|
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
|
|
|
AIRWAY LMA UNIQUE DISP SZ 3 105200-000030
|
Facility
|
IP
|
$248.00
|
|
| Hospital Charge Code |
2968968
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.52 |
| Max. Negotiated Rate |
$228.16 |
| Rate for Payer: Aetna Commercial |
$223.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$213.28
|
| 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 5 105200-000050
|
Facility
|
OP
|
$248.00
|
|
| Hospital Charge Code |
2968970
|
|
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 SZ 5 105200-000050
|
Facility
|
IP
|
$248.00
|
|
| Hospital Charge Code |
2968970
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.52 |
| Max. Negotiated Rate |
$228.16 |
| Rate for Payer: Aetna Commercial |
$223.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$213.28
|
| 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 SIZE 1.5 105200-000015
|
Facility
|
IP
|
$314.00
|
|
| Hospital Charge Code |
2972785
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$153.86 |
| Max. Negotiated Rate |
$288.88 |
| Rate for Payer: Aetna Commercial |
$282.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$270.04
|
| 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 SIZE 1.5 105200-000015
|
Facility
|
OP
|
$314.00
|
|
| Hospital Charge Code |
2972785
|
|
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 SIZE 2.5 105200-000025
|
Facility
|
OP
|
$312.00
|
|
| Hospital Charge Code |
2972998
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$87.36 |
| Max. Negotiated Rate |
$1,248.00 |
| Rate for Payer: Aetna Commercial |
$280.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$268.32
|
| Rate for Payer: Aetna Managed Medicare |
$87.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$202.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$156.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$149.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$165.36
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Cigna Commercial |
$287.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$174.60
|
| Rate for Payer: Health EOS Commercial |
$277.68
|
| Rate for Payer: HFN Commercial |
$287.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$234.00
|
| Rate for Payer: Multiplan Commercial |
$249.60
|
| Rate for Payer: NAPHCARE Commercial |
$187.20
|
| Rate for Payer: Preferred Network Access Commercial |
$287.04
|
| Rate for Payer: Quartz Beloit One Network |
$152.88
|
| Rate for Payer: Quartz Commercial |
$202.80
|
| Rate for Payer: Quartz Medicare Advantage |
$187.20
|
| Rate for Payer: The Alliance Commercial |
$1,248.00
|
| Rate for Payer: WEA Trust Commercial |
$171.60
|
| Rate for Payer: WPS Commercial |
$231.10
|
|
|
AIRWAY LMA UNIQUE SIZE 2.5 105200-000025
|
Facility
|
IP
|
$312.00
|
|
| Hospital Charge Code |
2972998
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$152.88 |
| Max. Negotiated Rate |
$287.04 |
| Rate for Payer: Aetna Commercial |
$280.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$268.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$165.36
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Cigna Commercial |
$287.04
|
| Rate for Payer: Health EOS Commercial |
$277.68
|
| Rate for Payer: HFN Commercial |
$287.04
|
| Rate for Payer: Multiplan Commercial |
$249.60
|
| Rate for Payer: NAPHCARE Commercial |
$187.20
|
| Rate for Payer: Preferred Network Access Commercial |
$287.04
|
| Rate for Payer: Quartz Beloit One Network |
$152.88
|
| Rate for Payer: Quartz Commercial |
$187.20
|
| Rate for Payer: WEA Trust Commercial |
$171.60
|
| Rate for Payer: WPS Commercial |
$231.10
|
|
|
Airway-Nasal
|
Facility
|
IP
|
$125.00
|
|
| Hospital Charge Code |
3101735
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$61.25 |
| Max. Negotiated Rate |
$115.00 |
| Rate for Payer: Aetna Commercial |
$112.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$107.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$66.25
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cigna Commercial |
$115.00
|
| Rate for Payer: Health EOS Commercial |
$111.25
|
| Rate for Payer: HFN Commercial |
$115.00
|
| Rate for Payer: Multiplan Commercial |
$100.00
|
| Rate for Payer: NAPHCARE Commercial |
$75.00
|
| Rate for Payer: Preferred Network Access Commercial |
$115.00
|
| Rate for Payer: Quartz Beloit One Network |
$61.25
|
| Rate for Payer: Quartz Commercial |
$75.00
|
| Rate for Payer: WEA Trust Commercial |
$68.75
|
| Rate for Payer: WPS Commercial |
$92.59
|
|
|
Airway-Nasal
|
Facility
|
OP
|
$125.00
|
|
| Hospital Charge Code |
3101735
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$35.00 |
| Max. Negotiated Rate |
$500.00 |
| Rate for Payer: Aetna Commercial |
$112.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$107.50
|
| Rate for Payer: Aetna Managed Medicare |
$35.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$81.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$62.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$60.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$66.25
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cigna Commercial |
$115.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$69.95
|
| Rate for Payer: Health EOS Commercial |
$111.25
|
| Rate for Payer: HFN Commercial |
$115.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$93.75
|
| Rate for Payer: Multiplan Commercial |
$100.00
|
| Rate for Payer: NAPHCARE Commercial |
$75.00
|
| Rate for Payer: Preferred Network Access Commercial |
$115.00
|
| Rate for Payer: Quartz Beloit One Network |
$61.25
|
| Rate for Payer: Quartz Commercial |
$81.25
|
| Rate for Payer: Quartz Medicare Advantage |
$75.00
|
| Rate for Payer: The Alliance Commercial |
$500.00
|
| Rate for Payer: WEA Trust Commercial |
$68.75
|
| Rate for Payer: WPS Commercial |
$92.59
|
|
|
AIRWAY NASOPH 16fr LATEX FREE
|
Facility
|
IP
|
$101.00
|
|
| Hospital Charge Code |
2963760
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$49.49 |
| Max. Negotiated Rate |
$92.92 |
| Rate for Payer: Aetna Commercial |
$90.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$86.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$53.53
|
| Rate for Payer: Cash Price |
$30.30
|
| Rate for Payer: Cigna Commercial |
$92.92
|
| Rate for Payer: Health EOS Commercial |
$89.89
|
| Rate for Payer: HFN Commercial |
$92.92
|
| Rate for Payer: Multiplan Commercial |
$80.80
|
| Rate for Payer: NAPHCARE Commercial |
$60.60
|
| Rate for Payer: Preferred Network Access Commercial |
$92.92
|
| Rate for Payer: Quartz Beloit One Network |
$49.49
|
| Rate for Payer: Quartz Commercial |
$60.60
|
| Rate for Payer: WEA Trust Commercial |
$55.55
|
| Rate for Payer: WPS Commercial |
$74.81
|
|
|
AIRWAY NASOPH 16fr LATEX FREE
|
Facility
|
OP
|
$101.00
|
|
| Hospital Charge Code |
2963760
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$28.28 |
| Max. Negotiated Rate |
$404.00 |
| Rate for Payer: Aetna Commercial |
$90.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$86.86
|
| Rate for Payer: Aetna Managed Medicare |
$28.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$65.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$50.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$48.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$53.53
|
| Rate for Payer: Cash Price |
$30.30
|
| Rate for Payer: Cigna Commercial |
$92.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$56.52
|
| Rate for Payer: Health EOS Commercial |
$89.89
|
| Rate for Payer: HFN Commercial |
$92.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$75.75
|
| Rate for Payer: Multiplan Commercial |
$80.80
|
| Rate for Payer: NAPHCARE Commercial |
$60.60
|
| Rate for Payer: Preferred Network Access Commercial |
$92.92
|
| Rate for Payer: Quartz Beloit One Network |
$49.49
|
| Rate for Payer: Quartz Commercial |
$65.65
|
| Rate for Payer: Quartz Medicare Advantage |
$60.60
|
| Rate for Payer: The Alliance Commercial |
$404.00
|
| Rate for Payer: WEA Trust Commercial |
$55.55
|
| Rate for Payer: WPS Commercial |
$74.81
|
|
|
AIRWAY NASOPH.30FR.LATEX FREE
|
Facility
|
IP
|
$101.00
|
|
| Hospital Charge Code |
2963755
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$49.49 |
| Max. Negotiated Rate |
$92.92 |
| Rate for Payer: Aetna Commercial |
$90.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$86.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$53.53
|
| Rate for Payer: Cash Price |
$30.30
|
| Rate for Payer: Cigna Commercial |
$92.92
|
| Rate for Payer: Health EOS Commercial |
$89.89
|
| Rate for Payer: HFN Commercial |
$92.92
|
| Rate for Payer: Multiplan Commercial |
$80.80
|
| Rate for Payer: NAPHCARE Commercial |
$60.60
|
| Rate for Payer: Preferred Network Access Commercial |
$92.92
|
| Rate for Payer: Quartz Beloit One Network |
$49.49
|
| Rate for Payer: Quartz Commercial |
$60.60
|
| Rate for Payer: WEA Trust Commercial |
$55.55
|
| Rate for Payer: WPS Commercial |
$74.81
|
|
|
AIRWAY NASOPH.30FR.LATEX FREE
|
Facility
|
OP
|
$101.00
|
|
| Hospital Charge Code |
2963755
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$28.28 |
| Max. Negotiated Rate |
$404.00 |
| Rate for Payer: Aetna Commercial |
$90.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$86.86
|
| Rate for Payer: Aetna Managed Medicare |
$28.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$65.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$50.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$48.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$53.53
|
| Rate for Payer: Cash Price |
$30.30
|
| Rate for Payer: Cigna Commercial |
$92.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$56.52
|
| Rate for Payer: Health EOS Commercial |
$89.89
|
| Rate for Payer: HFN Commercial |
$92.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$75.75
|
| Rate for Payer: Multiplan Commercial |
$80.80
|
| Rate for Payer: NAPHCARE Commercial |
$60.60
|
| Rate for Payer: Preferred Network Access Commercial |
$92.92
|
| Rate for Payer: Quartz Beloit One Network |
$49.49
|
| Rate for Payer: Quartz Commercial |
$65.65
|
| Rate for Payer: Quartz Medicare Advantage |
$60.60
|
| Rate for Payer: The Alliance Commercial |
$404.00
|
| Rate for Payer: WEA Trust Commercial |
$55.55
|
| Rate for Payer: WPS Commercial |
$74.81
|
|
|
AIRWAY NASOPHAR. 14 FR.
|
Facility
|
IP
|
$101.00
|
|
| Hospital Charge Code |
2963761
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$49.49 |
| Max. Negotiated Rate |
$92.92 |
| Rate for Payer: Aetna Commercial |
$90.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$86.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$53.53
|
| Rate for Payer: Cash Price |
$30.30
|
| Rate for Payer: Cigna Commercial |
$92.92
|
| Rate for Payer: Health EOS Commercial |
$89.89
|
| Rate for Payer: HFN Commercial |
$92.92
|
| Rate for Payer: Multiplan Commercial |
$80.80
|
| Rate for Payer: NAPHCARE Commercial |
$60.60
|
| Rate for Payer: Preferred Network Access Commercial |
$92.92
|
| Rate for Payer: Quartz Beloit One Network |
$49.49
|
| Rate for Payer: Quartz Commercial |
$60.60
|
| Rate for Payer: WEA Trust Commercial |
$55.55
|
| Rate for Payer: WPS Commercial |
$74.81
|
|
|
AIRWAY NASOPHAR. 14 FR.
|
Facility
|
OP
|
$101.00
|
|
| Hospital Charge Code |
2963761
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$28.28 |
| Max. Negotiated Rate |
$404.00 |
| Rate for Payer: Aetna Commercial |
$90.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$86.86
|
| Rate for Payer: Aetna Managed Medicare |
$28.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$65.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$50.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$48.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$53.53
|
| Rate for Payer: Cash Price |
$30.30
|
| Rate for Payer: Cigna Commercial |
$92.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$56.52
|
| Rate for Payer: Health EOS Commercial |
$89.89
|
| Rate for Payer: HFN Commercial |
$92.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$75.75
|
| Rate for Payer: Multiplan Commercial |
$80.80
|
| Rate for Payer: NAPHCARE Commercial |
$60.60
|
| Rate for Payer: Preferred Network Access Commercial |
$92.92
|
| Rate for Payer: Quartz Beloit One Network |
$49.49
|
| Rate for Payer: Quartz Commercial |
$65.65
|
| Rate for Payer: Quartz Medicare Advantage |
$60.60
|
| Rate for Payer: The Alliance Commercial |
$404.00
|
| Rate for Payer: WEA Trust Commercial |
$55.55
|
| Rate for Payer: WPS Commercial |
$74.81
|
|
|
AIRWAY NASOPHAR. 18 FR.
|
Facility
|
IP
|
$101.00
|
|
| Hospital Charge Code |
2963759
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$49.49 |
| Max. Negotiated Rate |
$92.92 |
| Rate for Payer: Aetna Commercial |
$90.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$86.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$53.53
|
| Rate for Payer: Cash Price |
$30.30
|
| Rate for Payer: Cigna Commercial |
$92.92
|
| Rate for Payer: Health EOS Commercial |
$89.89
|
| Rate for Payer: HFN Commercial |
$92.92
|
| Rate for Payer: Multiplan Commercial |
$80.80
|
| Rate for Payer: NAPHCARE Commercial |
$60.60
|
| Rate for Payer: Preferred Network Access Commercial |
$92.92
|
| Rate for Payer: Quartz Beloit One Network |
$49.49
|
| Rate for Payer: Quartz Commercial |
$60.60
|
| Rate for Payer: WEA Trust Commercial |
$55.55
|
| Rate for Payer: WPS Commercial |
$74.81
|
|
|
AIRWAY NASOPHAR. 18 FR.
|
Facility
|
OP
|
$101.00
|
|
| Hospital Charge Code |
2963759
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$28.28 |
| Max. Negotiated Rate |
$404.00 |
| Rate for Payer: Aetna Commercial |
$90.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$86.86
|
| Rate for Payer: Aetna Managed Medicare |
$28.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$65.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$50.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$48.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$53.53
|
| Rate for Payer: Cash Price |
$30.30
|
| Rate for Payer: Cigna Commercial |
$92.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$56.52
|
| Rate for Payer: Health EOS Commercial |
$89.89
|
| Rate for Payer: HFN Commercial |
$92.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$75.75
|
| Rate for Payer: Multiplan Commercial |
$80.80
|
| Rate for Payer: NAPHCARE Commercial |
$60.60
|
| Rate for Payer: Preferred Network Access Commercial |
$92.92
|
| Rate for Payer: Quartz Beloit One Network |
$49.49
|
| Rate for Payer: Quartz Commercial |
$65.65
|
| Rate for Payer: Quartz Medicare Advantage |
$60.60
|
| Rate for Payer: The Alliance Commercial |
$404.00
|
| Rate for Payer: WEA Trust Commercial |
$55.55
|
| Rate for Payer: WPS Commercial |
$74.81
|
|
|
AIRWAY NASOPHAR. 22 FR
|
Facility
|
IP
|
$101.00
|
|
| Hospital Charge Code |
2963758
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$49.49 |
| Max. Negotiated Rate |
$92.92 |
| Rate for Payer: Aetna Commercial |
$90.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$86.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$53.53
|
| Rate for Payer: Cash Price |
$30.30
|
| Rate for Payer: Cigna Commercial |
$92.92
|
| Rate for Payer: Health EOS Commercial |
$89.89
|
| Rate for Payer: HFN Commercial |
$92.92
|
| Rate for Payer: Multiplan Commercial |
$80.80
|
| Rate for Payer: NAPHCARE Commercial |
$60.60
|
| Rate for Payer: Preferred Network Access Commercial |
$92.92
|
| Rate for Payer: Quartz Beloit One Network |
$49.49
|
| Rate for Payer: Quartz Commercial |
$60.60
|
| Rate for Payer: WEA Trust Commercial |
$55.55
|
| Rate for Payer: WPS Commercial |
$74.81
|
|
|
AIRWAY NASOPHAR. 22 FR
|
Facility
|
OP
|
$101.00
|
|
| Hospital Charge Code |
2963758
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$28.28 |
| Max. Negotiated Rate |
$404.00 |
| Rate for Payer: Aetna Commercial |
$90.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$86.86
|
| Rate for Payer: Aetna Managed Medicare |
$28.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$65.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$50.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$48.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$53.53
|
| Rate for Payer: Cash Price |
$30.30
|
| Rate for Payer: Cigna Commercial |
$92.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$56.52
|
| Rate for Payer: Health EOS Commercial |
$89.89
|
| Rate for Payer: HFN Commercial |
$92.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$75.75
|
| Rate for Payer: Multiplan Commercial |
$80.80
|
| Rate for Payer: NAPHCARE Commercial |
$60.60
|
| Rate for Payer: Preferred Network Access Commercial |
$92.92
|
| Rate for Payer: Quartz Beloit One Network |
$49.49
|
| Rate for Payer: Quartz Commercial |
$65.65
|
| Rate for Payer: Quartz Medicare Advantage |
$60.60
|
| Rate for Payer: The Alliance Commercial |
$404.00
|
| Rate for Payer: WEA Trust Commercial |
$55.55
|
| Rate for Payer: WPS Commercial |
$74.81
|
|
|
AIRWAY NASOPHARYNEAL 6.5
|
Facility
|
IP
|
$197.00
|
|
| Hospital Charge Code |
2963559
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$96.53 |
| Max. Negotiated Rate |
$181.24 |
| Rate for Payer: Aetna Commercial |
$177.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$169.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$104.41
|
| Rate for Payer: Cash Price |
$59.10
|
| Rate for Payer: Cigna Commercial |
$181.24
|
| Rate for Payer: Health EOS Commercial |
$175.33
|
| Rate for Payer: HFN Commercial |
$181.24
|
| Rate for Payer: Multiplan Commercial |
$157.60
|
| Rate for Payer: NAPHCARE Commercial |
$118.20
|
| Rate for Payer: Preferred Network Access Commercial |
$181.24
|
| Rate for Payer: Quartz Beloit One Network |
$96.53
|
| Rate for Payer: Quartz Commercial |
$118.20
|
| Rate for Payer: WEA Trust Commercial |
$108.35
|
| Rate for Payer: WPS Commercial |
$145.92
|
|
|
AIRWAY NASOPHARYNEAL 6.5
|
Facility
|
OP
|
$197.00
|
|
| Hospital Charge Code |
2963559
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$55.16 |
| Max. Negotiated Rate |
$788.00 |
| Rate for Payer: Aetna Commercial |
$177.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$169.42
|
| Rate for Payer: Aetna Managed Medicare |
$55.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$128.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$98.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$94.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$104.41
|
| Rate for Payer: Cash Price |
$59.10
|
| Rate for Payer: Cigna Commercial |
$181.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$110.24
|
| Rate for Payer: Health EOS Commercial |
$175.33
|
| Rate for Payer: HFN Commercial |
$181.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$147.75
|
| Rate for Payer: Multiplan Commercial |
$157.60
|
| Rate for Payer: NAPHCARE Commercial |
$118.20
|
| Rate for Payer: Preferred Network Access Commercial |
$181.24
|
| Rate for Payer: Quartz Beloit One Network |
$96.53
|
| Rate for Payer: Quartz Commercial |
$128.05
|
| Rate for Payer: Quartz Medicare Advantage |
$118.20
|
| Rate for Payer: The Alliance Commercial |
$788.00
|
| Rate for Payer: WEA Trust Commercial |
$108.35
|
| Rate for Payer: WPS Commercial |
$145.92
|
|
|
AIRWAY NASOPHARYNEAL 8.0
|
Facility
|
OP
|
$197.00
|
|
| Hospital Charge Code |
2963547
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$55.16 |
| Max. Negotiated Rate |
$788.00 |
| Rate for Payer: Aetna Commercial |
$177.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$169.42
|
| Rate for Payer: Aetna Managed Medicare |
$55.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$128.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$98.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$94.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$104.41
|
| Rate for Payer: Cash Price |
$59.10
|
| Rate for Payer: Cigna Commercial |
$181.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$110.24
|
| Rate for Payer: Health EOS Commercial |
$175.33
|
| Rate for Payer: HFN Commercial |
$181.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$147.75
|
| Rate for Payer: Multiplan Commercial |
$157.60
|
| Rate for Payer: NAPHCARE Commercial |
$118.20
|
| Rate for Payer: Preferred Network Access Commercial |
$181.24
|
| Rate for Payer: Quartz Beloit One Network |
$96.53
|
| Rate for Payer: Quartz Commercial |
$128.05
|
| Rate for Payer: Quartz Medicare Advantage |
$118.20
|
| Rate for Payer: The Alliance Commercial |
$788.00
|
| Rate for Payer: WEA Trust Commercial |
$108.35
|
| Rate for Payer: WPS Commercial |
$145.92
|
|
|
AIRWAY NASOPHARYNEAL 8.0
|
Facility
|
IP
|
$197.00
|
|
| Hospital Charge Code |
2963547
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$96.53 |
| Max. Negotiated Rate |
$181.24 |
| Rate for Payer: Aetna Commercial |
$177.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$169.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$104.41
|
| Rate for Payer: Cash Price |
$59.10
|
| Rate for Payer: Cigna Commercial |
$181.24
|
| Rate for Payer: Health EOS Commercial |
$175.33
|
| Rate for Payer: HFN Commercial |
$181.24
|
| Rate for Payer: Multiplan Commercial |
$157.60
|
| Rate for Payer: NAPHCARE Commercial |
$118.20
|
| Rate for Payer: Preferred Network Access Commercial |
$181.24
|
| Rate for Payer: Quartz Beloit One Network |
$96.53
|
| Rate for Payer: Quartz Commercial |
$118.20
|
| Rate for Payer: WEA Trust Commercial |
$108.35
|
| Rate for Payer: WPS Commercial |
$145.92
|
|
|
AIRWAY NASOPHARYNGEAL 12FR
|
Facility
|
IP
|
$101.00
|
|
| Hospital Charge Code |
2963762
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$49.49 |
| Max. Negotiated Rate |
$92.92 |
| Rate for Payer: Aetna Commercial |
$90.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$86.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$53.53
|
| Rate for Payer: Cash Price |
$30.30
|
| Rate for Payer: Cigna Commercial |
$92.92
|
| Rate for Payer: Health EOS Commercial |
$89.89
|
| Rate for Payer: HFN Commercial |
$92.92
|
| Rate for Payer: Multiplan Commercial |
$80.80
|
| Rate for Payer: NAPHCARE Commercial |
$60.60
|
| Rate for Payer: Preferred Network Access Commercial |
$92.92
|
| Rate for Payer: Quartz Beloit One Network |
$49.49
|
| Rate for Payer: Quartz Commercial |
$60.60
|
| Rate for Payer: WEA Trust Commercial |
$55.55
|
| Rate for Payer: WPS Commercial |
$74.81
|
|
