|
CANISTER INFOV.A.C. 500ML WITH GEL M8275063/10
|
Facility
IP
|
$853.00
|
|
|
Service Code
|
HCPCS A6550
|
| Hospital Charge Code |
3785556
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$417.97 |
| Max. Negotiated Rate |
$784.76 |
| Rate for Payer: Aetna Commercial |
$767.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$452.09
|
| Rate for Payer: Cash Price |
$255.90
|
| Rate for Payer: Cigna Commercial |
$784.76
|
| Rate for Payer: Health EOS Commercial |
$759.17
|
| Rate for Payer: HFN Commercial |
$784.76
|
| Rate for Payer: Multiplan Commercial |
$682.40
|
| Rate for Payer: NAPHCARE Commercial |
$511.80
|
| Rate for Payer: Preferred Network Access Commercial |
$784.76
|
| Rate for Payer: Quartz Beloit One Network |
$417.97
|
| Rate for Payer: Quartz Commercial |
$511.80
|
| Rate for Payer: WEA Trust Commercial |
$469.15
|
| Rate for Payer: WPS Commercial |
$631.82
|
|
|
CANISTER KIT W/ISOLYZER #M6275063-10
|
Facility
OP
|
$800.00
|
|
| Hospital Charge Code |
2974089
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$224.00 |
| Max. Negotiated Rate |
$3,200.00 |
| Rate for Payer: Aetna Commercial |
$720.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$688.00
|
| Rate for Payer: Aetna Managed Medicare |
$224.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$520.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$400.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$384.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$424.00
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cigna Commercial |
$736.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$447.68
|
| Rate for Payer: Health EOS Commercial |
$712.00
|
| Rate for Payer: HFN Commercial |
$736.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$600.00
|
| Rate for Payer: Multiplan Commercial |
$640.00
|
| Rate for Payer: NAPHCARE Commercial |
$480.00
|
| Rate for Payer: Preferred Network Access Commercial |
$736.00
|
| Rate for Payer: Quartz Beloit One Network |
$392.00
|
| Rate for Payer: Quartz Commercial |
$520.00
|
| Rate for Payer: Quartz Medicare Advantage |
$480.00
|
| Rate for Payer: The Alliance Commercial |
$3,200.00
|
| Rate for Payer: WEA Trust Commercial |
$440.00
|
| Rate for Payer: WPS Commercial |
$592.56
|
|
|
CANISTER KIT W/ISOLYZER #M6275063-10
|
Facility
IP
|
$800.00
|
|
| Hospital Charge Code |
2974089
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$392.00 |
| Max. Negotiated Rate |
$736.00 |
| Rate for Payer: Aetna Commercial |
$720.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$424.00
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cigna Commercial |
$736.00
|
| Rate for Payer: Health EOS Commercial |
$712.00
|
| Rate for Payer: HFN Commercial |
$736.00
|
| Rate for Payer: Multiplan Commercial |
$640.00
|
| Rate for Payer: NAPHCARE Commercial |
$480.00
|
| Rate for Payer: Preferred Network Access Commercial |
$736.00
|
| Rate for Payer: Quartz Beloit One Network |
$392.00
|
| Rate for Payer: Quartz Commercial |
$480.00
|
| Rate for Payer: WEA Trust Commercial |
$440.00
|
| Rate for Payer: WPS Commercial |
$592.56
|
|
|
CANISTER PREVENA 150ML PRE4095
|
Facility
OP
|
$556.00
|
|
|
Service Code
|
HCPCS A7000
|
| Hospital Charge Code |
5074885
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$155.68 |
| Max. Negotiated Rate |
$2,224.00 |
| Rate for Payer: Aetna Commercial |
$500.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$478.16
|
| Rate for Payer: Aetna Managed Medicare |
$155.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$361.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$278.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$266.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$294.68
|
| Rate for Payer: Cash Price |
$166.80
|
| Rate for Payer: Cigna Commercial |
$511.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$311.14
|
| Rate for Payer: Health EOS Commercial |
$494.84
|
| Rate for Payer: HFN Commercial |
$511.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$417.00
|
| Rate for Payer: Multiplan Commercial |
$444.80
|
| Rate for Payer: NAPHCARE Commercial |
$333.60
|
| Rate for Payer: Preferred Network Access Commercial |
$511.52
|
| Rate for Payer: Quartz Beloit One Network |
$272.44
|
| Rate for Payer: Quartz Commercial |
$361.40
|
| Rate for Payer: Quartz Medicare Advantage |
$333.60
|
| Rate for Payer: The Alliance Commercial |
$2,224.00
|
| Rate for Payer: WEA Trust Commercial |
$305.80
|
| Rate for Payer: WPS Commercial |
$411.83
|
|
|
CANISTER PREVENA 150ML PRE4095
|
Facility
IP
|
$556.00
|
|
|
Service Code
|
HCPCS A7000
|
| Hospital Charge Code |
5074885
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$272.44 |
| Max. Negotiated Rate |
$511.52 |
| Rate for Payer: Aetna Commercial |
$500.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$294.68
|
| Rate for Payer: Cash Price |
$166.80
|
| Rate for Payer: Cigna Commercial |
$511.52
|
| Rate for Payer: Health EOS Commercial |
$494.84
|
| Rate for Payer: HFN Commercial |
$511.52
|
| Rate for Payer: Multiplan Commercial |
$444.80
|
| Rate for Payer: NAPHCARE Commercial |
$333.60
|
| Rate for Payer: Preferred Network Access Commercial |
$511.52
|
| Rate for Payer: Quartz Beloit One Network |
$272.44
|
| Rate for Payer: Quartz Commercial |
$333.60
|
| Rate for Payer: WEA Trust Commercial |
$305.80
|
| Rate for Payer: WPS Commercial |
$411.83
|
|
|
CANISTER PREVENA 45ML PRE1095.S
|
Facility
IP
|
$505.00
|
|
|
Service Code
|
HCPCS A7000
|
| Hospital Charge Code |
4595761
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$247.45 |
| Max. Negotiated Rate |
$464.60 |
| Rate for Payer: Aetna Commercial |
$454.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$267.65
|
| Rate for Payer: Cash Price |
$151.50
|
| Rate for Payer: Cigna Commercial |
$464.60
|
| Rate for Payer: Health EOS Commercial |
$449.45
|
| Rate for Payer: HFN Commercial |
$464.60
|
| Rate for Payer: Multiplan Commercial |
$404.00
|
| Rate for Payer: NAPHCARE Commercial |
$303.00
|
| Rate for Payer: Preferred Network Access Commercial |
$464.60
|
| Rate for Payer: Quartz Beloit One Network |
$247.45
|
| Rate for Payer: Quartz Commercial |
$303.00
|
| Rate for Payer: WEA Trust Commercial |
$277.75
|
| Rate for Payer: WPS Commercial |
$374.05
|
|
|
CANISTER PREVENA 45ML PRE1095.S
|
Facility
OP
|
$505.00
|
|
|
Service Code
|
HCPCS A7000
|
| Hospital Charge Code |
4595761
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$141.40 |
| Max. Negotiated Rate |
$2,020.00 |
| Rate for Payer: Aetna Commercial |
$454.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$434.30
|
| Rate for Payer: Aetna Managed Medicare |
$141.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$328.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$252.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$242.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$267.65
|
| Rate for Payer: Cash Price |
$151.50
|
| Rate for Payer: Cigna Commercial |
$464.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$282.60
|
| Rate for Payer: Health EOS Commercial |
$449.45
|
| Rate for Payer: HFN Commercial |
$464.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$378.75
|
| Rate for Payer: Multiplan Commercial |
$404.00
|
| Rate for Payer: NAPHCARE Commercial |
$303.00
|
| Rate for Payer: Preferred Network Access Commercial |
$464.60
|
| Rate for Payer: Quartz Beloit One Network |
$247.45
|
| Rate for Payer: Quartz Commercial |
$328.25
|
| Rate for Payer: Quartz Medicare Advantage |
$303.00
|
| Rate for Payer: The Alliance Commercial |
$2,020.00
|
| Rate for Payer: WEA Trust Commercial |
$277.75
|
| Rate for Payer: WPS Commercial |
$374.05
|
|
|
CANISTER TRUCLEAR HI-FLOW 72200024
|
Facility
IP
|
$128.00
|
|
| Hospital Charge Code |
5074777
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$62.72 |
| Max. Negotiated Rate |
$117.76 |
| Rate for Payer: Aetna Commercial |
$115.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$67.84
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cigna Commercial |
$117.76
|
| Rate for Payer: Health EOS Commercial |
$113.92
|
| Rate for Payer: HFN Commercial |
$117.76
|
| Rate for Payer: Multiplan Commercial |
$102.40
|
| Rate for Payer: NAPHCARE Commercial |
$76.80
|
| Rate for Payer: Preferred Network Access Commercial |
$117.76
|
| Rate for Payer: Quartz Beloit One Network |
$62.72
|
| Rate for Payer: Quartz Commercial |
$76.80
|
| Rate for Payer: WEA Trust Commercial |
$70.40
|
| Rate for Payer: WPS Commercial |
$94.81
|
|
|
CANISTER TRUCLEAR HI-FLOW 72200024
|
Facility
OP
|
$128.00
|
|
| Hospital Charge Code |
5074777
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$35.84 |
| Max. Negotiated Rate |
$512.00 |
| Rate for Payer: Aetna Commercial |
$115.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$110.08
|
| Rate for Payer: Aetna Managed Medicare |
$35.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$83.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$64.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$61.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$67.84
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cigna Commercial |
$117.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$71.63
|
| Rate for Payer: Health EOS Commercial |
$113.92
|
| Rate for Payer: HFN Commercial |
$117.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$96.00
|
| Rate for Payer: Multiplan Commercial |
$102.40
|
| Rate for Payer: NAPHCARE Commercial |
$76.80
|
| Rate for Payer: Preferred Network Access Commercial |
$117.76
|
| Rate for Payer: Quartz Beloit One Network |
$62.72
|
| Rate for Payer: Quartz Commercial |
$83.20
|
| Rate for Payer: Quartz Medicare Advantage |
$76.80
|
| Rate for Payer: The Alliance Commercial |
$512.00
|
| Rate for Payer: WEA Trust Commercial |
$70.40
|
| Rate for Payer: WPS Commercial |
$94.81
|
|
|
Cannabinoids, Pnl Serum
|
Facility
OP
|
$263.00
|
|
|
Service Code
|
CPT 80349
|
| Hospital Charge Code |
5812130
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$73.64 |
| Max. Negotiated Rate |
$241.96 |
| Rate for Payer: Aetna Commercial |
$236.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$226.18
|
| Rate for Payer: Aetna Managed Medicare |
$73.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$170.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$131.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$126.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$139.39
|
| Rate for Payer: Cash Price |
$78.90
|
| Rate for Payer: Cash Price |
$78.90
|
| Rate for Payer: Cigna Commercial |
$241.96
|
| Rate for Payer: Health EOS Commercial |
$234.07
|
| Rate for Payer: HFN Commercial |
$241.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$197.25
|
| Rate for Payer: Multiplan Commercial |
$210.40
|
| Rate for Payer: NAPHCARE Commercial |
$157.80
|
| Rate for Payer: Preferred Network Access Commercial |
$241.96
|
| Rate for Payer: Quartz Beloit One Network |
$128.87
|
| Rate for Payer: Quartz Commercial |
$170.95
|
| Rate for Payer: Quartz Medicare Advantage |
$157.80
|
| Rate for Payer: United Healthcare PPO |
$197.25
|
| Rate for Payer: WEA Trust Commercial |
$144.65
|
| Rate for Payer: WPS Commercial |
$194.80
|
|
|
Cannabinoids, Pnl Serum
|
Professional
|
$263.00
|
|
|
Service Code
|
CPT 80349
|
| Hospital Charge Code |
5812130
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$80.06 |
| Max. Negotiated Rate |
$249.85 |
| Rate for Payer: Aetna Commercial |
$249.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$226.18
|
| Rate for Payer: Cash Price |
$78.90
|
| Rate for Payer: Cash Price |
$78.90
|
| Rate for Payer: Cigna Commercial |
$249.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$131.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$157.80
|
| Rate for Payer: Health EOS Commercial |
$239.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$80.06
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$80.06
|
| Rate for Payer: Multiplan Commercial |
$210.40
|
| Rate for Payer: Preferred Network Access Commercial |
$249.85
|
| Rate for Payer: Quartz Beloit One Network |
$115.72
|
| Rate for Payer: Quartz Commercial |
$149.91
|
| Rate for Payer: The Alliance Commercial |
$131.50
|
| Rate for Payer: WEA Trust Commercial |
$144.65
|
| Rate for Payer: WPS Commercial |
$194.80
|
|
|
Cannabinoids, Pnl Serum
|
Facility
IP
|
$263.00
|
|
|
Service Code
|
CPT 80349
|
| Hospital Charge Code |
5812130
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$128.87 |
| Max. Negotiated Rate |
$241.96 |
| Rate for Payer: Aetna Commercial |
$236.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$139.39
|
| Rate for Payer: Cash Price |
$78.90
|
| Rate for Payer: Cigna Commercial |
$241.96
|
| Rate for Payer: Health EOS Commercial |
$234.07
|
| Rate for Payer: HFN Commercial |
$241.96
|
| Rate for Payer: Multiplan Commercial |
$210.40
|
| Rate for Payer: NAPHCARE Commercial |
$157.80
|
| Rate for Payer: Preferred Network Access Commercial |
$241.96
|
| Rate for Payer: Quartz Beloit One Network |
$128.87
|
| Rate for Payer: Quartz Commercial |
$157.80
|
| Rate for Payer: WEA Trust Commercial |
$144.65
|
| Rate for Payer: WPS Commercial |
$194.80
|
|
|
CANN.SCREW 6.5 X 115MM #121643
|
Facility
OP
|
$2,674.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2975001
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$748.72 |
| Max. Negotiated Rate |
$2,460.08 |
| Rate for Payer: Aetna Commercial |
$2,406.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,299.64
|
| Rate for Payer: Aetna Managed Medicare |
$748.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,738.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,337.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,283.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,417.22
|
| Rate for Payer: Cash Price |
$802.20
|
| Rate for Payer: Cigna Commercial |
$2,460.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,496.37
|
| Rate for Payer: Health EOS Commercial |
$2,379.86
|
| Rate for Payer: HFN Commercial |
$2,460.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,005.50
|
| Rate for Payer: Multiplan Commercial |
$2,139.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,604.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,460.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,310.26
|
| Rate for Payer: Quartz Commercial |
$1,738.10
|
| Rate for Payer: Quartz Medicare Advantage |
$1,604.40
|
| Rate for Payer: WEA Trust Commercial |
$1,470.70
|
| Rate for Payer: WPS Commercial |
$1,980.63
|
|
|
CANN.SCREW 6.5 X 115MM #121643
|
Facility
IP
|
$2,674.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2975001
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,310.26 |
| Max. Negotiated Rate |
$2,460.08 |
| Rate for Payer: Aetna Commercial |
$2,406.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,417.22
|
| Rate for Payer: Cash Price |
$802.20
|
| Rate for Payer: Cigna Commercial |
$2,460.08
|
| Rate for Payer: Health EOS Commercial |
$2,379.86
|
| Rate for Payer: HFN Commercial |
$2,460.08
|
| Rate for Payer: Multiplan Commercial |
$2,139.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,604.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,460.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,310.26
|
| Rate for Payer: Quartz Commercial |
$1,604.40
|
| Rate for Payer: WEA Trust Commercial |
$1,470.70
|
| Rate for Payer: WPS Commercial |
$1,980.63
|
|
|
CANN.SCREW 6.5 X 120MM #121644
|
Facility
IP
|
$2,674.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2975068
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,310.26 |
| Max. Negotiated Rate |
$2,460.08 |
| Rate for Payer: Aetna Commercial |
$2,406.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,417.22
|
| Rate for Payer: Cash Price |
$802.20
|
| Rate for Payer: Cigna Commercial |
$2,460.08
|
| Rate for Payer: Health EOS Commercial |
$2,379.86
|
| Rate for Payer: HFN Commercial |
$2,460.08
|
| Rate for Payer: Multiplan Commercial |
$2,139.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,604.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,460.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,310.26
|
| Rate for Payer: Quartz Commercial |
$1,604.40
|
| Rate for Payer: WEA Trust Commercial |
$1,470.70
|
| Rate for Payer: WPS Commercial |
$1,980.63
|
|
|
CANN.SCREW 6.5 X 120MM #121644
|
Facility
OP
|
$2,674.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2975068
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$748.72 |
| Max. Negotiated Rate |
$2,460.08 |
| Rate for Payer: Aetna Commercial |
$2,406.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,299.64
|
| Rate for Payer: Aetna Managed Medicare |
$748.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,738.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,337.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,283.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,417.22
|
| Rate for Payer: Cash Price |
$802.20
|
| Rate for Payer: Cigna Commercial |
$2,460.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,496.37
|
| Rate for Payer: Health EOS Commercial |
$2,379.86
|
| Rate for Payer: HFN Commercial |
$2,460.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,005.50
|
| Rate for Payer: Multiplan Commercial |
$2,139.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,604.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,460.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,310.26
|
| Rate for Payer: Quartz Commercial |
$1,738.10
|
| Rate for Payer: Quartz Medicare Advantage |
$1,604.40
|
| Rate for Payer: WEA Trust Commercial |
$1,470.70
|
| Rate for Payer: WPS Commercial |
$1,980.63
|
|
|
CANNULA 02 NASAL 1867
|
Facility
IP
|
$49.00
|
|
|
Service Code
|
HCPCS A4615
|
| Hospital Charge Code |
2974614
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$24.01 |
| Max. Negotiated Rate |
$45.08 |
| Rate for Payer: Aetna Commercial |
$44.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$25.97
|
| Rate for Payer: Cash Price |
$14.70
|
| Rate for Payer: Cigna Commercial |
$45.08
|
| Rate for Payer: Health EOS Commercial |
$43.61
|
| Rate for Payer: HFN Commercial |
$45.08
|
| Rate for Payer: Multiplan Commercial |
$39.20
|
| Rate for Payer: NAPHCARE Commercial |
$29.40
|
| Rate for Payer: Preferred Network Access Commercial |
$45.08
|
| Rate for Payer: Quartz Beloit One Network |
$24.01
|
| Rate for Payer: Quartz Commercial |
$29.40
|
| Rate for Payer: WEA Trust Commercial |
$26.95
|
| Rate for Payer: WPS Commercial |
$36.29
|
|
|
CANNULA 02 NASAL 1867
|
Facility
OP
|
$49.00
|
|
|
Service Code
|
HCPCS A4615
|
| Hospital Charge Code |
2974614
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.72 |
| Max. Negotiated Rate |
$45.08 |
| Rate for Payer: Aetna Commercial |
$44.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$42.14
|
| Rate for Payer: Aetna Managed Medicare |
$13.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$31.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$24.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$23.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$25.97
|
| Rate for Payer: Cash Price |
$14.70
|
| Rate for Payer: Cigna Commercial |
$45.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$27.42
|
| Rate for Payer: Health EOS Commercial |
$43.61
|
| Rate for Payer: HFN Commercial |
$45.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$36.75
|
| Rate for Payer: Multiplan Commercial |
$39.20
|
| Rate for Payer: NAPHCARE Commercial |
$29.40
|
| Rate for Payer: Preferred Network Access Commercial |
$45.08
|
| Rate for Payer: Quartz Beloit One Network |
$24.01
|
| Rate for Payer: Quartz Commercial |
$31.85
|
| Rate for Payer: Quartz Medicare Advantage |
$29.40
|
| Rate for Payer: WEA Trust Commercial |
$26.95
|
| Rate for Payer: WPS Commercial |
$36.29
|
|
|
CANNULA 12FR CORONARY 30012
|
Facility
IP
|
$558.00
|
|
| Hospital Charge Code |
2965774
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$273.42 |
| Max. Negotiated Rate |
$513.36 |
| Rate for Payer: Aetna Commercial |
$502.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$295.74
|
| Rate for Payer: Cash Price |
$167.40
|
| Rate for Payer: Cigna Commercial |
$513.36
|
| Rate for Payer: Health EOS Commercial |
$496.62
|
| Rate for Payer: HFN Commercial |
$513.36
|
| Rate for Payer: Multiplan Commercial |
$446.40
|
| Rate for Payer: NAPHCARE Commercial |
$334.80
|
| Rate for Payer: Preferred Network Access Commercial |
$513.36
|
| Rate for Payer: Quartz Beloit One Network |
$273.42
|
| Rate for Payer: Quartz Commercial |
$334.80
|
| Rate for Payer: WEA Trust Commercial |
$306.90
|
| Rate for Payer: WPS Commercial |
$413.31
|
|
|
CANNULA 12FR CORONARY 30012
|
Facility
OP
|
$558.00
|
|
| Hospital Charge Code |
2965774
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$156.24 |
| Max. Negotiated Rate |
$2,232.00 |
| Rate for Payer: Aetna Commercial |
$502.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$479.88
|
| Rate for Payer: Aetna Managed Medicare |
$156.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$362.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$279.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$267.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$295.74
|
| Rate for Payer: Cash Price |
$167.40
|
| Rate for Payer: Cigna Commercial |
$513.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$312.26
|
| Rate for Payer: Health EOS Commercial |
$496.62
|
| Rate for Payer: HFN Commercial |
$513.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$418.50
|
| Rate for Payer: Multiplan Commercial |
$446.40
|
| Rate for Payer: NAPHCARE Commercial |
$334.80
|
| Rate for Payer: Preferred Network Access Commercial |
$513.36
|
| Rate for Payer: Quartz Beloit One Network |
$273.42
|
| Rate for Payer: Quartz Commercial |
$362.70
|
| Rate for Payer: Quartz Medicare Advantage |
$334.80
|
| Rate for Payer: The Alliance Commercial |
$2,232.00
|
| Rate for Payer: WEA Trust Commercial |
$306.90
|
| Rate for Payer: WPS Commercial |
$413.31
|
|
|
CANNULA 13FR RETROGRADE 94113T
|
Facility
OP
|
$1,184.00
|
|
| Hospital Charge Code |
2965372
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$331.52 |
| Max. Negotiated Rate |
$4,736.00 |
| Rate for Payer: Aetna Commercial |
$1,065.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,018.24
|
| Rate for Payer: Aetna Managed Medicare |
$331.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$769.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$592.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$568.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$627.52
|
| Rate for Payer: Cash Price |
$355.20
|
| Rate for Payer: Cigna Commercial |
$1,089.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$662.57
|
| Rate for Payer: Health EOS Commercial |
$1,053.76
|
| Rate for Payer: HFN Commercial |
$1,089.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$888.00
|
| Rate for Payer: Multiplan Commercial |
$947.20
|
| Rate for Payer: NAPHCARE Commercial |
$710.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,089.28
|
| Rate for Payer: Quartz Beloit One Network |
$580.16
|
| Rate for Payer: Quartz Commercial |
$769.60
|
| Rate for Payer: Quartz Medicare Advantage |
$710.40
|
| Rate for Payer: The Alliance Commercial |
$4,736.00
|
| Rate for Payer: WEA Trust Commercial |
$651.20
|
| Rate for Payer: WPS Commercial |
$876.99
|
|
|
CANNULA 13FR RETROGRADE 94113T
|
Facility
IP
|
$1,184.00
|
|
| Hospital Charge Code |
2965372
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$580.16 |
| Max. Negotiated Rate |
$1,089.28 |
| Rate for Payer: Aetna Commercial |
$1,065.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$627.52
|
| Rate for Payer: Cash Price |
$355.20
|
| Rate for Payer: Cigna Commercial |
$1,089.28
|
| Rate for Payer: Health EOS Commercial |
$1,053.76
|
| Rate for Payer: HFN Commercial |
$1,089.28
|
| Rate for Payer: Multiplan Commercial |
$947.20
|
| Rate for Payer: NAPHCARE Commercial |
$710.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,089.28
|
| Rate for Payer: Quartz Beloit One Network |
$580.16
|
| Rate for Payer: Quartz Commercial |
$710.40
|
| Rate for Payer: WEA Trust Commercial |
$651.20
|
| Rate for Payer: WPS Commercial |
$876.99
|
|
|
CANNULA 15FR RETROGRADE 94115T
|
Facility
IP
|
$1,535.00
|
|
| Hospital Charge Code |
2965341
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$752.15 |
| Max. Negotiated Rate |
$1,412.20 |
| Rate for Payer: Aetna Commercial |
$1,381.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$813.55
|
| Rate for Payer: Cash Price |
$460.50
|
| Rate for Payer: Cigna Commercial |
$1,412.20
|
| Rate for Payer: Health EOS Commercial |
$1,366.15
|
| Rate for Payer: HFN Commercial |
$1,412.20
|
| Rate for Payer: Multiplan Commercial |
$1,228.00
|
| Rate for Payer: NAPHCARE Commercial |
$921.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,412.20
|
| Rate for Payer: Quartz Beloit One Network |
$752.15
|
| Rate for Payer: Quartz Commercial |
$921.00
|
| Rate for Payer: WEA Trust Commercial |
$844.25
|
| Rate for Payer: WPS Commercial |
$1,136.97
|
|
|
CANNULA 15FR RETROGRADE 94115T
|
Facility
OP
|
$1,535.00
|
|
| Hospital Charge Code |
2965341
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$429.80 |
| Max. Negotiated Rate |
$6,140.00 |
| Rate for Payer: Aetna Commercial |
$1,381.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,320.10
|
| Rate for Payer: Aetna Managed Medicare |
$429.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$997.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$767.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$736.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$813.55
|
| Rate for Payer: Cash Price |
$460.50
|
| Rate for Payer: Cigna Commercial |
$1,412.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$858.99
|
| Rate for Payer: Health EOS Commercial |
$1,366.15
|
| Rate for Payer: HFN Commercial |
$1,412.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,151.25
|
| Rate for Payer: Multiplan Commercial |
$1,228.00
|
| Rate for Payer: NAPHCARE Commercial |
$921.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,412.20
|
| Rate for Payer: Quartz Beloit One Network |
$752.15
|
| Rate for Payer: Quartz Commercial |
$997.75
|
| Rate for Payer: Quartz Medicare Advantage |
$921.00
|
| Rate for Payer: The Alliance Commercial |
$6,140.00
|
| Rate for Payer: WEA Trust Commercial |
$844.25
|
| Rate for Payer: WPS Commercial |
$1,136.97
|
|
|
CANNULA 17FR FEMORAL ARTERIAL 96530-117
|
Facility
OP
|
$3,278.00
|
|
| Hospital Charge Code |
2965355
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$917.84 |
| Max. Negotiated Rate |
$13,112.00 |
| Rate for Payer: Aetna Commercial |
$2,950.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,819.08
|
| Rate for Payer: Aetna Managed Medicare |
$917.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,130.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,639.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,573.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,737.34
|
| Rate for Payer: Cash Price |
$983.40
|
| Rate for Payer: Cigna Commercial |
$3,015.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,834.37
|
| Rate for Payer: Health EOS Commercial |
$2,917.42
|
| Rate for Payer: HFN Commercial |
$3,015.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,458.50
|
| Rate for Payer: Multiplan Commercial |
$2,622.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,966.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,015.76
|
| Rate for Payer: Quartz Beloit One Network |
$1,606.22
|
| Rate for Payer: Quartz Commercial |
$2,130.70
|
| Rate for Payer: Quartz Medicare Advantage |
$1,966.80
|
| Rate for Payer: The Alliance Commercial |
$13,112.00
|
| Rate for Payer: WEA Trust Commercial |
$1,802.90
|
| Rate for Payer: WPS Commercial |
$2,428.01
|
|
