|
POUCH UROSTOMY 1-1/8 8485
|
Facility
|
OP
|
$151.00
|
|
| Hospital Charge Code |
2974519
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$43.97 |
| Max. Negotiated Rate |
$144.48 |
| Rate for Payer: Aetna Commercial |
$141.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$135.05
|
| Rate for Payer: Aetna Managed Medicare |
$43.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$102.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$78.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$75.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$83.23
|
| Rate for Payer: Cash Price |
$45.30
|
| Rate for Payer: Cigna Commercial |
$144.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$87.88
|
| Rate for Payer: Health EOS Commercial |
$139.77
|
| Rate for Payer: HFN Commercial |
$144.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$117.78
|
| Rate for Payer: Multiplan Commercial |
$125.63
|
| Rate for Payer: NAPHCARE Commercial |
$94.22
|
| Rate for Payer: Preferred Network Access Commercial |
$144.48
|
| Rate for Payer: Quartz Beloit One Network |
$76.95
|
| Rate for Payer: Quartz Commercial |
$102.08
|
| Rate for Payer: Quartz Medicare Advantage |
$94.22
|
| Rate for Payer: The Alliance Commercial |
$78.52
|
| Rate for Payer: WEA Trust Commercial |
$86.37
|
| Rate for Payer: WPS Commercial |
$116.32
|
|
|
POUCH UROSTOMY 1-1/8 8485
|
Facility
|
IP
|
$151.00
|
|
| Hospital Charge Code |
2974519
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$76.95 |
| Max. Negotiated Rate |
$144.48 |
| Rate for Payer: Aetna Commercial |
$141.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$135.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$83.23
|
| Rate for Payer: Cash Price |
$45.30
|
| Rate for Payer: Cigna Commercial |
$144.48
|
| Rate for Payer: Health EOS Commercial |
$139.77
|
| Rate for Payer: HFN Commercial |
$144.48
|
| Rate for Payer: Multiplan Commercial |
$125.63
|
| Rate for Payer: Preferred Network Access Commercial |
$144.48
|
| Rate for Payer: Quartz Beloit One Network |
$76.95
|
| Rate for Payer: Quartz Commercial |
$94.22
|
| Rate for Payer: WEA Trust Commercial |
$86.37
|
| Rate for Payer: WPS Commercial |
$116.32
|
|
|
POUCH UROSTOMY 1 3/4
|
Facility
|
OP
|
$55.00
|
|
| Hospital Charge Code |
3098283
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$16.02 |
| Max. Negotiated Rate |
$52.62 |
| Rate for Payer: Aetna Commercial |
$51.48
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$49.19
|
| Rate for Payer: Aetna Managed Medicare |
$16.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$37.18
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$28.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$27.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$30.32
|
| Rate for Payer: Cash Price |
$16.50
|
| Rate for Payer: Cigna Commercial |
$52.62
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$32.01
|
| Rate for Payer: Health EOS Commercial |
$50.91
|
| Rate for Payer: HFN Commercial |
$52.62
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$42.90
|
| Rate for Payer: Multiplan Commercial |
$45.76
|
| Rate for Payer: NAPHCARE Commercial |
$34.32
|
| Rate for Payer: Preferred Network Access Commercial |
$52.62
|
| Rate for Payer: Quartz Beloit One Network |
$28.03
|
| Rate for Payer: Quartz Commercial |
$37.18
|
| Rate for Payer: Quartz Medicare Advantage |
$34.32
|
| Rate for Payer: The Alliance Commercial |
$28.60
|
| Rate for Payer: WEA Trust Commercial |
$31.46
|
| Rate for Payer: WPS Commercial |
$42.37
|
|
|
POUCH UROSTOMY 1 3/4
|
Facility
|
IP
|
$55.00
|
|
| Hospital Charge Code |
3098283
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$28.03 |
| Max. Negotiated Rate |
$52.62 |
| Rate for Payer: Aetna Commercial |
$51.48
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$49.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$30.32
|
| Rate for Payer: Cash Price |
$16.50
|
| Rate for Payer: Cigna Commercial |
$52.62
|
| Rate for Payer: Health EOS Commercial |
$50.91
|
| Rate for Payer: HFN Commercial |
$52.62
|
| Rate for Payer: Multiplan Commercial |
$45.76
|
| Rate for Payer: Preferred Network Access Commercial |
$52.62
|
| Rate for Payer: Quartz Beloit One Network |
$28.03
|
| Rate for Payer: Quartz Commercial |
$34.32
|
| Rate for Payer: WEA Trust Commercial |
$31.46
|
| Rate for Payer: WPS Commercial |
$42.37
|
|
|
POUCH UROSTOMY CUT TO FIT 64MM 8460
|
Facility
|
IP
|
$116.00
|
|
| Hospital Charge Code |
2963713
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$59.11 |
| Max. Negotiated Rate |
$110.99 |
| Rate for Payer: Aetna Commercial |
$108.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$103.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$63.94
|
| Rate for Payer: Cash Price |
$34.80
|
| Rate for Payer: Cigna Commercial |
$110.99
|
| Rate for Payer: Health EOS Commercial |
$107.37
|
| Rate for Payer: HFN Commercial |
$110.99
|
| Rate for Payer: Multiplan Commercial |
$96.51
|
| Rate for Payer: Preferred Network Access Commercial |
$110.99
|
| Rate for Payer: Quartz Beloit One Network |
$59.11
|
| Rate for Payer: Quartz Commercial |
$72.38
|
| Rate for Payer: WEA Trust Commercial |
$66.35
|
| Rate for Payer: WPS Commercial |
$89.35
|
|
|
POUCH UROSTOMY CUT TO FIT 64MM 8460
|
Facility
|
OP
|
$116.00
|
|
| Hospital Charge Code |
2963713
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$33.78 |
| Max. Negotiated Rate |
$110.99 |
| Rate for Payer: Aetna Commercial |
$108.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$103.75
|
| Rate for Payer: Aetna Managed Medicare |
$33.78
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$78.42
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$60.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$57.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$63.94
|
| Rate for Payer: Cash Price |
$34.80
|
| Rate for Payer: Cigna Commercial |
$110.99
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$67.51
|
| Rate for Payer: Health EOS Commercial |
$107.37
|
| Rate for Payer: HFN Commercial |
$110.99
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$90.48
|
| Rate for Payer: Multiplan Commercial |
$96.51
|
| Rate for Payer: NAPHCARE Commercial |
$72.38
|
| Rate for Payer: Preferred Network Access Commercial |
$110.99
|
| Rate for Payer: Quartz Beloit One Network |
$59.11
|
| Rate for Payer: Quartz Commercial |
$78.42
|
| Rate for Payer: Quartz Medicare Advantage |
$72.38
|
| Rate for Payer: The Alliance Commercial |
$60.32
|
| Rate for Payer: WEA Trust Commercial |
$66.35
|
| Rate for Payer: WPS Commercial |
$89.35
|
|
|
POWDER OSTOMY STOMA 7906
|
Facility
|
OP
|
$142.00
|
|
| Hospital Charge Code |
2964049
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$41.35 |
| Max. Negotiated Rate |
$135.87 |
| Rate for Payer: Aetna Commercial |
$132.91
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$127.00
|
| Rate for Payer: Aetna Managed Medicare |
$41.35
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$95.99
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$73.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$70.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$78.27
|
| Rate for Payer: Cash Price |
$42.60
|
| Rate for Payer: Cigna Commercial |
$135.87
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$82.64
|
| Rate for Payer: Health EOS Commercial |
$131.44
|
| Rate for Payer: HFN Commercial |
$135.87
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$110.76
|
| Rate for Payer: Multiplan Commercial |
$118.14
|
| Rate for Payer: NAPHCARE Commercial |
$88.61
|
| Rate for Payer: Preferred Network Access Commercial |
$135.87
|
| Rate for Payer: Quartz Beloit One Network |
$72.36
|
| Rate for Payer: Quartz Commercial |
$95.99
|
| Rate for Payer: Quartz Medicare Advantage |
$88.61
|
| Rate for Payer: The Alliance Commercial |
$73.84
|
| Rate for Payer: WEA Trust Commercial |
$81.22
|
| Rate for Payer: WPS Commercial |
$109.38
|
|
|
POWDER OSTOMY STOMA 7906
|
Facility
|
IP
|
$142.00
|
|
| Hospital Charge Code |
2964049
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$72.36 |
| Max. Negotiated Rate |
$135.87 |
| Rate for Payer: Aetna Commercial |
$132.91
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$127.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$78.27
|
| Rate for Payer: Cash Price |
$42.60
|
| Rate for Payer: Cigna Commercial |
$135.87
|
| Rate for Payer: Health EOS Commercial |
$131.44
|
| Rate for Payer: HFN Commercial |
$135.87
|
| Rate for Payer: Multiplan Commercial |
$118.14
|
| Rate for Payer: Preferred Network Access Commercial |
$135.87
|
| Rate for Payer: Quartz Beloit One Network |
$72.36
|
| Rate for Payer: Quartz Commercial |
$88.61
|
| Rate for Payer: WEA Trust Commercial |
$81.22
|
| Rate for Payer: WPS Commercial |
$109.38
|
|
|
POWDER SURGICEL 3.0 GRAMS 3013SP
|
Facility
|
OP
|
$3,681.00
|
|
| Hospital Charge Code |
5384958
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,071.91 |
| Max. Negotiated Rate |
$3,521.98 |
| Rate for Payer: Aetna Commercial |
$3,445.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,292.29
|
| Rate for Payer: Aetna Managed Medicare |
$1,071.91
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,488.36
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,914.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,837.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,028.97
|
| Rate for Payer: Cash Price |
$1,104.30
|
| Rate for Payer: Cigna Commercial |
$3,521.98
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,142.34
|
| Rate for Payer: Health EOS Commercial |
$3,407.13
|
| Rate for Payer: HFN Commercial |
$3,521.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,871.18
|
| Rate for Payer: Multiplan Commercial |
$3,062.59
|
| Rate for Payer: NAPHCARE Commercial |
$2,296.94
|
| Rate for Payer: Preferred Network Access Commercial |
$3,521.98
|
| Rate for Payer: Quartz Beloit One Network |
$1,875.84
|
| Rate for Payer: Quartz Commercial |
$2,488.36
|
| Rate for Payer: Quartz Medicare Advantage |
$2,296.94
|
| Rate for Payer: The Alliance Commercial |
$1,914.12
|
| Rate for Payer: WEA Trust Commercial |
$2,105.53
|
| Rate for Payer: WPS Commercial |
$2,835.47
|
|
|
POWDER SURGICEL 3.0 GRAMS 3013SP
|
Facility
|
IP
|
$3,681.00
|
|
| Hospital Charge Code |
5384958
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,875.84 |
| Max. Negotiated Rate |
$3,521.98 |
| Rate for Payer: Aetna Commercial |
$3,445.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,292.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,028.97
|
| Rate for Payer: Cash Price |
$1,104.30
|
| Rate for Payer: Cigna Commercial |
$3,521.98
|
| Rate for Payer: Health EOS Commercial |
$3,407.13
|
| Rate for Payer: HFN Commercial |
$3,521.98
|
| Rate for Payer: Multiplan Commercial |
$3,062.59
|
| Rate for Payer: Preferred Network Access Commercial |
$3,521.98
|
| Rate for Payer: Quartz Beloit One Network |
$1,875.84
|
| Rate for Payer: Quartz Commercial |
$2,296.94
|
| Rate for Payer: WEA Trust Commercial |
$2,105.53
|
| Rate for Payer: WPS Commercial |
$2,835.47
|
|
|
POWERKIDS STARTER KIT
|
Facility
|
OP
|
$3,011.00
|
|
| Hospital Charge Code |
2973177
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$876.80 |
| Max. Negotiated Rate |
$2,880.92 |
| Rate for Payer: Aetna Commercial |
$2,818.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,693.04
|
| Rate for Payer: Aetna Managed Medicare |
$876.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,035.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,565.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,503.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,659.66
|
| Rate for Payer: Cash Price |
$903.30
|
| Rate for Payer: Cigna Commercial |
$2,880.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,752.40
|
| Rate for Payer: Health EOS Commercial |
$2,786.98
|
| Rate for Payer: HFN Commercial |
$2,880.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,348.58
|
| Rate for Payer: Multiplan Commercial |
$2,505.15
|
| Rate for Payer: NAPHCARE Commercial |
$1,878.86
|
| Rate for Payer: Preferred Network Access Commercial |
$2,880.92
|
| Rate for Payer: Quartz Beloit One Network |
$1,534.41
|
| Rate for Payer: Quartz Commercial |
$2,035.44
|
| Rate for Payer: Quartz Medicare Advantage |
$1,878.86
|
| Rate for Payer: The Alliance Commercial |
$1,565.72
|
| Rate for Payer: WEA Trust Commercial |
$1,722.29
|
| Rate for Payer: WPS Commercial |
$2,319.37
|
|
|
POWERKIDS STARTER KIT
|
Facility
|
IP
|
$3,011.00
|
|
| Hospital Charge Code |
2973177
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1,534.41 |
| Max. Negotiated Rate |
$2,880.92 |
| Rate for Payer: Aetna Commercial |
$2,818.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,693.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,659.66
|
| Rate for Payer: Cash Price |
$903.30
|
| Rate for Payer: Cigna Commercial |
$2,880.92
|
| Rate for Payer: Health EOS Commercial |
$2,786.98
|
| Rate for Payer: HFN Commercial |
$2,880.92
|
| Rate for Payer: Multiplan Commercial |
$2,505.15
|
| Rate for Payer: Preferred Network Access Commercial |
$2,880.92
|
| Rate for Payer: Quartz Beloit One Network |
$1,534.41
|
| Rate for Payer: Quartz Commercial |
$1,878.86
|
| Rate for Payer: WEA Trust Commercial |
$1,722.29
|
| Rate for Payer: WPS Commercial |
$2,319.37
|
|
|
POWERPICK 30 DEG AR-8150PP-30
|
Facility
|
IP
|
$1,539.00
|
|
| Hospital Charge Code |
5206679
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$784.27 |
| Max. Negotiated Rate |
$1,472.52 |
| Rate for Payer: Aetna Commercial |
$1,440.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,376.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$848.30
|
| Rate for Payer: Cash Price |
$461.70
|
| Rate for Payer: Cigna Commercial |
$1,472.52
|
| Rate for Payer: Health EOS Commercial |
$1,424.50
|
| Rate for Payer: HFN Commercial |
$1,472.52
|
| Rate for Payer: Multiplan Commercial |
$1,280.45
|
| Rate for Payer: Preferred Network Access Commercial |
$1,472.52
|
| Rate for Payer: Quartz Beloit One Network |
$784.27
|
| Rate for Payer: Quartz Commercial |
$960.34
|
| Rate for Payer: WEA Trust Commercial |
$880.31
|
| Rate for Payer: WPS Commercial |
$1,185.49
|
|
|
POWERPICK 30 DEG AR-8150PP-30
|
Facility
|
OP
|
$1,539.00
|
|
| Hospital Charge Code |
5206679
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$448.16 |
| Max. Negotiated Rate |
$1,472.52 |
| Rate for Payer: Aetna Commercial |
$1,440.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,376.48
|
| Rate for Payer: Aetna Managed Medicare |
$448.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,040.36
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$800.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$768.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$848.30
|
| Rate for Payer: Cash Price |
$461.70
|
| Rate for Payer: Cigna Commercial |
$1,472.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$895.70
|
| Rate for Payer: Health EOS Commercial |
$1,424.50
|
| Rate for Payer: HFN Commercial |
$1,472.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,200.42
|
| Rate for Payer: Multiplan Commercial |
$1,280.45
|
| Rate for Payer: NAPHCARE Commercial |
$960.34
|
| Rate for Payer: Preferred Network Access Commercial |
$1,472.52
|
| Rate for Payer: Quartz Beloit One Network |
$784.27
|
| Rate for Payer: Quartz Commercial |
$1,040.36
|
| Rate for Payer: Quartz Medicare Advantage |
$960.34
|
| Rate for Payer: The Alliance Commercial |
$800.28
|
| Rate for Payer: WEA Trust Commercial |
$880.31
|
| Rate for Payer: WPS Commercial |
$1,185.49
|
|
|
POWERPICK 45 DEG 1.5MM X 13CM AR-8150PP-45
|
Facility
|
OP
|
$1,539.00
|
|
| Hospital Charge Code |
4169027
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$448.16 |
| Max. Negotiated Rate |
$1,472.52 |
| Rate for Payer: Aetna Commercial |
$1,440.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,376.48
|
| Rate for Payer: Aetna Managed Medicare |
$448.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,040.36
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$800.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$768.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$848.30
|
| Rate for Payer: Cash Price |
$461.70
|
| Rate for Payer: Cigna Commercial |
$1,472.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$895.70
|
| Rate for Payer: Health EOS Commercial |
$1,424.50
|
| Rate for Payer: HFN Commercial |
$1,472.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,200.42
|
| Rate for Payer: Multiplan Commercial |
$1,280.45
|
| Rate for Payer: NAPHCARE Commercial |
$960.34
|
| Rate for Payer: Preferred Network Access Commercial |
$1,472.52
|
| Rate for Payer: Quartz Beloit One Network |
$784.27
|
| Rate for Payer: Quartz Commercial |
$1,040.36
|
| Rate for Payer: Quartz Medicare Advantage |
$960.34
|
| Rate for Payer: The Alliance Commercial |
$800.28
|
| Rate for Payer: WEA Trust Commercial |
$880.31
|
| Rate for Payer: WPS Commercial |
$1,185.49
|
|
|
POWERPICK 45 DEG 1.5MM X 13CM AR-8150PP-45
|
Facility
|
IP
|
$1,539.00
|
|
| Hospital Charge Code |
4169027
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$784.27 |
| Max. Negotiated Rate |
$1,472.52 |
| Rate for Payer: Aetna Commercial |
$1,440.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,376.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$848.30
|
| Rate for Payer: Cash Price |
$461.70
|
| Rate for Payer: Cigna Commercial |
$1,472.52
|
| Rate for Payer: Health EOS Commercial |
$1,424.50
|
| Rate for Payer: HFN Commercial |
$1,472.52
|
| Rate for Payer: Multiplan Commercial |
$1,280.45
|
| Rate for Payer: Preferred Network Access Commercial |
$1,472.52
|
| Rate for Payer: Quartz Beloit One Network |
$784.27
|
| Rate for Payer: Quartz Commercial |
$960.34
|
| Rate for Payer: WEA Trust Commercial |
$880.31
|
| Rate for Payer: WPS Commercial |
$1,185.49
|
|
|
POWER PORT 6FR 1616000
|
Facility
|
IP
|
$5,736.00
|
|
|
Service Code
|
HCPCS C1788
|
| Hospital Charge Code |
2975051
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,923.07 |
| Max. Negotiated Rate |
$5,488.20 |
| Rate for Payer: Aetna Commercial |
$5,368.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,130.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,161.68
|
| Rate for Payer: Cash Price |
$1,720.80
|
| Rate for Payer: Cigna Commercial |
$5,488.20
|
| Rate for Payer: Health EOS Commercial |
$5,309.24
|
| Rate for Payer: HFN Commercial |
$5,488.20
|
| Rate for Payer: Multiplan Commercial |
$4,772.35
|
| Rate for Payer: Preferred Network Access Commercial |
$5,488.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,923.07
|
| Rate for Payer: Quartz Commercial |
$3,579.26
|
| Rate for Payer: WEA Trust Commercial |
$3,280.99
|
| Rate for Payer: WPS Commercial |
$4,418.44
|
|
|
POWER PORT 6FR 1616000
|
Facility
|
OP
|
$5,736.00
|
|
|
Service Code
|
HCPCS C1788
|
| Hospital Charge Code |
2975051
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,670.32 |
| Max. Negotiated Rate |
$5,488.20 |
| Rate for Payer: Aetna Commercial |
$5,368.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,130.28
|
| Rate for Payer: Aetna Managed Medicare |
$1,670.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,877.54
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,982.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,863.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,161.68
|
| Rate for Payer: Cash Price |
$1,720.80
|
| Rate for Payer: Cigna Commercial |
$5,488.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,338.35
|
| Rate for Payer: Health EOS Commercial |
$5,309.24
|
| Rate for Payer: HFN Commercial |
$5,488.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,474.08
|
| Rate for Payer: Multiplan Commercial |
$4,772.35
|
| Rate for Payer: NAPHCARE Commercial |
$3,579.26
|
| Rate for Payer: Preferred Network Access Commercial |
$5,488.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,923.07
|
| Rate for Payer: Quartz Commercial |
$3,877.54
|
| Rate for Payer: Quartz Medicare Advantage |
$3,579.26
|
| Rate for Payer: The Alliance Commercial |
$2,982.72
|
| Rate for Payer: WEA Trust Commercial |
$3,280.99
|
| Rate for Payer: WPS Commercial |
$4,418.44
|
|
|
POWER PORT 8FR 1608062
|
Facility
|
OP
|
$6,211.00
|
|
|
Service Code
|
HCPCS C1788
|
| Hospital Charge Code |
2975052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,808.64 |
| Max. Negotiated Rate |
$5,942.68 |
| Rate for Payer: Aetna Commercial |
$5,813.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,555.12
|
| Rate for Payer: Aetna Managed Medicare |
$1,808.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,198.64
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,229.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,100.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,423.50
|
| Rate for Payer: Cash Price |
$1,863.30
|
| Rate for Payer: Cigna Commercial |
$5,942.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,614.80
|
| Rate for Payer: Health EOS Commercial |
$5,748.90
|
| Rate for Payer: HFN Commercial |
$5,942.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,844.58
|
| Rate for Payer: Multiplan Commercial |
$5,167.55
|
| Rate for Payer: NAPHCARE Commercial |
$3,875.66
|
| Rate for Payer: Preferred Network Access Commercial |
$5,942.68
|
| Rate for Payer: Quartz Beloit One Network |
$3,165.13
|
| Rate for Payer: Quartz Commercial |
$4,198.64
|
| Rate for Payer: Quartz Medicare Advantage |
$3,875.66
|
| Rate for Payer: The Alliance Commercial |
$3,229.72
|
| Rate for Payer: WEA Trust Commercial |
$3,552.69
|
| Rate for Payer: WPS Commercial |
$4,784.33
|
|
|
POWER PORT 8FR 1608062
|
Facility
|
IP
|
$6,211.00
|
|
|
Service Code
|
HCPCS C1788
|
| Hospital Charge Code |
2975052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,165.13 |
| Max. Negotiated Rate |
$5,942.68 |
| Rate for Payer: Aetna Commercial |
$5,813.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,555.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,423.50
|
| Rate for Payer: Cash Price |
$1,863.30
|
| Rate for Payer: Cigna Commercial |
$5,942.68
|
| Rate for Payer: Health EOS Commercial |
$5,748.90
|
| Rate for Payer: HFN Commercial |
$5,942.68
|
| Rate for Payer: Multiplan Commercial |
$5,167.55
|
| Rate for Payer: Preferred Network Access Commercial |
$5,942.68
|
| Rate for Payer: Quartz Beloit One Network |
$3,165.13
|
| Rate for Payer: Quartz Commercial |
$3,875.66
|
| Rate for Payer: WEA Trust Commercial |
$3,552.69
|
| Rate for Payer: WPS Commercial |
$4,784.33
|
|
|
POWER PORT DUAL 9.5FR 1829500
|
Facility
|
IP
|
$4,634.00
|
|
|
Service Code
|
HCPCS C1788
|
| Hospital Charge Code |
4519001
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,361.49 |
| Max. Negotiated Rate |
$4,433.81 |
| Rate for Payer: Aetna Commercial |
$4,337.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,144.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,554.26
|
| Rate for Payer: Cash Price |
$1,390.20
|
| Rate for Payer: Cigna Commercial |
$4,433.81
|
| Rate for Payer: Health EOS Commercial |
$4,289.23
|
| Rate for Payer: HFN Commercial |
$4,433.81
|
| Rate for Payer: Multiplan Commercial |
$3,855.49
|
| Rate for Payer: Preferred Network Access Commercial |
$4,433.81
|
| Rate for Payer: Quartz Beloit One Network |
$2,361.49
|
| Rate for Payer: Quartz Commercial |
$2,891.62
|
| Rate for Payer: WEA Trust Commercial |
$2,650.65
|
| Rate for Payer: WPS Commercial |
$3,569.57
|
|
|
POWER PORT DUAL 9.5FR 1829500
|
Facility
|
OP
|
$4,634.00
|
|
|
Service Code
|
HCPCS C1788
|
| Hospital Charge Code |
4519001
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,349.42 |
| Max. Negotiated Rate |
$4,433.81 |
| Rate for Payer: Aetna Commercial |
$4,337.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,144.65
|
| Rate for Payer: Aetna Managed Medicare |
$1,349.42
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,132.58
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,409.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,313.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,554.26
|
| Rate for Payer: Cash Price |
$1,390.20
|
| Rate for Payer: Cigna Commercial |
$4,433.81
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,696.99
|
| Rate for Payer: Health EOS Commercial |
$4,289.23
|
| Rate for Payer: HFN Commercial |
$4,433.81
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,614.52
|
| Rate for Payer: Multiplan Commercial |
$3,855.49
|
| Rate for Payer: NAPHCARE Commercial |
$2,891.62
|
| Rate for Payer: Preferred Network Access Commercial |
$4,433.81
|
| Rate for Payer: Quartz Beloit One Network |
$2,361.49
|
| Rate for Payer: Quartz Commercial |
$3,132.58
|
| Rate for Payer: Quartz Medicare Advantage |
$2,891.62
|
| Rate for Payer: The Alliance Commercial |
$2,409.68
|
| Rate for Payer: WEA Trust Commercial |
$2,650.65
|
| Rate for Payer: WPS Commercial |
$3,569.57
|
|
|
POWERRASP 4.0MM X 13CM AR-8400PR
|
Facility
|
OP
|
$2,128.00
|
|
| Hospital Charge Code |
4169028
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$619.67 |
| Max. Negotiated Rate |
$2,036.07 |
| Rate for Payer: Aetna Commercial |
$1,991.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,903.28
|
| Rate for Payer: Aetna Managed Medicare |
$619.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,438.53
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,106.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,062.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,172.95
|
| Rate for Payer: Cash Price |
$638.40
|
| Rate for Payer: Cigna Commercial |
$2,036.07
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,238.50
|
| Rate for Payer: Health EOS Commercial |
$1,969.68
|
| Rate for Payer: HFN Commercial |
$2,036.07
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,659.84
|
| Rate for Payer: Multiplan Commercial |
$1,770.50
|
| Rate for Payer: NAPHCARE Commercial |
$1,327.87
|
| Rate for Payer: Preferred Network Access Commercial |
$2,036.07
|
| Rate for Payer: Quartz Beloit One Network |
$1,084.43
|
| Rate for Payer: Quartz Commercial |
$1,438.53
|
| Rate for Payer: Quartz Medicare Advantage |
$1,327.87
|
| Rate for Payer: The Alliance Commercial |
$1,106.56
|
| Rate for Payer: WEA Trust Commercial |
$1,217.22
|
| Rate for Payer: WPS Commercial |
$1,639.20
|
|
|
POWERRASP 4.0MM X 13CM AR-8400PR
|
Facility
|
IP
|
$2,128.00
|
|
| Hospital Charge Code |
4169028
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,084.43 |
| Max. Negotiated Rate |
$2,036.07 |
| Rate for Payer: Aetna Commercial |
$1,991.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,903.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,172.95
|
| Rate for Payer: Cash Price |
$638.40
|
| Rate for Payer: Cigna Commercial |
$2,036.07
|
| Rate for Payer: Health EOS Commercial |
$1,969.68
|
| Rate for Payer: HFN Commercial |
$2,036.07
|
| Rate for Payer: Multiplan Commercial |
$1,770.50
|
| Rate for Payer: Preferred Network Access Commercial |
$2,036.07
|
| Rate for Payer: Quartz Beloit One Network |
$1,084.43
|
| Rate for Payer: Quartz Commercial |
$1,327.87
|
| Rate for Payer: WEA Trust Commercial |
$1,217.22
|
| Rate for Payer: WPS Commercial |
$1,639.20
|
|
|
POWERSTEP PROTECH 3/4 A M 5-6.5, W 7-8.5 1005-03A
|
Facility
|
IP
|
$354.00
|
|
| Hospital Charge Code |
2969910
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$180.40 |
| Max. Negotiated Rate |
$338.71 |
| Rate for Payer: Aetna Commercial |
$331.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$316.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$195.12
|
| Rate for Payer: Cash Price |
$106.20
|
| Rate for Payer: Cigna Commercial |
$338.71
|
| Rate for Payer: Health EOS Commercial |
$327.66
|
| Rate for Payer: HFN Commercial |
$338.71
|
| Rate for Payer: Multiplan Commercial |
$294.53
|
| Rate for Payer: Preferred Network Access Commercial |
$338.71
|
| Rate for Payer: Quartz Beloit One Network |
$180.40
|
| Rate for Payer: Quartz Commercial |
$220.90
|
| Rate for Payer: WEA Trust Commercial |
$202.49
|
| Rate for Payer: WPS Commercial |
$272.69
|
|
