|
BAG PERINEAL COLD PACK
|
Facility
|
IP
|
$69.00
|
|
| Hospital Charge Code |
2963524
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$35.16 |
| Max. Negotiated Rate |
$66.02 |
| Rate for Payer: Aetna Commercial |
$64.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$61.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$38.03
|
| Rate for Payer: Cash Price |
$20.70
|
| Rate for Payer: Cigna Commercial |
$66.02
|
| Rate for Payer: Health EOS Commercial |
$63.87
|
| Rate for Payer: HFN Commercial |
$66.02
|
| Rate for Payer: Multiplan Commercial |
$57.41
|
| Rate for Payer: Preferred Network Access Commercial |
$66.02
|
| Rate for Payer: Quartz Beloit One Network |
$35.16
|
| Rate for Payer: Quartz Commercial |
$43.06
|
| Rate for Payer: WEA Trust Commercial |
$39.47
|
| Rate for Payer: WPS Commercial |
$53.15
|
|
|
BAG SECURITY CRASH CART 7505
|
Facility
|
IP
|
$6,727.00
|
|
| Hospital Charge Code |
3000485
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$3,428.08 |
| Max. Negotiated Rate |
$6,436.39 |
| Rate for Payer: Aetna Commercial |
$6,296.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,016.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,707.92
|
| Rate for Payer: Cash Price |
$2,018.10
|
| Rate for Payer: Cigna Commercial |
$6,436.39
|
| Rate for Payer: Health EOS Commercial |
$6,226.51
|
| Rate for Payer: HFN Commercial |
$6,436.39
|
| Rate for Payer: Multiplan Commercial |
$5,596.86
|
| Rate for Payer: Preferred Network Access Commercial |
$6,436.39
|
| Rate for Payer: Quartz Beloit One Network |
$3,428.08
|
| Rate for Payer: Quartz Commercial |
$4,197.65
|
| Rate for Payer: WEA Trust Commercial |
$3,847.84
|
| Rate for Payer: WPS Commercial |
$5,181.81
|
|
|
BAG SECURITY CRASH CART 7505
|
Facility
|
OP
|
$6,727.00
|
|
| Hospital Charge Code |
3000485
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1,958.90 |
| Max. Negotiated Rate |
$6,436.39 |
| Rate for Payer: Aetna Commercial |
$6,296.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,016.63
|
| Rate for Payer: Aetna Managed Medicare |
$1,958.90
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,547.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,498.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,358.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,707.92
|
| Rate for Payer: Cash Price |
$2,018.10
|
| Rate for Payer: Cigna Commercial |
$6,436.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,915.11
|
| Rate for Payer: Health EOS Commercial |
$6,226.51
|
| Rate for Payer: HFN Commercial |
$6,436.39
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,247.06
|
| Rate for Payer: Multiplan Commercial |
$5,596.86
|
| Rate for Payer: NAPHCARE Commercial |
$4,197.65
|
| Rate for Payer: Preferred Network Access Commercial |
$6,436.39
|
| Rate for Payer: Quartz Beloit One Network |
$3,428.08
|
| Rate for Payer: Quartz Commercial |
$4,547.45
|
| Rate for Payer: Quartz Medicare Advantage |
$4,197.65
|
| Rate for Payer: The Alliance Commercial |
$3,498.04
|
| Rate for Payer: WEA Trust Commercial |
$3,847.84
|
| Rate for Payer: WPS Commercial |
$5,181.81
|
|
|
BAG URINARY LEG 1100ML
|
Facility
|
IP
|
$87.00
|
|
|
Service Code
|
HCPCS A4358
|
| Hospital Charge Code |
2974737
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$44.34 |
| Max. Negotiated Rate |
$83.24 |
| Rate for Payer: Aetna Commercial |
$81.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$77.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$47.95
|
| Rate for Payer: Cash Price |
$26.10
|
| Rate for Payer: Cigna Commercial |
$83.24
|
| Rate for Payer: Health EOS Commercial |
$80.53
|
| Rate for Payer: HFN Commercial |
$83.24
|
| Rate for Payer: Multiplan Commercial |
$72.38
|
| Rate for Payer: Preferred Network Access Commercial |
$83.24
|
| Rate for Payer: Quartz Beloit One Network |
$44.34
|
| Rate for Payer: Quartz Commercial |
$54.29
|
| Rate for Payer: WEA Trust Commercial |
$49.76
|
| Rate for Payer: WPS Commercial |
$67.02
|
|
|
BAG URINARY LEG 1100ML
|
Facility
|
OP
|
$87.00
|
|
|
Service Code
|
HCPCS A4358
|
| Hospital Charge Code |
2974737
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$25.33 |
| Max. Negotiated Rate |
$83.24 |
| Rate for Payer: Aetna Commercial |
$81.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$77.81
|
| Rate for Payer: Aetna Managed Medicare |
$25.33
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$58.81
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$45.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$43.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$47.95
|
| Rate for Payer: Cash Price |
$26.10
|
| Rate for Payer: Cash Price |
$26.10
|
| Rate for Payer: Cigna Commercial |
$83.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$50.63
|
| Rate for Payer: Health EOS Commercial |
$80.53
|
| Rate for Payer: HFN Commercial |
$83.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$67.86
|
| Rate for Payer: Multiplan Commercial |
$72.38
|
| Rate for Payer: NAPHCARE Commercial |
$54.29
|
| Rate for Payer: Preferred Network Access Commercial |
$83.24
|
| Rate for Payer: Quartz Beloit One Network |
$44.34
|
| Rate for Payer: Quartz Commercial |
$58.81
|
| Rate for Payer: Quartz Medicare Advantage |
$54.29
|
| Rate for Payer: The Alliance Commercial |
$39.35
|
| Rate for Payer: WEA Trust Commercial |
$49.76
|
| Rate for Payer: WPS Commercial |
$67.02
|
|
|
BAG URINE NEWBORN STERILE
|
Facility
|
OP
|
$52.00
|
|
| Hospital Charge Code |
2963744
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$15.14 |
| Max. Negotiated Rate |
$49.75 |
| Rate for Payer: Aetna Commercial |
$48.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$46.51
|
| Rate for Payer: Aetna Managed Medicare |
$15.14
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$35.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$27.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$25.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$28.66
|
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Cigna Commercial |
$49.75
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$30.26
|
| Rate for Payer: Health EOS Commercial |
$48.13
|
| Rate for Payer: HFN Commercial |
$49.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$40.56
|
| Rate for Payer: Multiplan Commercial |
$43.26
|
| Rate for Payer: NAPHCARE Commercial |
$32.45
|
| Rate for Payer: Preferred Network Access Commercial |
$49.75
|
| Rate for Payer: Quartz Beloit One Network |
$26.50
|
| Rate for Payer: Quartz Commercial |
$35.15
|
| Rate for Payer: Quartz Medicare Advantage |
$32.45
|
| Rate for Payer: The Alliance Commercial |
$27.04
|
| Rate for Payer: WEA Trust Commercial |
$29.74
|
| Rate for Payer: WPS Commercial |
$40.06
|
|
|
BAG URINE NEWBORN STERILE
|
Facility
|
IP
|
$52.00
|
|
| Hospital Charge Code |
2963744
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$26.50 |
| Max. Negotiated Rate |
$49.75 |
| Rate for Payer: Aetna Commercial |
$48.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$46.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$28.66
|
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Cigna Commercial |
$49.75
|
| Rate for Payer: Health EOS Commercial |
$48.13
|
| Rate for Payer: HFN Commercial |
$49.75
|
| Rate for Payer: Multiplan Commercial |
$43.26
|
| Rate for Payer: Preferred Network Access Commercial |
$49.75
|
| Rate for Payer: Quartz Beloit One Network |
$26.50
|
| Rate for Payer: Quartz Commercial |
$32.45
|
| Rate for Payer: WEA Trust Commercial |
$29.74
|
| Rate for Payer: WPS Commercial |
$40.06
|
|
|
BAG U STERILE PEDIATRIC SIZE
|
Facility
|
OP
|
$56.00
|
|
| Hospital Charge Code |
2964061
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$16.31 |
| Max. Negotiated Rate |
$53.58 |
| Rate for Payer: Aetna Commercial |
$52.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$50.09
|
| Rate for Payer: Aetna Managed Medicare |
$16.31
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$37.86
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$29.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$27.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$30.87
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Cigna Commercial |
$53.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$32.59
|
| Rate for Payer: Health EOS Commercial |
$51.83
|
| Rate for Payer: HFN Commercial |
$53.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$43.68
|
| Rate for Payer: Multiplan Commercial |
$46.59
|
| Rate for Payer: NAPHCARE Commercial |
$34.94
|
| Rate for Payer: Preferred Network Access Commercial |
$53.58
|
| Rate for Payer: Quartz Beloit One Network |
$28.54
|
| Rate for Payer: Quartz Commercial |
$37.86
|
| Rate for Payer: Quartz Medicare Advantage |
$34.94
|
| Rate for Payer: The Alliance Commercial |
$29.12
|
| Rate for Payer: WEA Trust Commercial |
$32.03
|
| Rate for Payer: WPS Commercial |
$43.14
|
|
|
BAG U STERILE PEDIATRIC SIZE
|
Facility
|
IP
|
$56.00
|
|
| Hospital Charge Code |
2964061
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$28.54 |
| Max. Negotiated Rate |
$53.58 |
| Rate for Payer: Aetna Commercial |
$52.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$50.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$30.87
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Cigna Commercial |
$53.58
|
| Rate for Payer: Health EOS Commercial |
$51.83
|
| Rate for Payer: HFN Commercial |
$53.58
|
| Rate for Payer: Multiplan Commercial |
$46.59
|
| Rate for Payer: Preferred Network Access Commercial |
$53.58
|
| Rate for Payer: Quartz Beloit One Network |
$28.54
|
| Rate for Payer: Quartz Commercial |
$34.94
|
| Rate for Payer: WEA Trust Commercial |
$32.03
|
| Rate for Payer: WPS Commercial |
$43.14
|
|
|
Bakri Postpartum Balloon - Individual Charges
|
Facility
|
OP
|
$1,809.00
|
|
| Hospital Charge Code |
5082615
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$526.78 |
| Max. Negotiated Rate |
$1,730.85 |
| Rate for Payer: Aetna Commercial |
$1,693.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,617.97
|
| Rate for Payer: Aetna Managed Medicare |
$526.78
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,222.88
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$940.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$903.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$997.12
|
| Rate for Payer: Cash Price |
$542.70
|
| Rate for Payer: Cigna Commercial |
$1,730.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,052.84
|
| Rate for Payer: Health EOS Commercial |
$1,674.41
|
| Rate for Payer: HFN Commercial |
$1,730.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,411.02
|
| Rate for Payer: Multiplan Commercial |
$1,505.09
|
| Rate for Payer: NAPHCARE Commercial |
$1,128.82
|
| Rate for Payer: Preferred Network Access Commercial |
$1,730.85
|
| Rate for Payer: Quartz Beloit One Network |
$921.87
|
| Rate for Payer: Quartz Commercial |
$1,222.88
|
| Rate for Payer: Quartz Medicare Advantage |
$1,128.82
|
| Rate for Payer: The Alliance Commercial |
$940.68
|
| Rate for Payer: United Healthcare PPO |
$1,411.02
|
| Rate for Payer: WEA Trust Commercial |
$1,034.75
|
| Rate for Payer: WPS Commercial |
$1,393.47
|
|
|
Bakri Postpartum Balloon - Individual Charges
|
Facility
|
IP
|
$1,809.00
|
|
| Hospital Charge Code |
5082615
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$921.87 |
| Max. Negotiated Rate |
$1,730.85 |
| Rate for Payer: Aetna Commercial |
$1,693.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,617.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$997.12
|
| Rate for Payer: Cash Price |
$542.70
|
| Rate for Payer: Cigna Commercial |
$1,730.85
|
| Rate for Payer: Health EOS Commercial |
$1,674.41
|
| Rate for Payer: HFN Commercial |
$1,730.85
|
| Rate for Payer: Multiplan Commercial |
$1,505.09
|
| Rate for Payer: Preferred Network Access Commercial |
$1,730.85
|
| Rate for Payer: Quartz Beloit One Network |
$921.87
|
| Rate for Payer: Quartz Commercial |
$1,128.82
|
| Rate for Payer: WEA Trust Commercial |
$1,034.75
|
| Rate for Payer: WPS Commercial |
$1,393.47
|
|
|
Balanced Salt Solution 15ml [Med]
|
Facility
|
OP
|
$21.00
|
|
| Hospital Charge Code |
2974916
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.12 |
| Max. Negotiated Rate |
$20.09 |
| Rate for Payer: Aetna Commercial |
$19.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$18.78
|
| Rate for Payer: Aetna Managed Medicare |
$6.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$14.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11.58
|
| Rate for Payer: Cash Price |
$6.30
|
| Rate for Payer: Cigna Commercial |
$20.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12.22
|
| Rate for Payer: Health EOS Commercial |
$19.44
|
| Rate for Payer: HFN Commercial |
$20.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$16.38
|
| Rate for Payer: Multiplan Commercial |
$17.47
|
| Rate for Payer: NAPHCARE Commercial |
$13.10
|
| Rate for Payer: Preferred Network Access Commercial |
$20.09
|
| Rate for Payer: Quartz Beloit One Network |
$10.70
|
| Rate for Payer: Quartz Commercial |
$14.20
|
| Rate for Payer: Quartz Medicare Advantage |
$13.10
|
| Rate for Payer: The Alliance Commercial |
$10.92
|
| Rate for Payer: WEA Trust Commercial |
$12.01
|
| Rate for Payer: WPS Commercial |
$16.18
|
|
|
Balanced Salt Solution 15ml [Med]
|
Facility
|
IP
|
$21.00
|
|
| Hospital Charge Code |
2974916
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.70 |
| Max. Negotiated Rate |
$20.09 |
| Rate for Payer: Aetna Commercial |
$19.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$18.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11.58
|
| Rate for Payer: Cash Price |
$6.30
|
| Rate for Payer: Cigna Commercial |
$20.09
|
| Rate for Payer: Health EOS Commercial |
$19.44
|
| Rate for Payer: HFN Commercial |
$20.09
|
| Rate for Payer: Multiplan Commercial |
$17.47
|
| Rate for Payer: Preferred Network Access Commercial |
$20.09
|
| Rate for Payer: Quartz Beloit One Network |
$10.70
|
| Rate for Payer: Quartz Commercial |
$13.10
|
| Rate for Payer: WEA Trust Commercial |
$12.01
|
| Rate for Payer: WPS Commercial |
$16.18
|
|
|
Balanced Salt Solution 30ml [Med]
|
Facility
|
OP
|
$31.00
|
|
| Hospital Charge Code |
2974917
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.03 |
| Max. Negotiated Rate |
$29.66 |
| Rate for Payer: Aetna Commercial |
$29.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$27.73
|
| Rate for Payer: Aetna Managed Medicare |
$9.03
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$20.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$16.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$15.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$17.09
|
| Rate for Payer: Cash Price |
$9.30
|
| Rate for Payer: Cigna Commercial |
$29.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$18.04
|
| Rate for Payer: Health EOS Commercial |
$28.69
|
| Rate for Payer: HFN Commercial |
$29.66
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$24.18
|
| Rate for Payer: Multiplan Commercial |
$25.79
|
| Rate for Payer: NAPHCARE Commercial |
$19.34
|
| Rate for Payer: Preferred Network Access Commercial |
$29.66
|
| Rate for Payer: Quartz Beloit One Network |
$15.80
|
| Rate for Payer: Quartz Commercial |
$20.96
|
| Rate for Payer: Quartz Medicare Advantage |
$19.34
|
| Rate for Payer: The Alliance Commercial |
$16.12
|
| Rate for Payer: WEA Trust Commercial |
$17.73
|
| Rate for Payer: WPS Commercial |
$23.88
|
|
|
Balanced Salt Solution 30ml [Med]
|
Facility
|
IP
|
$31.00
|
|
| Hospital Charge Code |
2974917
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.80 |
| Max. Negotiated Rate |
$29.66 |
| Rate for Payer: Aetna Commercial |
$29.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$27.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$17.09
|
| Rate for Payer: Cash Price |
$9.30
|
| Rate for Payer: Cigna Commercial |
$29.66
|
| Rate for Payer: Health EOS Commercial |
$28.69
|
| Rate for Payer: HFN Commercial |
$29.66
|
| Rate for Payer: Multiplan Commercial |
$25.79
|
| Rate for Payer: Preferred Network Access Commercial |
$29.66
|
| Rate for Payer: Quartz Beloit One Network |
$15.80
|
| Rate for Payer: Quartz Commercial |
$19.34
|
| Rate for Payer: WEA Trust Commercial |
$17.73
|
| Rate for Payer: WPS Commercial |
$23.88
|
|
|
BALLON NC 3.5 x8mm #1011756-08***DISCONTINUED
|
Facility
|
OP
|
$2,683.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
2973242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$781.29 |
| Max. Negotiated Rate |
$2,567.09 |
| Rate for Payer: Aetna Commercial |
$2,511.29
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,399.68
|
| Rate for Payer: Aetna Managed Medicare |
$781.29
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,813.71
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,395.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,339.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,478.87
|
| Rate for Payer: Cash Price |
$804.90
|
| Rate for Payer: Cigna Commercial |
$2,567.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,561.51
|
| Rate for Payer: Health EOS Commercial |
$2,483.38
|
| Rate for Payer: HFN Commercial |
$2,567.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,092.74
|
| Rate for Payer: Multiplan Commercial |
$2,232.26
|
| Rate for Payer: NAPHCARE Commercial |
$1,674.19
|
| Rate for Payer: Preferred Network Access Commercial |
$2,567.09
|
| Rate for Payer: Quartz Beloit One Network |
$1,367.26
|
| Rate for Payer: Quartz Commercial |
$1,813.71
|
| Rate for Payer: Quartz Medicare Advantage |
$1,674.19
|
| Rate for Payer: The Alliance Commercial |
$1,395.16
|
| Rate for Payer: WEA Trust Commercial |
$1,534.68
|
| Rate for Payer: WPS Commercial |
$2,066.71
|
|
|
BALLON NC 3.5 x8mm #1011756-08***DISCONTINUED
|
Facility
|
IP
|
$2,683.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
2973242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,367.26 |
| Max. Negotiated Rate |
$2,567.09 |
| Rate for Payer: Aetna Commercial |
$2,511.29
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,399.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,478.87
|
| Rate for Payer: Cash Price |
$804.90
|
| Rate for Payer: Cigna Commercial |
$2,567.09
|
| Rate for Payer: Health EOS Commercial |
$2,483.38
|
| Rate for Payer: HFN Commercial |
$2,567.09
|
| Rate for Payer: Multiplan Commercial |
$2,232.26
|
| Rate for Payer: Preferred Network Access Commercial |
$2,567.09
|
| Rate for Payer: Quartz Beloit One Network |
$1,367.26
|
| Rate for Payer: Quartz Commercial |
$1,674.19
|
| Rate for Payer: WEA Trust Commercial |
$1,534.68
|
| Rate for Payer: WPS Commercial |
$2,066.71
|
|
|
BALLOON 06X40mm AB35W06040080
|
Facility
|
OP
|
$1,708.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
2972507
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$497.37 |
| Max. Negotiated Rate |
$1,634.21 |
| Rate for Payer: Aetna Commercial |
$1,598.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,527.64
|
| Rate for Payer: Aetna Managed Medicare |
$497.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,154.61
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$888.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$852.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$941.45
|
| Rate for Payer: Cash Price |
$512.40
|
| Rate for Payer: Cigna Commercial |
$1,634.21
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$994.06
|
| Rate for Payer: Health EOS Commercial |
$1,580.92
|
| Rate for Payer: HFN Commercial |
$1,634.21
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,332.24
|
| Rate for Payer: Multiplan Commercial |
$1,421.06
|
| Rate for Payer: NAPHCARE Commercial |
$1,065.79
|
| Rate for Payer: Preferred Network Access Commercial |
$1,634.21
|
| Rate for Payer: Quartz Beloit One Network |
$870.40
|
| Rate for Payer: Quartz Commercial |
$1,154.61
|
| Rate for Payer: Quartz Medicare Advantage |
$1,065.79
|
| Rate for Payer: The Alliance Commercial |
$888.16
|
| Rate for Payer: WEA Trust Commercial |
$976.98
|
| Rate for Payer: WPS Commercial |
$1,315.67
|
|
|
BALLOON 06X40mm AB35W06040080
|
Facility
|
IP
|
$1,708.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
2972507
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$870.40 |
| Max. Negotiated Rate |
$1,634.21 |
| Rate for Payer: Aetna Commercial |
$1,598.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,527.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$941.45
|
| Rate for Payer: Cash Price |
$512.40
|
| Rate for Payer: Cigna Commercial |
$1,634.21
|
| Rate for Payer: Health EOS Commercial |
$1,580.92
|
| Rate for Payer: HFN Commercial |
$1,634.21
|
| Rate for Payer: Multiplan Commercial |
$1,421.06
|
| Rate for Payer: Preferred Network Access Commercial |
$1,634.21
|
| Rate for Payer: Quartz Beloit One Network |
$870.40
|
| Rate for Payer: Quartz Commercial |
$1,065.79
|
| Rate for Payer: WEA Trust Commercial |
$976.98
|
| Rate for Payer: WPS Commercial |
$1,315.67
|
|
|
BALLOON 10 X20mm AB35W10020080
|
Facility
|
OP
|
$1,708.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
2972508
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$497.37 |
| Max. Negotiated Rate |
$1,634.21 |
| Rate for Payer: Aetna Commercial |
$1,598.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,527.64
|
| Rate for Payer: Aetna Managed Medicare |
$497.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,154.61
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$888.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$852.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$941.45
|
| Rate for Payer: Cash Price |
$512.40
|
| Rate for Payer: Cigna Commercial |
$1,634.21
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$994.06
|
| Rate for Payer: Health EOS Commercial |
$1,580.92
|
| Rate for Payer: HFN Commercial |
$1,634.21
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,332.24
|
| Rate for Payer: Multiplan Commercial |
$1,421.06
|
| Rate for Payer: NAPHCARE Commercial |
$1,065.79
|
| Rate for Payer: Preferred Network Access Commercial |
$1,634.21
|
| Rate for Payer: Quartz Beloit One Network |
$870.40
|
| Rate for Payer: Quartz Commercial |
$1,154.61
|
| Rate for Payer: Quartz Medicare Advantage |
$1,065.79
|
| Rate for Payer: The Alliance Commercial |
$888.16
|
| Rate for Payer: WEA Trust Commercial |
$976.98
|
| Rate for Payer: WPS Commercial |
$1,315.67
|
|
|
BALLOON 10 X20mm AB35W10020080
|
Facility
|
IP
|
$1,708.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
2972508
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$870.40 |
| Max. Negotiated Rate |
$1,634.21 |
| Rate for Payer: Aetna Commercial |
$1,598.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,527.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$941.45
|
| Rate for Payer: Cash Price |
$512.40
|
| Rate for Payer: Cigna Commercial |
$1,634.21
|
| Rate for Payer: Health EOS Commercial |
$1,580.92
|
| Rate for Payer: HFN Commercial |
$1,634.21
|
| Rate for Payer: Multiplan Commercial |
$1,421.06
|
| Rate for Payer: Preferred Network Access Commercial |
$1,634.21
|
| Rate for Payer: Quartz Beloit One Network |
$870.40
|
| Rate for Payer: Quartz Commercial |
$1,065.79
|
| Rate for Payer: WEA Trust Commercial |
$976.98
|
| Rate for Payer: WPS Commercial |
$1,315.67
|
|
|
BALLOON 10.X40mm AB35W10040080
|
Facility
|
OP
|
$1,708.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
2972514
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$497.37 |
| Max. Negotiated Rate |
$1,634.21 |
| Rate for Payer: Aetna Commercial |
$1,598.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,527.64
|
| Rate for Payer: Aetna Managed Medicare |
$497.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,154.61
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$888.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$852.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$941.45
|
| Rate for Payer: Cash Price |
$512.40
|
| Rate for Payer: Cigna Commercial |
$1,634.21
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$994.06
|
| Rate for Payer: Health EOS Commercial |
$1,580.92
|
| Rate for Payer: HFN Commercial |
$1,634.21
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,332.24
|
| Rate for Payer: Multiplan Commercial |
$1,421.06
|
| Rate for Payer: NAPHCARE Commercial |
$1,065.79
|
| Rate for Payer: Preferred Network Access Commercial |
$1,634.21
|
| Rate for Payer: Quartz Beloit One Network |
$870.40
|
| Rate for Payer: Quartz Commercial |
$1,154.61
|
| Rate for Payer: Quartz Medicare Advantage |
$1,065.79
|
| Rate for Payer: The Alliance Commercial |
$888.16
|
| Rate for Payer: WEA Trust Commercial |
$976.98
|
| Rate for Payer: WPS Commercial |
$1,315.67
|
|
|
BALLOON 10.X40mm AB35W10040080
|
Facility
|
IP
|
$1,708.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
2972514
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$870.40 |
| Max. Negotiated Rate |
$1,634.21 |
| Rate for Payer: Aetna Commercial |
$1,598.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,527.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$941.45
|
| Rate for Payer: Cash Price |
$512.40
|
| Rate for Payer: Cigna Commercial |
$1,634.21
|
| Rate for Payer: Health EOS Commercial |
$1,580.92
|
| Rate for Payer: HFN Commercial |
$1,634.21
|
| Rate for Payer: Multiplan Commercial |
$1,421.06
|
| Rate for Payer: Preferred Network Access Commercial |
$1,634.21
|
| Rate for Payer: Quartz Beloit One Network |
$870.40
|
| Rate for Payer: Quartz Commercial |
$1,065.79
|
| Rate for Payer: WEA Trust Commercial |
$976.98
|
| Rate for Payer: WPS Commercial |
$1,315.67
|
|
|
BALLOON 2.0 X 120 PTA
|
Facility
|
IP
|
$3,415.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
2973376
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,740.28 |
| Max. Negotiated Rate |
$3,267.47 |
| Rate for Payer: Aetna Commercial |
$3,196.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,054.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,882.35
|
| Rate for Payer: Cash Price |
$1,024.50
|
| Rate for Payer: Cigna Commercial |
$3,267.47
|
| Rate for Payer: Health EOS Commercial |
$3,160.92
|
| Rate for Payer: HFN Commercial |
$3,267.47
|
| Rate for Payer: Multiplan Commercial |
$2,841.28
|
| Rate for Payer: Preferred Network Access Commercial |
$3,267.47
|
| Rate for Payer: Quartz Beloit One Network |
$1,740.28
|
| Rate for Payer: Quartz Commercial |
$2,130.96
|
| Rate for Payer: WEA Trust Commercial |
$1,953.38
|
| Rate for Payer: WPS Commercial |
$2,630.57
|
|
|
BALLOON 2.0 X 120 PTA
|
Facility
|
OP
|
$3,415.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
2973376
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$994.45 |
| Max. Negotiated Rate |
$3,267.47 |
| Rate for Payer: Aetna Commercial |
$3,196.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,054.38
|
| Rate for Payer: Aetna Managed Medicare |
$994.45
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,308.54
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,775.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,704.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,882.35
|
| Rate for Payer: Cash Price |
$1,024.50
|
| Rate for Payer: Cigna Commercial |
$3,267.47
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,987.53
|
| Rate for Payer: Health EOS Commercial |
$3,160.92
|
| Rate for Payer: HFN Commercial |
$3,267.47
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,663.70
|
| Rate for Payer: Multiplan Commercial |
$2,841.28
|
| Rate for Payer: NAPHCARE Commercial |
$2,130.96
|
| Rate for Payer: Preferred Network Access Commercial |
$3,267.47
|
| Rate for Payer: Quartz Beloit One Network |
$1,740.28
|
| Rate for Payer: Quartz Commercial |
$2,308.54
|
| Rate for Payer: Quartz Medicare Advantage |
$2,130.96
|
| Rate for Payer: The Alliance Commercial |
$1,775.80
|
| Rate for Payer: WEA Trust Commercial |
$1,953.38
|
| Rate for Payer: WPS Commercial |
$2,630.57
|
|
