|
Airway - BCE
|
Facility
IP
|
$44.00
|
|
| Hospital Charge Code |
3101734
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$21.56 |
| Max. Negotiated Rate |
$40.48 |
| Rate for Payer: Aetna Commercial |
$39.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$23.32
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Cigna Commercial |
$40.48
|
| Rate for Payer: Health EOS Commercial |
$39.16
|
| Rate for Payer: HFN Commercial |
$40.48
|
| Rate for Payer: Multiplan Commercial |
$35.20
|
| Rate for Payer: NAPHCARE Commercial |
$26.40
|
| Rate for Payer: Preferred Network Access Commercial |
$40.48
|
| Rate for Payer: Quartz Beloit One Network |
$21.56
|
| Rate for Payer: Quartz Commercial |
$26.40
|
| Rate for Payer: WEA Trust Commercial |
$24.20
|
| Rate for Payer: WPS Commercial |
$32.59
|
|
|
Airway - BCE
|
Facility
OP
|
$44.00
|
|
| Hospital Charge Code |
3101734
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$12.32 |
| Max. Negotiated Rate |
$176.00 |
| Rate for Payer: Aetna Commercial |
$39.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$37.84
|
| Rate for Payer: Aetna Managed Medicare |
$12.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$28.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$22.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$21.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$23.32
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Cigna Commercial |
$40.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$24.62
|
| Rate for Payer: Health EOS Commercial |
$39.16
|
| Rate for Payer: HFN Commercial |
$40.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$33.00
|
| Rate for Payer: Multiplan Commercial |
$35.20
|
| Rate for Payer: NAPHCARE Commercial |
$26.40
|
| Rate for Payer: Preferred Network Access Commercial |
$40.48
|
| Rate for Payer: Quartz Beloit One Network |
$21.56
|
| Rate for Payer: Quartz Commercial |
$28.60
|
| Rate for Payer: Quartz Medicare Advantage |
$26.40
|
| Rate for Payer: The Alliance Commercial |
$176.00
|
| Rate for Payer: WEA Trust Commercial |
$24.20
|
| Rate for Payer: WPS Commercial |
$32.59
|
|
|
AIRWAY IGEL SIZE 3 8203000
|
Facility
OP
|
$514.00
|
|
| Hospital Charge Code |
5496860
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$143.92 |
| Max. Negotiated Rate |
$2,056.00 |
| Rate for Payer: Aetna Commercial |
$462.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$442.04
|
| Rate for Payer: Aetna Managed Medicare |
$143.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$334.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$257.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$246.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$272.42
|
| Rate for Payer: Cash Price |
$154.20
|
| Rate for Payer: Cigna Commercial |
$472.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$287.63
|
| Rate for Payer: Health EOS Commercial |
$457.46
|
| Rate for Payer: HFN Commercial |
$472.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$385.50
|
| Rate for Payer: Multiplan Commercial |
$411.20
|
| Rate for Payer: NAPHCARE Commercial |
$308.40
|
| Rate for Payer: Preferred Network Access Commercial |
$472.88
|
| Rate for Payer: Quartz Beloit One Network |
$251.86
|
| Rate for Payer: Quartz Commercial |
$334.10
|
| Rate for Payer: Quartz Medicare Advantage |
$308.40
|
| Rate for Payer: The Alliance Commercial |
$2,056.00
|
| Rate for Payer: WEA Trust Commercial |
$282.70
|
| Rate for Payer: WPS Commercial |
$380.72
|
|
|
AIRWAY IGEL SIZE 3 8203000
|
Facility
IP
|
$514.00
|
|
| Hospital Charge Code |
5496860
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$251.86 |
| Max. Negotiated Rate |
$472.88 |
| Rate for Payer: Aetna Commercial |
$462.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$272.42
|
| Rate for Payer: Cash Price |
$154.20
|
| Rate for Payer: Cigna Commercial |
$472.88
|
| Rate for Payer: Health EOS Commercial |
$457.46
|
| Rate for Payer: HFN Commercial |
$472.88
|
| Rate for Payer: Multiplan Commercial |
$411.20
|
| Rate for Payer: NAPHCARE Commercial |
$308.40
|
| Rate for Payer: Preferred Network Access Commercial |
$472.88
|
| Rate for Payer: Quartz Beloit One Network |
$251.86
|
| Rate for Payer: Quartz Commercial |
$308.40
|
| Rate for Payer: WEA Trust Commercial |
$282.70
|
| Rate for Payer: WPS Commercial |
$380.72
|
|
|
AIRWAY IGEL SIZE 4 8204000
|
Facility
IP
|
$514.00
|
|
| Hospital Charge Code |
5496861
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$251.86 |
| Max. Negotiated Rate |
$472.88 |
| Rate for Payer: Aetna Commercial |
$462.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$272.42
|
| Rate for Payer: Cash Price |
$154.20
|
| Rate for Payer: Cigna Commercial |
$472.88
|
| Rate for Payer: Health EOS Commercial |
$457.46
|
| Rate for Payer: HFN Commercial |
$472.88
|
| Rate for Payer: Multiplan Commercial |
$411.20
|
| Rate for Payer: NAPHCARE Commercial |
$308.40
|
| Rate for Payer: Preferred Network Access Commercial |
$472.88
|
| Rate for Payer: Quartz Beloit One Network |
$251.86
|
| Rate for Payer: Quartz Commercial |
$308.40
|
| Rate for Payer: WEA Trust Commercial |
$282.70
|
| Rate for Payer: WPS Commercial |
$380.72
|
|
|
AIRWAY IGEL SIZE 4 8204000
|
Facility
OP
|
$514.00
|
|
| Hospital Charge Code |
5496861
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$143.92 |
| Max. Negotiated Rate |
$2,056.00 |
| Rate for Payer: Aetna Commercial |
$462.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$442.04
|
| Rate for Payer: Aetna Managed Medicare |
$143.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$334.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$257.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$246.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$272.42
|
| Rate for Payer: Cash Price |
$154.20
|
| Rate for Payer: Cigna Commercial |
$472.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$287.63
|
| Rate for Payer: Health EOS Commercial |
$457.46
|
| Rate for Payer: HFN Commercial |
$472.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$385.50
|
| Rate for Payer: Multiplan Commercial |
$411.20
|
| Rate for Payer: NAPHCARE Commercial |
$308.40
|
| Rate for Payer: Preferred Network Access Commercial |
$472.88
|
| Rate for Payer: Quartz Beloit One Network |
$251.86
|
| Rate for Payer: Quartz Commercial |
$334.10
|
| Rate for Payer: Quartz Medicare Advantage |
$308.40
|
| Rate for Payer: The Alliance Commercial |
$2,056.00
|
| Rate for Payer: WEA Trust Commercial |
$282.70
|
| Rate for Payer: WPS Commercial |
$380.72
|
|
|
AIRWAY IGEL SIZE 5 8205000
|
Facility
OP
|
$514.00
|
|
| Hospital Charge Code |
5496862
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$143.92 |
| Max. Negotiated Rate |
$2,056.00 |
| Rate for Payer: Aetna Commercial |
$462.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$442.04
|
| Rate for Payer: Aetna Managed Medicare |
$143.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$334.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$257.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$246.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$272.42
|
| Rate for Payer: Cash Price |
$154.20
|
| Rate for Payer: Cigna Commercial |
$472.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$287.63
|
| Rate for Payer: Health EOS Commercial |
$457.46
|
| Rate for Payer: HFN Commercial |
$472.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$385.50
|
| Rate for Payer: Multiplan Commercial |
$411.20
|
| Rate for Payer: NAPHCARE Commercial |
$308.40
|
| Rate for Payer: Preferred Network Access Commercial |
$472.88
|
| Rate for Payer: Quartz Beloit One Network |
$251.86
|
| Rate for Payer: Quartz Commercial |
$334.10
|
| Rate for Payer: Quartz Medicare Advantage |
$308.40
|
| Rate for Payer: The Alliance Commercial |
$2,056.00
|
| Rate for Payer: WEA Trust Commercial |
$282.70
|
| Rate for Payer: WPS Commercial |
$380.72
|
|
|
AIRWAY IGEL SIZE 5 8205000
|
Facility
IP
|
$514.00
|
|
| Hospital Charge Code |
5496862
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$251.86 |
| Max. Negotiated Rate |
$472.88 |
| Rate for Payer: Aetna Commercial |
$462.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$272.42
|
| Rate for Payer: Cash Price |
$154.20
|
| Rate for Payer: Cigna Commercial |
$472.88
|
| Rate for Payer: Health EOS Commercial |
$457.46
|
| Rate for Payer: HFN Commercial |
$472.88
|
| Rate for Payer: Multiplan Commercial |
$411.20
|
| Rate for Payer: NAPHCARE Commercial |
$308.40
|
| Rate for Payer: Preferred Network Access Commercial |
$472.88
|
| Rate for Payer: Quartz Beloit One Network |
$251.86
|
| Rate for Payer: Quartz Commercial |
$308.40
|
| Rate for Payer: WEA Trust Commercial |
$282.70
|
| Rate for Payer: WPS Commercial |
$380.72
|
|
|
AIRWAY INFANT STER.DISP.50MM
|
Facility
OP
|
$25.00
|
|
| Hospital Charge Code |
2962806
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.00 |
| Max. Negotiated Rate |
$100.00 |
| Rate for Payer: Aetna Commercial |
$22.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$21.50
|
| Rate for Payer: Aetna Managed Medicare |
$7.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$16.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$12.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$12.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$13.25
|
| Rate for Payer: Cash Price |
$7.50
|
| Rate for Payer: Cigna Commercial |
$23.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13.99
|
| Rate for Payer: Health EOS Commercial |
$22.25
|
| Rate for Payer: HFN Commercial |
$23.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18.75
|
| Rate for Payer: Multiplan Commercial |
$20.00
|
| Rate for Payer: NAPHCARE Commercial |
$15.00
|
| Rate for Payer: Preferred Network Access Commercial |
$23.00
|
| Rate for Payer: Quartz Beloit One Network |
$12.25
|
| Rate for Payer: Quartz Commercial |
$16.25
|
| Rate for Payer: Quartz Medicare Advantage |
$15.00
|
| Rate for Payer: The Alliance Commercial |
$100.00
|
| Rate for Payer: WEA Trust Commercial |
$13.75
|
| Rate for Payer: WPS Commercial |
$18.52
|
|
|
AIRWAY INFANT STER.DISP.50MM
|
Facility
IP
|
$25.00
|
|
| Hospital Charge Code |
2962806
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.25 |
| Max. Negotiated Rate |
$23.00 |
| Rate for Payer: Aetna Commercial |
$22.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$13.25
|
| Rate for Payer: Cash Price |
$7.50
|
| Rate for Payer: Cigna Commercial |
$23.00
|
| Rate for Payer: Health EOS Commercial |
$22.25
|
| Rate for Payer: HFN Commercial |
$23.00
|
| Rate for Payer: Multiplan Commercial |
$20.00
|
| Rate for Payer: NAPHCARE Commercial |
$15.00
|
| Rate for Payer: Preferred Network Access Commercial |
$23.00
|
| Rate for Payer: Quartz Beloit One Network |
$12.25
|
| Rate for Payer: Quartz Commercial |
$15.00
|
| Rate for Payer: WEA Trust Commercial |
$13.75
|
| Rate for Payer: WPS Commercial |
$18.52
|
|
|
AIRWAY LMA FLEXIBLE ADULT SIZE 4 115040
|
Facility
OP
|
$542.00
|
|
| Hospital Charge Code |
2973274
|
|
Hospital Revenue Code
|
272
|
| 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
|
|
|
AIRWAY LMA FLEXIBLE ADULT SIZE 4 115040
|
Facility
IP
|
$542.00
|
|
| Hospital Charge Code |
2973274
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$265.58 |
| Max. Negotiated Rate |
$498.64 |
| Rate for Payer: Aetna Commercial |
$487.80
|
| 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
|
|
|
AIRWAY LMA FLEXIBLE CHILD SIZE 2.5 115025
|
Facility
OP
|
$542.00
|
|
| Hospital Charge Code |
2973151
|
|
Hospital Revenue Code
|
272
|
| 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
|
|
|
AIRWAY LMA FLEXIBLE CHILD SIZE 2.5 115025
|
Facility
IP
|
$542.00
|
|
| Hospital Charge Code |
2973151
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$265.58 |
| Max. Negotiated Rate |
$498.64 |
| Rate for Payer: Aetna Commercial |
$487.80
|
| 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
|
|
|
AIRWAY LMA FLEXIBLE CHILD SIZE 3 115030
|
Facility
OP
|
$503.00
|
|
| Hospital Charge Code |
2973273
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$140.84 |
| Max. Negotiated Rate |
$2,012.00 |
| Rate for Payer: Aetna Commercial |
$452.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$432.58
|
| Rate for Payer: Aetna Managed Medicare |
$140.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$326.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$251.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$241.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$266.59
|
| Rate for Payer: Cash Price |
$150.90
|
| Rate for Payer: Cigna Commercial |
$462.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$281.48
|
| Rate for Payer: Health EOS Commercial |
$447.67
|
| Rate for Payer: HFN Commercial |
$462.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$377.25
|
| Rate for Payer: Multiplan Commercial |
$402.40
|
| Rate for Payer: NAPHCARE Commercial |
$301.80
|
| Rate for Payer: Preferred Network Access Commercial |
$462.76
|
| Rate for Payer: Quartz Beloit One Network |
$246.47
|
| Rate for Payer: Quartz Commercial |
$326.95
|
| Rate for Payer: Quartz Medicare Advantage |
$301.80
|
| Rate for Payer: The Alliance Commercial |
$2,012.00
|
| Rate for Payer: WEA Trust Commercial |
$276.65
|
| Rate for Payer: WPS Commercial |
$372.57
|
|
|
AIRWAY LMA FLEXIBLE CHILD SIZE 3 115030
|
Facility
IP
|
$503.00
|
|
| Hospital Charge Code |
2973273
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$246.47 |
| Max. Negotiated Rate |
$462.76 |
| Rate for Payer: Aetna Commercial |
$452.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$266.59
|
| Rate for Payer: Cash Price |
$150.90
|
| Rate for Payer: Cigna Commercial |
$462.76
|
| Rate for Payer: Health EOS Commercial |
$447.67
|
| Rate for Payer: HFN Commercial |
$462.76
|
| Rate for Payer: Multiplan Commercial |
$402.40
|
| Rate for Payer: NAPHCARE Commercial |
$301.80
|
| Rate for Payer: Preferred Network Access Commercial |
$462.76
|
| Rate for Payer: Quartz Beloit One Network |
$246.47
|
| Rate for Payer: Quartz Commercial |
$301.80
|
| Rate for Payer: WEA Trust Commercial |
$276.65
|
| Rate for Payer: WPS Commercial |
$372.57
|
|
|
AIRWAY LMA FLEXIBLE INFANT/CHLD SIZE 2 115020
|
Facility
OP
|
$542.00
|
|
| Hospital Charge Code |
2973272
|
|
Hospital Revenue Code
|
272
|
| 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
|
|
|
AIRWAY LMA FLEXIBLE INFANT/CHLD SIZE 2 115020
|
Facility
IP
|
$542.00
|
|
| Hospital Charge Code |
2973272
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$265.58 |
| Max. Negotiated Rate |
$498.64 |
| Rate for Payer: Aetna Commercial |
$487.80
|
| 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
|
|
|
AIRWAY LMA UNIQUE DISP SIZE 4 105200-000040
|
Facility
OP
|
$248.00
|
|
| Hospital Charge Code |
2968969
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$69.44 |
| Max. Negotiated Rate |
$992.00 |
| Rate for Payer: Aetna Commercial |
$223.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$213.28
|
| Rate for Payer: Aetna Managed Medicare |
$69.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$161.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$124.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$119.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$131.44
|
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Cigna Commercial |
$228.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$138.78
|
| Rate for Payer: Health EOS Commercial |
$220.72
|
| Rate for Payer: HFN Commercial |
$228.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$186.00
|
| Rate for Payer: Multiplan Commercial |
$198.40
|
| Rate for Payer: NAPHCARE Commercial |
$148.80
|
| Rate for Payer: Preferred Network Access Commercial |
$228.16
|
| Rate for Payer: Quartz Beloit One Network |
$121.52
|
| Rate for Payer: Quartz Commercial |
$161.20
|
| Rate for Payer: Quartz Medicare Advantage |
$148.80
|
| Rate for Payer: The Alliance Commercial |
$992.00
|
| Rate for Payer: WEA Trust Commercial |
$136.40
|
| Rate for Payer: WPS Commercial |
$183.69
|
|
|
AIRWAY LMA UNIQUE DISP SIZE 4 105200-000040
|
Facility
IP
|
$248.00
|
|
| Hospital Charge Code |
2968969
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.52 |
| Max. Negotiated Rate |
$228.16 |
| Rate for Payer: Aetna Commercial |
$223.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$131.44
|
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Cigna Commercial |
$228.16
|
| Rate for Payer: Health EOS Commercial |
$220.72
|
| Rate for Payer: HFN Commercial |
$228.16
|
| Rate for Payer: Multiplan Commercial |
$198.40
|
| Rate for Payer: NAPHCARE Commercial |
$148.80
|
| Rate for Payer: Preferred Network Access Commercial |
$228.16
|
| Rate for Payer: Quartz Beloit One Network |
$121.52
|
| Rate for Payer: Quartz Commercial |
$148.80
|
| Rate for Payer: WEA Trust Commercial |
$136.40
|
| Rate for Payer: WPS Commercial |
$183.69
|
|
|
AIRWAY LMA UNIQUE DISP SZ 1
|
Facility
IP
|
$314.00
|
|
| Hospital Charge Code |
2969080
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$153.86 |
| Max. Negotiated Rate |
$288.88 |
| Rate for Payer: Aetna Commercial |
$282.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$166.42
|
| Rate for Payer: Cash Price |
$94.20
|
| Rate for Payer: Cigna Commercial |
$288.88
|
| Rate for Payer: Health EOS Commercial |
$279.46
|
| Rate for Payer: HFN Commercial |
$288.88
|
| Rate for Payer: Multiplan Commercial |
$251.20
|
| Rate for Payer: NAPHCARE Commercial |
$188.40
|
| Rate for Payer: Preferred Network Access Commercial |
$288.88
|
| Rate for Payer: Quartz Beloit One Network |
$153.86
|
| Rate for Payer: Quartz Commercial |
$188.40
|
| Rate for Payer: WEA Trust Commercial |
$172.70
|
| Rate for Payer: WPS Commercial |
$232.58
|
|
|
AIRWAY LMA UNIQUE DISP SZ 1
|
Facility
OP
|
$314.00
|
|
| Hospital Charge Code |
2969080
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$87.92 |
| Max. Negotiated Rate |
$1,256.00 |
| Rate for Payer: Aetna Commercial |
$282.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$270.04
|
| Rate for Payer: Aetna Managed Medicare |
$87.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$204.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$157.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$150.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$166.42
|
| Rate for Payer: Cash Price |
$94.20
|
| Rate for Payer: Cigna Commercial |
$288.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$175.71
|
| Rate for Payer: Health EOS Commercial |
$279.46
|
| Rate for Payer: HFN Commercial |
$288.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$235.50
|
| Rate for Payer: Multiplan Commercial |
$251.20
|
| Rate for Payer: NAPHCARE Commercial |
$188.40
|
| Rate for Payer: Preferred Network Access Commercial |
$288.88
|
| Rate for Payer: Quartz Beloit One Network |
$153.86
|
| Rate for Payer: Quartz Commercial |
$204.10
|
| Rate for Payer: Quartz Medicare Advantage |
$188.40
|
| Rate for Payer: The Alliance Commercial |
$1,256.00
|
| Rate for Payer: WEA Trust Commercial |
$172.70
|
| Rate for Payer: WPS Commercial |
$232.58
|
|
|
AIRWAY LMA UNIQUE DISP SZ 2
|
Facility
IP
|
$314.00
|
|
| Hospital Charge Code |
2969081
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$153.86 |
| Max. Negotiated Rate |
$288.88 |
| Rate for Payer: Aetna Commercial |
$282.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$166.42
|
| Rate for Payer: Cash Price |
$94.20
|
| Rate for Payer: Cigna Commercial |
$288.88
|
| Rate for Payer: Health EOS Commercial |
$279.46
|
| Rate for Payer: HFN Commercial |
$288.88
|
| Rate for Payer: Multiplan Commercial |
$251.20
|
| Rate for Payer: NAPHCARE Commercial |
$188.40
|
| Rate for Payer: Preferred Network Access Commercial |
$288.88
|
| Rate for Payer: Quartz Beloit One Network |
$153.86
|
| Rate for Payer: Quartz Commercial |
$188.40
|
| Rate for Payer: WEA Trust Commercial |
$172.70
|
| Rate for Payer: WPS Commercial |
$232.58
|
|
|
AIRWAY LMA UNIQUE DISP SZ 2
|
Facility
OP
|
$314.00
|
|
| Hospital Charge Code |
2969081
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$87.92 |
| Max. Negotiated Rate |
$1,256.00 |
| Rate for Payer: Aetna Commercial |
$282.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$270.04
|
| Rate for Payer: Aetna Managed Medicare |
$87.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$204.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$157.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$150.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$166.42
|
| Rate for Payer: Cash Price |
$94.20
|
| Rate for Payer: Cigna Commercial |
$288.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$175.71
|
| Rate for Payer: Health EOS Commercial |
$279.46
|
| Rate for Payer: HFN Commercial |
$288.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$235.50
|
| Rate for Payer: Multiplan Commercial |
$251.20
|
| Rate for Payer: NAPHCARE Commercial |
$188.40
|
| Rate for Payer: Preferred Network Access Commercial |
$288.88
|
| Rate for Payer: Quartz Beloit One Network |
$153.86
|
| Rate for Payer: Quartz Commercial |
$204.10
|
| Rate for Payer: Quartz Medicare Advantage |
$188.40
|
| Rate for Payer: The Alliance Commercial |
$1,256.00
|
| Rate for Payer: WEA Trust Commercial |
$172.70
|
| Rate for Payer: WPS Commercial |
$232.58
|
|
|
AIRWAY LMA UNIQUE DISP SZ 3 105200-000030
|
Facility
OP
|
$248.00
|
|
| Hospital Charge Code |
2968968
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$69.44 |
| Max. Negotiated Rate |
$992.00 |
| Rate for Payer: Aetna Commercial |
$223.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$213.28
|
| Rate for Payer: Aetna Managed Medicare |
$69.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$161.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$124.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$119.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$131.44
|
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Cigna Commercial |
$228.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$138.78
|
| Rate for Payer: Health EOS Commercial |
$220.72
|
| Rate for Payer: HFN Commercial |
$228.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$186.00
|
| Rate for Payer: Multiplan Commercial |
$198.40
|
| Rate for Payer: NAPHCARE Commercial |
$148.80
|
| Rate for Payer: Preferred Network Access Commercial |
$228.16
|
| Rate for Payer: Quartz Beloit One Network |
$121.52
|
| Rate for Payer: Quartz Commercial |
$161.20
|
| Rate for Payer: Quartz Medicare Advantage |
$148.80
|
| Rate for Payer: The Alliance Commercial |
$992.00
|
| Rate for Payer: WEA Trust Commercial |
$136.40
|
| Rate for Payer: WPS Commercial |
$183.69
|
|
