|
DRAIN ROUND SUCTION 1/8 (10FR) 0070310"
|
Facility
|
OP
|
$231.00
|
|
| Hospital Charge Code |
2963354
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$67.27 |
| Max. Negotiated Rate |
$221.02 |
| Rate for Payer: Aetna Commercial |
$216.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$206.61
|
| Rate for Payer: Aetna Managed Medicare |
$67.27
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$156.16
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$120.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$115.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$127.33
|
| Rate for Payer: Cash Price |
$69.30
|
| Rate for Payer: Cigna Commercial |
$221.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$134.44
|
| Rate for Payer: Health EOS Commercial |
$213.81
|
| Rate for Payer: HFN Commercial |
$221.02
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$180.18
|
| Rate for Payer: Multiplan Commercial |
$192.19
|
| Rate for Payer: NAPHCARE Commercial |
$144.14
|
| Rate for Payer: Preferred Network Access Commercial |
$221.02
|
| Rate for Payer: Quartz Beloit One Network |
$117.72
|
| Rate for Payer: Quartz Commercial |
$156.16
|
| Rate for Payer: Quartz Medicare Advantage |
$144.14
|
| Rate for Payer: The Alliance Commercial |
$120.12
|
| Rate for Payer: WEA Trust Commercial |
$132.13
|
| Rate for Payer: WPS Commercial |
$177.94
|
|
|
DRAIN SHOULDER LESION 23030
|
Professional
|
Both
|
$1,517.00
|
|
|
Service Code
|
CPT 23030
|
| Hospital Charge Code |
3013757
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$232.06 |
| Max. Negotiated Rate |
$1,498.80 |
| Rate for Payer: Aetna Commercial |
$1,498.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,356.80
|
| Rate for Payer: Aetna Managed Medicare |
$232.06
|
| Rate for Payer: Anthem Medicare Advantage |
$232.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$232.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$232.06
|
| Rate for Payer: Cash Price |
$455.10
|
| Rate for Payer: Cash Price |
$455.10
|
| Rate for Payer: Cash Price |
$455.10
|
| Rate for Payer: Cigna Commercial |
$1,498.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$259.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$232.06
|
| Rate for Payer: Health EOS Commercial |
$1,435.69
|
| Rate for Payer: HFN Commercial |
$1,498.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$873.70
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$873.70
|
| Rate for Payer: Independent Care Health Plan Medicare |
$232.06
|
| Rate for Payer: Multiplan Commercial |
$1,262.14
|
| Rate for Payer: NAPHCARE Commercial |
$348.08
|
| Rate for Payer: Preferred Network Access Commercial |
$1,498.80
|
| Rate for Payer: Quartz Beloit One Network |
$694.18
|
| Rate for Payer: Quartz Commercial |
$899.28
|
| Rate for Payer: Quartz Medicare Advantage |
$232.06
|
| Rate for Payer: The Alliance Commercial |
$986.23
|
| Rate for Payer: United Healthcare Medicaid |
$259.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$232.06
|
| Rate for Payer: WEA Trust Commercial |
$867.72
|
| Rate for Payer: WPS Commercial |
$1,044.25
|
|
|
DRAIN THIGH/KNEE LESION 27301
|
Professional
|
Both
|
$1,866.00
|
|
|
Service Code
|
CPT 27301
|
| Hospital Charge Code |
3014043
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$204.11 |
| Max. Negotiated Rate |
$2,071.46 |
| Rate for Payer: Aetna Commercial |
$1,843.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,668.95
|
| Rate for Payer: Aetna Managed Medicare |
$460.32
|
| Rate for Payer: Anthem Medicare Advantage |
$460.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$460.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$460.32
|
| Rate for Payer: Cash Price |
$559.80
|
| Rate for Payer: Cash Price |
$559.80
|
| Rate for Payer: Cash Price |
$559.80
|
| Rate for Payer: Cigna Commercial |
$1,843.61
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$204.11
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$460.32
|
| Rate for Payer: Health EOS Commercial |
$1,765.98
|
| Rate for Payer: HFN Commercial |
$1,843.61
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,739.31
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,739.31
|
| Rate for Payer: Independent Care Health Plan Medicare |
$460.32
|
| Rate for Payer: Multiplan Commercial |
$1,552.51
|
| Rate for Payer: NAPHCARE Commercial |
$690.49
|
| Rate for Payer: Preferred Network Access Commercial |
$1,843.61
|
| Rate for Payer: Quartz Beloit One Network |
$853.88
|
| Rate for Payer: Quartz Commercial |
$1,106.16
|
| Rate for Payer: Quartz Medicare Advantage |
$460.32
|
| Rate for Payer: The Alliance Commercial |
$1,956.38
|
| Rate for Payer: United Healthcare Medicaid |
$204.11
|
| Rate for Payer: United Healthcare Medicare Advantage |
$460.32
|
| Rate for Payer: WEA Trust Commercial |
$1,067.35
|
| Rate for Payer: WPS Commercial |
$2,071.46
|
|
|
DRAIN WOUND TUBING 1/4 0070330"
|
Facility
|
IP
|
$378.00
|
|
| Hospital Charge Code |
2963353
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$192.63 |
| Max. Negotiated Rate |
$361.67 |
| Rate for Payer: Aetna Commercial |
$353.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$338.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$208.35
|
| Rate for Payer: Cash Price |
$113.40
|
| Rate for Payer: Cigna Commercial |
$361.67
|
| Rate for Payer: Health EOS Commercial |
$349.88
|
| Rate for Payer: HFN Commercial |
$361.67
|
| Rate for Payer: Multiplan Commercial |
$314.50
|
| Rate for Payer: Preferred Network Access Commercial |
$361.67
|
| Rate for Payer: Quartz Beloit One Network |
$192.63
|
| Rate for Payer: Quartz Commercial |
$235.87
|
| Rate for Payer: WEA Trust Commercial |
$216.22
|
| Rate for Payer: WPS Commercial |
$291.17
|
|
|
DRAIN WOUND TUBING 1/4 0070330"
|
Facility
|
OP
|
$378.00
|
|
| Hospital Charge Code |
2963353
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$110.07 |
| Max. Negotiated Rate |
$361.67 |
| Rate for Payer: Aetna Commercial |
$353.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$338.08
|
| Rate for Payer: Aetna Managed Medicare |
$110.07
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$255.53
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$196.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$188.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$208.35
|
| Rate for Payer: Cash Price |
$113.40
|
| Rate for Payer: Cigna Commercial |
$361.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$220.00
|
| Rate for Payer: Health EOS Commercial |
$349.88
|
| Rate for Payer: HFN Commercial |
$361.67
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$294.84
|
| Rate for Payer: Multiplan Commercial |
$314.50
|
| Rate for Payer: NAPHCARE Commercial |
$235.87
|
| Rate for Payer: Preferred Network Access Commercial |
$361.67
|
| Rate for Payer: Quartz Beloit One Network |
$192.63
|
| Rate for Payer: Quartz Commercial |
$255.53
|
| Rate for Payer: Quartz Medicare Advantage |
$235.87
|
| Rate for Payer: The Alliance Commercial |
$196.56
|
| Rate for Payer: WEA Trust Commercial |
$216.22
|
| Rate for Payer: WPS Commercial |
$291.17
|
|
|
DRAIN WOUND TUBING FLAT 10mm 0070440
|
Facility
|
IP
|
$182.00
|
|
| Hospital Charge Code |
2963515
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$92.75 |
| Max. Negotiated Rate |
$174.14 |
| Rate for Payer: Aetna Commercial |
$170.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$162.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$100.32
|
| Rate for Payer: Cash Price |
$54.60
|
| Rate for Payer: Cigna Commercial |
$174.14
|
| Rate for Payer: Health EOS Commercial |
$168.46
|
| Rate for Payer: HFN Commercial |
$174.14
|
| Rate for Payer: Multiplan Commercial |
$151.42
|
| Rate for Payer: Preferred Network Access Commercial |
$174.14
|
| Rate for Payer: Quartz Beloit One Network |
$92.75
|
| Rate for Payer: Quartz Commercial |
$113.57
|
| Rate for Payer: WEA Trust Commercial |
$104.10
|
| Rate for Payer: WPS Commercial |
$140.19
|
|
|
DRAIN WOUND TUBING FLAT 10mm 0070440
|
Facility
|
OP
|
$182.00
|
|
| Hospital Charge Code |
2963515
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$53.00 |
| Max. Negotiated Rate |
$174.14 |
| Rate for Payer: Aetna Commercial |
$170.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$162.78
|
| Rate for Payer: Aetna Managed Medicare |
$53.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$123.03
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$94.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$90.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$100.32
|
| Rate for Payer: Cash Price |
$54.60
|
| Rate for Payer: Cigna Commercial |
$174.14
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$105.92
|
| Rate for Payer: Health EOS Commercial |
$168.46
|
| Rate for Payer: HFN Commercial |
$174.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$141.96
|
| Rate for Payer: Multiplan Commercial |
$151.42
|
| Rate for Payer: NAPHCARE Commercial |
$113.57
|
| Rate for Payer: Preferred Network Access Commercial |
$174.14
|
| Rate for Payer: Quartz Beloit One Network |
$92.75
|
| Rate for Payer: Quartz Commercial |
$123.03
|
| Rate for Payer: Quartz Medicare Advantage |
$113.57
|
| Rate for Payer: The Alliance Commercial |
$94.64
|
| Rate for Payer: WEA Trust Commercial |
$104.10
|
| Rate for Payer: WPS Commercial |
$140.19
|
|
|
DRAPE ALCON APERTURE 8065153120
|
Facility
|
IP
|
$382.00
|
|
| Hospital Charge Code |
5264687
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$194.67 |
| Max. Negotiated Rate |
$365.50 |
| Rate for Payer: Aetna Commercial |
$357.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$341.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$210.56
|
| Rate for Payer: Cash Price |
$114.60
|
| Rate for Payer: Cigna Commercial |
$365.50
|
| Rate for Payer: Health EOS Commercial |
$353.58
|
| Rate for Payer: HFN Commercial |
$365.50
|
| Rate for Payer: Multiplan Commercial |
$317.82
|
| Rate for Payer: Preferred Network Access Commercial |
$365.50
|
| Rate for Payer: Quartz Beloit One Network |
$194.67
|
| Rate for Payer: Quartz Commercial |
$238.37
|
| Rate for Payer: WEA Trust Commercial |
$218.50
|
| Rate for Payer: WPS Commercial |
$294.25
|
|
|
DRAPE ALCON APERTURE 8065153120
|
Facility
|
OP
|
$382.00
|
|
| Hospital Charge Code |
5264687
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$111.24 |
| Max. Negotiated Rate |
$365.50 |
| Rate for Payer: Aetna Commercial |
$357.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$341.66
|
| Rate for Payer: Aetna Managed Medicare |
$111.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$258.23
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$198.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$190.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$210.56
|
| Rate for Payer: Cash Price |
$114.60
|
| Rate for Payer: Cigna Commercial |
$365.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$222.32
|
| Rate for Payer: Health EOS Commercial |
$353.58
|
| Rate for Payer: HFN Commercial |
$365.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$297.96
|
| Rate for Payer: Multiplan Commercial |
$317.82
|
| Rate for Payer: NAPHCARE Commercial |
$238.37
|
| Rate for Payer: Preferred Network Access Commercial |
$365.50
|
| Rate for Payer: Quartz Beloit One Network |
$194.67
|
| Rate for Payer: Quartz Commercial |
$258.23
|
| Rate for Payer: Quartz Medicare Advantage |
$238.37
|
| Rate for Payer: The Alliance Commercial |
$198.64
|
| Rate for Payer: WEA Trust Commercial |
$218.50
|
| Rate for Payer: WPS Commercial |
$294.25
|
|
|
DRAPE ARTHOSCOPY ORTHOARTS 89267
|
Facility
|
OP
|
$777.00
|
|
| Hospital Charge Code |
2963022
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$226.26 |
| Max. Negotiated Rate |
$743.43 |
| Rate for Payer: Aetna Commercial |
$727.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$694.95
|
| Rate for Payer: Aetna Managed Medicare |
$226.26
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$525.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$404.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$387.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$428.28
|
| Rate for Payer: Cash Price |
$233.10
|
| Rate for Payer: Cigna Commercial |
$743.43
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$452.21
|
| Rate for Payer: Health EOS Commercial |
$719.19
|
| Rate for Payer: HFN Commercial |
$743.43
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$606.06
|
| Rate for Payer: Multiplan Commercial |
$646.46
|
| Rate for Payer: NAPHCARE Commercial |
$484.85
|
| Rate for Payer: Preferred Network Access Commercial |
$743.43
|
| Rate for Payer: Quartz Beloit One Network |
$395.96
|
| Rate for Payer: Quartz Commercial |
$525.25
|
| Rate for Payer: Quartz Medicare Advantage |
$484.85
|
| Rate for Payer: The Alliance Commercial |
$404.04
|
| Rate for Payer: WEA Trust Commercial |
$444.44
|
| Rate for Payer: WPS Commercial |
$598.52
|
|
|
DRAPE ARTHOSCOPY ORTHOARTS 89267
|
Facility
|
IP
|
$777.00
|
|
| Hospital Charge Code |
2963022
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$395.96 |
| Max. Negotiated Rate |
$743.43 |
| Rate for Payer: Aetna Commercial |
$727.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$694.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$428.28
|
| Rate for Payer: Cash Price |
$233.10
|
| Rate for Payer: Cigna Commercial |
$743.43
|
| Rate for Payer: Health EOS Commercial |
$719.19
|
| Rate for Payer: HFN Commercial |
$743.43
|
| Rate for Payer: Multiplan Commercial |
$646.46
|
| Rate for Payer: Preferred Network Access Commercial |
$743.43
|
| Rate for Payer: Quartz Beloit One Network |
$395.96
|
| Rate for Payer: Quartz Commercial |
$484.85
|
| Rate for Payer: WEA Trust Commercial |
$444.44
|
| Rate for Payer: WPS Commercial |
$598.52
|
|
|
DRAPE BARRIER STERILE FIELD
|
Facility
|
OP
|
$84.00
|
|
| Hospital Charge Code |
2963937
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$24.46 |
| Max. Negotiated Rate |
$80.37 |
| Rate for Payer: Aetna Commercial |
$78.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$75.13
|
| Rate for Payer: Aetna Managed Medicare |
$24.46
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$56.78
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$43.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$41.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$46.30
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cigna Commercial |
$80.37
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$48.89
|
| Rate for Payer: Health EOS Commercial |
$77.75
|
| Rate for Payer: HFN Commercial |
$80.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$65.52
|
| Rate for Payer: Multiplan Commercial |
$69.89
|
| Rate for Payer: NAPHCARE Commercial |
$52.42
|
| Rate for Payer: Preferred Network Access Commercial |
$80.37
|
| Rate for Payer: Quartz Beloit One Network |
$42.81
|
| Rate for Payer: Quartz Commercial |
$56.78
|
| Rate for Payer: Quartz Medicare Advantage |
$52.42
|
| Rate for Payer: The Alliance Commercial |
$43.68
|
| Rate for Payer: WEA Trust Commercial |
$48.05
|
| Rate for Payer: WPS Commercial |
$64.71
|
|
|
DRAPE BARRIER STERILE FIELD
|
Facility
|
IP
|
$84.00
|
|
| Hospital Charge Code |
2963937
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$42.81 |
| Max. Negotiated Rate |
$80.37 |
| Rate for Payer: Aetna Commercial |
$78.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$75.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$46.30
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cigna Commercial |
$80.37
|
| Rate for Payer: Health EOS Commercial |
$77.75
|
| Rate for Payer: HFN Commercial |
$80.37
|
| Rate for Payer: Multiplan Commercial |
$69.89
|
| Rate for Payer: Preferred Network Access Commercial |
$80.37
|
| Rate for Payer: Quartz Beloit One Network |
$42.81
|
| Rate for Payer: Quartz Commercial |
$52.42
|
| Rate for Payer: WEA Trust Commercial |
$48.05
|
| Rate for Payer: WPS Commercial |
$64.71
|
|
|
DRAPE BEACH CHAIR 89066
|
Facility
|
OP
|
$375.00
|
|
| Hospital Charge Code |
6202988
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$109.20 |
| Max. Negotiated Rate |
$358.80 |
| Rate for Payer: Aetna Commercial |
$351.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$335.40
|
| Rate for Payer: Aetna Managed Medicare |
$109.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$253.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$195.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$187.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$206.70
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cigna Commercial |
$358.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$218.25
|
| Rate for Payer: Health EOS Commercial |
$347.10
|
| Rate for Payer: HFN Commercial |
$358.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$292.50
|
| Rate for Payer: Multiplan Commercial |
$312.00
|
| Rate for Payer: NAPHCARE Commercial |
$234.00
|
| Rate for Payer: Preferred Network Access Commercial |
$358.80
|
| Rate for Payer: Quartz Beloit One Network |
$191.10
|
| Rate for Payer: Quartz Commercial |
$253.50
|
| Rate for Payer: Quartz Medicare Advantage |
$234.00
|
| Rate for Payer: The Alliance Commercial |
$195.00
|
| Rate for Payer: WEA Trust Commercial |
$214.50
|
| Rate for Payer: WPS Commercial |
$288.86
|
|
|
DRAPE BEACH CHAIR 89066
|
Facility
|
IP
|
$375.00
|
|
| Hospital Charge Code |
6202988
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$191.10 |
| Max. Negotiated Rate |
$358.80 |
| Rate for Payer: Aetna Commercial |
$351.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$335.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$206.70
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cigna Commercial |
$358.80
|
| Rate for Payer: Health EOS Commercial |
$347.10
|
| Rate for Payer: HFN Commercial |
$358.80
|
| Rate for Payer: Multiplan Commercial |
$312.00
|
| Rate for Payer: Preferred Network Access Commercial |
$358.80
|
| Rate for Payer: Quartz Beloit One Network |
$191.10
|
| Rate for Payer: Quartz Commercial |
$234.00
|
| Rate for Payer: WEA Trust Commercial |
$214.50
|
| Rate for Payer: WPS Commercial |
$288.86
|
|
|
DRAPE BRACHIAL ANGIOGRAPHY
|
Facility
|
OP
|
$93.00
|
|
| Hospital Charge Code |
2974748
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$27.08 |
| Max. Negotiated Rate |
$88.98 |
| Rate for Payer: Aetna Commercial |
$87.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$83.18
|
| Rate for Payer: Aetna Managed Medicare |
$27.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$62.87
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$48.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$46.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$51.26
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cigna Commercial |
$88.98
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$54.13
|
| Rate for Payer: Health EOS Commercial |
$86.08
|
| Rate for Payer: HFN Commercial |
$88.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$72.54
|
| Rate for Payer: Multiplan Commercial |
$77.38
|
| Rate for Payer: NAPHCARE Commercial |
$58.03
|
| Rate for Payer: Preferred Network Access Commercial |
$88.98
|
| Rate for Payer: Quartz Beloit One Network |
$47.39
|
| Rate for Payer: Quartz Commercial |
$62.87
|
| Rate for Payer: Quartz Medicare Advantage |
$58.03
|
| Rate for Payer: The Alliance Commercial |
$48.36
|
| Rate for Payer: WEA Trust Commercial |
$53.20
|
| Rate for Payer: WPS Commercial |
$71.64
|
|
|
DRAPE BRACHIAL ANGIOGRAPHY
|
Facility
|
IP
|
$93.00
|
|
| Hospital Charge Code |
2974748
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$47.39 |
| Max. Negotiated Rate |
$88.98 |
| Rate for Payer: Aetna Commercial |
$87.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$83.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$51.26
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cigna Commercial |
$88.98
|
| Rate for Payer: Health EOS Commercial |
$86.08
|
| Rate for Payer: HFN Commercial |
$88.98
|
| Rate for Payer: Multiplan Commercial |
$77.38
|
| Rate for Payer: Preferred Network Access Commercial |
$88.98
|
| Rate for Payer: Quartz Beloit One Network |
$47.39
|
| Rate for Payer: Quartz Commercial |
$58.03
|
| Rate for Payer: WEA Trust Commercial |
$53.20
|
| Rate for Payer: WPS Commercial |
$71.64
|
|
|
DRAPE BUTTOCK POUCH 29.5X44 89415
|
Facility
|
IP
|
$80.00
|
|
| Hospital Charge Code |
5106622
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$40.77 |
| Max. Negotiated Rate |
$76.54 |
| Rate for Payer: Aetna Commercial |
$74.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$71.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$44.10
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cigna Commercial |
$76.54
|
| Rate for Payer: Health EOS Commercial |
$74.05
|
| Rate for Payer: HFN Commercial |
$76.54
|
| Rate for Payer: Multiplan Commercial |
$66.56
|
| Rate for Payer: Preferred Network Access Commercial |
$76.54
|
| Rate for Payer: Quartz Beloit One Network |
$40.77
|
| Rate for Payer: Quartz Commercial |
$49.92
|
| Rate for Payer: WEA Trust Commercial |
$45.76
|
| Rate for Payer: WPS Commercial |
$61.62
|
|
|
DRAPE BUTTOCK POUCH 29.5X44 89415
|
Facility
|
OP
|
$80.00
|
|
| Hospital Charge Code |
5106622
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$23.30 |
| Max. Negotiated Rate |
$76.54 |
| Rate for Payer: Aetna Commercial |
$74.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$71.55
|
| Rate for Payer: Aetna Managed Medicare |
$23.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$54.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$41.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$39.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$44.10
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cigna Commercial |
$76.54
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$46.56
|
| Rate for Payer: Health EOS Commercial |
$74.05
|
| Rate for Payer: HFN Commercial |
$76.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$62.40
|
| Rate for Payer: Multiplan Commercial |
$66.56
|
| Rate for Payer: NAPHCARE Commercial |
$49.92
|
| Rate for Payer: Preferred Network Access Commercial |
$76.54
|
| Rate for Payer: Quartz Beloit One Network |
$40.77
|
| Rate for Payer: Quartz Commercial |
$54.08
|
| Rate for Payer: Quartz Medicare Advantage |
$49.92
|
| Rate for Payer: The Alliance Commercial |
$41.60
|
| Rate for Payer: WEA Trust Commercial |
$45.76
|
| Rate for Payer: WPS Commercial |
$61.62
|
|
|
DRAPE C-ARM MINI ORTHOSCAN 1000-0100
|
Facility
|
OP
|
$289.00
|
|
| Hospital Charge Code |
3369506
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$84.16 |
| Max. Negotiated Rate |
$276.52 |
| Rate for Payer: Aetna Commercial |
$270.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$258.48
|
| Rate for Payer: Aetna Managed Medicare |
$84.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$195.36
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$150.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$144.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$159.30
|
| Rate for Payer: Cash Price |
$86.70
|
| Rate for Payer: Cigna Commercial |
$276.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$168.20
|
| Rate for Payer: Health EOS Commercial |
$267.50
|
| Rate for Payer: HFN Commercial |
$276.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$225.42
|
| Rate for Payer: Multiplan Commercial |
$240.45
|
| Rate for Payer: NAPHCARE Commercial |
$180.34
|
| Rate for Payer: Preferred Network Access Commercial |
$276.52
|
| Rate for Payer: Quartz Beloit One Network |
$147.27
|
| Rate for Payer: Quartz Commercial |
$195.36
|
| Rate for Payer: Quartz Medicare Advantage |
$180.34
|
| Rate for Payer: The Alliance Commercial |
$150.28
|
| Rate for Payer: WEA Trust Commercial |
$165.31
|
| Rate for Payer: WPS Commercial |
$222.62
|
|
|
DRAPE C-ARM MINI ORTHOSCAN 1000-0100
|
Facility
|
IP
|
$289.00
|
|
| Hospital Charge Code |
3369506
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$147.27 |
| Max. Negotiated Rate |
$276.52 |
| Rate for Payer: Aetna Commercial |
$270.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$258.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$159.30
|
| Rate for Payer: Cash Price |
$86.70
|
| Rate for Payer: Cigna Commercial |
$276.52
|
| Rate for Payer: Health EOS Commercial |
$267.50
|
| Rate for Payer: HFN Commercial |
$276.52
|
| Rate for Payer: Multiplan Commercial |
$240.45
|
| Rate for Payer: Preferred Network Access Commercial |
$276.52
|
| Rate for Payer: Quartz Beloit One Network |
$147.27
|
| Rate for Payer: Quartz Commercial |
$180.34
|
| Rate for Payer: WEA Trust Commercial |
$165.31
|
| Rate for Payer: WPS Commercial |
$222.62
|
|
|
DRAPE C-ARM MOBILE X-RAY 4951
|
Facility
|
IP
|
$140.00
|
|
| Hospital Charge Code |
2963434
|
|
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
|
|
|
DRAPE C-ARM MOBILE X-RAY 4951
|
Facility
|
OP
|
$140.00
|
|
| Hospital Charge Code |
2963434
|
|
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
|
|
|
DRAPE C-ARMOR 5523
|
Facility
|
IP
|
$854.00
|
|
| Hospital Charge Code |
5240715
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$435.20 |
| Max. Negotiated Rate |
$817.11 |
| Rate for Payer: Aetna Commercial |
$799.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$763.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$470.72
|
| Rate for Payer: Cash Price |
$256.20
|
| Rate for Payer: Cigna Commercial |
$817.11
|
| Rate for Payer: Health EOS Commercial |
$790.46
|
| Rate for Payer: HFN Commercial |
$817.11
|
| Rate for Payer: Multiplan Commercial |
$710.53
|
| Rate for Payer: Preferred Network Access Commercial |
$817.11
|
| Rate for Payer: Quartz Beloit One Network |
$435.20
|
| Rate for Payer: Quartz Commercial |
$532.90
|
| Rate for Payer: WEA Trust Commercial |
$488.49
|
| Rate for Payer: WPS Commercial |
$657.84
|
|
|
DRAPE C-ARMOR 5523
|
Facility
|
OP
|
$854.00
|
|
| Hospital Charge Code |
5240715
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$248.68 |
| Max. Negotiated Rate |
$817.11 |
| Rate for Payer: Aetna Commercial |
$799.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$763.82
|
| Rate for Payer: Aetna Managed Medicare |
$248.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$577.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$444.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$426.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$470.72
|
| Rate for Payer: Cash Price |
$256.20
|
| Rate for Payer: Cigna Commercial |
$817.11
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$497.03
|
| Rate for Payer: Health EOS Commercial |
$790.46
|
| Rate for Payer: HFN Commercial |
$817.11
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$666.12
|
| Rate for Payer: Multiplan Commercial |
$710.53
|
| Rate for Payer: NAPHCARE Commercial |
$532.90
|
| Rate for Payer: Preferred Network Access Commercial |
$817.11
|
| Rate for Payer: Quartz Beloit One Network |
$435.20
|
| Rate for Payer: Quartz Commercial |
$577.30
|
| Rate for Payer: Quartz Medicare Advantage |
$532.90
|
| Rate for Payer: The Alliance Commercial |
$444.08
|
| Rate for Payer: WEA Trust Commercial |
$488.49
|
| Rate for Payer: WPS Commercial |
$657.84
|
|
