|
TUBE ET ORAL/NASAL 8MM 18780
|
Facility
|
OP
|
$75.00
|
|
|
Service Code
|
HCPCS A0398
|
| Hospital Charge Code |
5520685
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.84 |
| Max. Negotiated Rate |
$71.76 |
| Rate for Payer: Aetna Commercial |
$70.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$67.08
|
| Rate for Payer: Aetna Managed Medicare |
$21.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$50.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$39.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$37.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$41.34
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cigna Commercial |
$71.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$43.65
|
| Rate for Payer: Health EOS Commercial |
$69.42
|
| Rate for Payer: HFN Commercial |
$71.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$58.50
|
| Rate for Payer: Multiplan Commercial |
$62.40
|
| Rate for Payer: NAPHCARE Commercial |
$46.80
|
| Rate for Payer: Preferred Network Access Commercial |
$71.76
|
| Rate for Payer: Quartz Beloit One Network |
$38.22
|
| Rate for Payer: Quartz Commercial |
$50.70
|
| Rate for Payer: Quartz Medicare Advantage |
$46.80
|
| Rate for Payer: The Alliance Commercial |
$39.00
|
| Rate for Payer: WEA Trust Commercial |
$42.90
|
| Rate for Payer: WPS Commercial |
$57.77
|
|
|
TUBE ET ORAL/NASAL 8MM 18780
|
Facility
|
IP
|
$75.00
|
|
|
Service Code
|
HCPCS A0398
|
| Hospital Charge Code |
5520685
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$38.22 |
| Max. Negotiated Rate |
$71.76 |
| Rate for Payer: Aetna Commercial |
$70.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$67.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$41.34
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cigna Commercial |
$71.76
|
| Rate for Payer: Health EOS Commercial |
$69.42
|
| Rate for Payer: HFN Commercial |
$71.76
|
| Rate for Payer: Multiplan Commercial |
$62.40
|
| Rate for Payer: Preferred Network Access Commercial |
$71.76
|
| Rate for Payer: Quartz Beloit One Network |
$38.22
|
| Rate for Payer: Quartz Commercial |
$46.80
|
| Rate for Payer: WEA Trust Commercial |
$42.90
|
| Rate for Payer: WPS Commercial |
$57.77
|
|
|
TUBE ET ORAL/NASAL 9MM 18790
|
Facility
|
IP
|
$72.00
|
|
|
Service Code
|
HCPCS A4623
|
| Hospital Charge Code |
5520687
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$36.69 |
| Max. Negotiated Rate |
$68.89 |
| Rate for Payer: Aetna Commercial |
$67.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$64.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$39.69
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cigna Commercial |
$68.89
|
| Rate for Payer: Health EOS Commercial |
$66.64
|
| Rate for Payer: HFN Commercial |
$68.89
|
| Rate for Payer: Multiplan Commercial |
$59.90
|
| Rate for Payer: Preferred Network Access Commercial |
$68.89
|
| Rate for Payer: Quartz Beloit One Network |
$36.69
|
| Rate for Payer: Quartz Commercial |
$44.93
|
| Rate for Payer: WEA Trust Commercial |
$41.18
|
| Rate for Payer: WPS Commercial |
$55.46
|
|
|
TUBE ET ORAL/NASAL 9MM 18790
|
Facility
|
OP
|
$72.00
|
|
|
Service Code
|
HCPCS A4623
|
| Hospital Charge Code |
5520687
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$20.97 |
| Max. Negotiated Rate |
$68.89 |
| Rate for Payer: Aetna Commercial |
$67.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$64.40
|
| Rate for Payer: Aetna Managed Medicare |
$20.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$48.67
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$37.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$35.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$39.69
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cigna Commercial |
$68.89
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$41.90
|
| Rate for Payer: Health EOS Commercial |
$66.64
|
| Rate for Payer: HFN Commercial |
$68.89
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$56.16
|
| Rate for Payer: Multiplan Commercial |
$59.90
|
| Rate for Payer: NAPHCARE Commercial |
$44.93
|
| Rate for Payer: Preferred Network Access Commercial |
$68.89
|
| Rate for Payer: Quartz Beloit One Network |
$36.69
|
| Rate for Payer: Quartz Commercial |
$48.67
|
| Rate for Payer: Quartz Medicare Advantage |
$44.93
|
| Rate for Payer: The Alliance Commercial |
$38.85
|
| Rate for Payer: WEA Trust Commercial |
$41.18
|
| Rate for Payer: WPS Commercial |
$55.46
|
|
|
TUBE ET RUSCH LEFT DBL 26F 116100260
|
Facility
|
IP
|
$1,023.00
|
|
| Hospital Charge Code |
4104321
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$521.32 |
| Max. Negotiated Rate |
$978.81 |
| Rate for Payer: Aetna Commercial |
$957.53
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$914.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$563.88
|
| Rate for Payer: Cash Price |
$306.90
|
| Rate for Payer: Cigna Commercial |
$978.81
|
| Rate for Payer: Health EOS Commercial |
$946.89
|
| Rate for Payer: HFN Commercial |
$978.81
|
| Rate for Payer: Multiplan Commercial |
$851.14
|
| Rate for Payer: Preferred Network Access Commercial |
$978.81
|
| Rate for Payer: Quartz Beloit One Network |
$521.32
|
| Rate for Payer: Quartz Commercial |
$638.35
|
| Rate for Payer: WEA Trust Commercial |
$585.16
|
| Rate for Payer: WPS Commercial |
$788.02
|
|
|
TUBE ET RUSCH LEFT DBL 26F 116100260
|
Facility
|
OP
|
$1,023.00
|
|
| Hospital Charge Code |
4104321
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$297.90 |
| Max. Negotiated Rate |
$978.81 |
| Rate for Payer: Aetna Commercial |
$957.53
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$914.97
|
| Rate for Payer: Aetna Managed Medicare |
$297.90
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$691.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$531.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$510.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$563.88
|
| Rate for Payer: Cash Price |
$306.90
|
| Rate for Payer: Cigna Commercial |
$978.81
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$595.39
|
| Rate for Payer: Health EOS Commercial |
$946.89
|
| Rate for Payer: HFN Commercial |
$978.81
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$797.94
|
| Rate for Payer: Multiplan Commercial |
$851.14
|
| Rate for Payer: NAPHCARE Commercial |
$638.35
|
| Rate for Payer: Preferred Network Access Commercial |
$978.81
|
| Rate for Payer: Quartz Beloit One Network |
$521.32
|
| Rate for Payer: Quartz Commercial |
$691.55
|
| Rate for Payer: Quartz Medicare Advantage |
$638.35
|
| Rate for Payer: The Alliance Commercial |
$531.96
|
| Rate for Payer: WEA Trust Commercial |
$585.16
|
| Rate for Payer: WPS Commercial |
$788.02
|
|
|
TUBE ET RUSCH LEFT DBL 28F 116100280
|
Facility
|
OP
|
$964.00
|
|
| Hospital Charge Code |
4108264
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$280.72 |
| Max. Negotiated Rate |
$922.36 |
| Rate for Payer: Aetna Commercial |
$902.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$862.20
|
| Rate for Payer: Aetna Managed Medicare |
$280.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$651.66
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$501.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$481.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$531.36
|
| Rate for Payer: Cash Price |
$289.20
|
| Rate for Payer: Cigna Commercial |
$922.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$561.05
|
| Rate for Payer: Health EOS Commercial |
$892.28
|
| Rate for Payer: HFN Commercial |
$922.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$751.92
|
| Rate for Payer: Multiplan Commercial |
$802.05
|
| Rate for Payer: NAPHCARE Commercial |
$601.54
|
| Rate for Payer: Preferred Network Access Commercial |
$922.36
|
| Rate for Payer: Quartz Beloit One Network |
$491.25
|
| Rate for Payer: Quartz Commercial |
$651.66
|
| Rate for Payer: Quartz Medicare Advantage |
$601.54
|
| Rate for Payer: The Alliance Commercial |
$501.28
|
| Rate for Payer: WEA Trust Commercial |
$551.41
|
| Rate for Payer: WPS Commercial |
$742.57
|
|
|
TUBE ET RUSCH LEFT DBL 28F 116100280
|
Facility
|
IP
|
$964.00
|
|
| Hospital Charge Code |
4108264
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$491.25 |
| Max. Negotiated Rate |
$922.36 |
| Rate for Payer: Aetna Commercial |
$902.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$862.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$531.36
|
| Rate for Payer: Cash Price |
$289.20
|
| Rate for Payer: Cigna Commercial |
$922.36
|
| Rate for Payer: Health EOS Commercial |
$892.28
|
| Rate for Payer: HFN Commercial |
$922.36
|
| Rate for Payer: Multiplan Commercial |
$802.05
|
| Rate for Payer: Preferred Network Access Commercial |
$922.36
|
| Rate for Payer: Quartz Beloit One Network |
$491.25
|
| Rate for Payer: Quartz Commercial |
$601.54
|
| Rate for Payer: WEA Trust Commercial |
$551.41
|
| Rate for Payer: WPS Commercial |
$742.57
|
|
|
TUBE ET UNCUFFED 2.0MM 86232
|
Facility
|
OP
|
$140.00
|
|
| Hospital Charge Code |
2963575
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$40.77 |
| Max. Negotiated Rate |
$133.95 |
| Rate for Payer: Aetna Commercial |
$131.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$125.22
|
| Rate for Payer: Aetna Managed Medicare |
$40.77
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$94.64
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$72.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$69.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$77.17
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cigna Commercial |
$133.95
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$81.48
|
| Rate for Payer: Health EOS Commercial |
$129.58
|
| Rate for Payer: HFN Commercial |
$133.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$109.20
|
| Rate for Payer: Multiplan Commercial |
$116.48
|
| Rate for Payer: NAPHCARE Commercial |
$87.36
|
| Rate for Payer: Preferred Network Access Commercial |
$133.95
|
| Rate for Payer: Quartz Beloit One Network |
$71.34
|
| Rate for Payer: Quartz Commercial |
$94.64
|
| Rate for Payer: Quartz Medicare Advantage |
$87.36
|
| Rate for Payer: The Alliance Commercial |
$72.80
|
| Rate for Payer: WEA Trust Commercial |
$80.08
|
| Rate for Payer: WPS Commercial |
$107.84
|
|
|
TUBE ET UNCUFFED 2.0MM 86232
|
Facility
|
IP
|
$140.00
|
|
| Hospital Charge Code |
2963575
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$71.34 |
| Max. Negotiated Rate |
$133.95 |
| Rate for Payer: Aetna Commercial |
$131.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$125.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$77.17
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cigna Commercial |
$133.95
|
| Rate for Payer: Health EOS Commercial |
$129.58
|
| Rate for Payer: HFN Commercial |
$133.95
|
| Rate for Payer: Multiplan Commercial |
$116.48
|
| Rate for Payer: Preferred Network Access Commercial |
$133.95
|
| Rate for Payer: Quartz Beloit One Network |
$71.34
|
| Rate for Payer: Quartz Commercial |
$87.36
|
| Rate for Payer: WEA Trust Commercial |
$80.08
|
| Rate for Payer: WPS Commercial |
$107.84
|
|
|
TUBE ET UNCUFFED 2.5mm 86233
|
Facility
|
OP
|
$140.00
|
|
| Hospital Charge Code |
2963910
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$40.77 |
| Max. Negotiated Rate |
$133.95 |
| Rate for Payer: Aetna Commercial |
$131.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$125.22
|
| Rate for Payer: Aetna Managed Medicare |
$40.77
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$94.64
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$72.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$69.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$77.17
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cigna Commercial |
$133.95
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$81.48
|
| Rate for Payer: Health EOS Commercial |
$129.58
|
| Rate for Payer: HFN Commercial |
$133.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$109.20
|
| Rate for Payer: Multiplan Commercial |
$116.48
|
| Rate for Payer: NAPHCARE Commercial |
$87.36
|
| Rate for Payer: Preferred Network Access Commercial |
$133.95
|
| Rate for Payer: Quartz Beloit One Network |
$71.34
|
| Rate for Payer: Quartz Commercial |
$94.64
|
| Rate for Payer: Quartz Medicare Advantage |
$87.36
|
| Rate for Payer: The Alliance Commercial |
$72.80
|
| Rate for Payer: WEA Trust Commercial |
$80.08
|
| Rate for Payer: WPS Commercial |
$107.84
|
|
|
TUBE ET UNCUFFED 2.5mm 86233
|
Facility
|
IP
|
$140.00
|
|
| Hospital Charge Code |
2963910
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$71.34 |
| Max. Negotiated Rate |
$133.95 |
| Rate for Payer: Aetna Commercial |
$131.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$125.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$77.17
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cigna Commercial |
$133.95
|
| Rate for Payer: Health EOS Commercial |
$129.58
|
| Rate for Payer: HFN Commercial |
$133.95
|
| Rate for Payer: Multiplan Commercial |
$116.48
|
| Rate for Payer: Preferred Network Access Commercial |
$133.95
|
| Rate for Payer: Quartz Beloit One Network |
$71.34
|
| Rate for Payer: Quartz Commercial |
$87.36
|
| Rate for Payer: WEA Trust Commercial |
$80.08
|
| Rate for Payer: WPS Commercial |
$107.84
|
|
|
TUBE ET UNCUFFED 3.0mm***DEDE 9/23
|
Facility
|
IP
|
$136.00
|
|
| Hospital Charge Code |
2963610
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$69.31 |
| Max. Negotiated Rate |
$130.12 |
| Rate for Payer: Aetna Commercial |
$127.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$121.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$74.96
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cigna Commercial |
$130.12
|
| Rate for Payer: Health EOS Commercial |
$125.88
|
| Rate for Payer: HFN Commercial |
$130.12
|
| Rate for Payer: Multiplan Commercial |
$113.15
|
| Rate for Payer: Preferred Network Access Commercial |
$130.12
|
| Rate for Payer: Quartz Beloit One Network |
$69.31
|
| Rate for Payer: Quartz Commercial |
$84.86
|
| Rate for Payer: WEA Trust Commercial |
$77.79
|
| Rate for Payer: WPS Commercial |
$104.76
|
|
|
TUBE ET UNCUFFED 3.0mm***DEDE 9/23
|
Facility
|
OP
|
$136.00
|
|
| Hospital Charge Code |
2963610
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$39.60 |
| Max. Negotiated Rate |
$130.12 |
| Rate for Payer: Aetna Commercial |
$127.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$121.64
|
| Rate for Payer: Aetna Managed Medicare |
$39.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$91.94
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$70.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$67.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$74.96
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cigna Commercial |
$130.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$79.15
|
| Rate for Payer: Health EOS Commercial |
$125.88
|
| Rate for Payer: HFN Commercial |
$130.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$106.08
|
| Rate for Payer: Multiplan Commercial |
$113.15
|
| Rate for Payer: NAPHCARE Commercial |
$84.86
|
| Rate for Payer: Preferred Network Access Commercial |
$130.12
|
| Rate for Payer: Quartz Beloit One Network |
$69.31
|
| Rate for Payer: Quartz Commercial |
$91.94
|
| Rate for Payer: Quartz Medicare Advantage |
$84.86
|
| Rate for Payer: The Alliance Commercial |
$70.72
|
| Rate for Payer: WEA Trust Commercial |
$77.79
|
| Rate for Payer: WPS Commercial |
$104.76
|
|
|
TUBE ET UNCUFFED 3.5mm MS-23335
|
Facility
|
OP
|
$140.00
|
|
| Hospital Charge Code |
2963554
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$40.77 |
| Max. Negotiated Rate |
$133.95 |
| Rate for Payer: Aetna Commercial |
$131.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$125.22
|
| Rate for Payer: Aetna Managed Medicare |
$40.77
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$94.64
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$72.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$69.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$77.17
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cigna Commercial |
$133.95
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$81.48
|
| Rate for Payer: Health EOS Commercial |
$129.58
|
| Rate for Payer: HFN Commercial |
$133.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$109.20
|
| Rate for Payer: Multiplan Commercial |
$116.48
|
| Rate for Payer: NAPHCARE Commercial |
$87.36
|
| Rate for Payer: Preferred Network Access Commercial |
$133.95
|
| Rate for Payer: Quartz Beloit One Network |
$71.34
|
| Rate for Payer: Quartz Commercial |
$94.64
|
| Rate for Payer: Quartz Medicare Advantage |
$87.36
|
| Rate for Payer: The Alliance Commercial |
$72.80
|
| Rate for Payer: WEA Trust Commercial |
$80.08
|
| Rate for Payer: WPS Commercial |
$107.84
|
|
|
TUBE ET UNCUFFED 3.5mm MS-23335
|
Facility
|
IP
|
$140.00
|
|
| Hospital Charge Code |
2963554
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$71.34 |
| Max. Negotiated Rate |
$133.95 |
| Rate for Payer: Aetna Commercial |
$131.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$125.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$77.17
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cigna Commercial |
$133.95
|
| Rate for Payer: Health EOS Commercial |
$129.58
|
| Rate for Payer: HFN Commercial |
$133.95
|
| Rate for Payer: Multiplan Commercial |
$116.48
|
| Rate for Payer: Preferred Network Access Commercial |
$133.95
|
| Rate for Payer: Quartz Beloit One Network |
$71.34
|
| Rate for Payer: Quartz Commercial |
$87.36
|
| Rate for Payer: WEA Trust Commercial |
$80.08
|
| Rate for Payer: WPS Commercial |
$107.84
|
|
|
TUBE ET UNCUFFED 4.0mm
|
Facility
|
OP
|
$57.00
|
|
| Hospital Charge Code |
2963911
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.60 |
| Max. Negotiated Rate |
$54.54 |
| Rate for Payer: Aetna Commercial |
$53.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$50.98
|
| Rate for Payer: Aetna Managed Medicare |
$16.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$38.53
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$29.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$28.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$31.42
|
| Rate for Payer: Cash Price |
$17.10
|
| Rate for Payer: Cigna Commercial |
$54.54
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$33.17
|
| Rate for Payer: Health EOS Commercial |
$52.76
|
| Rate for Payer: HFN Commercial |
$54.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$44.46
|
| Rate for Payer: Multiplan Commercial |
$47.42
|
| Rate for Payer: NAPHCARE Commercial |
$35.57
|
| Rate for Payer: Preferred Network Access Commercial |
$54.54
|
| Rate for Payer: Quartz Beloit One Network |
$29.05
|
| Rate for Payer: Quartz Commercial |
$38.53
|
| Rate for Payer: Quartz Medicare Advantage |
$35.57
|
| Rate for Payer: The Alliance Commercial |
$29.64
|
| Rate for Payer: WEA Trust Commercial |
$32.60
|
| Rate for Payer: WPS Commercial |
$43.91
|
|
|
TUBE ET UNCUFFED 4.0mm
|
Facility
|
IP
|
$57.00
|
|
| Hospital Charge Code |
2963911
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$29.05 |
| Max. Negotiated Rate |
$54.54 |
| Rate for Payer: Aetna Commercial |
$53.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$50.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$31.42
|
| Rate for Payer: Cash Price |
$17.10
|
| Rate for Payer: Cigna Commercial |
$54.54
|
| Rate for Payer: Health EOS Commercial |
$52.76
|
| Rate for Payer: HFN Commercial |
$54.54
|
| Rate for Payer: Multiplan Commercial |
$47.42
|
| Rate for Payer: Preferred Network Access Commercial |
$54.54
|
| Rate for Payer: Quartz Beloit One Network |
$29.05
|
| Rate for Payer: Quartz Commercial |
$35.57
|
| Rate for Payer: WEA Trust Commercial |
$32.60
|
| Rate for Payer: WPS Commercial |
$43.91
|
|
|
TUBE ET UNCUFFED W/STYLET 2.5mm 506525
|
Facility
|
OP
|
$517.00
|
|
| Hospital Charge Code |
4455568
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$150.55 |
| Max. Negotiated Rate |
$494.67 |
| Rate for Payer: Aetna Commercial |
$483.91
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$462.40
|
| Rate for Payer: Aetna Managed Medicare |
$150.55
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$349.49
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$268.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$258.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$284.97
|
| Rate for Payer: Cash Price |
$155.10
|
| Rate for Payer: Cigna Commercial |
$494.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$300.89
|
| Rate for Payer: Health EOS Commercial |
$478.54
|
| Rate for Payer: HFN Commercial |
$494.67
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$403.26
|
| Rate for Payer: Multiplan Commercial |
$430.14
|
| Rate for Payer: NAPHCARE Commercial |
$322.61
|
| Rate for Payer: Preferred Network Access Commercial |
$494.67
|
| Rate for Payer: Quartz Beloit One Network |
$263.46
|
| Rate for Payer: Quartz Commercial |
$349.49
|
| Rate for Payer: Quartz Medicare Advantage |
$322.61
|
| Rate for Payer: The Alliance Commercial |
$268.84
|
| Rate for Payer: WEA Trust Commercial |
$295.72
|
| Rate for Payer: WPS Commercial |
$398.25
|
|
|
TUBE ET UNCUFFED W/STYLET 2.5mm 506525
|
Facility
|
IP
|
$517.00
|
|
| Hospital Charge Code |
4455568
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$263.46 |
| Max. Negotiated Rate |
$494.67 |
| Rate for Payer: HFN Commercial |
$494.67
|
| Rate for Payer: Aetna Commercial |
$483.91
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$462.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$284.97
|
| Rate for Payer: Cash Price |
$155.10
|
| Rate for Payer: Cigna Commercial |
$494.67
|
| Rate for Payer: Health EOS Commercial |
$478.54
|
| Rate for Payer: Multiplan Commercial |
$430.14
|
| Rate for Payer: Preferred Network Access Commercial |
$494.67
|
| Rate for Payer: Quartz Beloit One Network |
$263.46
|
| Rate for Payer: Quartz Commercial |
$322.61
|
| Rate for Payer: WEA Trust Commercial |
$295.72
|
| Rate for Payer: WPS Commercial |
$398.25
|
|
|
TUBE ET UNIVENT 6.5 1202628
|
Facility
|
IP
|
$2,551.00
|
|
| Hospital Charge Code |
4055456
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,299.99 |
| Max. Negotiated Rate |
$2,440.80 |
| Rate for Payer: Aetna Commercial |
$2,387.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,281.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,406.11
|
| Rate for Payer: Cash Price |
$765.30
|
| Rate for Payer: Cigna Commercial |
$2,440.80
|
| Rate for Payer: Health EOS Commercial |
$2,361.21
|
| Rate for Payer: HFN Commercial |
$2,440.80
|
| Rate for Payer: Multiplan Commercial |
$2,122.43
|
| Rate for Payer: Preferred Network Access Commercial |
$2,440.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,299.99
|
| Rate for Payer: Quartz Commercial |
$1,591.82
|
| Rate for Payer: WEA Trust Commercial |
$1,459.17
|
| Rate for Payer: WPS Commercial |
$1,965.04
|
|
|
TUBE ET UNIVENT 6.5 1202628
|
Facility
|
OP
|
$2,551.00
|
|
| Hospital Charge Code |
4055456
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$742.85 |
| Max. Negotiated Rate |
$2,440.80 |
| Rate for Payer: Aetna Commercial |
$2,387.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,281.61
|
| Rate for Payer: Aetna Managed Medicare |
$742.85
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,724.48
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,326.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,273.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,406.11
|
| Rate for Payer: Cash Price |
$765.30
|
| Rate for Payer: Cigna Commercial |
$2,440.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,484.68
|
| Rate for Payer: Health EOS Commercial |
$2,361.21
|
| Rate for Payer: HFN Commercial |
$2,440.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,989.78
|
| Rate for Payer: Multiplan Commercial |
$2,122.43
|
| Rate for Payer: NAPHCARE Commercial |
$1,591.82
|
| Rate for Payer: Preferred Network Access Commercial |
$2,440.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,299.99
|
| Rate for Payer: Quartz Commercial |
$1,724.48
|
| Rate for Payer: Quartz Medicare Advantage |
$1,591.82
|
| Rate for Payer: The Alliance Commercial |
$1,326.52
|
| Rate for Payer: WEA Trust Commercial |
$1,459.17
|
| Rate for Payer: WPS Commercial |
$1,965.04
|
|
|
TUBE ET UNIVENT 7.0 1202630
|
Facility
|
IP
|
$2,551.00
|
|
| Hospital Charge Code |
4055457
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,299.99 |
| Max. Negotiated Rate |
$2,440.80 |
| Rate for Payer: Aetna Commercial |
$2,387.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,281.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,406.11
|
| Rate for Payer: Cash Price |
$765.30
|
| Rate for Payer: Cigna Commercial |
$2,440.80
|
| Rate for Payer: Health EOS Commercial |
$2,361.21
|
| Rate for Payer: HFN Commercial |
$2,440.80
|
| Rate for Payer: Multiplan Commercial |
$2,122.43
|
| Rate for Payer: Preferred Network Access Commercial |
$2,440.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,299.99
|
| Rate for Payer: Quartz Commercial |
$1,591.82
|
| Rate for Payer: WEA Trust Commercial |
$1,459.17
|
| Rate for Payer: WPS Commercial |
$1,965.04
|
|
|
TUBE ET UNIVENT 7.0 1202630
|
Facility
|
OP
|
$2,551.00
|
|
| Hospital Charge Code |
4055457
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$742.85 |
| Max. Negotiated Rate |
$2,440.80 |
| Rate for Payer: Aetna Commercial |
$2,387.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,281.61
|
| Rate for Payer: Aetna Managed Medicare |
$742.85
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,724.48
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,326.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,273.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,406.11
|
| Rate for Payer: Cash Price |
$765.30
|
| Rate for Payer: Cigna Commercial |
$2,440.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,484.68
|
| Rate for Payer: Health EOS Commercial |
$2,361.21
|
| Rate for Payer: HFN Commercial |
$2,440.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,989.78
|
| Rate for Payer: Multiplan Commercial |
$2,122.43
|
| Rate for Payer: NAPHCARE Commercial |
$1,591.82
|
| Rate for Payer: Preferred Network Access Commercial |
$2,440.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,299.99
|
| Rate for Payer: Quartz Commercial |
$1,724.48
|
| Rate for Payer: Quartz Medicare Advantage |
$1,591.82
|
| Rate for Payer: The Alliance Commercial |
$1,326.52
|
| Rate for Payer: WEA Trust Commercial |
$1,459.17
|
| Rate for Payer: WPS Commercial |
$1,965.04
|
|
|
TUBE EXTENSION ADLT DISP W/ADAPTER 60 #487000"
|
Facility
|
IP
|
$85.00
|
|
| Hospital Charge Code |
2974543
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$43.32 |
| Max. Negotiated Rate |
$81.33 |
| Rate for Payer: Aetna Commercial |
$79.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$76.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$46.85
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Cigna Commercial |
$81.33
|
| Rate for Payer: Health EOS Commercial |
$78.68
|
| Rate for Payer: HFN Commercial |
$81.33
|
| Rate for Payer: Multiplan Commercial |
$70.72
|
| Rate for Payer: Preferred Network Access Commercial |
$81.33
|
| Rate for Payer: Quartz Beloit One Network |
$43.32
|
| Rate for Payer: Quartz Commercial |
$53.04
|
| Rate for Payer: WEA Trust Commercial |
$48.62
|
| Rate for Payer: WPS Commercial |
$65.48
|
|
