|
CANNULA ARTERIAL 24FR/7MM SOFT-FLOW ANGLED TIP SUTURE BULB NON-VENT 5768
|
Facility
|
OP
|
$1,331.00
|
|
| Hospital Charge Code |
5074616
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$372.68 |
| Max. Negotiated Rate |
$5,324.00 |
| Rate for Payer: Aetna Commercial |
$1,197.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,144.66
|
| Rate for Payer: Aetna Managed Medicare |
$372.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$865.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$665.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$638.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$705.43
|
| Rate for Payer: Cash Price |
$399.30
|
| Rate for Payer: Cigna Commercial |
$1,224.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$744.83
|
| Rate for Payer: Health EOS Commercial |
$1,184.59
|
| Rate for Payer: HFN Commercial |
$1,224.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$998.25
|
| Rate for Payer: Multiplan Commercial |
$1,064.80
|
| Rate for Payer: NAPHCARE Commercial |
$798.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,224.52
|
| Rate for Payer: Quartz Beloit One Network |
$652.19
|
| Rate for Payer: Quartz Commercial |
$865.15
|
| Rate for Payer: Quartz Medicare Advantage |
$798.60
|
| Rate for Payer: The Alliance Commercial |
$5,324.00
|
| Rate for Payer: WEA Trust Commercial |
$732.05
|
| Rate for Payer: WPS Commercial |
$985.87
|
|
|
CANNULA ARTERIAL 24FR/7MM SOFT-FLOW ANGLED TIP SUTURE BULB NON-VENT 5768
|
Facility
|
IP
|
$1,331.00
|
|
| Hospital Charge Code |
5074616
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$652.19 |
| Max. Negotiated Rate |
$1,224.52 |
| Rate for Payer: Aetna Commercial |
$1,197.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,144.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$705.43
|
| Rate for Payer: Cash Price |
$399.30
|
| Rate for Payer: Cigna Commercial |
$1,224.52
|
| Rate for Payer: Health EOS Commercial |
$1,184.59
|
| Rate for Payer: HFN Commercial |
$1,224.52
|
| Rate for Payer: Multiplan Commercial |
$1,064.80
|
| Rate for Payer: NAPHCARE Commercial |
$798.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,224.52
|
| Rate for Payer: Quartz Beloit One Network |
$652.19
|
| Rate for Payer: Quartz Commercial |
$798.60
|
| Rate for Payer: WEA Trust Commercial |
$732.05
|
| Rate for Payer: WPS Commercial |
$985.87
|
|
|
CANNULA ARTERIAL 24FR/8MM SOFT-FLOW EXTENDED NON-VENT 4950
|
Facility
|
OP
|
$1,256.00
|
|
| Hospital Charge Code |
5349137
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$351.68 |
| Max. Negotiated Rate |
$5,024.00 |
| Rate for Payer: Aetna Commercial |
$1,130.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,080.16
|
| Rate for Payer: Aetna Managed Medicare |
$351.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$816.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$628.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$602.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$665.68
|
| Rate for Payer: Cash Price |
$376.80
|
| Rate for Payer: Cigna Commercial |
$1,155.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$702.86
|
| Rate for Payer: Health EOS Commercial |
$1,117.84
|
| Rate for Payer: HFN Commercial |
$1,155.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$942.00
|
| Rate for Payer: Multiplan Commercial |
$1,004.80
|
| Rate for Payer: NAPHCARE Commercial |
$753.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,155.52
|
| Rate for Payer: Quartz Beloit One Network |
$615.44
|
| Rate for Payer: Quartz Commercial |
$816.40
|
| Rate for Payer: Quartz Medicare Advantage |
$753.60
|
| Rate for Payer: The Alliance Commercial |
$5,024.00
|
| Rate for Payer: WEA Trust Commercial |
$690.80
|
| Rate for Payer: WPS Commercial |
$930.32
|
|
|
CANNULA ARTERIAL 24FR/8MM SOFT-FLOW EXTENDED NON-VENT 4950
|
Facility
|
IP
|
$1,256.00
|
|
| Hospital Charge Code |
5349137
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$615.44 |
| Max. Negotiated Rate |
$1,155.52 |
| Rate for Payer: Aetna Commercial |
$1,130.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,080.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$665.68
|
| Rate for Payer: Cash Price |
$376.80
|
| Rate for Payer: Cigna Commercial |
$1,155.52
|
| Rate for Payer: Health EOS Commercial |
$1,117.84
|
| Rate for Payer: HFN Commercial |
$1,155.52
|
| Rate for Payer: Multiplan Commercial |
$1,004.80
|
| Rate for Payer: NAPHCARE Commercial |
$753.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,155.52
|
| Rate for Payer: Quartz Beloit One Network |
$615.44
|
| Rate for Payer: Quartz Commercial |
$753.60
|
| Rate for Payer: WEA Trust Commercial |
$690.80
|
| Rate for Payer: WPS Commercial |
$930.32
|
|
|
CANNULA ARTERIAL EOPA 22FR #77622
|
Facility
|
IP
|
$1,040.00
|
|
| Hospital Charge Code |
4088498
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$509.60 |
| Max. Negotiated Rate |
$956.80 |
| Rate for Payer: Aetna Commercial |
$936.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$894.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$551.20
|
| Rate for Payer: Cash Price |
$312.00
|
| Rate for Payer: Cigna Commercial |
$956.80
|
| Rate for Payer: Health EOS Commercial |
$925.60
|
| Rate for Payer: HFN Commercial |
$956.80
|
| Rate for Payer: Multiplan Commercial |
$832.00
|
| Rate for Payer: NAPHCARE Commercial |
$624.00
|
| Rate for Payer: Preferred Network Access Commercial |
$956.80
|
| Rate for Payer: Quartz Beloit One Network |
$509.60
|
| Rate for Payer: Quartz Commercial |
$624.00
|
| Rate for Payer: WEA Trust Commercial |
$572.00
|
| Rate for Payer: WPS Commercial |
$770.33
|
|
|
CANNULA ARTERIAL EOPA 22FR #77622
|
Facility
|
OP
|
$1,040.00
|
|
| Hospital Charge Code |
4088498
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$291.20 |
| Max. Negotiated Rate |
$4,160.00 |
| Rate for Payer: Aetna Commercial |
$936.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$894.40
|
| Rate for Payer: Aetna Managed Medicare |
$291.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$676.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$520.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$499.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$551.20
|
| Rate for Payer: Cash Price |
$312.00
|
| Rate for Payer: Cigna Commercial |
$956.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$581.98
|
| Rate for Payer: Health EOS Commercial |
$925.60
|
| Rate for Payer: HFN Commercial |
$956.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$780.00
|
| Rate for Payer: Multiplan Commercial |
$832.00
|
| Rate for Payer: NAPHCARE Commercial |
$624.00
|
| Rate for Payer: Preferred Network Access Commercial |
$956.80
|
| Rate for Payer: Quartz Beloit One Network |
$509.60
|
| Rate for Payer: Quartz Commercial |
$676.00
|
| Rate for Payer: Quartz Medicare Advantage |
$624.00
|
| Rate for Payer: The Alliance Commercial |
$4,160.00
|
| Rate for Payer: WEA Trust Commercial |
$572.00
|
| Rate for Payer: WPS Commercial |
$770.33
|
|
|
CANNULA CORONARY ARTERY 9/18FR X 11.4 IN STR PERFUSION (3.0/6.0MM X 290MM) 315806
|
Facility
|
OP
|
$1,361.00
|
|
| Hospital Charge Code |
3167471
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$381.08 |
| Max. Negotiated Rate |
$5,444.00 |
| Rate for Payer: Aetna Commercial |
$1,224.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,170.46
|
| Rate for Payer: Aetna Managed Medicare |
$381.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$884.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$680.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$653.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$721.33
|
| Rate for Payer: Cash Price |
$408.30
|
| Rate for Payer: Cigna Commercial |
$1,252.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$761.62
|
| Rate for Payer: Health EOS Commercial |
$1,211.29
|
| Rate for Payer: HFN Commercial |
$1,252.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,020.75
|
| Rate for Payer: Multiplan Commercial |
$1,088.80
|
| Rate for Payer: NAPHCARE Commercial |
$816.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,252.12
|
| Rate for Payer: Quartz Beloit One Network |
$666.89
|
| Rate for Payer: Quartz Commercial |
$884.65
|
| Rate for Payer: Quartz Medicare Advantage |
$816.60
|
| Rate for Payer: The Alliance Commercial |
$5,444.00
|
| Rate for Payer: WEA Trust Commercial |
$748.55
|
| Rate for Payer: WPS Commercial |
$1,008.09
|
|
|
CANNULA CORONARY ARTERY 9/18FR X 11.4 IN STR PERFUSION (3.0/6.0MM X 290MM) 315806
|
Facility
|
IP
|
$1,361.00
|
|
| Hospital Charge Code |
3167471
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$666.89 |
| Max. Negotiated Rate |
$1,252.12 |
| Rate for Payer: Aetna Commercial |
$1,224.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,170.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$721.33
|
| Rate for Payer: Cash Price |
$408.30
|
| Rate for Payer: Cigna Commercial |
$1,252.12
|
| Rate for Payer: Health EOS Commercial |
$1,211.29
|
| Rate for Payer: HFN Commercial |
$1,252.12
|
| Rate for Payer: Multiplan Commercial |
$1,088.80
|
| Rate for Payer: NAPHCARE Commercial |
$816.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,252.12
|
| Rate for Payer: Quartz Beloit One Network |
$666.89
|
| Rate for Payer: Quartz Commercial |
$816.60
|
| Rate for Payer: WEA Trust Commercial |
$748.55
|
| Rate for Payer: WPS Commercial |
$1,008.09
|
|
|
CANNULA CORONARY ARTERY PERFUSION 5MM 315805
|
Facility
|
IP
|
$1,361.00
|
|
| Hospital Charge Code |
5536764
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$666.89 |
| Max. Negotiated Rate |
$1,252.12 |
| Rate for Payer: Aetna Commercial |
$1,224.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,170.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$721.33
|
| Rate for Payer: Cash Price |
$408.30
|
| Rate for Payer: Cigna Commercial |
$1,252.12
|
| Rate for Payer: Health EOS Commercial |
$1,211.29
|
| Rate for Payer: HFN Commercial |
$1,252.12
|
| Rate for Payer: Multiplan Commercial |
$1,088.80
|
| Rate for Payer: NAPHCARE Commercial |
$816.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,252.12
|
| Rate for Payer: Quartz Beloit One Network |
$666.89
|
| Rate for Payer: Quartz Commercial |
$816.60
|
| Rate for Payer: WEA Trust Commercial |
$748.55
|
| Rate for Payer: WPS Commercial |
$1,008.09
|
|
|
CANNULA CORONARY ARTERY PERFUSION 5MM 315805
|
Facility
|
OP
|
$1,361.00
|
|
| Hospital Charge Code |
5536764
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$381.08 |
| Max. Negotiated Rate |
$5,444.00 |
| Rate for Payer: Aetna Commercial |
$1,224.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,170.46
|
| Rate for Payer: Aetna Managed Medicare |
$381.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$884.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$680.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$653.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$721.33
|
| Rate for Payer: Cash Price |
$408.30
|
| Rate for Payer: Cigna Commercial |
$1,252.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$761.62
|
| Rate for Payer: Health EOS Commercial |
$1,211.29
|
| Rate for Payer: HFN Commercial |
$1,252.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,020.75
|
| Rate for Payer: Multiplan Commercial |
$1,088.80
|
| Rate for Payer: NAPHCARE Commercial |
$816.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,252.12
|
| Rate for Payer: Quartz Beloit One Network |
$666.89
|
| Rate for Payer: Quartz Commercial |
$884.65
|
| Rate for Payer: Quartz Medicare Advantage |
$816.60
|
| Rate for Payer: The Alliance Commercial |
$5,444.00
|
| Rate for Payer: WEA Trust Commercial |
$748.55
|
| Rate for Payer: WPS Commercial |
$1,008.09
|
|
|
CANNULA CORONARY ARTERY PERFUSION 7MM 315807
|
Facility
|
OP
|
$1,361.00
|
|
| Hospital Charge Code |
5536765
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$381.08 |
| Max. Negotiated Rate |
$5,444.00 |
| Rate for Payer: Aetna Commercial |
$1,224.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,170.46
|
| Rate for Payer: Aetna Managed Medicare |
$381.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$884.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$680.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$653.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$721.33
|
| Rate for Payer: Cash Price |
$408.30
|
| Rate for Payer: Cigna Commercial |
$1,252.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$761.62
|
| Rate for Payer: Health EOS Commercial |
$1,211.29
|
| Rate for Payer: HFN Commercial |
$1,252.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,020.75
|
| Rate for Payer: Multiplan Commercial |
$1,088.80
|
| Rate for Payer: NAPHCARE Commercial |
$816.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,252.12
|
| Rate for Payer: Quartz Beloit One Network |
$666.89
|
| Rate for Payer: Quartz Commercial |
$884.65
|
| Rate for Payer: Quartz Medicare Advantage |
$816.60
|
| Rate for Payer: The Alliance Commercial |
$5,444.00
|
| Rate for Payer: WEA Trust Commercial |
$748.55
|
| Rate for Payer: WPS Commercial |
$1,008.09
|
|
|
CANNULA CORONARY ARTERY PERFUSION 7MM 315807
|
Facility
|
IP
|
$1,361.00
|
|
| Hospital Charge Code |
5536765
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$666.89 |
| Max. Negotiated Rate |
$1,252.12 |
| Rate for Payer: Aetna Commercial |
$1,224.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,170.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$721.33
|
| Rate for Payer: Cash Price |
$408.30
|
| Rate for Payer: Cigna Commercial |
$1,252.12
|
| Rate for Payer: Health EOS Commercial |
$1,211.29
|
| Rate for Payer: HFN Commercial |
$1,252.12
|
| Rate for Payer: Multiplan Commercial |
$1,088.80
|
| Rate for Payer: NAPHCARE Commercial |
$816.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,252.12
|
| Rate for Payer: Quartz Beloit One Network |
$666.89
|
| Rate for Payer: Quartz Commercial |
$816.60
|
| Rate for Payer: WEA Trust Commercial |
$748.55
|
| Rate for Payer: WPS Commercial |
$1,008.09
|
|
|
CANNULA CRYSTAL 5.75MM X 7CM AR-6560
|
Facility
|
IP
|
$514.00
|
|
| Hospital Charge Code |
4520230
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$251.86 |
| Max. Negotiated Rate |
$472.88 |
| Rate for Payer: Aetna Commercial |
$462.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$442.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$272.42
|
| Rate for Payer: Cash Price |
$154.20
|
| Rate for Payer: Cigna Commercial |
$472.88
|
| Rate for Payer: Health EOS Commercial |
$457.46
|
| Rate for Payer: HFN Commercial |
$472.88
|
| Rate for Payer: Multiplan Commercial |
$411.20
|
| Rate for Payer: NAPHCARE Commercial |
$308.40
|
| Rate for Payer: Preferred Network Access Commercial |
$472.88
|
| Rate for Payer: Quartz Beloit One Network |
$251.86
|
| Rate for Payer: Quartz Commercial |
$308.40
|
| Rate for Payer: WEA Trust Commercial |
$282.70
|
| Rate for Payer: WPS Commercial |
$380.72
|
|
|
CANNULA CRYSTAL 5.75MM X 7CM AR-6560
|
Facility
|
OP
|
$514.00
|
|
| Hospital Charge Code |
4520230
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$143.92 |
| Max. Negotiated Rate |
$2,056.00 |
| Rate for Payer: Aetna Commercial |
$462.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$442.04
|
| Rate for Payer: Aetna Managed Medicare |
$143.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$334.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$257.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$246.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$272.42
|
| Rate for Payer: Cash Price |
$154.20
|
| Rate for Payer: Cigna Commercial |
$472.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$287.63
|
| Rate for Payer: Health EOS Commercial |
$457.46
|
| Rate for Payer: HFN Commercial |
$472.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$385.50
|
| Rate for Payer: Multiplan Commercial |
$411.20
|
| Rate for Payer: NAPHCARE Commercial |
$308.40
|
| Rate for Payer: Preferred Network Access Commercial |
$472.88
|
| Rate for Payer: Quartz Beloit One Network |
$251.86
|
| Rate for Payer: Quartz Commercial |
$334.10
|
| Rate for Payer: Quartz Medicare Advantage |
$308.40
|
| Rate for Payer: The Alliance Commercial |
$2,056.00
|
| Rate for Payer: WEA Trust Commercial |
$282.70
|
| Rate for Payer: WPS Commercial |
$380.72
|
|
|
CANNULA DISP INNER 7.0 FOR 8.0mm TUBE
|
Facility
|
OP
|
$86.00
|
|
|
Service Code
|
HCPCS A4623
|
| Hospital Charge Code |
2969215
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$24.08 |
| Max. Negotiated Rate |
$344.00 |
| Rate for Payer: Aetna Commercial |
$77.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$73.96
|
| Rate for Payer: Aetna Managed Medicare |
$24.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$55.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$43.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$41.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$45.58
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Cigna Commercial |
$79.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$48.13
|
| Rate for Payer: Health EOS Commercial |
$76.54
|
| Rate for Payer: HFN Commercial |
$79.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$64.50
|
| Rate for Payer: Multiplan Commercial |
$68.80
|
| Rate for Payer: NAPHCARE Commercial |
$51.60
|
| Rate for Payer: Preferred Network Access Commercial |
$79.12
|
| Rate for Payer: Quartz Beloit One Network |
$42.14
|
| Rate for Payer: Quartz Commercial |
$55.90
|
| Rate for Payer: Quartz Medicare Advantage |
$51.60
|
| Rate for Payer: The Alliance Commercial |
$344.00
|
| Rate for Payer: WEA Trust Commercial |
$47.30
|
| Rate for Payer: WPS Commercial |
$63.70
|
|
|
CANNULA DISP INNER 7.0 FOR 8.0mm TUBE
|
Facility
|
IP
|
$86.00
|
|
|
Service Code
|
HCPCS A4623
|
| Hospital Charge Code |
2969215
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$42.14 |
| Max. Negotiated Rate |
$79.12 |
| Rate for Payer: Aetna Commercial |
$77.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$73.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$45.58
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Cigna Commercial |
$79.12
|
| Rate for Payer: Health EOS Commercial |
$76.54
|
| Rate for Payer: HFN Commercial |
$79.12
|
| Rate for Payer: Multiplan Commercial |
$68.80
|
| Rate for Payer: NAPHCARE Commercial |
$51.60
|
| Rate for Payer: Preferred Network Access Commercial |
$79.12
|
| Rate for Payer: Quartz Beloit One Network |
$42.14
|
| Rate for Payer: Quartz Commercial |
$51.60
|
| Rate for Payer: WEA Trust Commercial |
$47.30
|
| Rate for Payer: WPS Commercial |
$63.70
|
|
|
CANNULA DUPLO TIP 318 0600038 (MED)
|
Facility
|
OP
|
$1,021.00
|
|
| Hospital Charge Code |
4294560
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$285.88 |
| Max. Negotiated Rate |
$4,084.00 |
| Rate for Payer: Aetna Commercial |
$918.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$878.06
|
| Rate for Payer: Aetna Managed Medicare |
$285.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$663.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$510.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$490.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$541.13
|
| Rate for Payer: Cash Price |
$306.30
|
| Rate for Payer: Cigna Commercial |
$939.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$571.35
|
| Rate for Payer: Health EOS Commercial |
$908.69
|
| Rate for Payer: HFN Commercial |
$939.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$765.75
|
| Rate for Payer: Multiplan Commercial |
$816.80
|
| Rate for Payer: NAPHCARE Commercial |
$612.60
|
| Rate for Payer: Preferred Network Access Commercial |
$939.32
|
| Rate for Payer: Quartz Beloit One Network |
$500.29
|
| Rate for Payer: Quartz Commercial |
$663.65
|
| Rate for Payer: Quartz Medicare Advantage |
$612.60
|
| Rate for Payer: The Alliance Commercial |
$4,084.00
|
| Rate for Payer: WEA Trust Commercial |
$561.55
|
| Rate for Payer: WPS Commercial |
$756.25
|
|
|
CANNULA DUPLO TIP 318 0600038 (MED)
|
Facility
|
IP
|
$1,021.00
|
|
| Hospital Charge Code |
4294560
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$500.29 |
| Max. Negotiated Rate |
$939.32 |
| Rate for Payer: Aetna Commercial |
$918.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$878.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$541.13
|
| Rate for Payer: Cash Price |
$306.30
|
| Rate for Payer: Cigna Commercial |
$939.32
|
| Rate for Payer: Health EOS Commercial |
$908.69
|
| Rate for Payer: HFN Commercial |
$939.32
|
| Rate for Payer: Multiplan Commercial |
$816.80
|
| Rate for Payer: NAPHCARE Commercial |
$612.60
|
| Rate for Payer: Preferred Network Access Commercial |
$939.32
|
| Rate for Payer: Quartz Beloit One Network |
$500.29
|
| Rate for Payer: Quartz Commercial |
$612.60
|
| Rate for Payer: WEA Trust Commercial |
$561.55
|
| Rate for Payer: WPS Commercial |
$756.25
|
|
|
CANNULA ETCO2 CAPNOLINE PLUS O2 010433
|
Facility
|
IP
|
$360.00
|
|
|
Service Code
|
HCPCS A4615
|
| Hospital Charge Code |
4230450
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$176.40 |
| Max. Negotiated Rate |
$331.20 |
| Rate for Payer: Aetna Commercial |
$324.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$309.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$190.80
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Cigna Commercial |
$331.20
|
| Rate for Payer: Health EOS Commercial |
$320.40
|
| Rate for Payer: HFN Commercial |
$331.20
|
| Rate for Payer: Multiplan Commercial |
$288.00
|
| Rate for Payer: NAPHCARE Commercial |
$216.00
|
| Rate for Payer: Preferred Network Access Commercial |
$331.20
|
| Rate for Payer: Quartz Beloit One Network |
$176.40
|
| Rate for Payer: Quartz Commercial |
$216.00
|
| Rate for Payer: WEA Trust Commercial |
$198.00
|
| Rate for Payer: WPS Commercial |
$266.65
|
|
|
CANNULA ETCO2 CAPNOLINE PLUS O2 010433
|
Facility
|
OP
|
$360.00
|
|
|
Service Code
|
HCPCS A4615
|
| Hospital Charge Code |
4230450
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$100.80 |
| Max. Negotiated Rate |
$1,440.00 |
| Rate for Payer: Aetna Commercial |
$324.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$309.60
|
| Rate for Payer: Aetna Managed Medicare |
$100.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$234.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$180.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$172.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$190.80
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Cigna Commercial |
$331.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$201.46
|
| Rate for Payer: Health EOS Commercial |
$320.40
|
| Rate for Payer: HFN Commercial |
$331.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$270.00
|
| Rate for Payer: Multiplan Commercial |
$288.00
|
| Rate for Payer: NAPHCARE Commercial |
$216.00
|
| Rate for Payer: Preferred Network Access Commercial |
$331.20
|
| Rate for Payer: Quartz Beloit One Network |
$176.40
|
| Rate for Payer: Quartz Commercial |
$234.00
|
| Rate for Payer: Quartz Medicare Advantage |
$216.00
|
| Rate for Payer: The Alliance Commercial |
$1,440.00
|
| Rate for Payer: WEA Trust Commercial |
$198.00
|
| Rate for Payer: WPS Commercial |
$266.65
|
|
|
CANNULA E-Z WRAP
|
Facility
|
IP
|
$25.00
|
|
| Hospital Charge Code |
2974631
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.25 |
| Max. Negotiated Rate |
$23.00 |
| Rate for Payer: Aetna Commercial |
$22.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$21.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$13.25
|
| Rate for Payer: Cash Price |
$7.50
|
| Rate for Payer: Cigna Commercial |
$23.00
|
| Rate for Payer: Health EOS Commercial |
$22.25
|
| Rate for Payer: HFN Commercial |
$23.00
|
| Rate for Payer: Multiplan Commercial |
$20.00
|
| Rate for Payer: NAPHCARE Commercial |
$15.00
|
| Rate for Payer: Preferred Network Access Commercial |
$23.00
|
| Rate for Payer: Quartz Beloit One Network |
$12.25
|
| Rate for Payer: Quartz Commercial |
$15.00
|
| Rate for Payer: WEA Trust Commercial |
$13.75
|
| Rate for Payer: WPS Commercial |
$18.52
|
|
|
CANNULA E-Z WRAP
|
Facility
|
OP
|
$25.00
|
|
| Hospital Charge Code |
2974631
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.00 |
| Max. Negotiated Rate |
$100.00 |
| Rate for Payer: Aetna Commercial |
$22.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$21.50
|
| Rate for Payer: Aetna Managed Medicare |
$7.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$16.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$12.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$12.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$13.25
|
| Rate for Payer: Cash Price |
$7.50
|
| Rate for Payer: Cigna Commercial |
$23.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13.99
|
| Rate for Payer: Health EOS Commercial |
$22.25
|
| Rate for Payer: HFN Commercial |
$23.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18.75
|
| Rate for Payer: Multiplan Commercial |
$20.00
|
| Rate for Payer: NAPHCARE Commercial |
$15.00
|
| Rate for Payer: Preferred Network Access Commercial |
$23.00
|
| Rate for Payer: Quartz Beloit One Network |
$12.25
|
| Rate for Payer: Quartz Commercial |
$16.25
|
| Rate for Payer: Quartz Medicare Advantage |
$15.00
|
| Rate for Payer: The Alliance Commercial |
$100.00
|
| Rate for Payer: WEA Trust Commercial |
$13.75
|
| Rate for Payer: WPS Commercial |
$18.52
|
|
|
CANNULA GEMINI SR8 AR-6572
|
Facility
|
IP
|
$682.00
|
|
| Hospital Charge Code |
4520425
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$334.18 |
| Max. Negotiated Rate |
$627.44 |
| Rate for Payer: Aetna Commercial |
$613.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$586.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$361.46
|
| Rate for Payer: Cash Price |
$204.60
|
| Rate for Payer: Cigna Commercial |
$627.44
|
| Rate for Payer: Health EOS Commercial |
$606.98
|
| Rate for Payer: HFN Commercial |
$627.44
|
| Rate for Payer: Multiplan Commercial |
$545.60
|
| Rate for Payer: NAPHCARE Commercial |
$409.20
|
| Rate for Payer: Preferred Network Access Commercial |
$627.44
|
| Rate for Payer: Quartz Beloit One Network |
$334.18
|
| Rate for Payer: Quartz Commercial |
$409.20
|
| Rate for Payer: WEA Trust Commercial |
$375.10
|
| Rate for Payer: WPS Commercial |
$505.16
|
|
|
CANNULA GEMINI SR8 AR-6572
|
Facility
|
OP
|
$682.00
|
|
| Hospital Charge Code |
4520425
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$190.96 |
| Max. Negotiated Rate |
$2,728.00 |
| Rate for Payer: Aetna Commercial |
$613.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$586.52
|
| Rate for Payer: Aetna Managed Medicare |
$190.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$443.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$341.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$327.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$361.46
|
| Rate for Payer: Cash Price |
$204.60
|
| Rate for Payer: Cigna Commercial |
$627.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$381.65
|
| Rate for Payer: Health EOS Commercial |
$606.98
|
| Rate for Payer: HFN Commercial |
$627.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$511.50
|
| Rate for Payer: Multiplan Commercial |
$545.60
|
| Rate for Payer: NAPHCARE Commercial |
$409.20
|
| Rate for Payer: Preferred Network Access Commercial |
$627.44
|
| Rate for Payer: Quartz Beloit One Network |
$334.18
|
| Rate for Payer: Quartz Commercial |
$443.30
|
| Rate for Payer: Quartz Medicare Advantage |
$409.20
|
| Rate for Payer: The Alliance Commercial |
$2,728.00
|
| Rate for Payer: WEA Trust Commercial |
$375.10
|
| Rate for Payer: WPS Commercial |
$505.16
|
|
|
CANNULAIDES SIZE 3 #CA103
|
Facility
|
IP
|
$164.00
|
|
| Hospital Charge Code |
2967912
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$80.36 |
| Max. Negotiated Rate |
$150.88 |
| Rate for Payer: Aetna Commercial |
$147.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$141.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$86.92
|
| Rate for Payer: Cash Price |
$49.20
|
| Rate for Payer: Cigna Commercial |
$150.88
|
| Rate for Payer: Health EOS Commercial |
$145.96
|
| Rate for Payer: HFN Commercial |
$150.88
|
| Rate for Payer: Multiplan Commercial |
$131.20
|
| Rate for Payer: NAPHCARE Commercial |
$98.40
|
| Rate for Payer: Preferred Network Access Commercial |
$150.88
|
| Rate for Payer: Quartz Beloit One Network |
$80.36
|
| Rate for Payer: Quartz Commercial |
$98.40
|
| Rate for Payer: WEA Trust Commercial |
$90.20
|
| Rate for Payer: WPS Commercial |
$121.47
|
|
