|
DRAPE CASSETTE LATEX FREE 890010
|
Facility
|
OP
|
$106.00
|
|
| Hospital Charge Code |
2963355
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$30.87 |
| Max. Negotiated Rate |
$101.42 |
| Rate for Payer: Aetna Commercial |
$99.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$94.81
|
| Rate for Payer: Aetna Managed Medicare |
$30.87
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$71.66
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$55.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$52.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$58.43
|
| Rate for Payer: Cash Price |
$31.80
|
| Rate for Payer: Cigna Commercial |
$101.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$61.69
|
| Rate for Payer: Health EOS Commercial |
$98.11
|
| Rate for Payer: HFN Commercial |
$101.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$82.68
|
| Rate for Payer: Multiplan Commercial |
$88.19
|
| Rate for Payer: NAPHCARE Commercial |
$66.14
|
| Rate for Payer: Preferred Network Access Commercial |
$101.42
|
| Rate for Payer: Quartz Beloit One Network |
$54.02
|
| Rate for Payer: Quartz Commercial |
$71.66
|
| Rate for Payer: Quartz Medicare Advantage |
$66.14
|
| Rate for Payer: The Alliance Commercial |
$55.12
|
| Rate for Payer: WEA Trust Commercial |
$60.63
|
| Rate for Payer: WPS Commercial |
$81.65
|
|
|
DRAPE CASSETTE LATEX FREE 890010
|
Facility
|
IP
|
$106.00
|
|
| Hospital Charge Code |
2963355
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$54.02 |
| Max. Negotiated Rate |
$101.42 |
| Rate for Payer: Aetna Commercial |
$99.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$94.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$58.43
|
| Rate for Payer: Cash Price |
$31.80
|
| Rate for Payer: Cigna Commercial |
$101.42
|
| Rate for Payer: Health EOS Commercial |
$98.11
|
| Rate for Payer: HFN Commercial |
$101.42
|
| Rate for Payer: Multiplan Commercial |
$88.19
|
| Rate for Payer: Preferred Network Access Commercial |
$101.42
|
| Rate for Payer: Quartz Beloit One Network |
$54.02
|
| Rate for Payer: Quartz Commercial |
$66.14
|
| Rate for Payer: WEA Trust Commercial |
$60.63
|
| Rate for Payer: WPS Commercial |
$81.65
|
|
|
DRAPE CRANIOTOMY W/POUCH
|
Facility
|
OP
|
$460.00
|
|
| Hospital Charge Code |
2963058
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$133.95 |
| Max. Negotiated Rate |
$440.13 |
| Rate for Payer: Aetna Commercial |
$430.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$411.42
|
| Rate for Payer: Aetna Managed Medicare |
$133.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$310.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$239.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$229.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$253.55
|
| Rate for Payer: Cash Price |
$138.00
|
| Rate for Payer: Cigna Commercial |
$440.13
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$267.72
|
| Rate for Payer: Health EOS Commercial |
$425.78
|
| Rate for Payer: HFN Commercial |
$440.13
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$358.80
|
| Rate for Payer: Multiplan Commercial |
$382.72
|
| Rate for Payer: NAPHCARE Commercial |
$287.04
|
| Rate for Payer: Preferred Network Access Commercial |
$440.13
|
| Rate for Payer: Quartz Beloit One Network |
$234.42
|
| Rate for Payer: Quartz Commercial |
$310.96
|
| Rate for Payer: Quartz Medicare Advantage |
$287.04
|
| Rate for Payer: The Alliance Commercial |
$239.20
|
| Rate for Payer: WEA Trust Commercial |
$263.12
|
| Rate for Payer: WPS Commercial |
$354.34
|
|
|
DRAPE CRANIOTOMY W/POUCH
|
Facility
|
IP
|
$460.00
|
|
| Hospital Charge Code |
2963058
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$234.42 |
| Max. Negotiated Rate |
$440.13 |
| Rate for Payer: Aetna Commercial |
$430.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$411.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$253.55
|
| Rate for Payer: Cash Price |
$138.00
|
| Rate for Payer: Cigna Commercial |
$440.13
|
| Rate for Payer: Health EOS Commercial |
$425.78
|
| Rate for Payer: HFN Commercial |
$440.13
|
| Rate for Payer: Multiplan Commercial |
$382.72
|
| Rate for Payer: Preferred Network Access Commercial |
$440.13
|
| Rate for Payer: Quartz Beloit One Network |
$234.42
|
| Rate for Payer: Quartz Commercial |
$287.04
|
| Rate for Payer: WEA Trust Commercial |
$263.12
|
| Rate for Payer: WPS Commercial |
$354.34
|
|
|
DRAPE C-SECTION STERI-DRAPE IOBAN 2 3M 6697
|
Facility
|
OP
|
$695.00
|
|
| Hospital Charge Code |
2963146
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$202.38 |
| Max. Negotiated Rate |
$664.98 |
| Rate for Payer: Aetna Commercial |
$650.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$621.61
|
| Rate for Payer: Aetna Managed Medicare |
$202.38
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$469.82
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$361.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$346.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$383.08
|
| Rate for Payer: Cash Price |
$208.50
|
| Rate for Payer: Cigna Commercial |
$664.98
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$404.49
|
| Rate for Payer: Health EOS Commercial |
$643.29
|
| Rate for Payer: HFN Commercial |
$664.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$542.10
|
| Rate for Payer: Multiplan Commercial |
$578.24
|
| Rate for Payer: NAPHCARE Commercial |
$433.68
|
| Rate for Payer: Preferred Network Access Commercial |
$664.98
|
| Rate for Payer: Quartz Beloit One Network |
$354.17
|
| Rate for Payer: Quartz Commercial |
$469.82
|
| Rate for Payer: Quartz Medicare Advantage |
$433.68
|
| Rate for Payer: The Alliance Commercial |
$361.40
|
| Rate for Payer: WEA Trust Commercial |
$397.54
|
| Rate for Payer: WPS Commercial |
$535.36
|
|
|
DRAPE C-SECTION STERI-DRAPE IOBAN 2 3M 6697
|
Facility
|
IP
|
$695.00
|
|
| Hospital Charge Code |
2963146
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$354.17 |
| Max. Negotiated Rate |
$664.98 |
| Rate for Payer: Aetna Commercial |
$650.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$621.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$383.08
|
| Rate for Payer: Cash Price |
$208.50
|
| Rate for Payer: Cigna Commercial |
$664.98
|
| Rate for Payer: Health EOS Commercial |
$643.29
|
| Rate for Payer: HFN Commercial |
$664.98
|
| Rate for Payer: Multiplan Commercial |
$578.24
|
| Rate for Payer: Preferred Network Access Commercial |
$664.98
|
| Rate for Payer: Quartz Beloit One Network |
$354.17
|
| Rate for Payer: Quartz Commercial |
$433.68
|
| Rate for Payer: WEA Trust Commercial |
$397.54
|
| Rate for Payer: WPS Commercial |
$535.36
|
|
|
DRAPE FENESTRATED BLUE DRAPE 17 X 27 PAIN MGT 189A18
|
Facility
|
IP
|
$244.00
|
|
| Hospital Charge Code |
4595222
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$124.34 |
| Max. Negotiated Rate |
$233.46 |
| Rate for Payer: Aetna Commercial |
$228.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$218.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$134.49
|
| Rate for Payer: Cash Price |
$73.20
|
| Rate for Payer: Cigna Commercial |
$233.46
|
| Rate for Payer: Health EOS Commercial |
$225.85
|
| Rate for Payer: HFN Commercial |
$233.46
|
| Rate for Payer: Multiplan Commercial |
$203.01
|
| Rate for Payer: Preferred Network Access Commercial |
$233.46
|
| Rate for Payer: Quartz Beloit One Network |
$124.34
|
| Rate for Payer: Quartz Commercial |
$152.26
|
| Rate for Payer: WEA Trust Commercial |
$139.57
|
| Rate for Payer: WPS Commercial |
$187.95
|
|
|
DRAPE FENESTRATED BLUE DRAPE 17 X 27 PAIN MGT 189A18
|
Facility
|
OP
|
$244.00
|
|
| Hospital Charge Code |
4595222
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$71.05 |
| Max. Negotiated Rate |
$233.46 |
| Rate for Payer: Aetna Commercial |
$228.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$218.23
|
| Rate for Payer: Aetna Managed Medicare |
$71.05
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$164.94
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$126.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$121.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$134.49
|
| Rate for Payer: Cash Price |
$73.20
|
| Rate for Payer: Cigna Commercial |
$233.46
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$142.01
|
| Rate for Payer: Health EOS Commercial |
$225.85
|
| Rate for Payer: HFN Commercial |
$233.46
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$190.32
|
| Rate for Payer: Multiplan Commercial |
$203.01
|
| Rate for Payer: NAPHCARE Commercial |
$152.26
|
| Rate for Payer: Preferred Network Access Commercial |
$233.46
|
| Rate for Payer: Quartz Beloit One Network |
$124.34
|
| Rate for Payer: Quartz Commercial |
$164.94
|
| Rate for Payer: Quartz Medicare Advantage |
$152.26
|
| Rate for Payer: The Alliance Commercial |
$126.88
|
| Rate for Payer: WEA Trust Commercial |
$139.57
|
| Rate for Payer: WPS Commercial |
$187.95
|
|
|
DRAPE HIP/POUCHES DYNJP8201
|
Facility
|
OP
|
$244.00
|
|
| Hospital Charge Code |
6220141
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$71.05 |
| Max. Negotiated Rate |
$233.46 |
| Rate for Payer: Aetna Commercial |
$228.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$218.23
|
| Rate for Payer: Aetna Managed Medicare |
$71.05
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$164.94
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$126.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$121.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$134.49
|
| Rate for Payer: Cash Price |
$73.20
|
| Rate for Payer: Cigna Commercial |
$233.46
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$142.01
|
| Rate for Payer: Health EOS Commercial |
$225.85
|
| Rate for Payer: HFN Commercial |
$233.46
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$190.32
|
| Rate for Payer: Multiplan Commercial |
$203.01
|
| Rate for Payer: NAPHCARE Commercial |
$152.26
|
| Rate for Payer: Preferred Network Access Commercial |
$233.46
|
| Rate for Payer: Quartz Beloit One Network |
$124.34
|
| Rate for Payer: Quartz Commercial |
$164.94
|
| Rate for Payer: Quartz Medicare Advantage |
$152.26
|
| Rate for Payer: The Alliance Commercial |
$126.88
|
| Rate for Payer: WEA Trust Commercial |
$139.57
|
| Rate for Payer: WPS Commercial |
$187.95
|
|
|
DRAPE HIP/POUCHES DYNJP8201
|
Facility
|
IP
|
$244.00
|
|
| Hospital Charge Code |
6220141
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$124.34 |
| Max. Negotiated Rate |
$233.46 |
| Rate for Payer: Aetna Commercial |
$228.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$218.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$134.49
|
| Rate for Payer: Cash Price |
$73.20
|
| Rate for Payer: Cigna Commercial |
$233.46
|
| Rate for Payer: Health EOS Commercial |
$225.85
|
| Rate for Payer: HFN Commercial |
$233.46
|
| Rate for Payer: Multiplan Commercial |
$203.01
|
| Rate for Payer: Preferred Network Access Commercial |
$233.46
|
| Rate for Payer: Quartz Beloit One Network |
$124.34
|
| Rate for Payer: Quartz Commercial |
$152.26
|
| Rate for Payer: WEA Trust Commercial |
$139.57
|
| Rate for Payer: WPS Commercial |
$187.95
|
|
|
DRAPE INCISE 13X13 IOBAN 6640EZ
|
Facility
|
IP
|
$34.00
|
|
| Hospital Charge Code |
2963578
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$17.33 |
| Max. Negotiated Rate |
$32.53 |
| Rate for Payer: Aetna Commercial |
$31.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$30.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$18.74
|
| Rate for Payer: Cash Price |
$10.20
|
| Rate for Payer: Cigna Commercial |
$32.53
|
| Rate for Payer: Health EOS Commercial |
$31.47
|
| Rate for Payer: HFN Commercial |
$32.53
|
| Rate for Payer: Multiplan Commercial |
$28.29
|
| Rate for Payer: Preferred Network Access Commercial |
$32.53
|
| Rate for Payer: Quartz Beloit One Network |
$17.33
|
| Rate for Payer: Quartz Commercial |
$21.22
|
| Rate for Payer: WEA Trust Commercial |
$19.45
|
| Rate for Payer: WPS Commercial |
$26.19
|
|
|
DRAPE INCISE 13X13 IOBAN 6640EZ
|
Facility
|
OP
|
$34.00
|
|
| Hospital Charge Code |
2963578
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.90 |
| Max. Negotiated Rate |
$32.53 |
| Rate for Payer: Aetna Commercial |
$31.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$30.41
|
| Rate for Payer: Aetna Managed Medicare |
$9.90
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$22.98
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$17.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$16.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$18.74
|
| Rate for Payer: Cash Price |
$10.20
|
| Rate for Payer: Cigna Commercial |
$32.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$19.79
|
| Rate for Payer: Health EOS Commercial |
$31.47
|
| Rate for Payer: HFN Commercial |
$32.53
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$26.52
|
| Rate for Payer: Multiplan Commercial |
$28.29
|
| Rate for Payer: NAPHCARE Commercial |
$21.22
|
| Rate for Payer: Preferred Network Access Commercial |
$32.53
|
| Rate for Payer: Quartz Beloit One Network |
$17.33
|
| Rate for Payer: Quartz Commercial |
$22.98
|
| Rate for Payer: Quartz Medicare Advantage |
$21.22
|
| Rate for Payer: The Alliance Commercial |
$17.68
|
| Rate for Payer: WEA Trust Commercial |
$19.45
|
| Rate for Payer: WPS Commercial |
$26.19
|
|
|
DRAPE INCISE LARGE IOBAN 6651EZ
|
Facility
|
OP
|
$93.00
|
|
| Hospital Charge Code |
2963908
|
|
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 INCISE LARGE IOBAN 6651EZ
|
Facility
|
IP
|
$93.00
|
|
| Hospital Charge Code |
2963908
|
|
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 IOBAN 29X29 6658
|
Facility
|
OP
|
$462.00
|
|
| Hospital Charge Code |
2965805
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$134.53 |
| Max. Negotiated Rate |
$442.04 |
| Rate for Payer: Aetna Commercial |
$432.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$413.21
|
| Rate for Payer: Aetna Managed Medicare |
$134.53
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$312.31
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$240.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$230.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$254.65
|
| Rate for Payer: Cash Price |
$138.60
|
| Rate for Payer: Cigna Commercial |
$442.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$268.88
|
| Rate for Payer: Health EOS Commercial |
$427.63
|
| Rate for Payer: HFN Commercial |
$442.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$360.36
|
| Rate for Payer: Multiplan Commercial |
$384.38
|
| Rate for Payer: NAPHCARE Commercial |
$288.29
|
| Rate for Payer: Preferred Network Access Commercial |
$442.04
|
| Rate for Payer: Quartz Beloit One Network |
$235.44
|
| Rate for Payer: Quartz Commercial |
$312.31
|
| Rate for Payer: Quartz Medicare Advantage |
$288.29
|
| Rate for Payer: The Alliance Commercial |
$240.24
|
| Rate for Payer: WEA Trust Commercial |
$264.26
|
| Rate for Payer: WPS Commercial |
$355.88
|
|
|
DRAPE IOBAN 29X29 6658
|
Facility
|
IP
|
$462.00
|
|
| Hospital Charge Code |
2965805
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$235.44 |
| Max. Negotiated Rate |
$442.04 |
| Rate for Payer: Aetna Commercial |
$432.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$413.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$254.65
|
| Rate for Payer: Cash Price |
$138.60
|
| Rate for Payer: Cigna Commercial |
$442.04
|
| Rate for Payer: Health EOS Commercial |
$427.63
|
| Rate for Payer: HFN Commercial |
$442.04
|
| Rate for Payer: Multiplan Commercial |
$384.38
|
| Rate for Payer: Preferred Network Access Commercial |
$442.04
|
| Rate for Payer: Quartz Beloit One Network |
$235.44
|
| Rate for Payer: Quartz Commercial |
$288.29
|
| Rate for Payer: WEA Trust Commercial |
$264.26
|
| Rate for Payer: WPS Commercial |
$355.88
|
|
|
DRAPE ISOL.W/IRRIG.POUCH 9106-07
|
Facility
|
IP
|
$991.00
|
|
| Hospital Charge Code |
2962892
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$505.01 |
| Max. Negotiated Rate |
$948.19 |
| Rate for Payer: Aetna Commercial |
$927.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$886.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$546.24
|
| Rate for Payer: Cash Price |
$297.30
|
| Rate for Payer: Cigna Commercial |
$948.19
|
| Rate for Payer: Health EOS Commercial |
$917.27
|
| Rate for Payer: HFN Commercial |
$948.19
|
| Rate for Payer: Multiplan Commercial |
$824.51
|
| Rate for Payer: Preferred Network Access Commercial |
$948.19
|
| Rate for Payer: Quartz Beloit One Network |
$505.01
|
| Rate for Payer: Quartz Commercial |
$618.38
|
| Rate for Payer: WEA Trust Commercial |
$566.85
|
| Rate for Payer: WPS Commercial |
$763.37
|
|
|
DRAPE ISOL.W/IRRIG.POUCH 9106-07
|
Facility
|
OP
|
$991.00
|
|
| Hospital Charge Code |
2962892
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$288.58 |
| Max. Negotiated Rate |
$948.19 |
| Rate for Payer: Aetna Commercial |
$927.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$886.35
|
| Rate for Payer: Aetna Managed Medicare |
$288.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$669.92
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$515.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$494.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$546.24
|
| Rate for Payer: Cash Price |
$297.30
|
| Rate for Payer: Cigna Commercial |
$948.19
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$576.76
|
| Rate for Payer: Health EOS Commercial |
$917.27
|
| Rate for Payer: HFN Commercial |
$948.19
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$772.98
|
| Rate for Payer: Multiplan Commercial |
$824.51
|
| Rate for Payer: NAPHCARE Commercial |
$618.38
|
| Rate for Payer: Preferred Network Access Commercial |
$948.19
|
| Rate for Payer: Quartz Beloit One Network |
$505.01
|
| Rate for Payer: Quartz Commercial |
$669.92
|
| Rate for Payer: Quartz Medicare Advantage |
$618.38
|
| Rate for Payer: The Alliance Commercial |
$515.32
|
| Rate for Payer: WEA Trust Commercial |
$566.85
|
| Rate for Payer: WPS Commercial |
$763.37
|
|
|
DRAPE LAPAROSCOPIC ABDOMINAL 89233
|
Facility
|
OP
|
$268.00
|
|
| Hospital Charge Code |
5240716
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$78.04 |
| Max. Negotiated Rate |
$256.42 |
| Rate for Payer: Aetna Commercial |
$250.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$239.70
|
| Rate for Payer: Aetna Managed Medicare |
$78.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$181.17
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$139.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$133.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$147.72
|
| Rate for Payer: Cash Price |
$80.40
|
| Rate for Payer: Cigna Commercial |
$256.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$155.98
|
| Rate for Payer: Health EOS Commercial |
$248.06
|
| Rate for Payer: HFN Commercial |
$256.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$209.04
|
| Rate for Payer: Multiplan Commercial |
$222.98
|
| Rate for Payer: NAPHCARE Commercial |
$167.23
|
| Rate for Payer: Preferred Network Access Commercial |
$256.42
|
| Rate for Payer: Quartz Beloit One Network |
$136.57
|
| Rate for Payer: Quartz Commercial |
$181.17
|
| Rate for Payer: Quartz Medicare Advantage |
$167.23
|
| Rate for Payer: The Alliance Commercial |
$139.36
|
| Rate for Payer: WEA Trust Commercial |
$153.30
|
| Rate for Payer: WPS Commercial |
$206.44
|
|
|
DRAPE LAPAROSCOPIC ABDOMINAL 89233
|
Facility
|
IP
|
$268.00
|
|
| Hospital Charge Code |
5240716
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$136.57 |
| Max. Negotiated Rate |
$256.42 |
| Rate for Payer: Aetna Commercial |
$250.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$239.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$147.72
|
| Rate for Payer: Cash Price |
$80.40
|
| Rate for Payer: Cigna Commercial |
$256.42
|
| Rate for Payer: Health EOS Commercial |
$248.06
|
| Rate for Payer: HFN Commercial |
$256.42
|
| Rate for Payer: Multiplan Commercial |
$222.98
|
| Rate for Payer: Preferred Network Access Commercial |
$256.42
|
| Rate for Payer: Quartz Beloit One Network |
$136.57
|
| Rate for Payer: Quartz Commercial |
$167.23
|
| Rate for Payer: WEA Trust Commercial |
$153.30
|
| Rate for Payer: WPS Commercial |
$206.44
|
|
|
DRAPE LAPAROTOMY 89221
|
Facility
|
IP
|
$192.00
|
|
| Hospital Charge Code |
2963264
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$97.84 |
| Max. Negotiated Rate |
$183.71 |
| Rate for Payer: Aetna Commercial |
$179.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$171.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$105.83
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cigna Commercial |
$183.71
|
| Rate for Payer: Health EOS Commercial |
$177.72
|
| Rate for Payer: HFN Commercial |
$183.71
|
| Rate for Payer: Multiplan Commercial |
$159.74
|
| Rate for Payer: Preferred Network Access Commercial |
$183.71
|
| Rate for Payer: Quartz Beloit One Network |
$97.84
|
| Rate for Payer: Quartz Commercial |
$119.81
|
| Rate for Payer: WEA Trust Commercial |
$109.82
|
| Rate for Payer: WPS Commercial |
$147.90
|
|
|
DRAPE LAPAROTOMY 89221
|
Facility
|
OP
|
$192.00
|
|
| Hospital Charge Code |
2963264
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$55.91 |
| Max. Negotiated Rate |
$183.71 |
| Rate for Payer: Aetna Commercial |
$179.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$171.72
|
| Rate for Payer: Aetna Managed Medicare |
$55.91
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$129.79
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$99.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$95.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$105.83
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cigna Commercial |
$183.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$111.74
|
| Rate for Payer: Health EOS Commercial |
$177.72
|
| Rate for Payer: HFN Commercial |
$183.71
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$149.76
|
| Rate for Payer: Multiplan Commercial |
$159.74
|
| Rate for Payer: NAPHCARE Commercial |
$119.81
|
| Rate for Payer: Preferred Network Access Commercial |
$183.71
|
| Rate for Payer: Quartz Beloit One Network |
$97.84
|
| Rate for Payer: Quartz Commercial |
$129.79
|
| Rate for Payer: Quartz Medicare Advantage |
$119.81
|
| Rate for Payer: The Alliance Commercial |
$99.84
|
| Rate for Payer: WEA Trust Commercial |
$109.82
|
| Rate for Payer: WPS Commercial |
$147.90
|
|
|
DRAPE LINGEMAN LATEX FREE 1-0425
|
Facility
|
IP
|
$791.00
|
|
| Hospital Charge Code |
2962809
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$403.09 |
| Max. Negotiated Rate |
$756.83 |
| Rate for Payer: Aetna Commercial |
$740.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$707.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$436.00
|
| Rate for Payer: Cash Price |
$237.30
|
| Rate for Payer: Cigna Commercial |
$756.83
|
| Rate for Payer: Health EOS Commercial |
$732.15
|
| Rate for Payer: HFN Commercial |
$756.83
|
| Rate for Payer: Multiplan Commercial |
$658.11
|
| Rate for Payer: Preferred Network Access Commercial |
$756.83
|
| Rate for Payer: Quartz Beloit One Network |
$403.09
|
| Rate for Payer: Quartz Commercial |
$493.58
|
| Rate for Payer: WEA Trust Commercial |
$452.45
|
| Rate for Payer: WPS Commercial |
$609.31
|
|
|
DRAPE LINGEMAN LATEX FREE 1-0425
|
Facility
|
OP
|
$791.00
|
|
| Hospital Charge Code |
2962809
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$230.34 |
| Max. Negotiated Rate |
$756.83 |
| Rate for Payer: Aetna Commercial |
$740.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$707.47
|
| Rate for Payer: Aetna Managed Medicare |
$230.34
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$534.72
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$411.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$394.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$436.00
|
| Rate for Payer: Cash Price |
$237.30
|
| Rate for Payer: Cigna Commercial |
$756.83
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$460.36
|
| Rate for Payer: Health EOS Commercial |
$732.15
|
| Rate for Payer: HFN Commercial |
$756.83
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$616.98
|
| Rate for Payer: Multiplan Commercial |
$658.11
|
| Rate for Payer: NAPHCARE Commercial |
$493.58
|
| Rate for Payer: Preferred Network Access Commercial |
$756.83
|
| Rate for Payer: Quartz Beloit One Network |
$403.09
|
| Rate for Payer: Quartz Commercial |
$534.72
|
| Rate for Payer: Quartz Medicare Advantage |
$493.58
|
| Rate for Payer: The Alliance Commercial |
$411.32
|
| Rate for Payer: WEA Trust Commercial |
$452.45
|
| Rate for Payer: WPS Commercial |
$609.31
|
|
|
DRAPE MEDIUM 47617
|
Facility
|
OP
|
$62.00
|
|
| Hospital Charge Code |
2963468
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$18.05 |
| Max. Negotiated Rate |
$59.32 |
| Rate for Payer: Aetna Commercial |
$58.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$55.45
|
| Rate for Payer: Aetna Managed Medicare |
$18.05
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$41.91
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$32.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$30.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$34.17
|
| Rate for Payer: Cash Price |
$18.60
|
| Rate for Payer: Cigna Commercial |
$59.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$36.08
|
| Rate for Payer: Health EOS Commercial |
$57.39
|
| Rate for Payer: HFN Commercial |
$59.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$48.36
|
| Rate for Payer: Multiplan Commercial |
$51.58
|
| Rate for Payer: NAPHCARE Commercial |
$38.69
|
| Rate for Payer: Preferred Network Access Commercial |
$59.32
|
| Rate for Payer: Quartz Beloit One Network |
$31.60
|
| Rate for Payer: Quartz Commercial |
$41.91
|
| Rate for Payer: Quartz Medicare Advantage |
$38.69
|
| Rate for Payer: The Alliance Commercial |
$32.24
|
| Rate for Payer: WEA Trust Commercial |
$35.46
|
| Rate for Payer: WPS Commercial |
$47.76
|
|
