|
CANNULA CRYSTAL 5.75MM X 7CM AR-6560
|
Facility
|
OP
|
$514.00
|
|
| Hospital Charge Code |
4520230
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$149.68 |
| Max. Negotiated Rate |
$491.80 |
| Rate for Payer: Aetna Commercial |
$481.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$459.72
|
| Rate for Payer: Aetna Managed Medicare |
$149.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$347.46
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$267.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$256.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$283.32
|
| Rate for Payer: Cash Price |
$154.20
|
| Rate for Payer: Cigna Commercial |
$491.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$299.15
|
| Rate for Payer: Health EOS Commercial |
$475.76
|
| Rate for Payer: HFN Commercial |
$491.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$400.92
|
| Rate for Payer: Multiplan Commercial |
$427.65
|
| Rate for Payer: NAPHCARE Commercial |
$320.74
|
| Rate for Payer: Preferred Network Access Commercial |
$491.80
|
| Rate for Payer: Quartz Beloit One Network |
$261.93
|
| Rate for Payer: Quartz Commercial |
$347.46
|
| Rate for Payer: Quartz Medicare Advantage |
$320.74
|
| Rate for Payer: The Alliance Commercial |
$267.28
|
| Rate for Payer: WEA Trust Commercial |
$294.01
|
| Rate for Payer: WPS Commercial |
$395.93
|
|
|
CANNULA CRYSTAL 5.75MM X 7CM AR-6560
|
Facility
|
IP
|
$514.00
|
|
| Hospital Charge Code |
4520230
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$261.93 |
| Max. Negotiated Rate |
$491.80 |
| Rate for Payer: Aetna Commercial |
$481.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$459.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$283.32
|
| Rate for Payer: Cash Price |
$154.20
|
| Rate for Payer: Cigna Commercial |
$491.80
|
| Rate for Payer: Health EOS Commercial |
$475.76
|
| Rate for Payer: HFN Commercial |
$491.80
|
| Rate for Payer: Multiplan Commercial |
$427.65
|
| Rate for Payer: Preferred Network Access Commercial |
$491.80
|
| Rate for Payer: Quartz Beloit One Network |
$261.93
|
| Rate for Payer: Quartz Commercial |
$320.74
|
| Rate for Payer: WEA Trust Commercial |
$294.01
|
| Rate for Payer: WPS Commercial |
$395.93
|
|
|
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 |
$25.04 |
| Max. Negotiated Rate |
$82.28 |
| Rate for Payer: Aetna Commercial |
$80.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$76.92
|
| Rate for Payer: Aetna Managed Medicare |
$25.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$58.14
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$44.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$42.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$47.40
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Cigna Commercial |
$82.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$50.05
|
| Rate for Payer: Health EOS Commercial |
$79.60
|
| Rate for Payer: HFN Commercial |
$82.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$67.08
|
| Rate for Payer: Multiplan Commercial |
$71.55
|
| Rate for Payer: NAPHCARE Commercial |
$53.66
|
| Rate for Payer: Preferred Network Access Commercial |
$82.28
|
| Rate for Payer: Quartz Beloit One Network |
$43.83
|
| Rate for Payer: Quartz Commercial |
$58.14
|
| Rate for Payer: Quartz Medicare Advantage |
$53.66
|
| Rate for Payer: The Alliance Commercial |
$38.85
|
| Rate for Payer: WEA Trust Commercial |
$49.19
|
| Rate for Payer: WPS Commercial |
$66.25
|
|
|
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 |
$43.83 |
| Max. Negotiated Rate |
$82.28 |
| Rate for Payer: Aetna Commercial |
$80.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$76.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$47.40
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Cigna Commercial |
$82.28
|
| Rate for Payer: Health EOS Commercial |
$79.60
|
| Rate for Payer: HFN Commercial |
$82.28
|
| Rate for Payer: Multiplan Commercial |
$71.55
|
| Rate for Payer: Preferred Network Access Commercial |
$82.28
|
| Rate for Payer: Quartz Beloit One Network |
$43.83
|
| Rate for Payer: Quartz Commercial |
$53.66
|
| Rate for Payer: WEA Trust Commercial |
$49.19
|
| Rate for Payer: WPS Commercial |
$66.25
|
|
|
CANNULA DUPLO TIP 318 0600038 (MED)
|
Facility
|
OP
|
$1,021.00
|
|
| Hospital Charge Code |
4294560
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$297.32 |
| Max. Negotiated Rate |
$976.89 |
| Rate for Payer: Aetna Commercial |
$955.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$913.18
|
| Rate for Payer: Aetna Managed Medicare |
$297.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$690.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$530.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$509.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$562.78
|
| Rate for Payer: Cash Price |
$306.30
|
| Rate for Payer: Cigna Commercial |
$976.89
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$594.22
|
| Rate for Payer: Health EOS Commercial |
$945.04
|
| Rate for Payer: HFN Commercial |
$976.89
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$796.38
|
| Rate for Payer: Multiplan Commercial |
$849.47
|
| Rate for Payer: NAPHCARE Commercial |
$637.10
|
| Rate for Payer: Preferred Network Access Commercial |
$976.89
|
| Rate for Payer: Quartz Beloit One Network |
$520.30
|
| Rate for Payer: Quartz Commercial |
$690.20
|
| Rate for Payer: Quartz Medicare Advantage |
$637.10
|
| Rate for Payer: The Alliance Commercial |
$530.92
|
| Rate for Payer: WEA Trust Commercial |
$584.01
|
| Rate for Payer: WPS Commercial |
$786.48
|
|
|
CANNULA DUPLO TIP 318 0600038 (MED)
|
Facility
|
IP
|
$1,021.00
|
|
| Hospital Charge Code |
4294560
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$520.30 |
| Max. Negotiated Rate |
$976.89 |
| Rate for Payer: Aetna Commercial |
$955.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$913.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$562.78
|
| Rate for Payer: Cash Price |
$306.30
|
| Rate for Payer: Cigna Commercial |
$976.89
|
| Rate for Payer: Health EOS Commercial |
$945.04
|
| Rate for Payer: HFN Commercial |
$976.89
|
| Rate for Payer: Multiplan Commercial |
$849.47
|
| Rate for Payer: Preferred Network Access Commercial |
$976.89
|
| Rate for Payer: Quartz Beloit One Network |
$520.30
|
| Rate for Payer: Quartz Commercial |
$637.10
|
| Rate for Payer: WEA Trust Commercial |
$584.01
|
| Rate for Payer: WPS Commercial |
$786.48
|
|
|
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 |
$183.46 |
| Max. Negotiated Rate |
$344.45 |
| Rate for Payer: Aetna Commercial |
$336.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$321.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$198.43
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Cigna Commercial |
$344.45
|
| Rate for Payer: Health EOS Commercial |
$333.22
|
| Rate for Payer: HFN Commercial |
$344.45
|
| Rate for Payer: Multiplan Commercial |
$299.52
|
| Rate for Payer: Preferred Network Access Commercial |
$344.45
|
| Rate for Payer: Quartz Beloit One Network |
$183.46
|
| Rate for Payer: Quartz Commercial |
$224.64
|
| Rate for Payer: WEA Trust Commercial |
$205.92
|
| Rate for Payer: WPS Commercial |
$277.31
|
|
|
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 |
$4.33 |
| Max. Negotiated Rate |
$344.45 |
| Rate for Payer: Aetna Commercial |
$336.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$321.98
|
| Rate for Payer: Aetna Managed Medicare |
$104.83
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$243.36
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$187.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$179.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$198.43
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Cigna Commercial |
$344.45
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$209.52
|
| Rate for Payer: Health EOS Commercial |
$333.22
|
| Rate for Payer: HFN Commercial |
$344.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$280.80
|
| Rate for Payer: Multiplan Commercial |
$299.52
|
| Rate for Payer: NAPHCARE Commercial |
$224.64
|
| Rate for Payer: Preferred Network Access Commercial |
$344.45
|
| Rate for Payer: Quartz Beloit One Network |
$183.46
|
| Rate for Payer: Quartz Commercial |
$243.36
|
| Rate for Payer: Quartz Medicare Advantage |
$224.64
|
| Rate for Payer: The Alliance Commercial |
$4.33
|
| Rate for Payer: WEA Trust Commercial |
$205.92
|
| Rate for Payer: WPS Commercial |
$277.31
|
|
|
CANNULA E-Z WRAP
|
Facility
|
IP
|
$25.00
|
|
| Hospital Charge Code |
2974631
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.74 |
| Max. Negotiated Rate |
$23.92 |
| Rate for Payer: Aetna Commercial |
$23.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$22.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$13.78
|
| Rate for Payer: Cash Price |
$7.50
|
| Rate for Payer: Cigna Commercial |
$23.92
|
| Rate for Payer: Health EOS Commercial |
$23.14
|
| Rate for Payer: HFN Commercial |
$23.92
|
| Rate for Payer: Multiplan Commercial |
$20.80
|
| Rate for Payer: Preferred Network Access Commercial |
$23.92
|
| Rate for Payer: Quartz Beloit One Network |
$12.74
|
| Rate for Payer: Quartz Commercial |
$15.60
|
| Rate for Payer: WEA Trust Commercial |
$14.30
|
| Rate for Payer: WPS Commercial |
$19.26
|
|
|
CANNULA E-Z WRAP
|
Facility
|
OP
|
$25.00
|
|
| Hospital Charge Code |
2974631
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.28 |
| Max. Negotiated Rate |
$23.92 |
| Rate for Payer: Aetna Commercial |
$23.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$22.36
|
| Rate for Payer: Aetna Managed Medicare |
$7.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$16.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$13.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$12.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$13.78
|
| Rate for Payer: Cash Price |
$7.50
|
| Rate for Payer: Cigna Commercial |
$23.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$14.55
|
| Rate for Payer: Health EOS Commercial |
$23.14
|
| Rate for Payer: HFN Commercial |
$23.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$19.50
|
| Rate for Payer: Multiplan Commercial |
$20.80
|
| Rate for Payer: NAPHCARE Commercial |
$15.60
|
| Rate for Payer: Preferred Network Access Commercial |
$23.92
|
| Rate for Payer: Quartz Beloit One Network |
$12.74
|
| Rate for Payer: Quartz Commercial |
$16.90
|
| Rate for Payer: Quartz Medicare Advantage |
$15.60
|
| Rate for Payer: The Alliance Commercial |
$13.00
|
| Rate for Payer: WEA Trust Commercial |
$14.30
|
| Rate for Payer: WPS Commercial |
$19.26
|
|
|
CANNULA GEMINI SR8 AR-6572
|
Facility
|
IP
|
$682.00
|
|
| Hospital Charge Code |
4520425
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$347.55 |
| Max. Negotiated Rate |
$652.54 |
| Rate for Payer: Aetna Commercial |
$638.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$609.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$375.92
|
| Rate for Payer: Cash Price |
$204.60
|
| Rate for Payer: Cigna Commercial |
$652.54
|
| Rate for Payer: Health EOS Commercial |
$631.26
|
| Rate for Payer: HFN Commercial |
$652.54
|
| Rate for Payer: Multiplan Commercial |
$567.42
|
| Rate for Payer: Preferred Network Access Commercial |
$652.54
|
| Rate for Payer: Quartz Beloit One Network |
$347.55
|
| Rate for Payer: Quartz Commercial |
$425.57
|
| Rate for Payer: WEA Trust Commercial |
$390.10
|
| Rate for Payer: WPS Commercial |
$525.34
|
|
|
CANNULA GEMINI SR8 AR-6572
|
Facility
|
OP
|
$682.00
|
|
| Hospital Charge Code |
4520425
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$198.60 |
| Max. Negotiated Rate |
$652.54 |
| Rate for Payer: Aetna Commercial |
$638.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$609.98
|
| Rate for Payer: Aetna Managed Medicare |
$198.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$461.03
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$354.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$340.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$375.92
|
| Rate for Payer: Cash Price |
$204.60
|
| Rate for Payer: Cigna Commercial |
$652.54
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$396.92
|
| Rate for Payer: Health EOS Commercial |
$631.26
|
| Rate for Payer: HFN Commercial |
$652.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$531.96
|
| Rate for Payer: Multiplan Commercial |
$567.42
|
| Rate for Payer: NAPHCARE Commercial |
$425.57
|
| Rate for Payer: Preferred Network Access Commercial |
$652.54
|
| Rate for Payer: Quartz Beloit One Network |
$347.55
|
| Rate for Payer: Quartz Commercial |
$461.03
|
| Rate for Payer: Quartz Medicare Advantage |
$425.57
|
| Rate for Payer: The Alliance Commercial |
$354.64
|
| Rate for Payer: WEA Trust Commercial |
$390.10
|
| Rate for Payer: WPS Commercial |
$525.34
|
|
|
CANNULAIDES SIZE 3 #CA103
|
Facility
|
IP
|
$164.00
|
|
| Hospital Charge Code |
2967912
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$83.57 |
| Max. Negotiated Rate |
$156.92 |
| Rate for Payer: Aetna Commercial |
$153.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$146.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$90.40
|
| Rate for Payer: Cash Price |
$49.20
|
| Rate for Payer: Cigna Commercial |
$156.92
|
| Rate for Payer: Health EOS Commercial |
$151.80
|
| Rate for Payer: HFN Commercial |
$156.92
|
| Rate for Payer: Multiplan Commercial |
$136.45
|
| Rate for Payer: Preferred Network Access Commercial |
$156.92
|
| Rate for Payer: Quartz Beloit One Network |
$83.57
|
| Rate for Payer: Quartz Commercial |
$102.34
|
| Rate for Payer: WEA Trust Commercial |
$93.81
|
| Rate for Payer: WPS Commercial |
$126.33
|
|
|
CANNULAIDES SIZE 3 #CA103
|
Facility
|
OP
|
$164.00
|
|
| Hospital Charge Code |
2967912
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$47.76 |
| Max. Negotiated Rate |
$156.92 |
| Rate for Payer: Aetna Commercial |
$153.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$146.68
|
| Rate for Payer: Aetna Managed Medicare |
$47.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$110.86
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$85.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$81.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$90.40
|
| Rate for Payer: Cash Price |
$49.20
|
| Rate for Payer: Cigna Commercial |
$156.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$95.45
|
| Rate for Payer: Health EOS Commercial |
$151.80
|
| Rate for Payer: HFN Commercial |
$156.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$127.92
|
| Rate for Payer: Multiplan Commercial |
$136.45
|
| Rate for Payer: NAPHCARE Commercial |
$102.34
|
| Rate for Payer: Preferred Network Access Commercial |
$156.92
|
| Rate for Payer: Quartz Beloit One Network |
$83.57
|
| Rate for Payer: Quartz Commercial |
$110.86
|
| Rate for Payer: Quartz Medicare Advantage |
$102.34
|
| Rate for Payer: The Alliance Commercial |
$85.28
|
| Rate for Payer: WEA Trust Commercial |
$93.81
|
| Rate for Payer: WPS Commercial |
$126.33
|
|
|
CANNULAIDES SIZE 4 #CA104
|
Facility
|
OP
|
$164.00
|
|
| Hospital Charge Code |
2972926
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$47.76 |
| Max. Negotiated Rate |
$156.92 |
| Rate for Payer: Aetna Commercial |
$153.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$146.68
|
| Rate for Payer: Aetna Managed Medicare |
$47.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$110.86
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$85.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$81.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$90.40
|
| Rate for Payer: Cash Price |
$49.20
|
| Rate for Payer: Cigna Commercial |
$156.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$95.45
|
| Rate for Payer: Health EOS Commercial |
$151.80
|
| Rate for Payer: HFN Commercial |
$156.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$127.92
|
| Rate for Payer: Multiplan Commercial |
$136.45
|
| Rate for Payer: NAPHCARE Commercial |
$102.34
|
| Rate for Payer: Preferred Network Access Commercial |
$156.92
|
| Rate for Payer: Quartz Beloit One Network |
$83.57
|
| Rate for Payer: Quartz Commercial |
$110.86
|
| Rate for Payer: Quartz Medicare Advantage |
$102.34
|
| Rate for Payer: The Alliance Commercial |
$85.28
|
| Rate for Payer: WEA Trust Commercial |
$93.81
|
| Rate for Payer: WPS Commercial |
$126.33
|
|
|
CANNULAIDES SIZE 4 #CA104
|
Facility
|
IP
|
$164.00
|
|
| Hospital Charge Code |
2972926
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$83.57 |
| Max. Negotiated Rate |
$156.92 |
| Rate for Payer: Aetna Commercial |
$153.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$146.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$90.40
|
| Rate for Payer: Cash Price |
$49.20
|
| Rate for Payer: Cigna Commercial |
$156.92
|
| Rate for Payer: Health EOS Commercial |
$151.80
|
| Rate for Payer: HFN Commercial |
$156.92
|
| Rate for Payer: Multiplan Commercial |
$136.45
|
| Rate for Payer: Preferred Network Access Commercial |
$156.92
|
| Rate for Payer: Quartz Beloit One Network |
$83.57
|
| Rate for Payer: Quartz Commercial |
$102.34
|
| Rate for Payer: WEA Trust Commercial |
$93.81
|
| Rate for Payer: WPS Commercial |
$126.33
|
|
|
CANNULA INFANT NASAL 1601
|
Facility
|
IP
|
$66.00
|
|
|
Service Code
|
HCPCS A4615
|
| Hospital Charge Code |
2974766
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$33.63 |
| Max. Negotiated Rate |
$63.15 |
| Rate for Payer: Aetna Commercial |
$61.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$59.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$36.38
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cigna Commercial |
$63.15
|
| Rate for Payer: Health EOS Commercial |
$61.09
|
| Rate for Payer: HFN Commercial |
$63.15
|
| Rate for Payer: Multiplan Commercial |
$54.91
|
| Rate for Payer: Preferred Network Access Commercial |
$63.15
|
| Rate for Payer: Quartz Beloit One Network |
$33.63
|
| Rate for Payer: Quartz Commercial |
$41.18
|
| Rate for Payer: WEA Trust Commercial |
$37.75
|
| Rate for Payer: WPS Commercial |
$50.84
|
|
|
CANNULA INFANT NASAL 1601
|
Facility
|
OP
|
$66.00
|
|
|
Service Code
|
HCPCS A4615
|
| Hospital Charge Code |
2974766
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.33 |
| Max. Negotiated Rate |
$63.15 |
| Rate for Payer: Aetna Commercial |
$61.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$59.03
|
| Rate for Payer: Aetna Managed Medicare |
$19.22
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$44.62
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$34.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$32.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$36.38
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cigna Commercial |
$63.15
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$38.41
|
| Rate for Payer: Health EOS Commercial |
$61.09
|
| Rate for Payer: HFN Commercial |
$63.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$51.48
|
| Rate for Payer: Multiplan Commercial |
$54.91
|
| Rate for Payer: NAPHCARE Commercial |
$41.18
|
| Rate for Payer: Preferred Network Access Commercial |
$63.15
|
| Rate for Payer: Quartz Beloit One Network |
$33.63
|
| Rate for Payer: Quartz Commercial |
$44.62
|
| Rate for Payer: Quartz Medicare Advantage |
$41.18
|
| Rate for Payer: The Alliance Commercial |
$4.33
|
| Rate for Payer: WEA Trust Commercial |
$37.75
|
| Rate for Payer: WPS Commercial |
$50.84
|
|
|
CANNULA NASAL CO2 W/ O2 ADULT 2013066-004
|
Facility
|
IP
|
$293.00
|
|
|
Service Code
|
HCPCS A4615
|
| Hospital Charge Code |
2963162
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$149.31 |
| Max. Negotiated Rate |
$280.34 |
| Rate for Payer: Aetna Commercial |
$274.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$262.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$161.50
|
| Rate for Payer: Cash Price |
$87.90
|
| Rate for Payer: Cigna Commercial |
$280.34
|
| Rate for Payer: Health EOS Commercial |
$271.20
|
| Rate for Payer: HFN Commercial |
$280.34
|
| Rate for Payer: Multiplan Commercial |
$243.78
|
| Rate for Payer: Preferred Network Access Commercial |
$280.34
|
| Rate for Payer: Quartz Beloit One Network |
$149.31
|
| Rate for Payer: Quartz Commercial |
$182.83
|
| Rate for Payer: WEA Trust Commercial |
$167.60
|
| Rate for Payer: WPS Commercial |
$225.70
|
|
|
CANNULA NASAL CO2 W/ O2 ADULT 2013066-004
|
Facility
|
OP
|
$293.00
|
|
|
Service Code
|
HCPCS A4615
|
| Hospital Charge Code |
2963162
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.33 |
| Max. Negotiated Rate |
$280.34 |
| Rate for Payer: Aetna Commercial |
$274.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$262.06
|
| Rate for Payer: Aetna Managed Medicare |
$85.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$198.07
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$152.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$146.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$161.50
|
| Rate for Payer: Cash Price |
$87.90
|
| Rate for Payer: Cash Price |
$87.90
|
| Rate for Payer: Cigna Commercial |
$280.34
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$170.53
|
| Rate for Payer: Health EOS Commercial |
$271.20
|
| Rate for Payer: HFN Commercial |
$280.34
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$228.54
|
| Rate for Payer: Multiplan Commercial |
$243.78
|
| Rate for Payer: NAPHCARE Commercial |
$182.83
|
| Rate for Payer: Preferred Network Access Commercial |
$280.34
|
| Rate for Payer: Quartz Beloit One Network |
$149.31
|
| Rate for Payer: Quartz Commercial |
$198.07
|
| Rate for Payer: Quartz Medicare Advantage |
$182.83
|
| Rate for Payer: The Alliance Commercial |
$4.33
|
| Rate for Payer: WEA Trust Commercial |
$167.60
|
| Rate for Payer: WPS Commercial |
$225.70
|
|
|
CANNULA NASAL HI-VNI ADULT LONG ProSoft XL
|
Facility
|
OP
|
$97.00
|
|
| Hospital Charge Code |
2972291
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$28.25 |
| Max. Negotiated Rate |
$92.81 |
| Rate for Payer: Aetna Commercial |
$90.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$86.76
|
| Rate for Payer: Aetna Managed Medicare |
$28.25
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$65.57
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$50.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$48.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$53.47
|
| Rate for Payer: Cash Price |
$29.10
|
| Rate for Payer: Cigna Commercial |
$92.81
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$56.45
|
| Rate for Payer: Health EOS Commercial |
$89.78
|
| Rate for Payer: HFN Commercial |
$92.81
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$75.66
|
| Rate for Payer: Multiplan Commercial |
$80.70
|
| Rate for Payer: NAPHCARE Commercial |
$60.53
|
| Rate for Payer: Preferred Network Access Commercial |
$92.81
|
| Rate for Payer: Quartz Beloit One Network |
$49.43
|
| Rate for Payer: Quartz Commercial |
$65.57
|
| Rate for Payer: Quartz Medicare Advantage |
$60.53
|
| Rate for Payer: The Alliance Commercial |
$50.44
|
| Rate for Payer: WEA Trust Commercial |
$55.48
|
| Rate for Payer: WPS Commercial |
$74.72
|
|
|
CANNULA NASAL HI-VNI ADULT LONG ProSoft XL
|
Facility
|
IP
|
$97.00
|
|
| Hospital Charge Code |
2972291
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$49.43 |
| Max. Negotiated Rate |
$92.81 |
| Rate for Payer: Aetna Commercial |
$90.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$86.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$53.47
|
| Rate for Payer: Cash Price |
$29.10
|
| Rate for Payer: Cigna Commercial |
$92.81
|
| Rate for Payer: Health EOS Commercial |
$89.78
|
| Rate for Payer: HFN Commercial |
$92.81
|
| Rate for Payer: Multiplan Commercial |
$80.70
|
| Rate for Payer: Preferred Network Access Commercial |
$92.81
|
| Rate for Payer: Quartz Beloit One Network |
$49.43
|
| Rate for Payer: Quartz Commercial |
$60.53
|
| Rate for Payer: WEA Trust Commercial |
$55.48
|
| Rate for Payer: WPS Commercial |
$74.72
|
|
|
CANNULA NASAL SMART CAPNOLINE MVAO
|
Facility
|
OP
|
$315.00
|
|
| Hospital Charge Code |
2962984
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$91.73 |
| Max. Negotiated Rate |
$301.39 |
| Rate for Payer: Aetna Commercial |
$294.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$281.74
|
| Rate for Payer: Aetna Managed Medicare |
$91.73
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$212.94
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$163.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$157.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$173.63
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Cigna Commercial |
$301.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$183.33
|
| Rate for Payer: Health EOS Commercial |
$291.56
|
| Rate for Payer: HFN Commercial |
$301.39
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$245.70
|
| Rate for Payer: Multiplan Commercial |
$262.08
|
| Rate for Payer: NAPHCARE Commercial |
$196.56
|
| Rate for Payer: Preferred Network Access Commercial |
$301.39
|
| Rate for Payer: Quartz Beloit One Network |
$160.52
|
| Rate for Payer: Quartz Commercial |
$212.94
|
| Rate for Payer: Quartz Medicare Advantage |
$196.56
|
| Rate for Payer: The Alliance Commercial |
$163.80
|
| Rate for Payer: WEA Trust Commercial |
$180.18
|
| Rate for Payer: WPS Commercial |
$242.64
|
|
|
CANNULA NASAL SMART CAPNOLINE MVAO
|
Facility
|
IP
|
$315.00
|
|
| Hospital Charge Code |
2962984
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$160.52 |
| Max. Negotiated Rate |
$301.39 |
| Rate for Payer: Aetna Commercial |
$294.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$281.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$173.63
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Cigna Commercial |
$301.39
|
| Rate for Payer: Health EOS Commercial |
$291.56
|
| Rate for Payer: HFN Commercial |
$301.39
|
| Rate for Payer: Multiplan Commercial |
$262.08
|
| Rate for Payer: Preferred Network Access Commercial |
$301.39
|
| Rate for Payer: Quartz Beloit One Network |
$160.52
|
| Rate for Payer: Quartz Commercial |
$196.56
|
| Rate for Payer: WEA Trust Commercial |
$180.18
|
| Rate for Payer: WPS Commercial |
$242.64
|
|
|
CANNULA ORAL NASAL PEDIATRIC #3471PEH-00
|
Facility
|
OP
|
$330.00
|
|
|
Service Code
|
HCPCS A4615
|
| Hospital Charge Code |
2972827
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.33 |
| Max. Negotiated Rate |
$315.74 |
| Rate for Payer: Aetna Commercial |
$308.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$295.15
|
| Rate for Payer: Aetna Managed Medicare |
$96.10
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$223.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$171.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$164.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$181.90
|
| Rate for Payer: Cash Price |
$99.00
|
| Rate for Payer: Cash Price |
$99.00
|
| Rate for Payer: Cigna Commercial |
$315.74
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$192.06
|
| Rate for Payer: Health EOS Commercial |
$305.45
|
| Rate for Payer: HFN Commercial |
$315.74
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$257.40
|
| Rate for Payer: Multiplan Commercial |
$274.56
|
| Rate for Payer: NAPHCARE Commercial |
$205.92
|
| Rate for Payer: Preferred Network Access Commercial |
$315.74
|
| Rate for Payer: Quartz Beloit One Network |
$168.17
|
| Rate for Payer: Quartz Commercial |
$223.08
|
| Rate for Payer: Quartz Medicare Advantage |
$205.92
|
| Rate for Payer: The Alliance Commercial |
$4.33
|
| Rate for Payer: WEA Trust Commercial |
$188.76
|
| Rate for Payer: WPS Commercial |
$254.20
|
|
