
|
OP
|
$12.00
|
|
| Hospital Charge Code |
2969066
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.36 |
| Max. Negotiated Rate |
$48.00 |
| Rate for Payer: Aetna Commercial |
$10.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10.32
|
| Rate for Payer: Aetna Managed Medicare |
$3.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6.36
|
| Rate for Payer: Cash Price |
$3.60
|
| Rate for Payer: Cigna Commercial |
$11.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6.72
|
| Rate for Payer: Health EOS Commercial |
$10.68
|
| Rate for Payer: HFN Commercial |
$11.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9.00
|
| Rate for Payer: Multiplan Commercial |
$9.60
|
| Rate for Payer: NAPHCARE Commercial |
$7.20
|
| Rate for Payer: Preferred Network Access Commercial |
$11.04
|
| Rate for Payer: Quartz Beloit One Network |
$5.88
|
| Rate for Payer: Quartz Commercial |
$7.80
|
| Rate for Payer: Quartz Medicare Advantage |
$7.20
|
| Rate for Payer: The Alliance Commercial |
$48.00
|
| Rate for Payer: WEA Trust Commercial |
$6.60
|
| Rate for Payer: WPS Commercial |
$8.89
|
|
|
Tube Suction Yankauer
|
Facility
|
OP
|
$75.00
|
|
| Hospital Charge Code |
3101759
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$21.00 |
| Max. Negotiated Rate |
$300.00 |
| Rate for Payer: Aetna Commercial |
$67.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$64.50
|
| Rate for Payer: Aetna Managed Medicare |
$21.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$48.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$37.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$36.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$39.75
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cigna Commercial |
$69.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$41.97
|
| Rate for Payer: Health EOS Commercial |
$66.75
|
| Rate for Payer: HFN Commercial |
$69.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$56.25
|
| Rate for Payer: Multiplan Commercial |
$60.00
|
| Rate for Payer: NAPHCARE Commercial |
$45.00
|
| Rate for Payer: Preferred Network Access Commercial |
$69.00
|
| Rate for Payer: Quartz Beloit One Network |
$36.75
|
| Rate for Payer: Quartz Commercial |
$48.75
|
| Rate for Payer: Quartz Medicare Advantage |
$45.00
|
| Rate for Payer: The Alliance Commercial |
$300.00
|
| Rate for Payer: WEA Trust Commercial |
$41.25
|
| Rate for Payer: WPS Commercial |
$55.55
|
|
|
Tube Suction Yankauer
|
Facility
|
IP
|
$75.00
|
|
| Hospital Charge Code |
3101759
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$36.75 |
| Max. Negotiated Rate |
$69.00 |
| Rate for Payer: Aetna Commercial |
$67.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$64.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$39.75
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cigna Commercial |
$69.00
|
| Rate for Payer: Health EOS Commercial |
$66.75
|
| Rate for Payer: HFN Commercial |
$69.00
|
| Rate for Payer: Multiplan Commercial |
$60.00
|
| Rate for Payer: NAPHCARE Commercial |
$45.00
|
| Rate for Payer: Preferred Network Access Commercial |
$69.00
|
| Rate for Payer: Quartz Beloit One Network |
$36.75
|
| Rate for Payer: Quartz Commercial |
$45.00
|
| Rate for Payer: WEA Trust Commercial |
$41.25
|
| Rate for Payer: WPS Commercial |
$55.55
|
|
|
Tube-Sump 10F
|
Facility
|
OP
|
$173.00
|
|
| Hospital Charge Code |
3101760
|
|
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-Sump 10F
|
Facility
|
IP
|
$173.00
|
|
| Hospital Charge Code |
3101760
|
|
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-Sump 14Fr
|
Facility
|
OP
|
$173.00
|
|
| Hospital Charge Code |
3101761
|
|
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-Sump 14Fr
|
Facility
|
IP
|
$173.00
|
|
| Hospital Charge Code |
3101761
|
|
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-Sump 18Fr
|
Facility
|
OP
|
$173.00
|
|
| Hospital Charge Code |
3101763
|
|
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-Sump 18Fr
|
Facility
|
IP
|
$173.00
|
|
| Hospital Charge Code |
3101763
|
|
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 SURGICAL IRRIGATION PD-IT
|
Facility
|
OP
|
$945.00
|
|
| Hospital Charge Code |
6172008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$264.60 |
| Max. Negotiated Rate |
$3,780.00 |
| Rate for Payer: Aetna Commercial |
$850.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$812.70
|
| Rate for Payer: Aetna Managed Medicare |
$264.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$614.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$472.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$453.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$500.85
|
| Rate for Payer: Cash Price |
$283.50
|
| Rate for Payer: Cigna Commercial |
$869.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$528.82
|
| Rate for Payer: Health EOS Commercial |
$841.05
|
| Rate for Payer: HFN Commercial |
$869.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$708.75
|
| Rate for Payer: Multiplan Commercial |
$756.00
|
| Rate for Payer: NAPHCARE Commercial |
$567.00
|
| Rate for Payer: Preferred Network Access Commercial |
$869.40
|
| Rate for Payer: Quartz Beloit One Network |
$463.05
|
| Rate for Payer: Quartz Commercial |
$614.25
|
| Rate for Payer: Quartz Medicare Advantage |
$567.00
|
| Rate for Payer: The Alliance Commercial |
$3,780.00
|
| Rate for Payer: WEA Trust Commercial |
$519.75
|
| Rate for Payer: WPS Commercial |
$699.96
|
|
|
TUBE SURGICAL IRRIGATION PD-IT
|
Facility
|
IP
|
$945.00
|
|
| Hospital Charge Code |
6172008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$463.05 |
| Max. Negotiated Rate |
$869.40 |
| Rate for Payer: Aetna Commercial |
$850.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$812.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$500.85
|
| Rate for Payer: Cash Price |
$283.50
|
| Rate for Payer: Cigna Commercial |
$869.40
|
| Rate for Payer: Health EOS Commercial |
$841.05
|
| Rate for Payer: HFN Commercial |
$869.40
|
| Rate for Payer: Multiplan Commercial |
$756.00
|
| Rate for Payer: NAPHCARE Commercial |
$567.00
|
| Rate for Payer: Preferred Network Access Commercial |
$869.40
|
| Rate for Payer: Quartz Beloit One Network |
$463.05
|
| Rate for Payer: Quartz Commercial |
$567.00
|
| Rate for Payer: WEA Trust Commercial |
$519.75
|
| Rate for Payer: WPS Commercial |
$699.96
|
|
|
TUBE TEFLON T2 HUMERUS SYSTEM STERILE 1806-0073S
|
Facility
|
IP
|
$1,809.00
|
|
| Hospital Charge Code |
5611631
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$886.41 |
| Max. Negotiated Rate |
$1,664.28 |
| Rate for Payer: Aetna Commercial |
$1,628.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,555.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$958.77
|
| Rate for Payer: Cash Price |
$542.70
|
| Rate for Payer: Cigna Commercial |
$1,664.28
|
| Rate for Payer: Health EOS Commercial |
$1,610.01
|
| Rate for Payer: HFN Commercial |
$1,664.28
|
| Rate for Payer: Multiplan Commercial |
$1,447.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,085.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,664.28
|
| Rate for Payer: Quartz Beloit One Network |
$886.41
|
| Rate for Payer: Quartz Commercial |
$1,085.40
|
| Rate for Payer: WEA Trust Commercial |
$994.95
|
| Rate for Payer: WPS Commercial |
$1,339.93
|
|
|
TUBE TEFLON T2 HUMERUS SYSTEM STERILE 1806-0073S
|
Facility
|
OP
|
$1,809.00
|
|
| Hospital Charge Code |
5611631
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$506.52 |
| Max. Negotiated Rate |
$7,236.00 |
| Rate for Payer: Aetna Commercial |
$1,628.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,555.74
|
| Rate for Payer: Aetna Managed Medicare |
$506.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,175.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$904.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$868.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$958.77
|
| Rate for Payer: Cash Price |
$542.70
|
| Rate for Payer: Cigna Commercial |
$1,664.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,012.32
|
| Rate for Payer: Health EOS Commercial |
$1,610.01
|
| Rate for Payer: HFN Commercial |
$1,664.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,356.75
|
| Rate for Payer: Multiplan Commercial |
$1,447.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,085.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,664.28
|
| Rate for Payer: Quartz Beloit One Network |
$886.41
|
| Rate for Payer: Quartz Commercial |
$1,175.85
|
| Rate for Payer: Quartz Medicare Advantage |
$1,085.40
|
| Rate for Payer: The Alliance Commercial |
$7,236.00
|
| Rate for Payer: WEA Trust Commercial |
$994.95
|
| Rate for Payer: WPS Commercial |
$1,339.93
|
|
|
TUBE TRACH 6.0 BIVONA W/AIRE-
|
Facility
|
IP
|
$2,572.00
|
|
| Hospital Charge Code |
2966062
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,260.28 |
| Max. Negotiated Rate |
$2,366.24 |
| Rate for Payer: Aetna Commercial |
$2,314.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,211.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,363.16
|
| Rate for Payer: Cash Price |
$771.60
|
| Rate for Payer: Cigna Commercial |
$2,366.24
|
| Rate for Payer: Health EOS Commercial |
$2,289.08
|
| Rate for Payer: HFN Commercial |
$2,366.24
|
| Rate for Payer: Multiplan Commercial |
$2,057.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,543.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,366.24
|
| Rate for Payer: Quartz Beloit One Network |
$1,260.28
|
| Rate for Payer: Quartz Commercial |
$1,543.20
|
| Rate for Payer: WEA Trust Commercial |
$1,414.60
|
| Rate for Payer: WPS Commercial |
$1,905.08
|
|
|
TUBE TRACH 6.0 BIVONA W/AIRE-
|
Facility
|
OP
|
$2,572.00
|
|
| Hospital Charge Code |
2966062
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$720.16 |
| Max. Negotiated Rate |
$10,288.00 |
| Rate for Payer: Aetna Commercial |
$2,314.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,211.92
|
| Rate for Payer: Aetna Managed Medicare |
$720.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,671.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,286.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,234.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,363.16
|
| Rate for Payer: Cash Price |
$771.60
|
| Rate for Payer: Cigna Commercial |
$2,366.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,439.29
|
| Rate for Payer: Health EOS Commercial |
$2,289.08
|
| Rate for Payer: HFN Commercial |
$2,366.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,929.00
|
| Rate for Payer: Multiplan Commercial |
$2,057.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,543.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,366.24
|
| Rate for Payer: Quartz Beloit One Network |
$1,260.28
|
| Rate for Payer: Quartz Commercial |
$1,671.80
|
| Rate for Payer: Quartz Medicare Advantage |
$1,543.20
|
| Rate for Payer: The Alliance Commercial |
$10,288.00
|
| Rate for Payer: WEA Trust Commercial |
$1,414.60
|
| Rate for Payer: WPS Commercial |
$1,905.08
|
|
|
TUBE TRACH 6.0MM #100/875/060
|
Facility
|
IP
|
$1,464.00
|
|
| Hospital Charge Code |
2972293
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$717.36 |
| Max. Negotiated Rate |
$1,346.88 |
| Rate for Payer: Aetna Commercial |
$1,317.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,259.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$775.92
|
| Rate for Payer: Cash Price |
$439.20
|
| Rate for Payer: Cigna Commercial |
$1,346.88
|
| Rate for Payer: Health EOS Commercial |
$1,302.96
|
| Rate for Payer: HFN Commercial |
$1,346.88
|
| Rate for Payer: Multiplan Commercial |
$1,171.20
|
| Rate for Payer: NAPHCARE Commercial |
$878.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,346.88
|
| Rate for Payer: Quartz Beloit One Network |
$717.36
|
| Rate for Payer: Quartz Commercial |
$878.40
|
| Rate for Payer: WEA Trust Commercial |
$805.20
|
| Rate for Payer: WPS Commercial |
$1,084.38
|
|
|
TUBE TRACH 6.0MM #100/875/060
|
Facility
|
OP
|
$1,464.00
|
|
| Hospital Charge Code |
2972293
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$409.92 |
| Max. Negotiated Rate |
$5,856.00 |
| Rate for Payer: Aetna Commercial |
$1,317.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,259.04
|
| Rate for Payer: Aetna Managed Medicare |
$409.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$951.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$732.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$702.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$775.92
|
| Rate for Payer: Cash Price |
$439.20
|
| Rate for Payer: Cigna Commercial |
$1,346.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$819.25
|
| Rate for Payer: Health EOS Commercial |
$1,302.96
|
| Rate for Payer: HFN Commercial |
$1,346.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,098.00
|
| Rate for Payer: Multiplan Commercial |
$1,171.20
|
| Rate for Payer: NAPHCARE Commercial |
$878.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,346.88
|
| Rate for Payer: Quartz Beloit One Network |
$717.36
|
| Rate for Payer: Quartz Commercial |
$951.60
|
| Rate for Payer: Quartz Medicare Advantage |
$878.40
|
| Rate for Payer: The Alliance Commercial |
$5,856.00
|
| Rate for Payer: WEA Trust Commercial |
$805.20
|
| Rate for Payer: WPS Commercial |
$1,084.38
|
|
|
TUBE TRACH 6 CFD FEN 6DFEN
|
Facility
|
IP
|
$1,669.00
|
|
| Hospital Charge Code |
5415163
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$817.81 |
| Max. Negotiated Rate |
$1,535.48 |
| Rate for Payer: Aetna Commercial |
$1,502.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,435.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$884.57
|
| Rate for Payer: Cash Price |
$500.70
|
| Rate for Payer: Cigna Commercial |
$1,535.48
|
| Rate for Payer: Health EOS Commercial |
$1,485.41
|
| Rate for Payer: HFN Commercial |
$1,535.48
|
| Rate for Payer: Multiplan Commercial |
$1,335.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,001.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,535.48
|
| Rate for Payer: Quartz Beloit One Network |
$817.81
|
| Rate for Payer: Quartz Commercial |
$1,001.40
|
| Rate for Payer: WEA Trust Commercial |
$917.95
|
| Rate for Payer: WPS Commercial |
$1,236.23
|
|
|
TUBE TRACH 6 CFD FEN 6DFEN
|
Facility
|
OP
|
$1,669.00
|
|
| Hospital Charge Code |
5415163
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$467.32 |
| Max. Negotiated Rate |
$6,676.00 |
| Rate for Payer: Aetna Commercial |
$1,502.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,435.34
|
| Rate for Payer: Aetna Managed Medicare |
$467.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,084.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$834.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$801.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$884.57
|
| Rate for Payer: Cash Price |
$500.70
|
| Rate for Payer: Cigna Commercial |
$1,535.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$933.97
|
| Rate for Payer: Health EOS Commercial |
$1,485.41
|
| Rate for Payer: HFN Commercial |
$1,535.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,251.75
|
| Rate for Payer: Multiplan Commercial |
$1,335.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,001.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,535.48
|
| Rate for Payer: Quartz Beloit One Network |
$817.81
|
| Rate for Payer: Quartz Commercial |
$1,084.85
|
| Rate for Payer: Quartz Medicare Advantage |
$1,001.40
|
| Rate for Payer: The Alliance Commercial |
$6,676.00
|
| Rate for Payer: WEA Trust Commercial |
$917.95
|
| Rate for Payer: WPS Commercial |
$1,236.23
|
|
|
TUBE TRACH 6 CFD NON-FEN 6DCT***DEDE 10/23
|
Facility
|
OP
|
$991.00
|
|
| Hospital Charge Code |
2965801
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$277.48 |
| Max. Negotiated Rate |
$3,964.00 |
| Rate for Payer: Aetna Commercial |
$891.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$852.26
|
| Rate for Payer: Aetna Managed Medicare |
$277.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$644.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$495.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$475.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$525.23
|
| Rate for Payer: Cash Price |
$297.30
|
| Rate for Payer: Cigna Commercial |
$911.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$554.56
|
| Rate for Payer: Health EOS Commercial |
$881.99
|
| Rate for Payer: HFN Commercial |
$911.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$743.25
|
| Rate for Payer: Multiplan Commercial |
$792.80
|
| Rate for Payer: NAPHCARE Commercial |
$594.60
|
| Rate for Payer: Preferred Network Access Commercial |
$911.72
|
| Rate for Payer: Quartz Beloit One Network |
$485.59
|
| Rate for Payer: Quartz Commercial |
$644.15
|
| Rate for Payer: Quartz Medicare Advantage |
$594.60
|
| Rate for Payer: The Alliance Commercial |
$3,964.00
|
| Rate for Payer: WEA Trust Commercial |
$545.05
|
| Rate for Payer: WPS Commercial |
$734.03
|
|
|
TUBE TRACH 6 CFD NON-FEN 6DCT***DEDE 10/23
|
Facility
|
IP
|
$991.00
|
|
| Hospital Charge Code |
2965801
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$485.59 |
| Max. Negotiated Rate |
$911.72 |
| Rate for Payer: Aetna Commercial |
$891.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$852.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$525.23
|
| Rate for Payer: Cash Price |
$297.30
|
| Rate for Payer: Cigna Commercial |
$911.72
|
| Rate for Payer: Health EOS Commercial |
$881.99
|
| Rate for Payer: HFN Commercial |
$911.72
|
| Rate for Payer: Multiplan Commercial |
$792.80
|
| Rate for Payer: NAPHCARE Commercial |
$594.60
|
| Rate for Payer: Preferred Network Access Commercial |
$911.72
|
| Rate for Payer: Quartz Beloit One Network |
$485.59
|
| Rate for Payer: Quartz Commercial |
$594.60
|
| Rate for Payer: WEA Trust Commercial |
$545.05
|
| Rate for Payer: WPS Commercial |
$734.03
|
|
