|
CANNULA PASSPORT BUTTON 12 X 30 AR-6592-12-30
|
Facility
OP
|
$1,574.00
|
|
| Hospital Charge Code |
5307004
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$440.72 |
| Max. Negotiated Rate |
$6,296.00 |
| Rate for Payer: Aetna Commercial |
$1,416.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,353.64
|
| Rate for Payer: Aetna Managed Medicare |
$440.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,023.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$787.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$755.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$834.22
|
| Rate for Payer: Cash Price |
$472.20
|
| Rate for Payer: Cigna Commercial |
$1,448.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$880.81
|
| Rate for Payer: Health EOS Commercial |
$1,400.86
|
| Rate for Payer: HFN Commercial |
$1,448.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,180.50
|
| Rate for Payer: Multiplan Commercial |
$1,259.20
|
| Rate for Payer: NAPHCARE Commercial |
$944.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,448.08
|
| Rate for Payer: Quartz Beloit One Network |
$771.26
|
| Rate for Payer: Quartz Commercial |
$1,023.10
|
| Rate for Payer: Quartz Medicare Advantage |
$944.40
|
| Rate for Payer: The Alliance Commercial |
$6,296.00
|
| Rate for Payer: WEA Trust Commercial |
$865.70
|
| Rate for Payer: WPS Commercial |
$1,165.86
|
|
|
CANNULA PASSPORT BUTTON 12 X 30 AR-6592-12-30
|
Facility
IP
|
$1,574.00
|
|
| Hospital Charge Code |
5307004
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$771.26 |
| Max. Negotiated Rate |
$1,448.08 |
| Rate for Payer: Aetna Commercial |
$1,416.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$834.22
|
| Rate for Payer: Cash Price |
$472.20
|
| Rate for Payer: Cigna Commercial |
$1,448.08
|
| Rate for Payer: Health EOS Commercial |
$1,400.86
|
| Rate for Payer: HFN Commercial |
$1,448.08
|
| Rate for Payer: Multiplan Commercial |
$1,259.20
|
| Rate for Payer: NAPHCARE Commercial |
$944.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,448.08
|
| Rate for Payer: Quartz Beloit One Network |
$771.26
|
| Rate for Payer: Quartz Commercial |
$944.40
|
| Rate for Payer: WEA Trust Commercial |
$865.70
|
| Rate for Payer: WPS Commercial |
$1,165.86
|
|
|
CANNULA PASSPORT BUTTON 12 X 40 AR-6592-12-40
|
Facility
OP
|
$860.09
|
|
| Hospital Charge Code |
6246141
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$240.83 |
| Max. Negotiated Rate |
$3,440.36 |
| Rate for Payer: Aetna Commercial |
$774.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$739.68
|
| Rate for Payer: Aetna Managed Medicare |
$240.83
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$559.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$430.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$412.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$455.85
|
| Rate for Payer: Cash Price |
$258.03
|
| Rate for Payer: Cigna Commercial |
$791.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$481.31
|
| Rate for Payer: Health EOS Commercial |
$765.48
|
| Rate for Payer: HFN Commercial |
$791.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$645.07
|
| Rate for Payer: Multiplan Commercial |
$688.07
|
| Rate for Payer: NAPHCARE Commercial |
$516.05
|
| Rate for Payer: Preferred Network Access Commercial |
$791.28
|
| Rate for Payer: Quartz Beloit One Network |
$421.44
|
| Rate for Payer: Quartz Commercial |
$559.06
|
| Rate for Payer: Quartz Medicare Advantage |
$516.05
|
| Rate for Payer: The Alliance Commercial |
$3,440.36
|
| Rate for Payer: WEA Trust Commercial |
$473.05
|
| Rate for Payer: WPS Commercial |
$637.07
|
|
|
CANNULA PASSPORT BUTTON 12 X 40 AR-6592-12-40
|
Facility
IP
|
$860.09
|
|
| Hospital Charge Code |
6246141
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$421.44 |
| Max. Negotiated Rate |
$791.28 |
| Rate for Payer: Aetna Commercial |
$774.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$455.85
|
| Rate for Payer: Cash Price |
$258.03
|
| Rate for Payer: Cigna Commercial |
$791.28
|
| Rate for Payer: Health EOS Commercial |
$765.48
|
| Rate for Payer: HFN Commercial |
$791.28
|
| Rate for Payer: Multiplan Commercial |
$688.07
|
| Rate for Payer: NAPHCARE Commercial |
$516.05
|
| Rate for Payer: Preferred Network Access Commercial |
$791.28
|
| Rate for Payer: Quartz Beloit One Network |
$421.44
|
| Rate for Payer: Quartz Commercial |
$516.05
|
| Rate for Payer: WEA Trust Commercial |
$473.05
|
| Rate for Payer: WPS Commercial |
$637.07
|
|
|
CANNULA PASSPORT BUTTON 8 X 30 AR-6592-08-30
|
Facility
IP
|
$926.00
|
|
| Hospital Charge Code |
4520132
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$453.74 |
| Max. Negotiated Rate |
$851.92 |
| Rate for Payer: Aetna Commercial |
$833.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$490.78
|
| Rate for Payer: Cash Price |
$277.80
|
| Rate for Payer: Cigna Commercial |
$851.92
|
| Rate for Payer: Health EOS Commercial |
$824.14
|
| Rate for Payer: HFN Commercial |
$851.92
|
| Rate for Payer: Multiplan Commercial |
$740.80
|
| Rate for Payer: NAPHCARE Commercial |
$555.60
|
| Rate for Payer: Preferred Network Access Commercial |
$851.92
|
| Rate for Payer: Quartz Beloit One Network |
$453.74
|
| Rate for Payer: Quartz Commercial |
$555.60
|
| Rate for Payer: WEA Trust Commercial |
$509.30
|
| Rate for Payer: WPS Commercial |
$685.89
|
|
|
CANNULA PASSPORT BUTTON 8 X 30 AR-6592-08-30
|
Facility
OP
|
$926.00
|
|
| Hospital Charge Code |
4520132
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$259.28 |
| Max. Negotiated Rate |
$3,704.00 |
| Rate for Payer: Aetna Commercial |
$833.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$796.36
|
| Rate for Payer: Aetna Managed Medicare |
$259.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$601.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$463.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$444.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$490.78
|
| Rate for Payer: Cash Price |
$277.80
|
| Rate for Payer: Cigna Commercial |
$851.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$518.19
|
| Rate for Payer: Health EOS Commercial |
$824.14
|
| Rate for Payer: HFN Commercial |
$851.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$694.50
|
| Rate for Payer: Multiplan Commercial |
$740.80
|
| Rate for Payer: NAPHCARE Commercial |
$555.60
|
| Rate for Payer: Preferred Network Access Commercial |
$851.92
|
| Rate for Payer: Quartz Beloit One Network |
$453.74
|
| Rate for Payer: Quartz Commercial |
$601.90
|
| Rate for Payer: Quartz Medicare Advantage |
$555.60
|
| Rate for Payer: The Alliance Commercial |
$3,704.00
|
| Rate for Payer: WEA Trust Commercial |
$509.30
|
| Rate for Payer: WPS Commercial |
$685.89
|
|
|
CANNULA PASSPORT BUTTON 8 X 40 AR-6592-08-40
|
Facility
IP
|
$709.00
|
|
| Hospital Charge Code |
4520133
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$347.41 |
| Max. Negotiated Rate |
$652.28 |
| Rate for Payer: Aetna Commercial |
$638.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$375.77
|
| Rate for Payer: Cash Price |
$212.70
|
| Rate for Payer: Cigna Commercial |
$652.28
|
| Rate for Payer: Health EOS Commercial |
$631.01
|
| Rate for Payer: HFN Commercial |
$652.28
|
| Rate for Payer: Multiplan Commercial |
$567.20
|
| Rate for Payer: NAPHCARE Commercial |
$425.40
|
| Rate for Payer: Preferred Network Access Commercial |
$652.28
|
| Rate for Payer: Quartz Beloit One Network |
$347.41
|
| Rate for Payer: Quartz Commercial |
$425.40
|
| Rate for Payer: WEA Trust Commercial |
$389.95
|
| Rate for Payer: WPS Commercial |
$525.16
|
|
|
CANNULA PASSPORT BUTTON 8 X 40 AR-6592-08-40
|
Facility
OP
|
$709.00
|
|
| Hospital Charge Code |
4520133
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$198.52 |
| Max. Negotiated Rate |
$2,836.00 |
| Rate for Payer: Aetna Commercial |
$638.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$609.74
|
| Rate for Payer: Aetna Managed Medicare |
$198.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$460.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$354.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$340.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$375.77
|
| Rate for Payer: Cash Price |
$212.70
|
| Rate for Payer: Cigna Commercial |
$652.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$396.76
|
| Rate for Payer: Health EOS Commercial |
$631.01
|
| Rate for Payer: HFN Commercial |
$652.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$531.75
|
| Rate for Payer: Multiplan Commercial |
$567.20
|
| Rate for Payer: NAPHCARE Commercial |
$425.40
|
| Rate for Payer: Preferred Network Access Commercial |
$652.28
|
| Rate for Payer: Quartz Beloit One Network |
$347.41
|
| Rate for Payer: Quartz Commercial |
$460.85
|
| Rate for Payer: Quartz Medicare Advantage |
$425.40
|
| Rate for Payer: The Alliance Commercial |
$2,836.00
|
| Rate for Payer: WEA Trust Commercial |
$389.95
|
| Rate for Payer: WPS Commercial |
$525.16
|
|
|
CANNULA PASSPORT BUTTON 8 X 50 AR-6592-08-50
|
Facility
OP
|
$709.00
|
|
| Hospital Charge Code |
4520231
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$198.52 |
| Max. Negotiated Rate |
$2,836.00 |
| Rate for Payer: Aetna Commercial |
$638.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$609.74
|
| Rate for Payer: Aetna Managed Medicare |
$198.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$460.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$354.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$340.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$375.77
|
| Rate for Payer: Cash Price |
$212.70
|
| Rate for Payer: Cigna Commercial |
$652.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$396.76
|
| Rate for Payer: Health EOS Commercial |
$631.01
|
| Rate for Payer: HFN Commercial |
$652.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$531.75
|
| Rate for Payer: Multiplan Commercial |
$567.20
|
| Rate for Payer: NAPHCARE Commercial |
$425.40
|
| Rate for Payer: Preferred Network Access Commercial |
$652.28
|
| Rate for Payer: Quartz Beloit One Network |
$347.41
|
| Rate for Payer: Quartz Commercial |
$460.85
|
| Rate for Payer: Quartz Medicare Advantage |
$425.40
|
| Rate for Payer: The Alliance Commercial |
$2,836.00
|
| Rate for Payer: WEA Trust Commercial |
$389.95
|
| Rate for Payer: WPS Commercial |
$525.16
|
|
|
CANNULA PASSPORT BUTTON 8 X 50 AR-6592-08-50
|
Facility
IP
|
$709.00
|
|
| Hospital Charge Code |
4520231
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$347.41 |
| Max. Negotiated Rate |
$652.28 |
| Rate for Payer: Aetna Commercial |
$638.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$375.77
|
| Rate for Payer: Cash Price |
$212.70
|
| Rate for Payer: Cigna Commercial |
$652.28
|
| Rate for Payer: Health EOS Commercial |
$631.01
|
| Rate for Payer: HFN Commercial |
$652.28
|
| Rate for Payer: Multiplan Commercial |
$567.20
|
| Rate for Payer: NAPHCARE Commercial |
$425.40
|
| Rate for Payer: Preferred Network Access Commercial |
$652.28
|
| Rate for Payer: Quartz Beloit One Network |
$347.41
|
| Rate for Payer: Quartz Commercial |
$425.40
|
| Rate for Payer: WEA Trust Commercial |
$389.95
|
| Rate for Payer: WPS Commercial |
$525.16
|
|
|
CANNULA RADIOFREQUENCY 18G X 145MM 10MM TIP CURVED PMF18-14510CS
|
Facility
OP
|
$440.00
|
|
| Hospital Charge Code |
4595244
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$123.20 |
| Max. Negotiated Rate |
$1,760.00 |
| Rate for Payer: Aetna Commercial |
$396.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$378.40
|
| Rate for Payer: Aetna Managed Medicare |
$123.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$286.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$220.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$211.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$233.20
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cigna Commercial |
$404.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$246.22
|
| Rate for Payer: Health EOS Commercial |
$391.60
|
| Rate for Payer: HFN Commercial |
$404.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$330.00
|
| Rate for Payer: Multiplan Commercial |
$352.00
|
| Rate for Payer: NAPHCARE Commercial |
$264.00
|
| Rate for Payer: Preferred Network Access Commercial |
$404.80
|
| Rate for Payer: Quartz Beloit One Network |
$215.60
|
| Rate for Payer: Quartz Commercial |
$286.00
|
| Rate for Payer: Quartz Medicare Advantage |
$264.00
|
| Rate for Payer: The Alliance Commercial |
$1,760.00
|
| Rate for Payer: WEA Trust Commercial |
$242.00
|
| Rate for Payer: WPS Commercial |
$325.91
|
|
|
CANNULA RADIOFREQUENCY 18G X 145MM 10MM TIP CURVED PMF18-14510CS
|
Facility
IP
|
$440.00
|
|
| Hospital Charge Code |
4595244
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$215.60 |
| Max. Negotiated Rate |
$404.80 |
| Rate for Payer: Aetna Commercial |
$396.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$233.20
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cigna Commercial |
$404.80
|
| Rate for Payer: Health EOS Commercial |
$391.60
|
| Rate for Payer: HFN Commercial |
$404.80
|
| Rate for Payer: Multiplan Commercial |
$352.00
|
| Rate for Payer: NAPHCARE Commercial |
$264.00
|
| Rate for Payer: Preferred Network Access Commercial |
$404.80
|
| Rate for Payer: Quartz Beloit One Network |
$215.60
|
| Rate for Payer: Quartz Commercial |
$264.00
|
| Rate for Payer: WEA Trust Commercial |
$242.00
|
| Rate for Payer: WPS Commercial |
$325.91
|
|
|
CANNULA RX XL 4582
|
Facility
IP
|
$1,629.00
|
|
| Hospital Charge Code |
2972371
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$798.21 |
| Max. Negotiated Rate |
$1,498.68 |
| Rate for Payer: Aetna Commercial |
$1,466.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$863.37
|
| Rate for Payer: Cash Price |
$488.70
|
| Rate for Payer: Cigna Commercial |
$1,498.68
|
| Rate for Payer: Health EOS Commercial |
$1,449.81
|
| Rate for Payer: HFN Commercial |
$1,498.68
|
| Rate for Payer: Multiplan Commercial |
$1,303.20
|
| Rate for Payer: NAPHCARE Commercial |
$977.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,498.68
|
| Rate for Payer: Quartz Beloit One Network |
$798.21
|
| Rate for Payer: Quartz Commercial |
$977.40
|
| Rate for Payer: WEA Trust Commercial |
$895.95
|
| Rate for Payer: WPS Commercial |
$1,206.60
|
|
|
CANNULA RX XL 4582
|
Facility
OP
|
$1,629.00
|
|
| Hospital Charge Code |
2972371
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$456.12 |
| Max. Negotiated Rate |
$6,516.00 |
| Rate for Payer: Aetna Commercial |
$1,466.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,400.94
|
| Rate for Payer: Aetna Managed Medicare |
$456.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,058.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$814.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$781.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$863.37
|
| Rate for Payer: Cash Price |
$488.70
|
| Rate for Payer: Cigna Commercial |
$1,498.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$911.59
|
| Rate for Payer: Health EOS Commercial |
$1,449.81
|
| Rate for Payer: HFN Commercial |
$1,498.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,221.75
|
| Rate for Payer: Multiplan Commercial |
$1,303.20
|
| Rate for Payer: NAPHCARE Commercial |
$977.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,498.68
|
| Rate for Payer: Quartz Beloit One Network |
$798.21
|
| Rate for Payer: Quartz Commercial |
$1,058.85
|
| Rate for Payer: Quartz Medicare Advantage |
$977.40
|
| Rate for Payer: The Alliance Commercial |
$6,516.00
|
| Rate for Payer: WEA Trust Commercial |
$895.95
|
| Rate for Payer: WPS Commercial |
$1,206.60
|
|
|
CANNULA SAPHENOUS VEIN PER-3006S
|
Facility
IP
|
$131.00
|
|
| Hospital Charge Code |
2965157
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$64.19 |
| Max. Negotiated Rate |
$120.52 |
| Rate for Payer: Aetna Commercial |
$117.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$69.43
|
| Rate for Payer: Cash Price |
$39.30
|
| Rate for Payer: Cigna Commercial |
$120.52
|
| Rate for Payer: Health EOS Commercial |
$116.59
|
| Rate for Payer: HFN Commercial |
$120.52
|
| Rate for Payer: Multiplan Commercial |
$104.80
|
| Rate for Payer: NAPHCARE Commercial |
$78.60
|
| Rate for Payer: Preferred Network Access Commercial |
$120.52
|
| Rate for Payer: Quartz Beloit One Network |
$64.19
|
| Rate for Payer: Quartz Commercial |
$78.60
|
| Rate for Payer: WEA Trust Commercial |
$72.05
|
| Rate for Payer: WPS Commercial |
$97.03
|
|
|
CANNULA SAPHENOUS VEIN PER-3006S
|
Facility
OP
|
$131.00
|
|
| Hospital Charge Code |
2965157
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$36.68 |
| Max. Negotiated Rate |
$524.00 |
| Rate for Payer: Aetna Commercial |
$117.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$112.66
|
| Rate for Payer: Aetna Managed Medicare |
$36.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$85.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$65.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$62.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$69.43
|
| Rate for Payer: Cash Price |
$39.30
|
| Rate for Payer: Cigna Commercial |
$120.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$73.31
|
| Rate for Payer: Health EOS Commercial |
$116.59
|
| Rate for Payer: HFN Commercial |
$120.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$98.25
|
| Rate for Payer: Multiplan Commercial |
$104.80
|
| Rate for Payer: NAPHCARE Commercial |
$78.60
|
| Rate for Payer: Preferred Network Access Commercial |
$120.52
|
| Rate for Payer: Quartz Beloit One Network |
$64.19
|
| Rate for Payer: Quartz Commercial |
$85.15
|
| Rate for Payer: Quartz Medicare Advantage |
$78.60
|
| Rate for Payer: The Alliance Commercial |
$524.00
|
| Rate for Payer: WEA Trust Commercial |
$72.05
|
| Rate for Payer: WPS Commercial |
$97.03
|
|
|
CANNULA SET 6.0x75 C7332
|
Facility
OP
|
$421.00
|
|
| Hospital Charge Code |
2964878
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$117.88 |
| Max. Negotiated Rate |
$1,684.00 |
| Rate for Payer: Aetna Commercial |
$378.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$362.06
|
| Rate for Payer: Aetna Managed Medicare |
$117.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$273.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$210.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$202.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$223.13
|
| Rate for Payer: Cash Price |
$126.30
|
| Rate for Payer: Cigna Commercial |
$387.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$235.59
|
| Rate for Payer: Health EOS Commercial |
$374.69
|
| Rate for Payer: HFN Commercial |
$387.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$315.75
|
| Rate for Payer: Multiplan Commercial |
$336.80
|
| Rate for Payer: NAPHCARE Commercial |
$252.60
|
| Rate for Payer: Preferred Network Access Commercial |
$387.32
|
| Rate for Payer: Quartz Beloit One Network |
$206.29
|
| Rate for Payer: Quartz Commercial |
$273.65
|
| Rate for Payer: Quartz Medicare Advantage |
$252.60
|
| Rate for Payer: The Alliance Commercial |
$1,684.00
|
| Rate for Payer: WEA Trust Commercial |
$231.55
|
| Rate for Payer: WPS Commercial |
$311.83
|
|
|
CANNULA SET 6.0x75 C7332
|
Facility
IP
|
$421.00
|
|
| Hospital Charge Code |
2964878
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$206.29 |
| Max. Negotiated Rate |
$387.32 |
| Rate for Payer: Aetna Commercial |
$378.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$223.13
|
| Rate for Payer: Cash Price |
$126.30
|
| Rate for Payer: Cigna Commercial |
$387.32
|
| Rate for Payer: Health EOS Commercial |
$374.69
|
| Rate for Payer: HFN Commercial |
$387.32
|
| Rate for Payer: Multiplan Commercial |
$336.80
|
| Rate for Payer: NAPHCARE Commercial |
$252.60
|
| Rate for Payer: Preferred Network Access Commercial |
$387.32
|
| Rate for Payer: Quartz Beloit One Network |
$206.29
|
| Rate for Payer: Quartz Commercial |
$252.60
|
| Rate for Payer: WEA Trust Commercial |
$231.55
|
| Rate for Payer: WPS Commercial |
$311.83
|
|
|
CANNULA SET 8.4x50 C7352
|
Facility
OP
|
$421.00
|
|
| Hospital Charge Code |
2964879
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$117.88 |
| Max. Negotiated Rate |
$1,684.00 |
| Rate for Payer: Aetna Commercial |
$378.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$362.06
|
| Rate for Payer: Aetna Managed Medicare |
$117.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$273.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$210.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$202.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$223.13
|
| Rate for Payer: Cash Price |
$126.30
|
| Rate for Payer: Cigna Commercial |
$387.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$235.59
|
| Rate for Payer: Health EOS Commercial |
$374.69
|
| Rate for Payer: HFN Commercial |
$387.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$315.75
|
| Rate for Payer: Multiplan Commercial |
$336.80
|
| Rate for Payer: NAPHCARE Commercial |
$252.60
|
| Rate for Payer: Preferred Network Access Commercial |
$387.32
|
| Rate for Payer: Quartz Beloit One Network |
$206.29
|
| Rate for Payer: Quartz Commercial |
$273.65
|
| Rate for Payer: Quartz Medicare Advantage |
$252.60
|
| Rate for Payer: The Alliance Commercial |
$1,684.00
|
| Rate for Payer: WEA Trust Commercial |
$231.55
|
| Rate for Payer: WPS Commercial |
$311.83
|
|
|
CANNULA SET 8.4x50 C7352
|
Facility
IP
|
$421.00
|
|
| Hospital Charge Code |
2964879
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$206.29 |
| Max. Negotiated Rate |
$387.32 |
| Rate for Payer: Aetna Commercial |
$378.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$223.13
|
| Rate for Payer: Cash Price |
$126.30
|
| Rate for Payer: Cigna Commercial |
$387.32
|
| Rate for Payer: Health EOS Commercial |
$374.69
|
| Rate for Payer: HFN Commercial |
$387.32
|
| Rate for Payer: Multiplan Commercial |
$336.80
|
| Rate for Payer: NAPHCARE Commercial |
$252.60
|
| Rate for Payer: Preferred Network Access Commercial |
$387.32
|
| Rate for Payer: Quartz Beloit One Network |
$206.29
|
| Rate for Payer: Quartz Commercial |
$252.60
|
| Rate for Payer: WEA Trust Commercial |
$231.55
|
| Rate for Payer: WPS Commercial |
$311.83
|
|
|
CANNULA SET 8.4x75 C7362
|
Facility
OP
|
$421.00
|
|
| Hospital Charge Code |
2964880
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$117.88 |
| Max. Negotiated Rate |
$1,684.00 |
| Rate for Payer: Aetna Commercial |
$378.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$362.06
|
| Rate for Payer: Aetna Managed Medicare |
$117.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$273.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$210.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$202.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$223.13
|
| Rate for Payer: Cash Price |
$126.30
|
| Rate for Payer: Cigna Commercial |
$387.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$235.59
|
| Rate for Payer: Health EOS Commercial |
$374.69
|
| Rate for Payer: HFN Commercial |
$387.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$315.75
|
| Rate for Payer: Multiplan Commercial |
$336.80
|
| Rate for Payer: NAPHCARE Commercial |
$252.60
|
| Rate for Payer: Preferred Network Access Commercial |
$387.32
|
| Rate for Payer: Quartz Beloit One Network |
$206.29
|
| Rate for Payer: Quartz Commercial |
$273.65
|
| Rate for Payer: Quartz Medicare Advantage |
$252.60
|
| Rate for Payer: The Alliance Commercial |
$1,684.00
|
| Rate for Payer: WEA Trust Commercial |
$231.55
|
| Rate for Payer: WPS Commercial |
$311.83
|
|
|
CANNULA SET 8.4x75 C7362
|
Facility
IP
|
$421.00
|
|
| Hospital Charge Code |
2964880
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$206.29 |
| Max. Negotiated Rate |
$387.32 |
| Rate for Payer: Aetna Commercial |
$378.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$223.13
|
| Rate for Payer: Cash Price |
$126.30
|
| Rate for Payer: Cigna Commercial |
$387.32
|
| Rate for Payer: Health EOS Commercial |
$374.69
|
| Rate for Payer: HFN Commercial |
$387.32
|
| Rate for Payer: Multiplan Commercial |
$336.80
|
| Rate for Payer: NAPHCARE Commercial |
$252.60
|
| Rate for Payer: Preferred Network Access Commercial |
$387.32
|
| Rate for Payer: Quartz Beloit One Network |
$206.29
|
| Rate for Payer: Quartz Commercial |
$252.60
|
| Rate for Payer: WEA Trust Commercial |
$231.55
|
| Rate for Payer: WPS Commercial |
$311.83
|
|
|
CANNULA SHOULDER 9704
|
Facility
OP
|
$421.00
|
|
| Hospital Charge Code |
2964881
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$117.88 |
| Max. Negotiated Rate |
$1,684.00 |
| Rate for Payer: Aetna Commercial |
$378.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$362.06
|
| Rate for Payer: Aetna Managed Medicare |
$117.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$273.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$210.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$202.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$223.13
|
| Rate for Payer: Cash Price |
$126.30
|
| Rate for Payer: Cigna Commercial |
$387.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$235.59
|
| Rate for Payer: Health EOS Commercial |
$374.69
|
| Rate for Payer: HFN Commercial |
$387.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$315.75
|
| Rate for Payer: Multiplan Commercial |
$336.80
|
| Rate for Payer: NAPHCARE Commercial |
$252.60
|
| Rate for Payer: Preferred Network Access Commercial |
$387.32
|
| Rate for Payer: Quartz Beloit One Network |
$206.29
|
| Rate for Payer: Quartz Commercial |
$273.65
|
| Rate for Payer: Quartz Medicare Advantage |
$252.60
|
| Rate for Payer: The Alliance Commercial |
$1,684.00
|
| Rate for Payer: WEA Trust Commercial |
$231.55
|
| Rate for Payer: WPS Commercial |
$311.83
|
|
|
CANNULA SHOULDER 9704
|
Facility
IP
|
$421.00
|
|
| Hospital Charge Code |
2964881
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$206.29 |
| Max. Negotiated Rate |
$387.32 |
| Rate for Payer: Aetna Commercial |
$378.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$223.13
|
| Rate for Payer: Cash Price |
$126.30
|
| Rate for Payer: Cigna Commercial |
$387.32
|
| Rate for Payer: Health EOS Commercial |
$374.69
|
| Rate for Payer: HFN Commercial |
$387.32
|
| Rate for Payer: Multiplan Commercial |
$336.80
|
| Rate for Payer: NAPHCARE Commercial |
$252.60
|
| Rate for Payer: Preferred Network Access Commercial |
$387.32
|
| Rate for Payer: Quartz Beloit One Network |
$206.29
|
| Rate for Payer: Quartz Commercial |
$252.60
|
| Rate for Payer: WEA Trust Commercial |
$231.55
|
| Rate for Payer: WPS Commercial |
$311.83
|
|
|
CANNULA SOFTECH NASAL 14 FT
|
Facility
IP
|
$46.00
|
|
|
Service Code
|
HCPCS A4615
|
| Hospital Charge Code |
2974602
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$22.54 |
| Max. Negotiated Rate |
$42.32 |
| Rate for Payer: Aetna Commercial |
$41.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$24.38
|
| Rate for Payer: Cash Price |
$13.80
|
| Rate for Payer: Cigna Commercial |
$42.32
|
| Rate for Payer: Health EOS Commercial |
$40.94
|
| Rate for Payer: HFN Commercial |
$42.32
|
| Rate for Payer: Multiplan Commercial |
$36.80
|
| Rate for Payer: NAPHCARE Commercial |
$27.60
|
| Rate for Payer: Preferred Network Access Commercial |
$42.32
|
| Rate for Payer: Quartz Beloit One Network |
$22.54
|
| Rate for Payer: Quartz Commercial |
$27.60
|
| Rate for Payer: WEA Trust Commercial |
$25.30
|
| Rate for Payer: WPS Commercial |
$34.07
|
|
