|
POUCH SENSURA MIO 1080ML 12.5 18642"
|
Facility
|
IP
|
$10.00
|
|
| Hospital Charge Code |
6207072
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.90 |
| Max. Negotiated Rate |
$9.20 |
| Rate for Payer: Aetna Commercial |
$9.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5.30
|
| Rate for Payer: Cash Price |
$3.00
|
| Rate for Payer: Cigna Commercial |
$9.20
|
| Rate for Payer: Health EOS Commercial |
$8.90
|
| Rate for Payer: HFN Commercial |
$9.20
|
| Rate for Payer: Multiplan Commercial |
$8.00
|
| Rate for Payer: NAPHCARE Commercial |
$6.00
|
| Rate for Payer: Preferred Network Access Commercial |
$9.20
|
| Rate for Payer: Quartz Beloit One Network |
$4.90
|
| Rate for Payer: Quartz Commercial |
$6.00
|
| Rate for Payer: WEA Trust Commercial |
$5.50
|
| Rate for Payer: WPS Commercial |
$7.41
|
|
|
POUCH SENSURA MIO 1080ML 12.5 18642"
|
Facility
|
OP
|
$10.00
|
|
| Hospital Charge Code |
6207072
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$40.00 |
| Rate for Payer: Aetna Commercial |
$9.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8.60
|
| Rate for Payer: Aetna Managed Medicare |
$2.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5.30
|
| Rate for Payer: Cash Price |
$3.00
|
| Rate for Payer: Cigna Commercial |
$9.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.60
|
| Rate for Payer: Health EOS Commercial |
$8.90
|
| Rate for Payer: HFN Commercial |
$9.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7.50
|
| Rate for Payer: Multiplan Commercial |
$8.00
|
| Rate for Payer: NAPHCARE Commercial |
$6.00
|
| Rate for Payer: Preferred Network Access Commercial |
$9.20
|
| Rate for Payer: Quartz Beloit One Network |
$4.90
|
| Rate for Payer: Quartz Commercial |
$6.50
|
| Rate for Payer: Quartz Medicare Advantage |
$6.00
|
| Rate for Payer: The Alliance Commercial |
$40.00
|
| Rate for Payer: WEA Trust Commercial |
$5.50
|
| Rate for Payer: WPS Commercial |
$7.41
|
|
|
POUCH UROSTOMY 1-1/8 8485
|
Facility
|
OP
|
$151.00
|
|
| Hospital Charge Code |
2974519
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$42.28 |
| Max. Negotiated Rate |
$604.00 |
| Rate for Payer: Aetna Commercial |
$135.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$129.86
|
| Rate for Payer: Aetna Managed Medicare |
$42.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$98.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$75.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$72.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$80.03
|
| Rate for Payer: Cash Price |
$45.30
|
| Rate for Payer: Cigna Commercial |
$138.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$84.50
|
| Rate for Payer: Health EOS Commercial |
$134.39
|
| Rate for Payer: HFN Commercial |
$138.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$113.25
|
| Rate for Payer: Multiplan Commercial |
$120.80
|
| Rate for Payer: NAPHCARE Commercial |
$90.60
|
| Rate for Payer: Preferred Network Access Commercial |
$138.92
|
| Rate for Payer: Quartz Beloit One Network |
$73.99
|
| Rate for Payer: Quartz Commercial |
$98.15
|
| Rate for Payer: Quartz Medicare Advantage |
$90.60
|
| Rate for Payer: The Alliance Commercial |
$604.00
|
| Rate for Payer: WEA Trust Commercial |
$83.05
|
| Rate for Payer: WPS Commercial |
$111.85
|
|
|
POUCH UROSTOMY 1-1/8 8485
|
Facility
|
IP
|
$151.00
|
|
| Hospital Charge Code |
2974519
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$73.99 |
| Max. Negotiated Rate |
$138.92 |
| Rate for Payer: Aetna Commercial |
$135.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$129.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$80.03
|
| Rate for Payer: Cash Price |
$45.30
|
| Rate for Payer: Cigna Commercial |
$138.92
|
| Rate for Payer: Health EOS Commercial |
$134.39
|
| Rate for Payer: HFN Commercial |
$138.92
|
| Rate for Payer: Multiplan Commercial |
$120.80
|
| Rate for Payer: NAPHCARE Commercial |
$90.60
|
| Rate for Payer: Preferred Network Access Commercial |
$138.92
|
| Rate for Payer: Quartz Beloit One Network |
$73.99
|
| Rate for Payer: Quartz Commercial |
$90.60
|
| Rate for Payer: WEA Trust Commercial |
$83.05
|
| Rate for Payer: WPS Commercial |
$111.85
|
|
|
POUCH UROSTOMY 1 3/4
|
Facility
|
OP
|
$55.00
|
|
| Hospital Charge Code |
3098283
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$15.40 |
| Max. Negotiated Rate |
$220.00 |
| Rate for Payer: Aetna Commercial |
$49.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$47.30
|
| Rate for Payer: Aetna Managed Medicare |
$15.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$35.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$27.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$26.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$29.15
|
| Rate for Payer: Cash Price |
$16.50
|
| Rate for Payer: Cigna Commercial |
$50.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$30.78
|
| Rate for Payer: Health EOS Commercial |
$48.95
|
| Rate for Payer: HFN Commercial |
$50.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$41.25
|
| Rate for Payer: Multiplan Commercial |
$44.00
|
| Rate for Payer: NAPHCARE Commercial |
$33.00
|
| Rate for Payer: Preferred Network Access Commercial |
$50.60
|
| Rate for Payer: Quartz Beloit One Network |
$26.95
|
| Rate for Payer: Quartz Commercial |
$35.75
|
| Rate for Payer: Quartz Medicare Advantage |
$33.00
|
| Rate for Payer: The Alliance Commercial |
$220.00
|
| Rate for Payer: WEA Trust Commercial |
$30.25
|
| Rate for Payer: WPS Commercial |
$40.74
|
|
|
POUCH UROSTOMY 1 3/4
|
Facility
|
IP
|
$55.00
|
|
| Hospital Charge Code |
3098283
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$26.95 |
| Max. Negotiated Rate |
$50.60 |
| Rate for Payer: Aetna Commercial |
$49.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$47.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$29.15
|
| Rate for Payer: Cash Price |
$16.50
|
| Rate for Payer: Cigna Commercial |
$50.60
|
| Rate for Payer: Health EOS Commercial |
$48.95
|
| Rate for Payer: HFN Commercial |
$50.60
|
| Rate for Payer: Multiplan Commercial |
$44.00
|
| Rate for Payer: NAPHCARE Commercial |
$33.00
|
| Rate for Payer: Preferred Network Access Commercial |
$50.60
|
| Rate for Payer: Quartz Beloit One Network |
$26.95
|
| Rate for Payer: Quartz Commercial |
$33.00
|
| Rate for Payer: WEA Trust Commercial |
$30.25
|
| Rate for Payer: WPS Commercial |
$40.74
|
|
|
POUCH UROSTOMY CUT TO FIT 64MM 8460
|
Facility
|
IP
|
$116.00
|
|
| Hospital Charge Code |
2963713
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$56.84 |
| Max. Negotiated Rate |
$106.72 |
| Rate for Payer: Aetna Commercial |
$104.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$99.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$61.48
|
| Rate for Payer: Cash Price |
$34.80
|
| Rate for Payer: Cigna Commercial |
$106.72
|
| Rate for Payer: Health EOS Commercial |
$103.24
|
| Rate for Payer: HFN Commercial |
$106.72
|
| Rate for Payer: Multiplan Commercial |
$92.80
|
| Rate for Payer: NAPHCARE Commercial |
$69.60
|
| Rate for Payer: Preferred Network Access Commercial |
$106.72
|
| Rate for Payer: Quartz Beloit One Network |
$56.84
|
| Rate for Payer: Quartz Commercial |
$69.60
|
| Rate for Payer: WEA Trust Commercial |
$63.80
|
| Rate for Payer: WPS Commercial |
$85.92
|
|
|
POUCH UROSTOMY CUT TO FIT 64MM 8460
|
Facility
|
OP
|
$116.00
|
|
| Hospital Charge Code |
2963713
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$32.48 |
| Max. Negotiated Rate |
$464.00 |
| Rate for Payer: Aetna Commercial |
$104.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$99.76
|
| Rate for Payer: Aetna Managed Medicare |
$32.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$75.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$58.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$55.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$61.48
|
| Rate for Payer: Cash Price |
$34.80
|
| Rate for Payer: Cigna Commercial |
$106.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$64.91
|
| Rate for Payer: Health EOS Commercial |
$103.24
|
| Rate for Payer: HFN Commercial |
$106.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$87.00
|
| Rate for Payer: Multiplan Commercial |
$92.80
|
| Rate for Payer: NAPHCARE Commercial |
$69.60
|
| Rate for Payer: Preferred Network Access Commercial |
$106.72
|
| Rate for Payer: Quartz Beloit One Network |
$56.84
|
| Rate for Payer: Quartz Commercial |
$75.40
|
| Rate for Payer: Quartz Medicare Advantage |
$69.60
|
| Rate for Payer: The Alliance Commercial |
$464.00
|
| Rate for Payer: WEA Trust Commercial |
$63.80
|
| Rate for Payer: WPS Commercial |
$85.92
|
|
|
POWDER OSTOMY STOMA 7906
|
Facility
|
IP
|
$142.00
|
|
| Hospital Charge Code |
2964049
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$69.58 |
| Max. Negotiated Rate |
$130.64 |
| Rate for Payer: Aetna Commercial |
$127.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$122.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$75.26
|
| Rate for Payer: Cash Price |
$42.60
|
| Rate for Payer: Cigna Commercial |
$130.64
|
| Rate for Payer: Health EOS Commercial |
$126.38
|
| Rate for Payer: HFN Commercial |
$130.64
|
| Rate for Payer: Multiplan Commercial |
$113.60
|
| Rate for Payer: NAPHCARE Commercial |
$85.20
|
| Rate for Payer: Preferred Network Access Commercial |
$130.64
|
| Rate for Payer: Quartz Beloit One Network |
$69.58
|
| Rate for Payer: Quartz Commercial |
$85.20
|
| Rate for Payer: WEA Trust Commercial |
$78.10
|
| Rate for Payer: WPS Commercial |
$105.18
|
|
|
POWDER OSTOMY STOMA 7906
|
Facility
|
OP
|
$142.00
|
|
| Hospital Charge Code |
2964049
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$39.76 |
| Max. Negotiated Rate |
$568.00 |
| Rate for Payer: Aetna Commercial |
$127.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$122.12
|
| Rate for Payer: Aetna Managed Medicare |
$39.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$92.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$71.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$68.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$75.26
|
| Rate for Payer: Cash Price |
$42.60
|
| Rate for Payer: Cigna Commercial |
$130.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$79.46
|
| Rate for Payer: Health EOS Commercial |
$126.38
|
| Rate for Payer: HFN Commercial |
$130.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$106.50
|
| Rate for Payer: Multiplan Commercial |
$113.60
|
| Rate for Payer: NAPHCARE Commercial |
$85.20
|
| Rate for Payer: Preferred Network Access Commercial |
$130.64
|
| Rate for Payer: Quartz Beloit One Network |
$69.58
|
| Rate for Payer: Quartz Commercial |
$92.30
|
| Rate for Payer: Quartz Medicare Advantage |
$85.20
|
| Rate for Payer: The Alliance Commercial |
$568.00
|
| Rate for Payer: WEA Trust Commercial |
$78.10
|
| Rate for Payer: WPS Commercial |
$105.18
|
|
|
POWDER SURGICEL 3.0 GRAMS 3013SP
|
Facility
|
IP
|
$3,681.00
|
|
| Hospital Charge Code |
5384958
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,803.69 |
| Max. Negotiated Rate |
$3,386.52 |
| Rate for Payer: Aetna Commercial |
$3,312.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,165.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,950.93
|
| Rate for Payer: Cash Price |
$1,104.30
|
| Rate for Payer: Cigna Commercial |
$3,386.52
|
| Rate for Payer: Health EOS Commercial |
$3,276.09
|
| Rate for Payer: HFN Commercial |
$3,386.52
|
| Rate for Payer: Multiplan Commercial |
$2,944.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,208.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,386.52
|
| Rate for Payer: Quartz Beloit One Network |
$1,803.69
|
| Rate for Payer: Quartz Commercial |
$2,208.60
|
| Rate for Payer: WEA Trust Commercial |
$2,024.55
|
| Rate for Payer: WPS Commercial |
$2,726.52
|
|
|
POWDER SURGICEL 3.0 GRAMS 3013SP
|
Facility
|
OP
|
$3,681.00
|
|
| Hospital Charge Code |
5384958
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,030.68 |
| Max. Negotiated Rate |
$14,724.00 |
| Rate for Payer: Aetna Commercial |
$3,312.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,165.66
|
| Rate for Payer: Aetna Managed Medicare |
$1,030.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,392.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,840.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,766.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,950.93
|
| Rate for Payer: Cash Price |
$1,104.30
|
| Rate for Payer: Cigna Commercial |
$3,386.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,059.89
|
| Rate for Payer: Health EOS Commercial |
$3,276.09
|
| Rate for Payer: HFN Commercial |
$3,386.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,760.75
|
| Rate for Payer: Multiplan Commercial |
$2,944.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,208.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,386.52
|
| Rate for Payer: Quartz Beloit One Network |
$1,803.69
|
| Rate for Payer: Quartz Commercial |
$2,392.65
|
| Rate for Payer: Quartz Medicare Advantage |
$2,208.60
|
| Rate for Payer: The Alliance Commercial |
$14,724.00
|
| Rate for Payer: WEA Trust Commercial |
$2,024.55
|
| Rate for Payer: WPS Commercial |
$2,726.52
|
|
|
POWERKIDS STARTER KIT
|
Facility
|
IP
|
$3,011.00
|
|
| Hospital Charge Code |
2973177
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1,475.39 |
| Max. Negotiated Rate |
$2,770.12 |
| Rate for Payer: Aetna Commercial |
$2,709.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,589.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,595.83
|
| Rate for Payer: Cash Price |
$903.30
|
| Rate for Payer: Cigna Commercial |
$2,770.12
|
| Rate for Payer: Health EOS Commercial |
$2,679.79
|
| Rate for Payer: HFN Commercial |
$2,770.12
|
| Rate for Payer: Multiplan Commercial |
$2,408.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,806.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,770.12
|
| Rate for Payer: Quartz Beloit One Network |
$1,475.39
|
| Rate for Payer: Quartz Commercial |
$1,806.60
|
| Rate for Payer: WEA Trust Commercial |
$1,656.05
|
| Rate for Payer: WPS Commercial |
$2,230.25
|
|
|
POWERKIDS STARTER KIT
|
Facility
|
OP
|
$3,011.00
|
|
| Hospital Charge Code |
2973177
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$843.08 |
| Max. Negotiated Rate |
$12,044.00 |
| Rate for Payer: Aetna Commercial |
$2,709.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,589.46
|
| Rate for Payer: Aetna Managed Medicare |
$843.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,957.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,505.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,445.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,595.83
|
| Rate for Payer: Cash Price |
$903.30
|
| Rate for Payer: Cigna Commercial |
$2,770.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,684.96
|
| Rate for Payer: Health EOS Commercial |
$2,679.79
|
| Rate for Payer: HFN Commercial |
$2,770.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,258.25
|
| Rate for Payer: Multiplan Commercial |
$2,408.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,806.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,770.12
|
| Rate for Payer: Quartz Beloit One Network |
$1,475.39
|
| Rate for Payer: Quartz Commercial |
$1,957.15
|
| Rate for Payer: Quartz Medicare Advantage |
$1,806.60
|
| Rate for Payer: The Alliance Commercial |
$12,044.00
|
| Rate for Payer: WEA Trust Commercial |
$1,656.05
|
| Rate for Payer: WPS Commercial |
$2,230.25
|
|
|
POWERPICK 30 DEG AR-8150PP-30
|
Facility
|
IP
|
$1,539.00
|
|
| Hospital Charge Code |
5206679
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$754.11 |
| Max. Negotiated Rate |
$1,415.88 |
| Rate for Payer: Aetna Commercial |
$1,385.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,323.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$815.67
|
| Rate for Payer: Cash Price |
$461.70
|
| Rate for Payer: Cigna Commercial |
$1,415.88
|
| Rate for Payer: Health EOS Commercial |
$1,369.71
|
| Rate for Payer: HFN Commercial |
$1,415.88
|
| Rate for Payer: Multiplan Commercial |
$1,231.20
|
| Rate for Payer: NAPHCARE Commercial |
$923.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,415.88
|
| Rate for Payer: Quartz Beloit One Network |
$754.11
|
| Rate for Payer: Quartz Commercial |
$923.40
|
| Rate for Payer: WEA Trust Commercial |
$846.45
|
| Rate for Payer: WPS Commercial |
$1,139.94
|
|
|
POWERPICK 30 DEG AR-8150PP-30
|
Facility
|
OP
|
$1,539.00
|
|
| Hospital Charge Code |
5206679
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$430.92 |
| Max. Negotiated Rate |
$6,156.00 |
| Rate for Payer: Aetna Commercial |
$1,385.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,323.54
|
| Rate for Payer: Aetna Managed Medicare |
$430.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,000.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$769.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$738.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$815.67
|
| Rate for Payer: Cash Price |
$461.70
|
| Rate for Payer: Cigna Commercial |
$1,415.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$861.22
|
| Rate for Payer: Health EOS Commercial |
$1,369.71
|
| Rate for Payer: HFN Commercial |
$1,415.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,154.25
|
| Rate for Payer: Multiplan Commercial |
$1,231.20
|
| Rate for Payer: NAPHCARE Commercial |
$923.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,415.88
|
| Rate for Payer: Quartz Beloit One Network |
$754.11
|
| Rate for Payer: Quartz Commercial |
$1,000.35
|
| Rate for Payer: Quartz Medicare Advantage |
$923.40
|
| Rate for Payer: The Alliance Commercial |
$6,156.00
|
| Rate for Payer: WEA Trust Commercial |
$846.45
|
| Rate for Payer: WPS Commercial |
$1,139.94
|
|
|
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 |
$754.11 |
| Max. Negotiated Rate |
$1,415.88 |
| Rate for Payer: Aetna Commercial |
$1,385.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,323.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$815.67
|
| Rate for Payer: Cash Price |
$461.70
|
| Rate for Payer: Cigna Commercial |
$1,415.88
|
| Rate for Payer: Health EOS Commercial |
$1,369.71
|
| Rate for Payer: HFN Commercial |
$1,415.88
|
| Rate for Payer: Multiplan Commercial |
$1,231.20
|
| Rate for Payer: NAPHCARE Commercial |
$923.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,415.88
|
| Rate for Payer: Quartz Beloit One Network |
$754.11
|
| Rate for Payer: Quartz Commercial |
$923.40
|
| Rate for Payer: WEA Trust Commercial |
$846.45
|
| Rate for Payer: WPS Commercial |
$1,139.94
|
|
|
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 |
$430.92 |
| Max. Negotiated Rate |
$6,156.00 |
| Rate for Payer: Aetna Commercial |
$1,385.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,323.54
|
| Rate for Payer: Aetna Managed Medicare |
$430.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,000.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$769.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$738.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$815.67
|
| Rate for Payer: Cash Price |
$461.70
|
| Rate for Payer: Cigna Commercial |
$1,415.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$861.22
|
| Rate for Payer: Health EOS Commercial |
$1,369.71
|
| Rate for Payer: HFN Commercial |
$1,415.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,154.25
|
| Rate for Payer: Multiplan Commercial |
$1,231.20
|
| Rate for Payer: NAPHCARE Commercial |
$923.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,415.88
|
| Rate for Payer: Quartz Beloit One Network |
$754.11
|
| Rate for Payer: Quartz Commercial |
$1,000.35
|
| Rate for Payer: Quartz Medicare Advantage |
$923.40
|
| Rate for Payer: The Alliance Commercial |
$6,156.00
|
| Rate for Payer: WEA Trust Commercial |
$846.45
|
| Rate for Payer: WPS Commercial |
$1,139.94
|
|
|
POWER PORT 6FR 1616000
|
Facility
|
IP
|
$5,736.00
|
|
|
Service Code
|
HCPCS C1788
|
| Hospital Charge Code |
2975051
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,810.64 |
| Max. Negotiated Rate |
$5,277.12 |
| Rate for Payer: Aetna Commercial |
$5,162.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,932.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,040.08
|
| Rate for Payer: Cash Price |
$1,720.80
|
| Rate for Payer: Cigna Commercial |
$5,277.12
|
| Rate for Payer: Health EOS Commercial |
$5,105.04
|
| Rate for Payer: HFN Commercial |
$5,277.12
|
| Rate for Payer: Multiplan Commercial |
$4,588.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,441.60
|
| Rate for Payer: Preferred Network Access Commercial |
$5,277.12
|
| Rate for Payer: Quartz Beloit One Network |
$2,810.64
|
| Rate for Payer: Quartz Commercial |
$3,441.60
|
| Rate for Payer: WEA Trust Commercial |
$3,154.80
|
| Rate for Payer: WPS Commercial |
$4,248.66
|
|
|
POWER PORT 6FR 1616000
|
Facility
|
OP
|
$5,736.00
|
|
|
Service Code
|
HCPCS C1788
|
| Hospital Charge Code |
2975051
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,606.08 |
| Max. Negotiated Rate |
$22,944.00 |
| Rate for Payer: Aetna Commercial |
$5,162.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,932.96
|
| Rate for Payer: Aetna Managed Medicare |
$1,606.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,728.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,868.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,753.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,040.08
|
| Rate for Payer: Cash Price |
$1,720.80
|
| Rate for Payer: Cigna Commercial |
$5,277.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,209.87
|
| Rate for Payer: Health EOS Commercial |
$5,105.04
|
| Rate for Payer: HFN Commercial |
$5,277.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,302.00
|
| Rate for Payer: Multiplan Commercial |
$4,588.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,441.60
|
| Rate for Payer: Preferred Network Access Commercial |
$5,277.12
|
| Rate for Payer: Quartz Beloit One Network |
$2,810.64
|
| Rate for Payer: Quartz Commercial |
$3,728.40
|
| Rate for Payer: Quartz Medicare Advantage |
$3,441.60
|
| Rate for Payer: The Alliance Commercial |
$22,944.00
|
| Rate for Payer: WEA Trust Commercial |
$3,154.80
|
| Rate for Payer: WPS Commercial |
$4,248.66
|
|
|
POWER PORT 8FR 1608062
|
Facility
|
OP
|
$6,211.00
|
|
|
Service Code
|
HCPCS C1788
|
| Hospital Charge Code |
2975052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,739.08 |
| Max. Negotiated Rate |
$24,844.00 |
| Rate for Payer: Aetna Commercial |
$5,589.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,341.46
|
| Rate for Payer: Aetna Managed Medicare |
$1,739.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,037.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,105.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,981.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,291.83
|
| Rate for Payer: Cash Price |
$1,863.30
|
| Rate for Payer: Cigna Commercial |
$5,714.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,475.68
|
| Rate for Payer: Health EOS Commercial |
$5,527.79
|
| Rate for Payer: HFN Commercial |
$5,714.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,658.25
|
| Rate for Payer: Multiplan Commercial |
$4,968.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,726.60
|
| Rate for Payer: Preferred Network Access Commercial |
$5,714.12
|
| Rate for Payer: Quartz Beloit One Network |
$3,043.39
|
| Rate for Payer: Quartz Commercial |
$4,037.15
|
| Rate for Payer: Quartz Medicare Advantage |
$3,726.60
|
| Rate for Payer: The Alliance Commercial |
$24,844.00
|
| Rate for Payer: WEA Trust Commercial |
$3,416.05
|
| Rate for Payer: WPS Commercial |
$4,600.49
|
|
|
POWER PORT 8FR 1608062
|
Facility
|
IP
|
$6,211.00
|
|
|
Service Code
|
HCPCS C1788
|
| Hospital Charge Code |
2975052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,043.39 |
| Max. Negotiated Rate |
$5,714.12 |
| Rate for Payer: Aetna Commercial |
$5,589.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,341.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,291.83
|
| Rate for Payer: Cash Price |
$1,863.30
|
| Rate for Payer: Cigna Commercial |
$5,714.12
|
| Rate for Payer: Health EOS Commercial |
$5,527.79
|
| Rate for Payer: HFN Commercial |
$5,714.12
|
| Rate for Payer: Multiplan Commercial |
$4,968.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,726.60
|
| Rate for Payer: Preferred Network Access Commercial |
$5,714.12
|
| Rate for Payer: Quartz Beloit One Network |
$3,043.39
|
| Rate for Payer: Quartz Commercial |
$3,726.60
|
| Rate for Payer: WEA Trust Commercial |
$3,416.05
|
| Rate for Payer: WPS Commercial |
$4,600.49
|
|
|
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 |
$2,270.66 |
| Max. Negotiated Rate |
$4,263.28 |
| Rate for Payer: Aetna Commercial |
$4,170.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,985.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,456.02
|
| Rate for Payer: Cash Price |
$1,390.20
|
| Rate for Payer: Cigna Commercial |
$4,263.28
|
| Rate for Payer: Health EOS Commercial |
$4,124.26
|
| Rate for Payer: HFN Commercial |
$4,263.28
|
| Rate for Payer: Multiplan Commercial |
$3,707.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,780.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,263.28
|
| Rate for Payer: Quartz Beloit One Network |
$2,270.66
|
| Rate for Payer: Quartz Commercial |
$2,780.40
|
| Rate for Payer: WEA Trust Commercial |
$2,548.70
|
| Rate for Payer: WPS Commercial |
$3,432.40
|
|
|
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 |
$1,297.52 |
| Max. Negotiated Rate |
$18,536.00 |
| Rate for Payer: Aetna Commercial |
$4,170.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,985.24
|
| Rate for Payer: Aetna Managed Medicare |
$1,297.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,012.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,317.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,224.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,456.02
|
| Rate for Payer: Cash Price |
$1,390.20
|
| Rate for Payer: Cigna Commercial |
$4,263.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,593.19
|
| Rate for Payer: Health EOS Commercial |
$4,124.26
|
| Rate for Payer: HFN Commercial |
$4,263.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,475.50
|
| Rate for Payer: Multiplan Commercial |
$3,707.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,780.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,263.28
|
| Rate for Payer: Quartz Beloit One Network |
$2,270.66
|
| Rate for Payer: Quartz Commercial |
$3,012.10
|
| Rate for Payer: Quartz Medicare Advantage |
$2,780.40
|
| Rate for Payer: The Alliance Commercial |
$18,536.00
|
| Rate for Payer: WEA Trust Commercial |
$2,548.70
|
| Rate for Payer: WPS Commercial |
$3,432.40
|
|
|
POWERRASP 4.0MM X 13CM AR-8400PR
|
Facility
|
IP
|
$2,128.00
|
|
| Hospital Charge Code |
4169028
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,042.72 |
| Max. Negotiated Rate |
$1,957.76 |
| Rate for Payer: Aetna Commercial |
$1,915.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,830.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,127.84
|
| Rate for Payer: Cash Price |
$638.40
|
| Rate for Payer: Cigna Commercial |
$1,957.76
|
| Rate for Payer: Health EOS Commercial |
$1,893.92
|
| Rate for Payer: HFN Commercial |
$1,957.76
|
| Rate for Payer: Multiplan Commercial |
$1,702.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,276.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,957.76
|
| Rate for Payer: Quartz Beloit One Network |
$1,042.72
|
| Rate for Payer: Quartz Commercial |
$1,276.80
|
| Rate for Payer: WEA Trust Commercial |
$1,170.40
|
| Rate for Payer: WPS Commercial |
$1,576.21
|
|
