|
CANNULA RADIOFREQUENCY 18G 60MM 10MM TIP CURVED
|
Facility
|
OP
|
$423.00
|
|
| Hospital Charge Code |
4595245
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$118.44 |
| Max. Negotiated Rate |
$1,692.00 |
| Rate for Payer: Aetna Commercial |
$380.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$363.78
|
| Rate for Payer: Aetna Managed Medicare |
$118.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$274.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$211.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$203.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$224.19
|
| Rate for Payer: Cash Price |
$126.90
|
| Rate for Payer: Cigna Commercial |
$389.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$236.71
|
| Rate for Payer: Health EOS Commercial |
$376.47
|
| Rate for Payer: HFN Commercial |
$389.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$317.25
|
| Rate for Payer: Multiplan Commercial |
$338.40
|
| Rate for Payer: NAPHCARE Commercial |
$253.80
|
| Rate for Payer: Preferred Network Access Commercial |
$389.16
|
| Rate for Payer: Quartz Beloit One Network |
$207.27
|
| Rate for Payer: Quartz Commercial |
$274.95
|
| Rate for Payer: Quartz Medicare Advantage |
$253.80
|
| Rate for Payer: The Alliance Commercial |
$1,692.00
|
| Rate for Payer: WEA Trust Commercial |
$232.65
|
| Rate for Payer: WPS Commercial |
$313.32
|
|
|
CANNULA RADIOFREQUENCY 18G 60MM 10MM TIP CURVED
|
Facility
|
IP
|
$423.00
|
|
| Hospital Charge Code |
4595245
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$207.27 |
| Max. Negotiated Rate |
$389.16 |
| Rate for Payer: Aetna Commercial |
$380.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$363.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$224.19
|
| Rate for Payer: Cash Price |
$126.90
|
| Rate for Payer: Cigna Commercial |
$389.16
|
| Rate for Payer: Health EOS Commercial |
$376.47
|
| Rate for Payer: HFN Commercial |
$389.16
|
| Rate for Payer: Multiplan Commercial |
$338.40
|
| Rate for Payer: NAPHCARE Commercial |
$253.80
|
| Rate for Payer: Preferred Network Access Commercial |
$389.16
|
| Rate for Payer: Quartz Beloit One Network |
$207.27
|
| Rate for Payer: Quartz Commercial |
$253.80
|
| Rate for Payer: WEA Trust Commercial |
$232.65
|
| Rate for Payer: WPS Commercial |
$313.32
|
|
|
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: Aetna Gatekeeper/Not Gatekeeper |
$378.40
|
| 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
|
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 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: Aetna Gatekeeper/Not Gatekeeper |
$1,400.94
|
| 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 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 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: Aetna Gatekeeper/Not Gatekeeper |
$112.66
|
| 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 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: Aetna Gatekeeper/Not Gatekeeper |
$362.06
|
| 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: Aetna Gatekeeper/Not Gatekeeper |
$362.06
|
| 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: Aetna Gatekeeper/Not Gatekeeper |
$362.06
|
| 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
|
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: Aetna Gatekeeper/Not Gatekeeper |
$362.06
|
| 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 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: Aetna Gatekeeper/Not Gatekeeper |
$39.56
|
| 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
|
|
|
CANNULA SOFTECH NASAL 14 FT
|
Facility
|
OP
|
$46.00
|
|
|
Service Code
|
HCPCS A4615
|
| Hospital Charge Code |
2974602
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.88 |
| Max. Negotiated Rate |
$184.00 |
| Rate for Payer: Aetna Commercial |
$41.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$39.56
|
| Rate for Payer: Aetna Managed Medicare |
$12.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$29.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$23.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22.08
|
| 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: Dean Health DHI/DHP/ASO |
$25.74
|
| Rate for Payer: Health EOS Commercial |
$40.94
|
| Rate for Payer: HFN Commercial |
$42.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$34.50
|
| 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 |
$29.90
|
| Rate for Payer: Quartz Medicare Advantage |
$27.60
|
| Rate for Payer: The Alliance Commercial |
$184.00
|
| Rate for Payer: WEA Trust Commercial |
$25.30
|
| Rate for Payer: WPS Commercial |
$34.07
|
|
|
CANNULA TWIST-IN 7MM X 7CM AR-6570
|
Facility
|
OP
|
$514.00
|
|
| Hospital Charge Code |
4640650
|
|
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 TWIST-IN 7MM X 7CM AR-6570
|
Facility
|
IP
|
$514.00
|
|
| Hospital Charge Code |
4640650
|
|
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 TWIST-IN AR-6530
|
Facility
|
OP
|
$534.00
|
|
| Hospital Charge Code |
4520229
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$149.52 |
| Max. Negotiated Rate |
$2,136.00 |
| Rate for Payer: Aetna Commercial |
$480.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$459.24
|
| Rate for Payer: Aetna Managed Medicare |
$149.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$347.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$267.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$256.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$283.02
|
| Rate for Payer: Cash Price |
$160.20
|
| Rate for Payer: Cigna Commercial |
$491.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$298.83
|
| Rate for Payer: Health EOS Commercial |
$475.26
|
| Rate for Payer: HFN Commercial |
$491.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$400.50
|
| Rate for Payer: Multiplan Commercial |
$427.20
|
| Rate for Payer: NAPHCARE Commercial |
$320.40
|
| Rate for Payer: Preferred Network Access Commercial |
$491.28
|
| Rate for Payer: Quartz Beloit One Network |
$261.66
|
| Rate for Payer: Quartz Commercial |
$347.10
|
| Rate for Payer: Quartz Medicare Advantage |
$320.40
|
| Rate for Payer: The Alliance Commercial |
$2,136.00
|
| Rate for Payer: WEA Trust Commercial |
$293.70
|
| Rate for Payer: WPS Commercial |
$395.53
|
|
|
CANNULA TWIST-IN AR-6530
|
Facility
|
IP
|
$534.00
|
|
| Hospital Charge Code |
4520229
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$261.66 |
| Max. Negotiated Rate |
$491.28 |
| Rate for Payer: Aetna Commercial |
$480.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$459.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$283.02
|
| Rate for Payer: Cash Price |
$160.20
|
| Rate for Payer: Cigna Commercial |
$491.28
|
| Rate for Payer: Health EOS Commercial |
$475.26
|
| Rate for Payer: HFN Commercial |
$491.28
|
| Rate for Payer: Multiplan Commercial |
$427.20
|
| Rate for Payer: NAPHCARE Commercial |
$320.40
|
| Rate for Payer: Preferred Network Access Commercial |
$491.28
|
| Rate for Payer: Quartz Beloit One Network |
$261.66
|
| Rate for Payer: Quartz Commercial |
$320.40
|
| Rate for Payer: WEA Trust Commercial |
$293.70
|
| Rate for Payer: WPS Commercial |
$395.53
|
|
|
CANNULA TWIST-IN NO SQUIRT CAP 8.25MM X 9CMAR-6540
|
Facility
|
IP
|
$672.00
|
|
| Hospital Charge Code |
5563402
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$329.28 |
| Max. Negotiated Rate |
$618.24 |
| Rate for Payer: Aetna Commercial |
$604.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$577.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$356.16
|
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: Cigna Commercial |
$618.24
|
| Rate for Payer: Health EOS Commercial |
$598.08
|
| Rate for Payer: HFN Commercial |
$618.24
|
| Rate for Payer: Multiplan Commercial |
$537.60
|
| Rate for Payer: NAPHCARE Commercial |
$403.20
|
| Rate for Payer: Preferred Network Access Commercial |
$618.24
|
| Rate for Payer: Quartz Beloit One Network |
$329.28
|
| Rate for Payer: Quartz Commercial |
$403.20
|
| Rate for Payer: WEA Trust Commercial |
$369.60
|
| Rate for Payer: WPS Commercial |
$497.75
|
|
|
CANNULA TWIST-IN NO SQUIRT CAP 8.25MM X 9CMAR-6540
|
Facility
|
OP
|
$672.00
|
|
| Hospital Charge Code |
5563402
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$188.16 |
| Max. Negotiated Rate |
$2,688.00 |
| Rate for Payer: Aetna Commercial |
$604.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$577.92
|
| Rate for Payer: Aetna Managed Medicare |
$188.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$436.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$336.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$322.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$356.16
|
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: Cigna Commercial |
$618.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$376.05
|
| Rate for Payer: Health EOS Commercial |
$598.08
|
| Rate for Payer: HFN Commercial |
$618.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$504.00
|
| Rate for Payer: Multiplan Commercial |
$537.60
|
| Rate for Payer: NAPHCARE Commercial |
$403.20
|
| Rate for Payer: Preferred Network Access Commercial |
$618.24
|
| Rate for Payer: Quartz Beloit One Network |
$329.28
|
| Rate for Payer: Quartz Commercial |
$436.80
|
| Rate for Payer: Quartz Medicare Advantage |
$403.20
|
| Rate for Payer: The Alliance Commercial |
$2,688.00
|
| Rate for Payer: WEA Trust Commercial |
$369.60
|
| Rate for Payer: WPS Commercial |
$497.75
|
|
|
CANNULA VEIN GRAFT 10010
|
Facility
|
OP
|
$259.00
|
|
| Hospital Charge Code |
2965378
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$72.52 |
| Max. Negotiated Rate |
$1,036.00 |
| Rate for Payer: Aetna Commercial |
$233.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$222.74
|
| Rate for Payer: Aetna Managed Medicare |
$72.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$168.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$129.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$124.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$137.27
|
| Rate for Payer: Cash Price |
$77.70
|
| Rate for Payer: Cigna Commercial |
$238.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$144.94
|
| Rate for Payer: Health EOS Commercial |
$230.51
|
| Rate for Payer: HFN Commercial |
$238.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$194.25
|
| Rate for Payer: Multiplan Commercial |
$207.20
|
| Rate for Payer: NAPHCARE Commercial |
$155.40
|
| Rate for Payer: Preferred Network Access Commercial |
$238.28
|
| Rate for Payer: Quartz Beloit One Network |
$126.91
|
| Rate for Payer: Quartz Commercial |
$168.35
|
| Rate for Payer: Quartz Medicare Advantage |
$155.40
|
| Rate for Payer: The Alliance Commercial |
$1,036.00
|
| Rate for Payer: WEA Trust Commercial |
$142.45
|
| Rate for Payer: WPS Commercial |
$191.84
|
|
