|
TUBE TRACH SHILEY 4 CFD NON-FEN 4CN65H
|
Facility
|
OP
|
$788.00
|
|
| Hospital Charge Code |
5641668
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$220.64 |
| Max. Negotiated Rate |
$3,152.00 |
| Rate for Payer: Aetna Commercial |
$709.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$677.68
|
| Rate for Payer: Aetna Managed Medicare |
$220.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$512.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$394.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$378.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$417.64
|
| Rate for Payer: Cash Price |
$236.40
|
| Rate for Payer: Cigna Commercial |
$724.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$440.96
|
| Rate for Payer: Health EOS Commercial |
$701.32
|
| Rate for Payer: HFN Commercial |
$724.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$591.00
|
| Rate for Payer: Multiplan Commercial |
$630.40
|
| Rate for Payer: NAPHCARE Commercial |
$472.80
|
| Rate for Payer: Preferred Network Access Commercial |
$724.96
|
| Rate for Payer: Quartz Beloit One Network |
$386.12
|
| Rate for Payer: Quartz Commercial |
$512.20
|
| Rate for Payer: Quartz Medicare Advantage |
$472.80
|
| Rate for Payer: The Alliance Commercial |
$3,152.00
|
| Rate for Payer: WEA Trust Commercial |
$433.40
|
| Rate for Payer: WPS Commercial |
$583.67
|
|
|
Tube Y-Type Wfilter
|
Facility
|
OP
|
$138.00
|
|
| Hospital Charge Code |
3101773
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$38.64 |
| Max. Negotiated Rate |
$552.00 |
| Rate for Payer: Aetna Commercial |
$124.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$118.68
|
| Rate for Payer: Aetna Managed Medicare |
$38.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$89.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$69.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$66.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$73.14
|
| Rate for Payer: Cash Price |
$41.40
|
| Rate for Payer: Cigna Commercial |
$126.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$77.22
|
| Rate for Payer: Health EOS Commercial |
$122.82
|
| Rate for Payer: HFN Commercial |
$126.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$103.50
|
| Rate for Payer: Multiplan Commercial |
$110.40
|
| Rate for Payer: NAPHCARE Commercial |
$82.80
|
| Rate for Payer: Preferred Network Access Commercial |
$126.96
|
| Rate for Payer: Quartz Beloit One Network |
$67.62
|
| Rate for Payer: Quartz Commercial |
$89.70
|
| Rate for Payer: Quartz Medicare Advantage |
$82.80
|
| Rate for Payer: The Alliance Commercial |
$552.00
|
| Rate for Payer: WEA Trust Commercial |
$75.90
|
| Rate for Payer: WPS Commercial |
$102.22
|
|
|
Tube Y-Type Wfilter
|
Facility
|
IP
|
$138.00
|
|
| Hospital Charge Code |
3101773
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$67.62 |
| Max. Negotiated Rate |
$126.96 |
| Rate for Payer: Aetna Commercial |
$124.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$118.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$73.14
|
| Rate for Payer: Cash Price |
$41.40
|
| Rate for Payer: Cigna Commercial |
$126.96
|
| Rate for Payer: Health EOS Commercial |
$122.82
|
| Rate for Payer: HFN Commercial |
$126.96
|
| Rate for Payer: Multiplan Commercial |
$110.40
|
| Rate for Payer: NAPHCARE Commercial |
$82.80
|
| Rate for Payer: Preferred Network Access Commercial |
$126.96
|
| Rate for Payer: Quartz Beloit One Network |
$67.62
|
| Rate for Payer: Quartz Commercial |
$82.80
|
| Rate for Payer: WEA Trust Commercial |
$75.90
|
| Rate for Payer: WPS Commercial |
$102.22
|
|
|
TUBIGRIP SIZE B (BEIGE) 1449
|
Facility
|
OP
|
$569.00
|
|
| Hospital Charge Code |
2974507
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$159.32 |
| Max. Negotiated Rate |
$2,276.00 |
| Rate for Payer: Aetna Commercial |
$512.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$489.34
|
| Rate for Payer: Aetna Managed Medicare |
$159.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$369.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$284.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$273.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$301.57
|
| Rate for Payer: Cash Price |
$170.70
|
| Rate for Payer: Cigna Commercial |
$523.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$318.41
|
| Rate for Payer: Health EOS Commercial |
$506.41
|
| Rate for Payer: HFN Commercial |
$523.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$426.75
|
| Rate for Payer: Multiplan Commercial |
$455.20
|
| Rate for Payer: NAPHCARE Commercial |
$341.40
|
| Rate for Payer: Preferred Network Access Commercial |
$523.48
|
| Rate for Payer: Quartz Beloit One Network |
$278.81
|
| Rate for Payer: Quartz Commercial |
$369.85
|
| Rate for Payer: Quartz Medicare Advantage |
$341.40
|
| Rate for Payer: The Alliance Commercial |
$2,276.00
|
| Rate for Payer: WEA Trust Commercial |
$312.95
|
| Rate for Payer: WPS Commercial |
$421.46
|
|
|
TUBIGRIP SIZE B (BEIGE) 1449
|
Facility
|
IP
|
$569.00
|
|
| Hospital Charge Code |
2974507
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$278.81 |
| Max. Negotiated Rate |
$523.48 |
| Rate for Payer: Aetna Commercial |
$512.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$489.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$301.57
|
| Rate for Payer: Cash Price |
$170.70
|
| Rate for Payer: Cigna Commercial |
$523.48
|
| Rate for Payer: Health EOS Commercial |
$506.41
|
| Rate for Payer: HFN Commercial |
$523.48
|
| Rate for Payer: Multiplan Commercial |
$455.20
|
| Rate for Payer: NAPHCARE Commercial |
$341.40
|
| Rate for Payer: Preferred Network Access Commercial |
$523.48
|
| Rate for Payer: Quartz Beloit One Network |
$278.81
|
| Rate for Payer: Quartz Commercial |
$341.40
|
| Rate for Payer: WEA Trust Commercial |
$312.95
|
| Rate for Payer: WPS Commercial |
$421.46
|
|
|
TUBIGRIP SIZE C #1450
|
Facility
|
IP
|
$652.00
|
|
| Hospital Charge Code |
2969639
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$319.48 |
| Max. Negotiated Rate |
$599.84 |
| Rate for Payer: Aetna Commercial |
$586.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$560.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$345.56
|
| Rate for Payer: Cash Price |
$195.60
|
| Rate for Payer: Cigna Commercial |
$599.84
|
| Rate for Payer: Health EOS Commercial |
$580.28
|
| Rate for Payer: HFN Commercial |
$599.84
|
| Rate for Payer: Multiplan Commercial |
$521.60
|
| Rate for Payer: NAPHCARE Commercial |
$391.20
|
| Rate for Payer: Preferred Network Access Commercial |
$599.84
|
| Rate for Payer: Quartz Beloit One Network |
$319.48
|
| Rate for Payer: Quartz Commercial |
$391.20
|
| Rate for Payer: WEA Trust Commercial |
$358.60
|
| Rate for Payer: WPS Commercial |
$482.94
|
|
|
TUBIGRIP SIZE C #1450
|
Facility
|
OP
|
$652.00
|
|
| Hospital Charge Code |
2969639
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$182.56 |
| Max. Negotiated Rate |
$2,608.00 |
| Rate for Payer: Aetna Commercial |
$586.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$560.72
|
| Rate for Payer: Aetna Managed Medicare |
$182.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$423.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$326.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$312.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$345.56
|
| Rate for Payer: Cash Price |
$195.60
|
| Rate for Payer: Cigna Commercial |
$599.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$364.86
|
| Rate for Payer: Health EOS Commercial |
$580.28
|
| Rate for Payer: HFN Commercial |
$599.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$489.00
|
| Rate for Payer: Multiplan Commercial |
$521.60
|
| Rate for Payer: NAPHCARE Commercial |
$391.20
|
| Rate for Payer: Preferred Network Access Commercial |
$599.84
|
| Rate for Payer: Quartz Beloit One Network |
$319.48
|
| Rate for Payer: Quartz Commercial |
$423.80
|
| Rate for Payer: Quartz Medicare Advantage |
$391.20
|
| Rate for Payer: The Alliance Commercial |
$2,608.00
|
| Rate for Payer: WEA Trust Commercial |
$358.60
|
| Rate for Payer: WPS Commercial |
$482.94
|
|
|
TUBIGRIP SIZE D #1451
|
Facility
|
IP
|
$749.00
|
|
| Hospital Charge Code |
2969634
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$367.01 |
| Max. Negotiated Rate |
$689.08 |
| Rate for Payer: Aetna Commercial |
$674.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$644.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$396.97
|
| Rate for Payer: Cash Price |
$224.70
|
| Rate for Payer: Cigna Commercial |
$689.08
|
| Rate for Payer: Health EOS Commercial |
$666.61
|
| Rate for Payer: HFN Commercial |
$689.08
|
| Rate for Payer: Multiplan Commercial |
$599.20
|
| Rate for Payer: NAPHCARE Commercial |
$449.40
|
| Rate for Payer: Preferred Network Access Commercial |
$689.08
|
| Rate for Payer: Quartz Beloit One Network |
$367.01
|
| Rate for Payer: Quartz Commercial |
$449.40
|
| Rate for Payer: WEA Trust Commercial |
$411.95
|
| Rate for Payer: WPS Commercial |
$554.78
|
|
|
TUBIGRIP SIZE D #1451
|
Facility
|
OP
|
$749.00
|
|
| Hospital Charge Code |
2969634
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$209.72 |
| Max. Negotiated Rate |
$2,996.00 |
| Rate for Payer: Aetna Commercial |
$674.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$644.14
|
| Rate for Payer: Aetna Managed Medicare |
$209.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$486.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$374.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$359.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$396.97
|
| Rate for Payer: Cash Price |
$224.70
|
| Rate for Payer: Cigna Commercial |
$689.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$419.14
|
| Rate for Payer: Health EOS Commercial |
$666.61
|
| Rate for Payer: HFN Commercial |
$689.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$561.75
|
| Rate for Payer: Multiplan Commercial |
$599.20
|
| Rate for Payer: NAPHCARE Commercial |
$449.40
|
| Rate for Payer: Preferred Network Access Commercial |
$689.08
|
| Rate for Payer: Quartz Beloit One Network |
$367.01
|
| Rate for Payer: Quartz Commercial |
$486.85
|
| Rate for Payer: Quartz Medicare Advantage |
$449.40
|
| Rate for Payer: The Alliance Commercial |
$2,996.00
|
| Rate for Payer: WEA Trust Commercial |
$411.95
|
| Rate for Payer: WPS Commercial |
$554.78
|
|
|
TUBIGRIP SIZE E (BEIGE) #1448
|
Facility
|
OP
|
$839.00
|
|
| Hospital Charge Code |
2965777
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$234.92 |
| Max. Negotiated Rate |
$3,356.00 |
| Rate for Payer: Aetna Commercial |
$755.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$721.54
|
| Rate for Payer: Aetna Managed Medicare |
$234.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$545.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$419.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$402.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$444.67
|
| Rate for Payer: Cash Price |
$251.70
|
| Rate for Payer: Cigna Commercial |
$771.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$469.50
|
| Rate for Payer: Health EOS Commercial |
$746.71
|
| Rate for Payer: HFN Commercial |
$771.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$629.25
|
| Rate for Payer: Multiplan Commercial |
$671.20
|
| Rate for Payer: NAPHCARE Commercial |
$503.40
|
| Rate for Payer: Preferred Network Access Commercial |
$771.88
|
| Rate for Payer: Quartz Beloit One Network |
$411.11
|
| Rate for Payer: Quartz Commercial |
$545.35
|
| Rate for Payer: Quartz Medicare Advantage |
$503.40
|
| Rate for Payer: The Alliance Commercial |
$3,356.00
|
| Rate for Payer: WEA Trust Commercial |
$461.45
|
| Rate for Payer: WPS Commercial |
$621.45
|
|
|
TUBIGRIP SIZE E (BEIGE) #1448
|
Facility
|
IP
|
$839.00
|
|
| Hospital Charge Code |
2965777
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$411.11 |
| Max. Negotiated Rate |
$771.88 |
| Rate for Payer: Aetna Commercial |
$755.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$721.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$444.67
|
| Rate for Payer: Cash Price |
$251.70
|
| Rate for Payer: Cigna Commercial |
$771.88
|
| Rate for Payer: Health EOS Commercial |
$746.71
|
| Rate for Payer: HFN Commercial |
$771.88
|
| Rate for Payer: Multiplan Commercial |
$671.20
|
| Rate for Payer: NAPHCARE Commercial |
$503.40
|
| Rate for Payer: Preferred Network Access Commercial |
$771.88
|
| Rate for Payer: Quartz Beloit One Network |
$411.11
|
| Rate for Payer: Quartz Commercial |
$503.40
|
| Rate for Payer: WEA Trust Commercial |
$461.45
|
| Rate for Payer: WPS Commercial |
$621.45
|
|
|
TUBIGRIP SIZE J #1440
|
Facility
|
OP
|
$542.00
|
|
| Hospital Charge Code |
2969699
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$151.76 |
| Max. Negotiated Rate |
$2,168.00 |
| Rate for Payer: Aetna Commercial |
$487.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$466.12
|
| Rate for Payer: Aetna Managed Medicare |
$151.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$352.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$271.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$260.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$287.26
|
| Rate for Payer: Cash Price |
$162.60
|
| Rate for Payer: Cigna Commercial |
$498.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$303.30
|
| Rate for Payer: Health EOS Commercial |
$482.38
|
| Rate for Payer: HFN Commercial |
$498.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$406.50
|
| Rate for Payer: Multiplan Commercial |
$433.60
|
| Rate for Payer: NAPHCARE Commercial |
$325.20
|
| Rate for Payer: Preferred Network Access Commercial |
$498.64
|
| Rate for Payer: Quartz Beloit One Network |
$265.58
|
| Rate for Payer: Quartz Commercial |
$352.30
|
| Rate for Payer: Quartz Medicare Advantage |
$325.20
|
| Rate for Payer: The Alliance Commercial |
$2,168.00
|
| Rate for Payer: WEA Trust Commercial |
$298.10
|
| Rate for Payer: WPS Commercial |
$401.46
|
|
|
TUBIGRIP SIZE J #1440
|
Facility
|
IP
|
$542.00
|
|
| Hospital Charge Code |
2969699
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$265.58 |
| Max. Negotiated Rate |
$498.64 |
| Rate for Payer: Aetna Commercial |
$487.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$466.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$287.26
|
| Rate for Payer: Cash Price |
$162.60
|
| Rate for Payer: Cigna Commercial |
$498.64
|
| Rate for Payer: Health EOS Commercial |
$482.38
|
| Rate for Payer: HFN Commercial |
$498.64
|
| Rate for Payer: Multiplan Commercial |
$433.60
|
| Rate for Payer: NAPHCARE Commercial |
$325.20
|
| Rate for Payer: Preferred Network Access Commercial |
$498.64
|
| Rate for Payer: Quartz Beloit One Network |
$265.58
|
| Rate for Payer: Quartz Commercial |
$325.20
|
| Rate for Payer: WEA Trust Commercial |
$298.10
|
| Rate for Payer: WPS Commercial |
$401.46
|
|
|
TUBIGRIP SIZE K #1441
|
Facility
|
OP
|
$1,564.00
|
|
| Hospital Charge Code |
2974065
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$437.92 |
| Max. Negotiated Rate |
$6,256.00 |
| Rate for Payer: Aetna Commercial |
$1,407.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,345.04
|
| Rate for Payer: Aetna Managed Medicare |
$437.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,016.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$782.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$750.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$828.92
|
| Rate for Payer: Cash Price |
$469.20
|
| Rate for Payer: Cigna Commercial |
$1,438.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$875.21
|
| Rate for Payer: Health EOS Commercial |
$1,391.96
|
| Rate for Payer: HFN Commercial |
$1,438.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,173.00
|
| Rate for Payer: Multiplan Commercial |
$1,251.20
|
| Rate for Payer: NAPHCARE Commercial |
$938.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,438.88
|
| Rate for Payer: Quartz Beloit One Network |
$766.36
|
| Rate for Payer: Quartz Commercial |
$1,016.60
|
| Rate for Payer: Quartz Medicare Advantage |
$938.40
|
| Rate for Payer: The Alliance Commercial |
$6,256.00
|
| Rate for Payer: WEA Trust Commercial |
$860.20
|
| Rate for Payer: WPS Commercial |
$1,158.45
|
|
|
TUBIGRIP SIZE K #1441
|
Facility
|
IP
|
$1,564.00
|
|
| Hospital Charge Code |
2974065
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$766.36 |
| Max. Negotiated Rate |
$1,438.88 |
| Rate for Payer: Aetna Commercial |
$1,407.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,345.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$828.92
|
| Rate for Payer: Cash Price |
$469.20
|
| Rate for Payer: Cigna Commercial |
$1,438.88
|
| Rate for Payer: Health EOS Commercial |
$1,391.96
|
| Rate for Payer: HFN Commercial |
$1,438.88
|
| Rate for Payer: Multiplan Commercial |
$1,251.20
|
| Rate for Payer: NAPHCARE Commercial |
$938.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,438.88
|
| Rate for Payer: Quartz Beloit One Network |
$766.36
|
| Rate for Payer: Quartz Commercial |
$938.40
|
| Rate for Payer: WEA Trust Commercial |
$860.20
|
| Rate for Payer: WPS Commercial |
$1,158.45
|
|
|
TUBING 10K ARTHRO 10K100
|
Facility
|
IP
|
$141.00
|
|
| Hospital Charge Code |
2962926
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$69.09 |
| Max. Negotiated Rate |
$129.72 |
| Rate for Payer: Aetna Commercial |
$126.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$121.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$74.73
|
| Rate for Payer: Cash Price |
$42.30
|
| Rate for Payer: Cigna Commercial |
$129.72
|
| Rate for Payer: Health EOS Commercial |
$125.49
|
| Rate for Payer: HFN Commercial |
$129.72
|
| Rate for Payer: Multiplan Commercial |
$112.80
|
| Rate for Payer: NAPHCARE Commercial |
$84.60
|
| Rate for Payer: Preferred Network Access Commercial |
$129.72
|
| Rate for Payer: Quartz Beloit One Network |
$69.09
|
| Rate for Payer: Quartz Commercial |
$84.60
|
| Rate for Payer: WEA Trust Commercial |
$77.55
|
| Rate for Payer: WPS Commercial |
$104.44
|
|
|
TUBING 10K ARTHRO 10K100
|
Facility
|
OP
|
$141.00
|
|
| Hospital Charge Code |
2962926
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$39.48 |
| Max. Negotiated Rate |
$564.00 |
| Rate for Payer: Aetna Commercial |
$126.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$121.26
|
| Rate for Payer: Aetna Managed Medicare |
$39.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$91.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$70.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$67.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$74.73
|
| Rate for Payer: Cash Price |
$42.30
|
| Rate for Payer: Cigna Commercial |
$129.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$78.90
|
| Rate for Payer: Health EOS Commercial |
$125.49
|
| Rate for Payer: HFN Commercial |
$129.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$105.75
|
| Rate for Payer: Multiplan Commercial |
$112.80
|
| Rate for Payer: NAPHCARE Commercial |
$84.60
|
| Rate for Payer: Preferred Network Access Commercial |
$129.72
|
| Rate for Payer: Quartz Beloit One Network |
$69.09
|
| Rate for Payer: Quartz Commercial |
$91.65
|
| Rate for Payer: Quartz Medicare Advantage |
$84.60
|
| Rate for Payer: The Alliance Commercial |
$564.00
|
| Rate for Payer: WEA Trust Commercial |
$77.55
|
| Rate for Payer: WPS Commercial |
$104.44
|
|
|
TUBING 10' NONCONDUCTIVE N510
|
Facility
|
IP
|
$30.00
|
|
| Hospital Charge Code |
2962818
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.70 |
| Max. Negotiated Rate |
$27.60 |
| Rate for Payer: Aetna Commercial |
$27.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$25.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$15.90
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna Commercial |
$27.60
|
| Rate for Payer: Health EOS Commercial |
$26.70
|
| Rate for Payer: HFN Commercial |
$27.60
|
| Rate for Payer: Multiplan Commercial |
$24.00
|
| Rate for Payer: NAPHCARE Commercial |
$18.00
|
| Rate for Payer: Preferred Network Access Commercial |
$27.60
|
| Rate for Payer: Quartz Beloit One Network |
$14.70
|
| Rate for Payer: Quartz Commercial |
$18.00
|
| Rate for Payer: WEA Trust Commercial |
$16.50
|
| Rate for Payer: WPS Commercial |
$22.22
|
|
|
TUBING 10' NONCONDUCTIVE N510
|
Facility
|
OP
|
$30.00
|
|
| Hospital Charge Code |
2962818
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.40 |
| Max. Negotiated Rate |
$120.00 |
| Rate for Payer: Aetna Commercial |
$27.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$25.80
|
| Rate for Payer: Aetna Managed Medicare |
$8.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$19.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$15.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$14.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$15.90
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna Commercial |
$27.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$16.79
|
| Rate for Payer: Health EOS Commercial |
$26.70
|
| Rate for Payer: HFN Commercial |
$27.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$22.50
|
| Rate for Payer: Multiplan Commercial |
$24.00
|
| Rate for Payer: NAPHCARE Commercial |
$18.00
|
| Rate for Payer: Preferred Network Access Commercial |
$27.60
|
| Rate for Payer: Quartz Beloit One Network |
$14.70
|
| Rate for Payer: Quartz Commercial |
$19.50
|
| Rate for Payer: Quartz Medicare Advantage |
$18.00
|
| Rate for Payer: The Alliance Commercial |
$120.00
|
| Rate for Payer: WEA Trust Commercial |
$16.50
|
| Rate for Payer: WPS Commercial |
$22.22
|
|
|
TUBING 45cm EXTENSION LINE 502100D
|
Facility
|
OP
|
$367.00
|
|
| Hospital Charge Code |
2972222
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$102.76 |
| Max. Negotiated Rate |
$1,468.00 |
| Rate for Payer: Aetna Commercial |
$330.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$315.62
|
| Rate for Payer: Aetna Managed Medicare |
$102.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$238.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$183.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$176.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$194.51
|
| Rate for Payer: Cash Price |
$110.10
|
| Rate for Payer: Cigna Commercial |
$337.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$205.37
|
| Rate for Payer: Health EOS Commercial |
$326.63
|
| Rate for Payer: HFN Commercial |
$337.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$275.25
|
| Rate for Payer: Multiplan Commercial |
$293.60
|
| Rate for Payer: NAPHCARE Commercial |
$220.20
|
| Rate for Payer: Preferred Network Access Commercial |
$337.64
|
| Rate for Payer: Quartz Beloit One Network |
$179.83
|
| Rate for Payer: Quartz Commercial |
$238.55
|
| Rate for Payer: Quartz Medicare Advantage |
$220.20
|
| Rate for Payer: The Alliance Commercial |
$1,468.00
|
| Rate for Payer: WEA Trust Commercial |
$201.85
|
| Rate for Payer: WPS Commercial |
$271.84
|
|
|
TUBING 45cm EXTENSION LINE 502100D
|
Facility
|
IP
|
$367.00
|
|
| Hospital Charge Code |
2972222
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$179.83 |
| Max. Negotiated Rate |
$337.64 |
| Rate for Payer: Aetna Commercial |
$330.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$315.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$194.51
|
| Rate for Payer: Cash Price |
$110.10
|
| Rate for Payer: Cigna Commercial |
$337.64
|
| Rate for Payer: Health EOS Commercial |
$326.63
|
| Rate for Payer: HFN Commercial |
$337.64
|
| Rate for Payer: Multiplan Commercial |
$293.60
|
| Rate for Payer: NAPHCARE Commercial |
$220.20
|
| Rate for Payer: Preferred Network Access Commercial |
$337.64
|
| Rate for Payer: Quartz Beloit One Network |
$179.83
|
| Rate for Payer: Quartz Commercial |
$220.20
|
| Rate for Payer: WEA Trust Commercial |
$201.85
|
| Rate for Payer: WPS Commercial |
$271.84
|
|
|
TUBING 4-LEAD TUR LATEX FREE C7111
|
Facility
|
OP
|
$438.00
|
|
| Hospital Charge Code |
2963282
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$122.64 |
| Max. Negotiated Rate |
$1,752.00 |
| Rate for Payer: Aetna Commercial |
$394.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$376.68
|
| Rate for Payer: Aetna Managed Medicare |
$122.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$284.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$219.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$210.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$232.14
|
| Rate for Payer: Cash Price |
$131.40
|
| Rate for Payer: Cigna Commercial |
$402.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$245.10
|
| Rate for Payer: Health EOS Commercial |
$389.82
|
| Rate for Payer: HFN Commercial |
$402.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$328.50
|
| Rate for Payer: Multiplan Commercial |
$350.40
|
| Rate for Payer: NAPHCARE Commercial |
$262.80
|
| Rate for Payer: Preferred Network Access Commercial |
$402.96
|
| Rate for Payer: Quartz Beloit One Network |
$214.62
|
| Rate for Payer: Quartz Commercial |
$284.70
|
| Rate for Payer: Quartz Medicare Advantage |
$262.80
|
| Rate for Payer: The Alliance Commercial |
$1,752.00
|
| Rate for Payer: WEA Trust Commercial |
$240.90
|
| Rate for Payer: WPS Commercial |
$324.43
|
|
|
TUBING 4-LEAD TUR LATEX FREE C7111
|
Facility
|
IP
|
$438.00
|
|
| Hospital Charge Code |
2963282
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$214.62 |
| Max. Negotiated Rate |
$402.96 |
| Rate for Payer: Aetna Commercial |
$394.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$376.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$232.14
|
| Rate for Payer: Cash Price |
$131.40
|
| Rate for Payer: Cigna Commercial |
$402.96
|
| Rate for Payer: Health EOS Commercial |
$389.82
|
| Rate for Payer: HFN Commercial |
$402.96
|
| Rate for Payer: Multiplan Commercial |
$350.40
|
| Rate for Payer: NAPHCARE Commercial |
$262.80
|
| Rate for Payer: Preferred Network Access Commercial |
$402.96
|
| Rate for Payer: Quartz Beloit One Network |
$214.62
|
| Rate for Payer: Quartz Commercial |
$262.80
|
| Rate for Payer: WEA Trust Commercial |
$240.90
|
| Rate for Payer: WPS Commercial |
$324.43
|
|
|
TUBING 60 ARTERIAL PRESSURE 42372-01
|
Facility
|
IP
|
$81.00
|
|
| Hospital Charge Code |
2965143
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$39.69 |
| Max. Negotiated Rate |
$74.52 |
| Rate for Payer: Aetna Commercial |
$72.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$69.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$42.93
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cigna Commercial |
$74.52
|
| Rate for Payer: Health EOS Commercial |
$72.09
|
| Rate for Payer: HFN Commercial |
$74.52
|
| Rate for Payer: Multiplan Commercial |
$64.80
|
| Rate for Payer: NAPHCARE Commercial |
$48.60
|
| Rate for Payer: Preferred Network Access Commercial |
$74.52
|
| Rate for Payer: Quartz Beloit One Network |
$39.69
|
| Rate for Payer: Quartz Commercial |
$48.60
|
| Rate for Payer: WEA Trust Commercial |
$44.55
|
| Rate for Payer: WPS Commercial |
$60.00
|
|
|
TUBING 60 ARTERIAL PRESSURE 42372-01
|
Facility
|
OP
|
$81.00
|
|
| Hospital Charge Code |
2965143
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$22.68 |
| Max. Negotiated Rate |
$324.00 |
| Rate for Payer: Aetna Commercial |
$72.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$69.66
|
| Rate for Payer: Aetna Managed Medicare |
$22.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$52.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$40.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$38.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$42.93
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cigna Commercial |
$74.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$45.33
|
| Rate for Payer: Health EOS Commercial |
$72.09
|
| Rate for Payer: HFN Commercial |
$74.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$60.75
|
| Rate for Payer: Multiplan Commercial |
$64.80
|
| Rate for Payer: NAPHCARE Commercial |
$48.60
|
| Rate for Payer: Preferred Network Access Commercial |
$74.52
|
| Rate for Payer: Quartz Beloit One Network |
$39.69
|
| Rate for Payer: Quartz Commercial |
$52.65
|
| Rate for Payer: Quartz Medicare Advantage |
$48.60
|
| Rate for Payer: The Alliance Commercial |
$324.00
|
| Rate for Payer: WEA Trust Commercial |
$44.55
|
| Rate for Payer: WPS Commercial |
$60.00
|
|
