|
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
|
|
|
CANNULA PASSPORT BUTTON 12 X 30 AR-6592-12-30
|
Facility
|
IP
|
$1,574.00
|
|
| Hospital Charge Code |
5307004
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$802.11 |
| Max. Negotiated Rate |
$1,506.00 |
| Rate for Payer: Aetna Commercial |
$1,473.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,407.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$867.59
|
| Rate for Payer: Cash Price |
$472.20
|
| Rate for Payer: Cigna Commercial |
$1,506.00
|
| Rate for Payer: Health EOS Commercial |
$1,456.89
|
| Rate for Payer: HFN Commercial |
$1,506.00
|
| Rate for Payer: Multiplan Commercial |
$1,309.57
|
| Rate for Payer: Preferred Network Access Commercial |
$1,506.00
|
| Rate for Payer: Quartz Beloit One Network |
$802.11
|
| Rate for Payer: Quartz Commercial |
$982.18
|
| Rate for Payer: WEA Trust Commercial |
$900.33
|
| Rate for Payer: WPS Commercial |
$1,212.45
|
|
|
CANNULA PASSPORT BUTTON 12 X 30 AR-6592-12-30
|
Facility
|
OP
|
$1,574.00
|
|
| Hospital Charge Code |
5307004
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$458.35 |
| Max. Negotiated Rate |
$1,506.00 |
| Rate for Payer: Aetna Commercial |
$1,473.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,407.79
|
| Rate for Payer: Aetna Managed Medicare |
$458.35
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,064.02
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$818.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$785.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$867.59
|
| Rate for Payer: Cash Price |
$472.20
|
| Rate for Payer: Cigna Commercial |
$1,506.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$916.07
|
| Rate for Payer: Health EOS Commercial |
$1,456.89
|
| Rate for Payer: HFN Commercial |
$1,506.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,227.72
|
| Rate for Payer: Multiplan Commercial |
$1,309.57
|
| Rate for Payer: NAPHCARE Commercial |
$982.18
|
| Rate for Payer: Preferred Network Access Commercial |
$1,506.00
|
| Rate for Payer: Quartz Beloit One Network |
$802.11
|
| Rate for Payer: Quartz Commercial |
$1,064.02
|
| Rate for Payer: Quartz Medicare Advantage |
$982.18
|
| Rate for Payer: The Alliance Commercial |
$818.48
|
| Rate for Payer: WEA Trust Commercial |
$900.33
|
| Rate for Payer: WPS Commercial |
$1,212.45
|
|
|
CANNULA PASSPORT BUTTON 12 X 40 AR-6592-12-40
|
Facility
|
IP
|
$860.09
|
|
| Hospital Charge Code |
6246141
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$438.30 |
| Max. Negotiated Rate |
$822.93 |
| Rate for Payer: Aetna Commercial |
$805.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$769.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$474.08
|
| Rate for Payer: Cash Price |
$258.03
|
| Rate for Payer: Cigna Commercial |
$822.93
|
| Rate for Payer: Health EOS Commercial |
$796.10
|
| Rate for Payer: HFN Commercial |
$822.93
|
| Rate for Payer: Multiplan Commercial |
$715.59
|
| Rate for Payer: Preferred Network Access Commercial |
$822.93
|
| Rate for Payer: Quartz Beloit One Network |
$438.30
|
| Rate for Payer: Quartz Commercial |
$536.70
|
| Rate for Payer: WEA Trust Commercial |
$491.97
|
| Rate for Payer: WPS Commercial |
$662.53
|
|
|
CANNULA PASSPORT BUTTON 12 X 40 AR-6592-12-40
|
Facility
|
OP
|
$860.09
|
|
| Hospital Charge Code |
6246141
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$250.46 |
| Max. Negotiated Rate |
$822.93 |
| Rate for Payer: Aetna Commercial |
$805.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$769.26
|
| Rate for Payer: Aetna Managed Medicare |
$250.46
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$581.42
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$447.25
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$429.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$474.08
|
| Rate for Payer: Cash Price |
$258.03
|
| Rate for Payer: Cigna Commercial |
$822.93
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$500.57
|
| Rate for Payer: Health EOS Commercial |
$796.10
|
| Rate for Payer: HFN Commercial |
$822.93
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$670.87
|
| Rate for Payer: Multiplan Commercial |
$715.59
|
| Rate for Payer: NAPHCARE Commercial |
$536.70
|
| Rate for Payer: Preferred Network Access Commercial |
$822.93
|
| Rate for Payer: Quartz Beloit One Network |
$438.30
|
| Rate for Payer: Quartz Commercial |
$581.42
|
| Rate for Payer: Quartz Medicare Advantage |
$536.70
|
| Rate for Payer: The Alliance Commercial |
$447.25
|
| Rate for Payer: WEA Trust Commercial |
$491.97
|
| Rate for Payer: WPS Commercial |
$662.53
|
|
|
CANNULA PASSPORT BUTTON 8 X 30 AR-6592-08-30
|
Facility
|
IP
|
$926.00
|
|
| Hospital Charge Code |
4520132
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$471.89 |
| Max. Negotiated Rate |
$886.00 |
| Rate for Payer: Aetna Commercial |
$866.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$828.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$510.41
|
| Rate for Payer: Cash Price |
$277.80
|
| Rate for Payer: Cigna Commercial |
$886.00
|
| Rate for Payer: Health EOS Commercial |
$857.11
|
| Rate for Payer: HFN Commercial |
$886.00
|
| Rate for Payer: Multiplan Commercial |
$770.43
|
| Rate for Payer: Preferred Network Access Commercial |
$886.00
|
| Rate for Payer: Quartz Beloit One Network |
$471.89
|
| Rate for Payer: Quartz Commercial |
$577.82
|
| Rate for Payer: WEA Trust Commercial |
$529.67
|
| Rate for Payer: WPS Commercial |
$713.30
|
|
|
CANNULA PASSPORT BUTTON 8 X 30 AR-6592-08-30
|
Facility
|
OP
|
$926.00
|
|
| Hospital Charge Code |
4520132
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$269.65 |
| Max. Negotiated Rate |
$886.00 |
| Rate for Payer: Aetna Commercial |
$866.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$828.21
|
| Rate for Payer: Aetna Managed Medicare |
$269.65
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$625.98
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$481.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$462.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$510.41
|
| Rate for Payer: Cash Price |
$277.80
|
| Rate for Payer: Cigna Commercial |
$886.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$538.93
|
| Rate for Payer: Health EOS Commercial |
$857.11
|
| Rate for Payer: HFN Commercial |
$886.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$722.28
|
| Rate for Payer: Multiplan Commercial |
$770.43
|
| Rate for Payer: NAPHCARE Commercial |
$577.82
|
| Rate for Payer: Preferred Network Access Commercial |
$886.00
|
| Rate for Payer: Quartz Beloit One Network |
$471.89
|
| Rate for Payer: Quartz Commercial |
$625.98
|
| Rate for Payer: Quartz Medicare Advantage |
$577.82
|
| Rate for Payer: The Alliance Commercial |
$481.52
|
| Rate for Payer: WEA Trust Commercial |
$529.67
|
| Rate for Payer: WPS Commercial |
$713.30
|
|
|
CANNULA PASSPORT BUTTON 8 X 40 AR-6592-08-40
|
Facility
|
IP
|
$709.00
|
|
| Hospital Charge Code |
4520133
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$361.31 |
| Max. Negotiated Rate |
$678.37 |
| Rate for Payer: Aetna Commercial |
$663.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$634.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$390.80
|
| Rate for Payer: Cash Price |
$212.70
|
| Rate for Payer: Cigna Commercial |
$678.37
|
| Rate for Payer: Health EOS Commercial |
$656.25
|
| Rate for Payer: HFN Commercial |
$678.37
|
| Rate for Payer: Multiplan Commercial |
$589.89
|
| Rate for Payer: Preferred Network Access Commercial |
$678.37
|
| Rate for Payer: Quartz Beloit One Network |
$361.31
|
| Rate for Payer: Quartz Commercial |
$442.42
|
| Rate for Payer: WEA Trust Commercial |
$405.55
|
| Rate for Payer: WPS Commercial |
$546.14
|
|
|
CANNULA PASSPORT BUTTON 8 X 40 AR-6592-08-40
|
Facility
|
OP
|
$709.00
|
|
| Hospital Charge Code |
4520133
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$206.46 |
| Max. Negotiated Rate |
$678.37 |
| Rate for Payer: Aetna Commercial |
$663.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$634.13
|
| Rate for Payer: Aetna Managed Medicare |
$206.46
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$479.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$368.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$353.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$390.80
|
| Rate for Payer: Cash Price |
$212.70
|
| Rate for Payer: Cigna Commercial |
$678.37
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$412.64
|
| Rate for Payer: Health EOS Commercial |
$656.25
|
| Rate for Payer: HFN Commercial |
$678.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$553.02
|
| Rate for Payer: Multiplan Commercial |
$589.89
|
| Rate for Payer: NAPHCARE Commercial |
$442.42
|
| Rate for Payer: Preferred Network Access Commercial |
$678.37
|
| Rate for Payer: Quartz Beloit One Network |
$361.31
|
| Rate for Payer: Quartz Commercial |
$479.28
|
| Rate for Payer: Quartz Medicare Advantage |
$442.42
|
| Rate for Payer: The Alliance Commercial |
$368.68
|
| Rate for Payer: WEA Trust Commercial |
$405.55
|
| Rate for Payer: WPS Commercial |
$546.14
|
|
|
CANNULA PASSPORT BUTTON 8 X 50 AR-6592-08-50
|
Facility
|
OP
|
$709.00
|
|
| Hospital Charge Code |
4520231
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$206.46 |
| Max. Negotiated Rate |
$678.37 |
| Rate for Payer: Aetna Commercial |
$663.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$634.13
|
| Rate for Payer: Aetna Managed Medicare |
$206.46
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$479.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$368.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$353.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$390.80
|
| Rate for Payer: Cash Price |
$212.70
|
| Rate for Payer: Cigna Commercial |
$678.37
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$412.64
|
| Rate for Payer: Health EOS Commercial |
$656.25
|
| Rate for Payer: HFN Commercial |
$678.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$553.02
|
| Rate for Payer: Multiplan Commercial |
$589.89
|
| Rate for Payer: NAPHCARE Commercial |
$442.42
|
| Rate for Payer: Preferred Network Access Commercial |
$678.37
|
| Rate for Payer: Quartz Beloit One Network |
$361.31
|
| Rate for Payer: Quartz Commercial |
$479.28
|
| Rate for Payer: Quartz Medicare Advantage |
$442.42
|
| Rate for Payer: The Alliance Commercial |
$368.68
|
| Rate for Payer: WEA Trust Commercial |
$405.55
|
| Rate for Payer: WPS Commercial |
$546.14
|
|
|
CANNULA PASSPORT BUTTON 8 X 50 AR-6592-08-50
|
Facility
|
IP
|
$709.00
|
|
| Hospital Charge Code |
4520231
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$361.31 |
| Max. Negotiated Rate |
$678.37 |
| Rate for Payer: Aetna Commercial |
$663.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$634.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$390.80
|
| Rate for Payer: Cash Price |
$212.70
|
| Rate for Payer: Cigna Commercial |
$678.37
|
| Rate for Payer: Health EOS Commercial |
$656.25
|
| Rate for Payer: HFN Commercial |
$678.37
|
| Rate for Payer: Multiplan Commercial |
$589.89
|
| Rate for Payer: Preferred Network Access Commercial |
$678.37
|
| Rate for Payer: Quartz Beloit One Network |
$361.31
|
| Rate for Payer: Quartz Commercial |
$442.42
|
| Rate for Payer: WEA Trust Commercial |
$405.55
|
| Rate for Payer: WPS Commercial |
$546.14
|
|
|
CANNULA RADIOFREQUENCY 18G 100MM 10MM TIP CURVED
|
Facility
|
IP
|
$440.00
|
|
| Hospital Charge Code |
4595243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$224.22 |
| Max. Negotiated Rate |
$420.99 |
| Rate for Payer: Aetna Commercial |
$411.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$393.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$242.53
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cigna Commercial |
$420.99
|
| Rate for Payer: Health EOS Commercial |
$407.26
|
| Rate for Payer: HFN Commercial |
$420.99
|
| Rate for Payer: Multiplan Commercial |
$366.08
|
| Rate for Payer: Preferred Network Access Commercial |
$420.99
|
| Rate for Payer: Quartz Beloit One Network |
$224.22
|
| Rate for Payer: Quartz Commercial |
$274.56
|
| Rate for Payer: WEA Trust Commercial |
$251.68
|
| Rate for Payer: WPS Commercial |
$338.93
|
|
|
CANNULA RADIOFREQUENCY 18G 100MM 10MM TIP CURVED
|
Facility
|
OP
|
$440.00
|
|
| Hospital Charge Code |
4595243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$128.13 |
| Max. Negotiated Rate |
$420.99 |
| Rate for Payer: Aetna Commercial |
$411.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$393.54
|
| Rate for Payer: Aetna Managed Medicare |
$128.13
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$297.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$228.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$219.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$242.53
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cigna Commercial |
$420.99
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$256.08
|
| Rate for Payer: Health EOS Commercial |
$407.26
|
| Rate for Payer: HFN Commercial |
$420.99
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$343.20
|
| Rate for Payer: Multiplan Commercial |
$366.08
|
| Rate for Payer: NAPHCARE Commercial |
$274.56
|
| Rate for Payer: Preferred Network Access Commercial |
$420.99
|
| Rate for Payer: Quartz Beloit One Network |
$224.22
|
| Rate for Payer: Quartz Commercial |
$297.44
|
| Rate for Payer: Quartz Medicare Advantage |
$274.56
|
| Rate for Payer: The Alliance Commercial |
$228.80
|
| Rate for Payer: WEA Trust Commercial |
$251.68
|
| Rate for Payer: WPS Commercial |
$338.93
|
|
|
CANNULA RADIOFREQUENCY 18G 60MM 10MM TIP CURVED
|
Facility
|
IP
|
$423.00
|
|
| Hospital Charge Code |
4595245
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$215.56 |
| Max. Negotiated Rate |
$404.73 |
| Rate for Payer: Aetna Commercial |
$395.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$378.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$233.16
|
| Rate for Payer: Cash Price |
$126.90
|
| Rate for Payer: Cigna Commercial |
$404.73
|
| Rate for Payer: Health EOS Commercial |
$391.53
|
| Rate for Payer: HFN Commercial |
$404.73
|
| Rate for Payer: Multiplan Commercial |
$351.94
|
| Rate for Payer: Preferred Network Access Commercial |
$404.73
|
| Rate for Payer: Quartz Beloit One Network |
$215.56
|
| Rate for Payer: Quartz Commercial |
$263.95
|
| Rate for Payer: WEA Trust Commercial |
$241.96
|
| Rate for Payer: WPS Commercial |
$325.84
|
|
|
CANNULA RADIOFREQUENCY 18G 60MM 10MM TIP CURVED
|
Facility
|
OP
|
$423.00
|
|
| Hospital Charge Code |
4595245
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$123.18 |
| Max. Negotiated Rate |
$404.73 |
| Rate for Payer: Aetna Commercial |
$395.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$378.33
|
| Rate for Payer: Aetna Managed Medicare |
$123.18
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$285.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$219.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$211.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$233.16
|
| Rate for Payer: Cash Price |
$126.90
|
| Rate for Payer: Cigna Commercial |
$404.73
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$246.19
|
| Rate for Payer: Health EOS Commercial |
$391.53
|
| Rate for Payer: HFN Commercial |
$404.73
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$329.94
|
| Rate for Payer: Multiplan Commercial |
$351.94
|
| Rate for Payer: NAPHCARE Commercial |
$263.95
|
| Rate for Payer: Preferred Network Access Commercial |
$404.73
|
| Rate for Payer: Quartz Beloit One Network |
$215.56
|
| Rate for Payer: Quartz Commercial |
$285.95
|
| Rate for Payer: Quartz Medicare Advantage |
$263.95
|
| Rate for Payer: The Alliance Commercial |
$219.96
|
| Rate for Payer: WEA Trust Commercial |
$241.96
|
| Rate for Payer: WPS Commercial |
$325.84
|
|
|
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 |
$128.13 |
| Max. Negotiated Rate |
$420.99 |
| Rate for Payer: Aetna Commercial |
$411.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$393.54
|
| Rate for Payer: Aetna Managed Medicare |
$128.13
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$297.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$228.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$219.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$242.53
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cigna Commercial |
$420.99
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$256.08
|
| Rate for Payer: Health EOS Commercial |
$407.26
|
| Rate for Payer: HFN Commercial |
$420.99
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$343.20
|
| Rate for Payer: Multiplan Commercial |
$366.08
|
| Rate for Payer: NAPHCARE Commercial |
$274.56
|
| Rate for Payer: Preferred Network Access Commercial |
$420.99
|
| Rate for Payer: Quartz Beloit One Network |
$224.22
|
| Rate for Payer: Quartz Commercial |
$297.44
|
| Rate for Payer: Quartz Medicare Advantage |
$274.56
|
| Rate for Payer: The Alliance Commercial |
$228.80
|
| Rate for Payer: WEA Trust Commercial |
$251.68
|
| Rate for Payer: WPS Commercial |
$338.93
|
|
|
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 |
$224.22 |
| Max. Negotiated Rate |
$420.99 |
| Rate for Payer: Aetna Commercial |
$411.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$393.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$242.53
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cigna Commercial |
$420.99
|
| Rate for Payer: Health EOS Commercial |
$407.26
|
| Rate for Payer: HFN Commercial |
$420.99
|
| Rate for Payer: Multiplan Commercial |
$366.08
|
| Rate for Payer: Preferred Network Access Commercial |
$420.99
|
| Rate for Payer: Quartz Beloit One Network |
$224.22
|
| Rate for Payer: Quartz Commercial |
$274.56
|
| Rate for Payer: WEA Trust Commercial |
$251.68
|
| Rate for Payer: WPS Commercial |
$338.93
|
|
|
CANNULA RX XL 4582
|
Facility
|
IP
|
$1,629.00
|
|
| Hospital Charge Code |
2972371
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$830.14 |
| Max. Negotiated Rate |
$1,558.63 |
| Rate for Payer: Aetna Commercial |
$1,524.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,456.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$897.90
|
| Rate for Payer: Cash Price |
$488.70
|
| Rate for Payer: Cigna Commercial |
$1,558.63
|
| Rate for Payer: Health EOS Commercial |
$1,507.80
|
| Rate for Payer: HFN Commercial |
$1,558.63
|
| Rate for Payer: Multiplan Commercial |
$1,355.33
|
| Rate for Payer: Preferred Network Access Commercial |
$1,558.63
|
| Rate for Payer: Quartz Beloit One Network |
$830.14
|
| Rate for Payer: Quartz Commercial |
$1,016.50
|
| Rate for Payer: WEA Trust Commercial |
$931.79
|
| Rate for Payer: WPS Commercial |
$1,254.82
|
|
|
CANNULA RX XL 4582
|
Facility
|
OP
|
$1,629.00
|
|
| Hospital Charge Code |
2972371
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$474.36 |
| Max. Negotiated Rate |
$1,558.63 |
| Rate for Payer: Aetna Commercial |
$1,524.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,456.98
|
| Rate for Payer: Aetna Managed Medicare |
$474.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,101.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$847.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$813.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$897.90
|
| Rate for Payer: Cash Price |
$488.70
|
| Rate for Payer: Cigna Commercial |
$1,558.63
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$948.08
|
| Rate for Payer: Health EOS Commercial |
$1,507.80
|
| Rate for Payer: HFN Commercial |
$1,558.63
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,270.62
|
| Rate for Payer: Multiplan Commercial |
$1,355.33
|
| Rate for Payer: NAPHCARE Commercial |
$1,016.50
|
| Rate for Payer: Preferred Network Access Commercial |
$1,558.63
|
| Rate for Payer: Quartz Beloit One Network |
$830.14
|
| Rate for Payer: Quartz Commercial |
$1,101.20
|
| Rate for Payer: Quartz Medicare Advantage |
$1,016.50
|
| Rate for Payer: The Alliance Commercial |
$847.08
|
| Rate for Payer: WEA Trust Commercial |
$931.79
|
| Rate for Payer: WPS Commercial |
$1,254.82
|
|
|
CANNULA SAPHENOUS VEIN PER-3006S
|
Facility
|
IP
|
$131.00
|
|
| Hospital Charge Code |
2965157
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$66.76 |
| Max. Negotiated Rate |
$125.34 |
| Rate for Payer: Aetna Commercial |
$122.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$117.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$72.21
|
| Rate for Payer: Cash Price |
$39.30
|
| Rate for Payer: Cigna Commercial |
$125.34
|
| Rate for Payer: Health EOS Commercial |
$121.25
|
| Rate for Payer: HFN Commercial |
$125.34
|
| Rate for Payer: Multiplan Commercial |
$108.99
|
| Rate for Payer: Preferred Network Access Commercial |
$125.34
|
| Rate for Payer: Quartz Beloit One Network |
$66.76
|
| Rate for Payer: Quartz Commercial |
$81.74
|
| Rate for Payer: WEA Trust Commercial |
$74.93
|
| Rate for Payer: WPS Commercial |
$100.91
|
|
|
CANNULA SAPHENOUS VEIN PER-3006S
|
Facility
|
OP
|
$131.00
|
|
| Hospital Charge Code |
2965157
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$38.15 |
| Max. Negotiated Rate |
$125.34 |
| Rate for Payer: Aetna Commercial |
$122.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$117.17
|
| Rate for Payer: Aetna Managed Medicare |
$38.15
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$88.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$68.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$65.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$72.21
|
| Rate for Payer: Cash Price |
$39.30
|
| Rate for Payer: Cigna Commercial |
$125.34
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$76.24
|
| Rate for Payer: Health EOS Commercial |
$121.25
|
| Rate for Payer: HFN Commercial |
$125.34
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$102.18
|
| Rate for Payer: Multiplan Commercial |
$108.99
|
| Rate for Payer: NAPHCARE Commercial |
$81.74
|
| Rate for Payer: Preferred Network Access Commercial |
$125.34
|
| Rate for Payer: Quartz Beloit One Network |
$66.76
|
| Rate for Payer: Quartz Commercial |
$88.56
|
| Rate for Payer: Quartz Medicare Advantage |
$81.74
|
| Rate for Payer: The Alliance Commercial |
$68.12
|
| Rate for Payer: WEA Trust Commercial |
$74.93
|
| Rate for Payer: WPS Commercial |
$100.91
|
|
|
CANNULA SET 6.0x75 C7332
|
Facility
|
OP
|
$421.00
|
|
| Hospital Charge Code |
2964878
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$122.60 |
| Max. Negotiated Rate |
$402.81 |
| Rate for Payer: Aetna Commercial |
$394.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$376.54
|
| Rate for Payer: Aetna Managed Medicare |
$122.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$284.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$218.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$210.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$232.06
|
| Rate for Payer: Cash Price |
$126.30
|
| Rate for Payer: Cigna Commercial |
$402.81
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$245.02
|
| Rate for Payer: Health EOS Commercial |
$389.68
|
| Rate for Payer: HFN Commercial |
$402.81
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$328.38
|
| Rate for Payer: Multiplan Commercial |
$350.27
|
| Rate for Payer: NAPHCARE Commercial |
$262.70
|
| Rate for Payer: Preferred Network Access Commercial |
$402.81
|
| Rate for Payer: Quartz Beloit One Network |
$214.54
|
| Rate for Payer: Quartz Commercial |
$284.60
|
| Rate for Payer: Quartz Medicare Advantage |
$262.70
|
| Rate for Payer: The Alliance Commercial |
$218.92
|
| Rate for Payer: WEA Trust Commercial |
$240.81
|
| Rate for Payer: WPS Commercial |
$324.30
|
|
|
CANNULA SET 6.0x75 C7332
|
Facility
|
IP
|
$421.00
|
|
| Hospital Charge Code |
2964878
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$214.54 |
| Max. Negotiated Rate |
$402.81 |
| Rate for Payer: Aetna Commercial |
$394.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$376.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$232.06
|
| Rate for Payer: Cash Price |
$126.30
|
| Rate for Payer: Cigna Commercial |
$402.81
|
| Rate for Payer: Health EOS Commercial |
$389.68
|
| Rate for Payer: HFN Commercial |
$402.81
|
| Rate for Payer: Multiplan Commercial |
$350.27
|
| Rate for Payer: Preferred Network Access Commercial |
$402.81
|
| Rate for Payer: Quartz Beloit One Network |
$214.54
|
| Rate for Payer: Quartz Commercial |
$262.70
|
| Rate for Payer: WEA Trust Commercial |
$240.81
|
| Rate for Payer: WPS Commercial |
$324.30
|
|
|
CANNULA SET 8.4x50 C7352
|
Facility
|
IP
|
$421.00
|
|
| Hospital Charge Code |
2964879
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$214.54 |
| Max. Negotiated Rate |
$402.81 |
| Rate for Payer: Aetna Commercial |
$394.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$376.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$232.06
|
| Rate for Payer: Cash Price |
$126.30
|
| Rate for Payer: Cigna Commercial |
$402.81
|
| Rate for Payer: Health EOS Commercial |
$389.68
|
| Rate for Payer: HFN Commercial |
$402.81
|
| Rate for Payer: Multiplan Commercial |
$350.27
|
| Rate for Payer: Preferred Network Access Commercial |
$402.81
|
| Rate for Payer: Quartz Beloit One Network |
$214.54
|
| Rate for Payer: Quartz Commercial |
$262.70
|
| Rate for Payer: WEA Trust Commercial |
$240.81
|
| Rate for Payer: WPS Commercial |
$324.30
|
|
|
CANNULA SET 8.4x50 C7352
|
Facility
|
OP
|
$421.00
|
|
| Hospital Charge Code |
2964879
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$122.60 |
| Max. Negotiated Rate |
$402.81 |
| Rate for Payer: Aetna Commercial |
$394.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$376.54
|
| Rate for Payer: Aetna Managed Medicare |
$122.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$284.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$218.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$210.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$232.06
|
| Rate for Payer: Cash Price |
$126.30
|
| Rate for Payer: Cigna Commercial |
$402.81
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$245.02
|
| Rate for Payer: Health EOS Commercial |
$389.68
|
| Rate for Payer: HFN Commercial |
$402.81
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$328.38
|
| Rate for Payer: Multiplan Commercial |
$350.27
|
| Rate for Payer: NAPHCARE Commercial |
$262.70
|
| Rate for Payer: Preferred Network Access Commercial |
$402.81
|
| Rate for Payer: Quartz Beloit One Network |
$214.54
|
| Rate for Payer: Quartz Commercial |
$284.60
|
| Rate for Payer: Quartz Medicare Advantage |
$262.70
|
| Rate for Payer: The Alliance Commercial |
$218.92
|
| Rate for Payer: WEA Trust Commercial |
$240.81
|
| Rate for Payer: WPS Commercial |
$324.30
|
|
