|
CANNULA VEIN GRAFT 10010
|
Facility
|
IP
|
$259.00
|
|
| Hospital Charge Code |
2965378
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$126.91 |
| Max. Negotiated Rate |
$238.28 |
| Rate for Payer: Aetna Commercial |
$233.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$222.74
|
| 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: Health EOS Commercial |
$230.51
|
| Rate for Payer: HFN Commercial |
$238.28
|
| 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 |
$155.40
|
| Rate for Payer: WEA Trust Commercial |
$142.45
|
| Rate for Payer: WPS Commercial |
$191.84
|
|
|
CANNULA VENOUS DLP SINGLE STAGE RT ANLGE METAL TIP 28 FR 69328
|
Facility
|
IP
|
$564.00
|
|
| Hospital Charge Code |
6179808
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$276.36 |
| Max. Negotiated Rate |
$518.88 |
| Rate for Payer: Aetna Commercial |
$507.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$485.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$298.92
|
| Rate for Payer: Cash Price |
$169.20
|
| Rate for Payer: Cigna Commercial |
$518.88
|
| Rate for Payer: Health EOS Commercial |
$501.96
|
| Rate for Payer: HFN Commercial |
$518.88
|
| Rate for Payer: Multiplan Commercial |
$451.20
|
| Rate for Payer: NAPHCARE Commercial |
$338.40
|
| Rate for Payer: Preferred Network Access Commercial |
$518.88
|
| Rate for Payer: Quartz Beloit One Network |
$276.36
|
| Rate for Payer: Quartz Commercial |
$338.40
|
| Rate for Payer: WEA Trust Commercial |
$310.20
|
| Rate for Payer: WPS Commercial |
$417.75
|
|
|
CANNULA VENOUS DLP SINGLE STAGE RT ANLGE METAL TIP 28 FR 69328
|
Facility
|
OP
|
$564.00
|
|
| Hospital Charge Code |
6179808
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$157.92 |
| Max. Negotiated Rate |
$2,256.00 |
| Rate for Payer: Aetna Commercial |
$507.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$485.04
|
| Rate for Payer: Aetna Managed Medicare |
$157.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$366.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$282.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$270.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$298.92
|
| Rate for Payer: Cash Price |
$169.20
|
| Rate for Payer: Cigna Commercial |
$518.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$315.61
|
| Rate for Payer: Health EOS Commercial |
$501.96
|
| Rate for Payer: HFN Commercial |
$518.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$423.00
|
| Rate for Payer: Multiplan Commercial |
$451.20
|
| Rate for Payer: NAPHCARE Commercial |
$338.40
|
| Rate for Payer: Preferred Network Access Commercial |
$518.88
|
| Rate for Payer: Quartz Beloit One Network |
$276.36
|
| Rate for Payer: Quartz Commercial |
$366.60
|
| Rate for Payer: Quartz Medicare Advantage |
$338.40
|
| Rate for Payer: The Alliance Commercial |
$2,256.00
|
| Rate for Payer: WEA Trust Commercial |
$310.20
|
| Rate for Payer: WPS Commercial |
$417.75
|
|
|
CANNULA VENOUS DLP SINGLE STAGE RT ANLGE METAL TIP 31 FR 69331
|
Facility
|
IP
|
$564.00
|
|
| Hospital Charge Code |
6179809
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$276.36 |
| Max. Negotiated Rate |
$518.88 |
| Rate for Payer: Aetna Commercial |
$507.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$485.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$298.92
|
| Rate for Payer: Cash Price |
$169.20
|
| Rate for Payer: Cigna Commercial |
$518.88
|
| Rate for Payer: Health EOS Commercial |
$501.96
|
| Rate for Payer: HFN Commercial |
$518.88
|
| Rate for Payer: Multiplan Commercial |
$451.20
|
| Rate for Payer: NAPHCARE Commercial |
$338.40
|
| Rate for Payer: Preferred Network Access Commercial |
$518.88
|
| Rate for Payer: Quartz Beloit One Network |
$276.36
|
| Rate for Payer: Quartz Commercial |
$338.40
|
| Rate for Payer: WEA Trust Commercial |
$310.20
|
| Rate for Payer: WPS Commercial |
$417.75
|
|
|
CANNULA VENOUS DLP SINGLE STAGE RT ANLGE METAL TIP 31 FR 69331
|
Facility
|
OP
|
$564.00
|
|
| Hospital Charge Code |
6179809
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$157.92 |
| Max. Negotiated Rate |
$2,256.00 |
| Rate for Payer: Aetna Commercial |
$507.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$485.04
|
| Rate for Payer: Aetna Managed Medicare |
$157.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$366.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$282.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$270.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$298.92
|
| Rate for Payer: Cash Price |
$169.20
|
| Rate for Payer: Cigna Commercial |
$518.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$315.61
|
| Rate for Payer: Health EOS Commercial |
$501.96
|
| Rate for Payer: HFN Commercial |
$518.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$423.00
|
| Rate for Payer: Multiplan Commercial |
$451.20
|
| Rate for Payer: NAPHCARE Commercial |
$338.40
|
| Rate for Payer: Preferred Network Access Commercial |
$518.88
|
| Rate for Payer: Quartz Beloit One Network |
$276.36
|
| Rate for Payer: Quartz Commercial |
$366.60
|
| Rate for Payer: Quartz Medicare Advantage |
$338.40
|
| Rate for Payer: The Alliance Commercial |
$2,256.00
|
| Rate for Payer: WEA Trust Commercial |
$310.20
|
| Rate for Payer: WPS Commercial |
$417.75
|
|
|
CANNULA VISCOAT 27GA 8065480120
|
Facility
|
OP
|
$165.00
|
|
| Hospital Charge Code |
4518846
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$46.20 |
| Max. Negotiated Rate |
$660.00 |
| Rate for Payer: Aetna Commercial |
$148.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$141.90
|
| Rate for Payer: Aetna Managed Medicare |
$46.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$107.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$82.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$79.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$87.45
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cigna Commercial |
$151.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$92.33
|
| Rate for Payer: Health EOS Commercial |
$146.85
|
| Rate for Payer: HFN Commercial |
$151.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$123.75
|
| Rate for Payer: Multiplan Commercial |
$132.00
|
| Rate for Payer: NAPHCARE Commercial |
$99.00
|
| Rate for Payer: Preferred Network Access Commercial |
$151.80
|
| Rate for Payer: Quartz Beloit One Network |
$80.85
|
| Rate for Payer: Quartz Commercial |
$107.25
|
| Rate for Payer: Quartz Medicare Advantage |
$99.00
|
| Rate for Payer: The Alliance Commercial |
$660.00
|
| Rate for Payer: WEA Trust Commercial |
$90.75
|
| Rate for Payer: WPS Commercial |
$122.22
|
|
|
CANNULA VISCOAT 27GA 8065480120
|
Facility
|
IP
|
$165.00
|
|
| Hospital Charge Code |
4518846
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$80.85 |
| Max. Negotiated Rate |
$151.80 |
| Rate for Payer: Aetna Commercial |
$148.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$141.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$87.45
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cigna Commercial |
$151.80
|
| Rate for Payer: Health EOS Commercial |
$146.85
|
| Rate for Payer: HFN Commercial |
$151.80
|
| Rate for Payer: Multiplan Commercial |
$132.00
|
| Rate for Payer: NAPHCARE Commercial |
$99.00
|
| Rate for Payer: Preferred Network Access Commercial |
$151.80
|
| Rate for Payer: Quartz Beloit One Network |
$80.85
|
| Rate for Payer: Quartz Commercial |
$99.00
|
| Rate for Payer: WEA Trust Commercial |
$90.75
|
| Rate for Payer: WPS Commercial |
$122.22
|
|
|
CANNULA ZONE NAVIGATOR ANTERIOR AR-7905
|
Facility
|
IP
|
$1,920.00
|
|
| Hospital Charge Code |
5685684
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$940.80 |
| Max. Negotiated Rate |
$1,766.40 |
| Rate for Payer: Aetna Commercial |
$1,728.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,651.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,017.60
|
| Rate for Payer: Cash Price |
$576.00
|
| Rate for Payer: Cigna Commercial |
$1,766.40
|
| Rate for Payer: Health EOS Commercial |
$1,708.80
|
| Rate for Payer: HFN Commercial |
$1,766.40
|
| Rate for Payer: Multiplan Commercial |
$1,536.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,152.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,766.40
|
| Rate for Payer: Quartz Beloit One Network |
$940.80
|
| Rate for Payer: Quartz Commercial |
$1,152.00
|
| Rate for Payer: WEA Trust Commercial |
$1,056.00
|
| Rate for Payer: WPS Commercial |
$1,422.14
|
|
|
CANNULA ZONE NAVIGATOR ANTERIOR AR-7905
|
Facility
|
OP
|
$1,920.00
|
|
| Hospital Charge Code |
5685684
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$537.60 |
| Max. Negotiated Rate |
$7,680.00 |
| Rate for Payer: Aetna Commercial |
$1,728.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,651.20
|
| Rate for Payer: Aetna Managed Medicare |
$537.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,248.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$960.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$921.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,017.60
|
| Rate for Payer: Cash Price |
$576.00
|
| Rate for Payer: Cigna Commercial |
$1,766.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,074.43
|
| Rate for Payer: Health EOS Commercial |
$1,708.80
|
| Rate for Payer: HFN Commercial |
$1,766.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,440.00
|
| Rate for Payer: Multiplan Commercial |
$1,536.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,152.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,766.40
|
| Rate for Payer: Quartz Beloit One Network |
$940.80
|
| Rate for Payer: Quartz Commercial |
$1,248.00
|
| Rate for Payer: Quartz Medicare Advantage |
$1,152.00
|
| Rate for Payer: The Alliance Commercial |
$7,680.00
|
| Rate for Payer: WEA Trust Commercial |
$1,056.00
|
| Rate for Payer: WPS Commercial |
$1,422.14
|
|
|
CANNULA ZONE NAVIGATOR SYSTEM LT MID/POSTERIOR AR-7910L
|
Facility
|
OP
|
$2,287.00
|
|
| Hospital Charge Code |
5599716
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$640.36 |
| Max. Negotiated Rate |
$9,148.00 |
| Rate for Payer: Aetna Commercial |
$2,058.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,966.82
|
| Rate for Payer: Aetna Managed Medicare |
$640.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,486.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,143.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,097.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,212.11
|
| Rate for Payer: Cash Price |
$686.10
|
| Rate for Payer: Cigna Commercial |
$2,104.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,279.81
|
| Rate for Payer: Health EOS Commercial |
$2,035.43
|
| Rate for Payer: HFN Commercial |
$2,104.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,715.25
|
| Rate for Payer: Multiplan Commercial |
$1,829.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,372.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,104.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,120.63
|
| Rate for Payer: Quartz Commercial |
$1,486.55
|
| Rate for Payer: Quartz Medicare Advantage |
$1,372.20
|
| Rate for Payer: The Alliance Commercial |
$9,148.00
|
| Rate for Payer: WEA Trust Commercial |
$1,257.85
|
| Rate for Payer: WPS Commercial |
$1,693.98
|
|
|
CANNULA ZONE NAVIGATOR SYSTEM LT MID/POSTERIOR AR-7910L
|
Facility
|
IP
|
$2,287.00
|
|
| Hospital Charge Code |
5599716
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,120.63 |
| Max. Negotiated Rate |
$2,104.04 |
| Rate for Payer: Aetna Commercial |
$2,058.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,966.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,212.11
|
| Rate for Payer: Cash Price |
$686.10
|
| Rate for Payer: Cigna Commercial |
$2,104.04
|
| Rate for Payer: Health EOS Commercial |
$2,035.43
|
| Rate for Payer: HFN Commercial |
$2,104.04
|
| Rate for Payer: Multiplan Commercial |
$1,829.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,372.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,104.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,120.63
|
| Rate for Payer: Quartz Commercial |
$1,372.20
|
| Rate for Payer: WEA Trust Commercial |
$1,257.85
|
| Rate for Payer: WPS Commercial |
$1,693.98
|
|
|
CANNULA ZONE NAVIGATOR SYSTEM RT MID/POSTERIOR AR-7910R
|
Facility
|
OP
|
$2,114.00
|
|
| Hospital Charge Code |
6131638
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$591.92 |
| Max. Negotiated Rate |
$8,456.00 |
| Rate for Payer: Aetna Commercial |
$1,902.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,818.04
|
| Rate for Payer: Aetna Managed Medicare |
$591.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,374.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,057.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,014.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,120.42
|
| Rate for Payer: Cash Price |
$634.20
|
| Rate for Payer: Cigna Commercial |
$1,944.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,182.99
|
| Rate for Payer: Health EOS Commercial |
$1,881.46
|
| Rate for Payer: HFN Commercial |
$1,944.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,585.50
|
| Rate for Payer: Multiplan Commercial |
$1,691.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,268.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,944.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,035.86
|
| Rate for Payer: Quartz Commercial |
$1,374.10
|
| Rate for Payer: Quartz Medicare Advantage |
$1,268.40
|
| Rate for Payer: The Alliance Commercial |
$8,456.00
|
| Rate for Payer: WEA Trust Commercial |
$1,162.70
|
| Rate for Payer: WPS Commercial |
$1,565.84
|
|
|
CANNULA ZONE NAVIGATOR SYSTEM RT MID/POSTERIOR AR-7910R
|
Facility
|
IP
|
$2,114.00
|
|
| Hospital Charge Code |
6131638
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,035.86 |
| Max. Negotiated Rate |
$1,944.88 |
| Rate for Payer: Aetna Commercial |
$1,902.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,818.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,120.42
|
| Rate for Payer: Cash Price |
$634.20
|
| Rate for Payer: Cigna Commercial |
$1,944.88
|
| Rate for Payer: Health EOS Commercial |
$1,881.46
|
| Rate for Payer: HFN Commercial |
$1,944.88
|
| Rate for Payer: Multiplan Commercial |
$1,691.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,268.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,944.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,035.86
|
| Rate for Payer: Quartz Commercial |
$1,268.40
|
| Rate for Payer: WEA Trust Commercial |
$1,162.70
|
| Rate for Payer: WPS Commercial |
$1,565.84
|
|
|
CANULA CO2 NASAL PEDS #2013066-005
|
Facility
|
IP
|
$277.00
|
|
| Hospital Charge Code |
2972674
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$135.73 |
| Max. Negotiated Rate |
$254.84 |
| Rate for Payer: Aetna Commercial |
$249.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$238.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$146.81
|
| Rate for Payer: Cash Price |
$83.10
|
| Rate for Payer: Cigna Commercial |
$254.84
|
| Rate for Payer: Health EOS Commercial |
$246.53
|
| Rate for Payer: HFN Commercial |
$254.84
|
| Rate for Payer: Multiplan Commercial |
$221.60
|
| Rate for Payer: NAPHCARE Commercial |
$166.20
|
| Rate for Payer: Preferred Network Access Commercial |
$254.84
|
| Rate for Payer: Quartz Beloit One Network |
$135.73
|
| Rate for Payer: Quartz Commercial |
$166.20
|
| Rate for Payer: WEA Trust Commercial |
$152.35
|
| Rate for Payer: WPS Commercial |
$205.17
|
|
|
CANULA CO2 NASAL PEDS #2013066-005
|
Facility
|
OP
|
$277.00
|
|
| Hospital Charge Code |
2972674
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$77.56 |
| Max. Negotiated Rate |
$1,108.00 |
| Rate for Payer: Aetna Commercial |
$249.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$238.22
|
| Rate for Payer: Aetna Managed Medicare |
$77.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$180.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$138.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$132.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$146.81
|
| Rate for Payer: Cash Price |
$83.10
|
| Rate for Payer: Cigna Commercial |
$254.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$155.01
|
| Rate for Payer: Health EOS Commercial |
$246.53
|
| Rate for Payer: HFN Commercial |
$254.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$207.75
|
| Rate for Payer: Multiplan Commercial |
$221.60
|
| Rate for Payer: NAPHCARE Commercial |
$166.20
|
| Rate for Payer: Preferred Network Access Commercial |
$254.84
|
| Rate for Payer: Quartz Beloit One Network |
$135.73
|
| Rate for Payer: Quartz Commercial |
$180.05
|
| Rate for Payer: Quartz Medicare Advantage |
$166.20
|
| Rate for Payer: The Alliance Commercial |
$1,108.00
|
| Rate for Payer: WEA Trust Commercial |
$152.35
|
| Rate for Payer: WPS Commercial |
$205.17
|
|
|
CAP 11.0 PROTECTION FIXATOR 394.97
|
Facility
|
OP
|
$54.00
|
|
| Hospital Charge Code |
5074638
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.12 |
| Max. Negotiated Rate |
$216.00 |
| Rate for Payer: Aetna Commercial |
$48.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$46.44
|
| Rate for Payer: Aetna Managed Medicare |
$15.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$35.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$27.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$25.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$28.62
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cigna Commercial |
$49.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$30.22
|
| Rate for Payer: Health EOS Commercial |
$48.06
|
| Rate for Payer: HFN Commercial |
$49.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$40.50
|
| Rate for Payer: Multiplan Commercial |
$43.20
|
| Rate for Payer: NAPHCARE Commercial |
$32.40
|
| Rate for Payer: Preferred Network Access Commercial |
$49.68
|
| Rate for Payer: Quartz Beloit One Network |
$26.46
|
| Rate for Payer: Quartz Commercial |
$35.10
|
| Rate for Payer: Quartz Medicare Advantage |
$32.40
|
| Rate for Payer: The Alliance Commercial |
$216.00
|
| Rate for Payer: WEA Trust Commercial |
$29.70
|
| Rate for Payer: WPS Commercial |
$40.00
|
|
|
CAP 11.0 PROTECTION FIXATOR 394.97
|
Facility
|
IP
|
$54.00
|
|
| Hospital Charge Code |
5074638
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$26.46 |
| Max. Negotiated Rate |
$49.68 |
| Rate for Payer: Aetna Commercial |
$48.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$46.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$28.62
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cigna Commercial |
$49.68
|
| Rate for Payer: Health EOS Commercial |
$48.06
|
| Rate for Payer: HFN Commercial |
$49.68
|
| Rate for Payer: Multiplan Commercial |
$43.20
|
| Rate for Payer: NAPHCARE Commercial |
$32.40
|
| Rate for Payer: Preferred Network Access Commercial |
$49.68
|
| Rate for Payer: Quartz Beloit One Network |
$26.46
|
| Rate for Payer: Quartz Commercial |
$32.40
|
| Rate for Payer: WEA Trust Commercial |
$29.70
|
| Rate for Payer: WPS Commercial |
$40.00
|
|
|
CAP 4.5 PROTECTION FIXATOR 394.992
|
Facility
|
IP
|
$84.00
|
|
| Hospital Charge Code |
2966160
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$41.16 |
| Max. Negotiated Rate |
$77.28 |
| Rate for Payer: Aetna Commercial |
$75.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$72.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$44.52
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cigna Commercial |
$77.28
|
| Rate for Payer: Health EOS Commercial |
$74.76
|
| Rate for Payer: HFN Commercial |
$77.28
|
| Rate for Payer: Multiplan Commercial |
$67.20
|
| Rate for Payer: NAPHCARE Commercial |
$50.40
|
| Rate for Payer: Preferred Network Access Commercial |
$77.28
|
| Rate for Payer: Quartz Beloit One Network |
$41.16
|
| Rate for Payer: Quartz Commercial |
$50.40
|
| Rate for Payer: WEA Trust Commercial |
$46.20
|
| Rate for Payer: WPS Commercial |
$62.22
|
|
|
CAP 4.5 PROTECTION FIXATOR 394.992
|
Facility
|
OP
|
$84.00
|
|
| Hospital Charge Code |
2966160
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$23.52 |
| Max. Negotiated Rate |
$336.00 |
| Rate for Payer: Aetna Commercial |
$75.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$72.24
|
| Rate for Payer: Aetna Managed Medicare |
$23.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$54.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$42.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$40.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$44.52
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cigna Commercial |
$77.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$47.01
|
| Rate for Payer: Health EOS Commercial |
$74.76
|
| Rate for Payer: HFN Commercial |
$77.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$63.00
|
| Rate for Payer: Multiplan Commercial |
$67.20
|
| Rate for Payer: NAPHCARE Commercial |
$50.40
|
| Rate for Payer: Preferred Network Access Commercial |
$77.28
|
| Rate for Payer: Quartz Beloit One Network |
$41.16
|
| Rate for Payer: Quartz Commercial |
$54.60
|
| Rate for Payer: Quartz Medicare Advantage |
$50.40
|
| Rate for Payer: The Alliance Commercial |
$336.00
|
| Rate for Payer: WEA Trust Commercial |
$46.20
|
| Rate for Payer: WPS Commercial |
$62.22
|
|
|
CAP 5.0 PROTECTION FIXATOR 394.993
|
Facility
|
OP
|
$87.00
|
|
| Hospital Charge Code |
2967340
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$24.36 |
| Max. Negotiated Rate |
$348.00 |
| Rate for Payer: Aetna Commercial |
$78.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$74.82
|
| Rate for Payer: Aetna Managed Medicare |
$24.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$56.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$43.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$41.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$46.11
|
| Rate for Payer: Cash Price |
$26.10
|
| Rate for Payer: Cigna Commercial |
$80.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$48.69
|
| Rate for Payer: Health EOS Commercial |
$77.43
|
| Rate for Payer: HFN Commercial |
$80.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$65.25
|
| Rate for Payer: Multiplan Commercial |
$69.60
|
| Rate for Payer: NAPHCARE Commercial |
$52.20
|
| Rate for Payer: Preferred Network Access Commercial |
$80.04
|
| Rate for Payer: Quartz Beloit One Network |
$42.63
|
| Rate for Payer: Quartz Commercial |
$56.55
|
| Rate for Payer: Quartz Medicare Advantage |
$52.20
|
| Rate for Payer: The Alliance Commercial |
$348.00
|
| Rate for Payer: WEA Trust Commercial |
$47.85
|
| Rate for Payer: WPS Commercial |
$64.44
|
|
|
CAP 5.0 PROTECTION FIXATOR 394.993
|
Facility
|
IP
|
$87.00
|
|
| Hospital Charge Code |
2967340
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$42.63 |
| Max. Negotiated Rate |
$80.04 |
| Rate for Payer: Aetna Commercial |
$78.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$74.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$46.11
|
| Rate for Payer: Cash Price |
$26.10
|
| Rate for Payer: Cigna Commercial |
$80.04
|
| Rate for Payer: Health EOS Commercial |
$77.43
|
| Rate for Payer: HFN Commercial |
$80.04
|
| Rate for Payer: Multiplan Commercial |
$69.60
|
| Rate for Payer: NAPHCARE Commercial |
$52.20
|
| Rate for Payer: Preferred Network Access Commercial |
$80.04
|
| Rate for Payer: Quartz Beloit One Network |
$42.63
|
| Rate for Payer: Quartz Commercial |
$52.20
|
| Rate for Payer: WEA Trust Commercial |
$47.85
|
| Rate for Payer: WPS Commercial |
$64.44
|
|
|
CAP 6.0 PROTECTION FIXATOR 394.994
|
Facility
|
OP
|
$84.00
|
|
| Hospital Charge Code |
2966156
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$23.52 |
| Max. Negotiated Rate |
$336.00 |
| Rate for Payer: Aetna Commercial |
$75.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$72.24
|
| Rate for Payer: Aetna Managed Medicare |
$23.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$54.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$42.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$40.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$44.52
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cigna Commercial |
$77.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$47.01
|
| Rate for Payer: Health EOS Commercial |
$74.76
|
| Rate for Payer: HFN Commercial |
$77.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$63.00
|
| Rate for Payer: Multiplan Commercial |
$67.20
|
| Rate for Payer: NAPHCARE Commercial |
$50.40
|
| Rate for Payer: Preferred Network Access Commercial |
$77.28
|
| Rate for Payer: Quartz Beloit One Network |
$41.16
|
| Rate for Payer: Quartz Commercial |
$54.60
|
| Rate for Payer: Quartz Medicare Advantage |
$50.40
|
| Rate for Payer: The Alliance Commercial |
$336.00
|
| Rate for Payer: WEA Trust Commercial |
$46.20
|
| Rate for Payer: WPS Commercial |
$62.22
|
|
|
CAP 6.0 PROTECTION FIXATOR 394.994
|
Facility
|
IP
|
$84.00
|
|
| Hospital Charge Code |
2966156
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$41.16 |
| Max. Negotiated Rate |
$77.28 |
| Rate for Payer: Aetna Commercial |
$75.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$72.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$44.52
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cigna Commercial |
$77.28
|
| Rate for Payer: Health EOS Commercial |
$74.76
|
| Rate for Payer: HFN Commercial |
$77.28
|
| Rate for Payer: Multiplan Commercial |
$67.20
|
| Rate for Payer: NAPHCARE Commercial |
$50.40
|
| Rate for Payer: Preferred Network Access Commercial |
$77.28
|
| Rate for Payer: Quartz Beloit One Network |
$41.16
|
| Rate for Payer: Quartz Commercial |
$50.40
|
| Rate for Payer: WEA Trust Commercial |
$46.20
|
| Rate for Payer: WPS Commercial |
$62.22
|
|
|
CAP 8.0 PROTECTIVE 395.781
|
Facility
|
OP
|
$64.00
|
|
| Hospital Charge Code |
2966157
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$17.92 |
| Max. Negotiated Rate |
$256.00 |
| Rate for Payer: Aetna Commercial |
$57.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$55.04
|
| Rate for Payer: Aetna Managed Medicare |
$17.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$41.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$32.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$30.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$33.92
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Cigna Commercial |
$58.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$35.81
|
| Rate for Payer: Health EOS Commercial |
$56.96
|
| Rate for Payer: HFN Commercial |
$58.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$48.00
|
| Rate for Payer: Multiplan Commercial |
$51.20
|
| Rate for Payer: NAPHCARE Commercial |
$38.40
|
| Rate for Payer: Preferred Network Access Commercial |
$58.88
|
| Rate for Payer: Quartz Beloit One Network |
$31.36
|
| Rate for Payer: Quartz Commercial |
$41.60
|
| Rate for Payer: Quartz Medicare Advantage |
$38.40
|
| Rate for Payer: The Alliance Commercial |
$256.00
|
| Rate for Payer: WEA Trust Commercial |
$35.20
|
| Rate for Payer: WPS Commercial |
$47.40
|
|
|
CAP 8.0 PROTECTIVE 395.781
|
Facility
|
IP
|
$64.00
|
|
| Hospital Charge Code |
2966157
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.36 |
| Max. Negotiated Rate |
$58.88 |
| Rate for Payer: Aetna Commercial |
$57.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$55.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$33.92
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Cigna Commercial |
$58.88
|
| Rate for Payer: Health EOS Commercial |
$56.96
|
| Rate for Payer: HFN Commercial |
$58.88
|
| Rate for Payer: Multiplan Commercial |
$51.20
|
| Rate for Payer: NAPHCARE Commercial |
$38.40
|
| Rate for Payer: Preferred Network Access Commercial |
$58.88
|
| Rate for Payer: Quartz Beloit One Network |
$31.36
|
| Rate for Payer: Quartz Commercial |
$38.40
|
| Rate for Payer: WEA Trust Commercial |
$35.20
|
| Rate for Payer: WPS Commercial |
$47.40
|
|
