|
BARD IVC ECLIPSE FILTER JUGU
|
Facility
|
IP
|
$10,066.00
|
|
|
Service Code
|
HCPCS C1880
|
| Hospital Charge Code |
2973750
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,129.63 |
| Max. Negotiated Rate |
$9,631.15 |
| Rate for Payer: Aetna Commercial |
$9,421.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,003.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,548.38
|
| Rate for Payer: Cash Price |
$3,019.80
|
| Rate for Payer: Cigna Commercial |
$9,631.15
|
| Rate for Payer: Health EOS Commercial |
$9,317.09
|
| Rate for Payer: HFN Commercial |
$9,631.15
|
| Rate for Payer: Multiplan Commercial |
$8,374.91
|
| Rate for Payer: Preferred Network Access Commercial |
$9,631.15
|
| Rate for Payer: Quartz Beloit One Network |
$5,129.63
|
| Rate for Payer: Quartz Commercial |
$6,281.18
|
| Rate for Payer: WEA Trust Commercial |
$5,757.75
|
| Rate for Payer: WPS Commercial |
$7,753.84
|
|
|
BARD IVC ECLIPSE FILTER JUGU
|
Facility
|
OP
|
$10,066.00
|
|
|
Service Code
|
HCPCS C1880
|
| Hospital Charge Code |
2973750
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,931.22 |
| Max. Negotiated Rate |
$9,631.15 |
| Rate for Payer: Aetna Commercial |
$9,421.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,003.03
|
| Rate for Payer: Aetna Managed Medicare |
$2,931.22
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,804.62
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,234.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,024.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,548.38
|
| Rate for Payer: Cash Price |
$3,019.80
|
| Rate for Payer: Cigna Commercial |
$9,631.15
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,858.41
|
| Rate for Payer: Health EOS Commercial |
$9,317.09
|
| Rate for Payer: HFN Commercial |
$9,631.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,851.48
|
| Rate for Payer: Multiplan Commercial |
$8,374.91
|
| Rate for Payer: NAPHCARE Commercial |
$6,281.18
|
| Rate for Payer: Preferred Network Access Commercial |
$9,631.15
|
| Rate for Payer: Quartz Beloit One Network |
$5,129.63
|
| Rate for Payer: Quartz Commercial |
$6,804.62
|
| Rate for Payer: Quartz Medicare Advantage |
$6,281.18
|
| Rate for Payer: The Alliance Commercial |
$5,234.32
|
| Rate for Payer: WEA Trust Commercial |
$5,757.75
|
| Rate for Payer: WPS Commercial |
$7,753.84
|
|
|
Barewire for NAVG Filter
|
Facility
|
IP
|
$2,215.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5460726
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,128.76 |
| Max. Negotiated Rate |
$2,119.31 |
| Rate for Payer: Aetna Commercial |
$2,073.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,981.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,220.91
|
| Rate for Payer: Cash Price |
$664.50
|
| Rate for Payer: Cigna Commercial |
$2,119.31
|
| Rate for Payer: Health EOS Commercial |
$2,050.20
|
| Rate for Payer: HFN Commercial |
$2,119.31
|
| Rate for Payer: Multiplan Commercial |
$1,842.88
|
| Rate for Payer: Preferred Network Access Commercial |
$2,119.31
|
| Rate for Payer: Quartz Beloit One Network |
$1,128.76
|
| Rate for Payer: Quartz Commercial |
$1,382.16
|
| Rate for Payer: WEA Trust Commercial |
$1,266.98
|
| Rate for Payer: WPS Commercial |
$1,706.21
|
|
|
Barewire for NAVG Filter
|
Facility
|
OP
|
$2,215.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5460726
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$645.01 |
| Max. Negotiated Rate |
$2,119.31 |
| Rate for Payer: Aetna Commercial |
$2,073.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,981.10
|
| Rate for Payer: Aetna Managed Medicare |
$645.01
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,497.34
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,151.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,105.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,220.91
|
| Rate for Payer: Cash Price |
$664.50
|
| Rate for Payer: Cigna Commercial |
$2,119.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,289.13
|
| Rate for Payer: Health EOS Commercial |
$2,050.20
|
| Rate for Payer: HFN Commercial |
$2,119.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,727.70
|
| Rate for Payer: Multiplan Commercial |
$1,842.88
|
| Rate for Payer: NAPHCARE Commercial |
$1,382.16
|
| Rate for Payer: Preferred Network Access Commercial |
$2,119.31
|
| Rate for Payer: Quartz Beloit One Network |
$1,128.76
|
| Rate for Payer: Quartz Commercial |
$1,497.34
|
| Rate for Payer: Quartz Medicare Advantage |
$1,382.16
|
| Rate for Payer: The Alliance Commercial |
$1,151.80
|
| Rate for Payer: WEA Trust Commercial |
$1,266.98
|
| Rate for Payer: WPS Commercial |
$1,706.21
|
|
|
BARI-AIR THERAPY BED
|
Facility
|
OP
|
$2,829.00
|
|
|
Service Code
|
HCPCS A9279
|
| Hospital Charge Code |
2964100
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$823.80 |
| Max. Negotiated Rate |
$2,706.79 |
| Rate for Payer: Aetna Commercial |
$2,647.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,530.26
|
| Rate for Payer: Aetna Managed Medicare |
$823.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,912.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,471.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,412.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,559.34
|
| Rate for Payer: Cash Price |
$848.70
|
| Rate for Payer: Cigna Commercial |
$2,706.79
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,646.48
|
| Rate for Payer: Health EOS Commercial |
$2,618.52
|
| Rate for Payer: HFN Commercial |
$2,706.79
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,206.62
|
| Rate for Payer: Multiplan Commercial |
$2,353.73
|
| Rate for Payer: NAPHCARE Commercial |
$1,765.30
|
| Rate for Payer: Preferred Network Access Commercial |
$2,706.79
|
| Rate for Payer: Quartz Beloit One Network |
$1,441.66
|
| Rate for Payer: Quartz Commercial |
$1,912.40
|
| Rate for Payer: Quartz Medicare Advantage |
$1,765.30
|
| Rate for Payer: The Alliance Commercial |
$1,471.08
|
| Rate for Payer: WEA Trust Commercial |
$1,618.19
|
| Rate for Payer: WPS Commercial |
$2,179.18
|
|
|
BARI-AIR THERAPY BED
|
Facility
|
IP
|
$2,829.00
|
|
|
Service Code
|
HCPCS A9279
|
| Hospital Charge Code |
2964100
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1,441.66 |
| Max. Negotiated Rate |
$2,706.79 |
| Rate for Payer: Aetna Commercial |
$2,647.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,530.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,559.34
|
| Rate for Payer: Cash Price |
$848.70
|
| Rate for Payer: Cigna Commercial |
$2,706.79
|
| Rate for Payer: Health EOS Commercial |
$2,618.52
|
| Rate for Payer: HFN Commercial |
$2,706.79
|
| Rate for Payer: Multiplan Commercial |
$2,353.73
|
| Rate for Payer: Preferred Network Access Commercial |
$2,706.79
|
| Rate for Payer: Quartz Beloit One Network |
$1,441.66
|
| Rate for Payer: Quartz Commercial |
$1,765.30
|
| Rate for Payer: WEA Trust Commercial |
$1,618.19
|
| Rate for Payer: WPS Commercial |
$2,179.18
|
|
|
Bariatric Ezio
|
Facility
|
OP
|
$266.00
|
|
| Hospital Charge Code |
3040373
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$77.46 |
| Max. Negotiated Rate |
$254.51 |
| Rate for Payer: Aetna Commercial |
$248.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$237.91
|
| Rate for Payer: Aetna Managed Medicare |
$77.46
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$179.82
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$138.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$132.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$146.62
|
| Rate for Payer: Cash Price |
$79.80
|
| Rate for Payer: Cigna Commercial |
$254.51
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$154.81
|
| Rate for Payer: Health EOS Commercial |
$246.21
|
| Rate for Payer: HFN Commercial |
$254.51
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$207.48
|
| Rate for Payer: Multiplan Commercial |
$221.31
|
| Rate for Payer: NAPHCARE Commercial |
$165.98
|
| Rate for Payer: Preferred Network Access Commercial |
$254.51
|
| Rate for Payer: Quartz Beloit One Network |
$135.55
|
| Rate for Payer: Quartz Commercial |
$179.82
|
| Rate for Payer: Quartz Medicare Advantage |
$165.98
|
| Rate for Payer: The Alliance Commercial |
$138.32
|
| Rate for Payer: WEA Trust Commercial |
$152.15
|
| Rate for Payer: WPS Commercial |
$204.90
|
|
|
Bariatric Ezio
|
Facility
|
IP
|
$266.00
|
|
| Hospital Charge Code |
3040373
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$135.55 |
| Max. Negotiated Rate |
$254.51 |
| Rate for Payer: Aetna Commercial |
$248.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$237.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$146.62
|
| Rate for Payer: Cash Price |
$79.80
|
| Rate for Payer: Cigna Commercial |
$254.51
|
| Rate for Payer: Health EOS Commercial |
$246.21
|
| Rate for Payer: HFN Commercial |
$254.51
|
| Rate for Payer: Multiplan Commercial |
$221.31
|
| Rate for Payer: Preferred Network Access Commercial |
$254.51
|
| Rate for Payer: Quartz Beloit One Network |
$135.55
|
| Rate for Payer: Quartz Commercial |
$165.98
|
| Rate for Payer: WEA Trust Commercial |
$152.15
|
| Rate for Payer: WPS Commercial |
$204.90
|
|
|
BARIATRIC W/SCALES
|
Facility
|
IP
|
$1,570.00
|
|
|
Service Code
|
HCPCS A9279
|
| Hospital Charge Code |
2964101
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$800.07 |
| Max. Negotiated Rate |
$1,502.18 |
| Rate for Payer: Aetna Commercial |
$1,469.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,404.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$865.38
|
| Rate for Payer: Cash Price |
$471.00
|
| Rate for Payer: Cigna Commercial |
$1,502.18
|
| Rate for Payer: Health EOS Commercial |
$1,453.19
|
| Rate for Payer: HFN Commercial |
$1,502.18
|
| Rate for Payer: Multiplan Commercial |
$1,306.24
|
| Rate for Payer: Preferred Network Access Commercial |
$1,502.18
|
| Rate for Payer: Quartz Beloit One Network |
$800.07
|
| Rate for Payer: Quartz Commercial |
$979.68
|
| Rate for Payer: WEA Trust Commercial |
$898.04
|
| Rate for Payer: WPS Commercial |
$1,209.37
|
|
|
BARIATRIC W/SCALES
|
Facility
|
OP
|
$1,570.00
|
|
|
Service Code
|
HCPCS A9279
|
| Hospital Charge Code |
2964101
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$457.18 |
| Max. Negotiated Rate |
$1,502.18 |
| Rate for Payer: Aetna Commercial |
$1,469.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,404.21
|
| Rate for Payer: Aetna Managed Medicare |
$457.18
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,061.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$816.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$783.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$865.38
|
| Rate for Payer: Cash Price |
$471.00
|
| Rate for Payer: Cigna Commercial |
$1,502.18
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$913.74
|
| Rate for Payer: Health EOS Commercial |
$1,453.19
|
| Rate for Payer: HFN Commercial |
$1,502.18
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,224.60
|
| Rate for Payer: Multiplan Commercial |
$1,306.24
|
| Rate for Payer: NAPHCARE Commercial |
$979.68
|
| Rate for Payer: Preferred Network Access Commercial |
$1,502.18
|
| Rate for Payer: Quartz Beloit One Network |
$800.07
|
| Rate for Payer: Quartz Commercial |
$1,061.32
|
| Rate for Payer: Quartz Medicare Advantage |
$979.68
|
| Rate for Payer: The Alliance Commercial |
$816.40
|
| Rate for Payer: WEA Trust Commercial |
$898.04
|
| Rate for Payer: WPS Commercial |
$1,209.37
|
|
|
BARRIER CTF CONVEX SENSURA 16931
|
Facility
|
OP
|
$213.00
|
|
| Hospital Charge Code |
5547235
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$62.03 |
| Max. Negotiated Rate |
$203.80 |
| Rate for Payer: Aetna Commercial |
$199.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$190.51
|
| Rate for Payer: Aetna Managed Medicare |
$62.03
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$143.99
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$110.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$106.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$117.41
|
| Rate for Payer: Cash Price |
$63.90
|
| Rate for Payer: Cigna Commercial |
$203.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$123.97
|
| Rate for Payer: Health EOS Commercial |
$197.15
|
| Rate for Payer: HFN Commercial |
$203.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$166.14
|
| Rate for Payer: Multiplan Commercial |
$177.22
|
| Rate for Payer: NAPHCARE Commercial |
$132.91
|
| Rate for Payer: Preferred Network Access Commercial |
$203.80
|
| Rate for Payer: Quartz Beloit One Network |
$108.54
|
| Rate for Payer: Quartz Commercial |
$143.99
|
| Rate for Payer: Quartz Medicare Advantage |
$132.91
|
| Rate for Payer: The Alliance Commercial |
$110.76
|
| Rate for Payer: WEA Trust Commercial |
$121.84
|
| Rate for Payer: WPS Commercial |
$164.07
|
|
|
BARRIER CTF CONVEX SENSURA 16931
|
Facility
|
IP
|
$213.00
|
|
| Hospital Charge Code |
5547235
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$108.54 |
| Max. Negotiated Rate |
$203.80 |
| Rate for Payer: Aetna Commercial |
$199.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$190.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$117.41
|
| Rate for Payer: Cash Price |
$63.90
|
| Rate for Payer: Cigna Commercial |
$203.80
|
| Rate for Payer: Health EOS Commercial |
$197.15
|
| Rate for Payer: HFN Commercial |
$203.80
|
| Rate for Payer: Multiplan Commercial |
$177.22
|
| Rate for Payer: Preferred Network Access Commercial |
$203.80
|
| Rate for Payer: Quartz Beloit One Network |
$108.54
|
| Rate for Payer: Quartz Commercial |
$132.91
|
| Rate for Payer: WEA Trust Commercial |
$121.84
|
| Rate for Payer: WPS Commercial |
$164.07
|
|
|
BARRIER FILM NO STING WIPE 3344
|
Facility
|
OP
|
$108.00
|
|
|
Service Code
|
HCPCS A4414
|
| Hospital Charge Code |
2974355
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$29.16 |
| Max. Negotiated Rate |
$103.33 |
| Rate for Payer: Aetna Commercial |
$101.09
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$96.60
|
| Rate for Payer: Aetna Managed Medicare |
$31.45
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$73.01
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$56.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$53.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$59.53
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cigna Commercial |
$103.33
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$62.86
|
| Rate for Payer: Health EOS Commercial |
$99.96
|
| Rate for Payer: HFN Commercial |
$103.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$84.24
|
| Rate for Payer: Multiplan Commercial |
$89.86
|
| Rate for Payer: NAPHCARE Commercial |
$67.39
|
| Rate for Payer: Preferred Network Access Commercial |
$103.33
|
| Rate for Payer: Quartz Beloit One Network |
$55.04
|
| Rate for Payer: Quartz Commercial |
$73.01
|
| Rate for Payer: Quartz Medicare Advantage |
$67.39
|
| Rate for Payer: The Alliance Commercial |
$29.16
|
| Rate for Payer: WEA Trust Commercial |
$61.78
|
| Rate for Payer: WPS Commercial |
$83.19
|
|
|
BARRIER FILM NO STING WIPE 3344
|
Facility
|
IP
|
$108.00
|
|
|
Service Code
|
HCPCS A4414
|
| Hospital Charge Code |
2974355
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$55.04 |
| Max. Negotiated Rate |
$103.33 |
| Rate for Payer: Aetna Commercial |
$101.09
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$96.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$59.53
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cigna Commercial |
$103.33
|
| Rate for Payer: Health EOS Commercial |
$99.96
|
| Rate for Payer: HFN Commercial |
$103.33
|
| Rate for Payer: Multiplan Commercial |
$89.86
|
| Rate for Payer: Preferred Network Access Commercial |
$103.33
|
| Rate for Payer: Quartz Beloit One Network |
$55.04
|
| Rate for Payer: Quartz Commercial |
$67.39
|
| Rate for Payer: WEA Trust Commercial |
$61.78
|
| Rate for Payer: WPS Commercial |
$83.19
|
|
|
BARRIER FLANGE CTF 1.75 15602"
|
Facility
|
OP
|
$56.00
|
|
|
Service Code
|
HCPCS A4409
|
| Hospital Charge Code |
4594656
|
|
Hospital Revenue Code
|
272
|
| 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: 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 |
$36.77
|
| Rate for Payer: WEA Trust Commercial |
$32.03
|
| Rate for Payer: WPS Commercial |
$43.14
|
|
|
BARRIER FLANGE CTF 1.75 15602"
|
Facility
|
IP
|
$56.00
|
|
|
Service Code
|
HCPCS A4409
|
| Hospital Charge Code |
4594656
|
|
Hospital Revenue Code
|
272
|
| 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
|
|
|
BARRIER HOLLISTER CTF 2.25 11203"
|
Facility
|
IP
|
$66.00
|
|
|
Service Code
|
HCPCS A4409
|
| Hospital Charge Code |
4595817
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$33.63 |
| Max. Negotiated Rate |
$63.15 |
| Rate for Payer: Aetna Commercial |
$61.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$59.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$36.38
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cigna Commercial |
$63.15
|
| Rate for Payer: Health EOS Commercial |
$61.09
|
| Rate for Payer: HFN Commercial |
$63.15
|
| Rate for Payer: Multiplan Commercial |
$54.91
|
| Rate for Payer: Preferred Network Access Commercial |
$63.15
|
| Rate for Payer: Quartz Beloit One Network |
$33.63
|
| Rate for Payer: Quartz Commercial |
$41.18
|
| Rate for Payer: WEA Trust Commercial |
$37.75
|
| Rate for Payer: WPS Commercial |
$50.84
|
|
|
BARRIER HOLLISTER CTF 2.25 11203"
|
Facility
|
OP
|
$66.00
|
|
|
Service Code
|
HCPCS A4409
|
| Hospital Charge Code |
4595817
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$19.22 |
| Max. Negotiated Rate |
$63.15 |
| Rate for Payer: Aetna Commercial |
$61.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$59.03
|
| Rate for Payer: Aetna Managed Medicare |
$19.22
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$44.62
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$34.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$32.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$36.38
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cigna Commercial |
$63.15
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$38.41
|
| Rate for Payer: Health EOS Commercial |
$61.09
|
| Rate for Payer: HFN Commercial |
$63.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$51.48
|
| Rate for Payer: Multiplan Commercial |
$54.91
|
| Rate for Payer: NAPHCARE Commercial |
$41.18
|
| Rate for Payer: Preferred Network Access Commercial |
$63.15
|
| Rate for Payer: Quartz Beloit One Network |
$33.63
|
| Rate for Payer: Quartz Commercial |
$44.62
|
| Rate for Payer: Quartz Medicare Advantage |
$41.18
|
| Rate for Payer: The Alliance Commercial |
$36.77
|
| Rate for Payer: WEA Trust Commercial |
$37.75
|
| Rate for Payer: WPS Commercial |
$50.84
|
|
|
BARRIER RING ADAPT CONVEX 30MM 79530
|
Facility
|
OP
|
$94.00
|
|
|
Service Code
|
HCPCS A4411
|
| Hospital Charge Code |
2969212
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$27.37 |
| Max. Negotiated Rate |
$89.94 |
| Rate for Payer: Aetna Commercial |
$87.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$84.07
|
| Rate for Payer: Aetna Managed Medicare |
$27.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$63.54
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$48.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$46.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$51.81
|
| Rate for Payer: Cash Price |
$28.20
|
| Rate for Payer: Cash Price |
$28.20
|
| Rate for Payer: Cigna Commercial |
$89.94
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$54.71
|
| Rate for Payer: Health EOS Commercial |
$87.01
|
| Rate for Payer: HFN Commercial |
$89.94
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$73.32
|
| Rate for Payer: Multiplan Commercial |
$78.21
|
| Rate for Payer: NAPHCARE Commercial |
$58.66
|
| Rate for Payer: Preferred Network Access Commercial |
$89.94
|
| Rate for Payer: Quartz Beloit One Network |
$47.90
|
| Rate for Payer: Quartz Commercial |
$63.54
|
| Rate for Payer: Quartz Medicare Advantage |
$58.66
|
| Rate for Payer: The Alliance Commercial |
$30.20
|
| Rate for Payer: WEA Trust Commercial |
$53.77
|
| Rate for Payer: WPS Commercial |
$72.41
|
|
|
BARRIER RING ADAPT CONVEX 30MM 79530
|
Facility
|
IP
|
$94.00
|
|
|
Service Code
|
HCPCS A4411
|
| Hospital Charge Code |
2969212
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$47.90 |
| Max. Negotiated Rate |
$89.94 |
| Rate for Payer: Aetna Commercial |
$87.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$84.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$51.81
|
| Rate for Payer: Cash Price |
$28.20
|
| Rate for Payer: Cigna Commercial |
$89.94
|
| Rate for Payer: Health EOS Commercial |
$87.01
|
| Rate for Payer: HFN Commercial |
$89.94
|
| Rate for Payer: Multiplan Commercial |
$78.21
|
| Rate for Payer: Preferred Network Access Commercial |
$89.94
|
| Rate for Payer: Quartz Beloit One Network |
$47.90
|
| Rate for Payer: Quartz Commercial |
$58.66
|
| Rate for Payer: WEA Trust Commercial |
$53.77
|
| Rate for Payer: WPS Commercial |
$72.41
|
|
|
BARRIER RING ADAPT CONVEX 40MM 79540
|
Facility
|
OP
|
$89.00
|
|
|
Service Code
|
HCPCS A4411
|
| Hospital Charge Code |
2969211
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$25.92 |
| Max. Negotiated Rate |
$85.16 |
| Rate for Payer: Aetna Commercial |
$83.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$79.60
|
| Rate for Payer: Aetna Managed Medicare |
$25.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$60.16
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$46.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$44.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$49.06
|
| Rate for Payer: Cash Price |
$26.70
|
| Rate for Payer: Cash Price |
$26.70
|
| Rate for Payer: Cigna Commercial |
$85.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$51.80
|
| Rate for Payer: Health EOS Commercial |
$82.38
|
| Rate for Payer: HFN Commercial |
$85.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$69.42
|
| Rate for Payer: Multiplan Commercial |
$74.05
|
| Rate for Payer: NAPHCARE Commercial |
$55.54
|
| Rate for Payer: Preferred Network Access Commercial |
$85.16
|
| Rate for Payer: Quartz Beloit One Network |
$45.35
|
| Rate for Payer: Quartz Commercial |
$60.16
|
| Rate for Payer: Quartz Medicare Advantage |
$55.54
|
| Rate for Payer: The Alliance Commercial |
$30.20
|
| Rate for Payer: WEA Trust Commercial |
$50.91
|
| Rate for Payer: WPS Commercial |
$68.56
|
|
|
BARRIER RING ADAPT CONVEX 40MM 79540
|
Facility
|
IP
|
$89.00
|
|
|
Service Code
|
HCPCS A4411
|
| Hospital Charge Code |
2969211
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$45.35 |
| Max. Negotiated Rate |
$85.16 |
| Rate for Payer: Aetna Commercial |
$83.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$79.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$49.06
|
| Rate for Payer: Cash Price |
$26.70
|
| Rate for Payer: Cigna Commercial |
$85.16
|
| Rate for Payer: Health EOS Commercial |
$82.38
|
| Rate for Payer: HFN Commercial |
$85.16
|
| Rate for Payer: Multiplan Commercial |
$74.05
|
| Rate for Payer: Preferred Network Access Commercial |
$85.16
|
| Rate for Payer: Quartz Beloit One Network |
$45.35
|
| Rate for Payer: Quartz Commercial |
$55.54
|
| Rate for Payer: WEA Trust Commercial |
$50.91
|
| Rate for Payer: WPS Commercial |
$68.56
|
|
|
BARRIER WIPE NO STING 59420600
|
Facility
|
OP
|
$10.00
|
|
|
Service Code
|
HCPCS A5120
|
| Hospital Charge Code |
2963786
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$2.91 |
| Max. Negotiated Rate |
$9.57 |
| Rate for Payer: Aetna Commercial |
$9.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8.94
|
| Rate for Payer: Aetna Managed Medicare |
$2.91
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6.76
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5.51
|
| Rate for Payer: Cash Price |
$3.00
|
| Rate for Payer: Cigna Commercial |
$9.57
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.82
|
| Rate for Payer: Health EOS Commercial |
$9.26
|
| Rate for Payer: HFN Commercial |
$9.57
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7.80
|
| Rate for Payer: Multiplan Commercial |
$8.32
|
| Rate for Payer: NAPHCARE Commercial |
$6.24
|
| Rate for Payer: Preferred Network Access Commercial |
$9.57
|
| Rate for Payer: Quartz Beloit One Network |
$5.10
|
| Rate for Payer: Quartz Commercial |
$6.76
|
| Rate for Payer: Quartz Medicare Advantage |
$6.24
|
| Rate for Payer: The Alliance Commercial |
$5.20
|
| Rate for Payer: WEA Trust Commercial |
$5.72
|
| Rate for Payer: WPS Commercial |
$7.70
|
|
|
BARRIER WIPE NO STING 59420600
|
Facility
|
IP
|
$10.00
|
|
|
Service Code
|
HCPCS A5120
|
| Hospital Charge Code |
2963786
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$5.10 |
| Max. Negotiated Rate |
$9.57 |
| Rate for Payer: Aetna Commercial |
$9.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5.51
|
| Rate for Payer: Cash Price |
$3.00
|
| Rate for Payer: Cigna Commercial |
$9.57
|
| Rate for Payer: Health EOS Commercial |
$9.26
|
| Rate for Payer: HFN Commercial |
$9.57
|
| Rate for Payer: Multiplan Commercial |
$8.32
|
| Rate for Payer: Preferred Network Access Commercial |
$9.57
|
| Rate for Payer: Quartz Beloit One Network |
$5.10
|
| Rate for Payer: Quartz Commercial |
$6.24
|
| Rate for Payer: WEA Trust Commercial |
$5.72
|
| Rate for Payer: WPS Commercial |
$7.70
|
|
|
BARTHOLIN CYST MARSUPIALIZATION
|
Facility
|
IP
|
$1,084.00
|
|
| Hospital Charge Code |
2959841
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$552.41 |
| Max. Negotiated Rate |
$1,037.17 |
| Rate for Payer: Aetna Commercial |
$1,014.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$969.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$597.50
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$1,037.17
|
| Rate for Payer: Health EOS Commercial |
$1,003.35
|
| Rate for Payer: HFN Commercial |
$1,037.17
|
| Rate for Payer: Multiplan Commercial |
$901.89
|
| Rate for Payer: Preferred Network Access Commercial |
$1,037.17
|
| Rate for Payer: Quartz Beloit One Network |
$552.41
|
| Rate for Payer: Quartz Commercial |
$676.42
|
| Rate for Payer: WEA Trust Commercial |
$620.05
|
| Rate for Payer: WPS Commercial |
$835.01
|
|
