|
CANNULA SET 8.4x75 C7362
|
Facility
|
OP
|
$421.00
|
|
| Hospital Charge Code |
2964880
|
|
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 8.4x75 C7362
|
Facility
|
IP
|
$421.00
|
|
| Hospital Charge Code |
2964880
|
|
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 SHOULDER 9704
|
Facility
|
OP
|
$421.00
|
|
| Hospital Charge Code |
2964881
|
|
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 SHOULDER 9704
|
Facility
|
IP
|
$421.00
|
|
| Hospital Charge Code |
2964881
|
|
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 SOFTECH NASAL 14 FT
|
Facility
|
OP
|
$46.00
|
|
|
Service Code
|
HCPCS A4615
|
| Hospital Charge Code |
2974602
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.33 |
| Max. Negotiated Rate |
$44.01 |
| Rate for Payer: Aetna Commercial |
$43.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$41.14
|
| Rate for Payer: Aetna Managed Medicare |
$13.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$31.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$23.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$25.36
|
| Rate for Payer: Cash Price |
$13.80
|
| Rate for Payer: Cash Price |
$13.80
|
| Rate for Payer: Cigna Commercial |
$44.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$26.77
|
| Rate for Payer: Health EOS Commercial |
$42.58
|
| Rate for Payer: HFN Commercial |
$44.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$35.88
|
| Rate for Payer: Multiplan Commercial |
$38.27
|
| Rate for Payer: NAPHCARE Commercial |
$28.70
|
| Rate for Payer: Preferred Network Access Commercial |
$44.01
|
| Rate for Payer: Quartz Beloit One Network |
$23.44
|
| Rate for Payer: Quartz Commercial |
$31.10
|
| Rate for Payer: Quartz Medicare Advantage |
$28.70
|
| Rate for Payer: The Alliance Commercial |
$4.33
|
| Rate for Payer: WEA Trust Commercial |
$26.31
|
| Rate for Payer: WPS Commercial |
$35.43
|
|
|
CANNULA SOFTECH NASAL 14 FT
|
Facility
|
IP
|
$46.00
|
|
|
Service Code
|
HCPCS A4615
|
| Hospital Charge Code |
2974602
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$23.44 |
| Max. Negotiated Rate |
$44.01 |
| Rate for Payer: Aetna Commercial |
$43.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$41.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$25.36
|
| Rate for Payer: Cash Price |
$13.80
|
| Rate for Payer: Cigna Commercial |
$44.01
|
| Rate for Payer: Health EOS Commercial |
$42.58
|
| Rate for Payer: HFN Commercial |
$44.01
|
| Rate for Payer: Multiplan Commercial |
$38.27
|
| Rate for Payer: Preferred Network Access Commercial |
$44.01
|
| Rate for Payer: Quartz Beloit One Network |
$23.44
|
| Rate for Payer: Quartz Commercial |
$28.70
|
| Rate for Payer: WEA Trust Commercial |
$26.31
|
| Rate for Payer: WPS Commercial |
$35.43
|
|
|
CANNULA TWIST-IN 7MM X 7CM AR-6570
|
Facility
|
OP
|
$514.00
|
|
| Hospital Charge Code |
4640650
|
|
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 TWIST-IN 7MM X 7CM AR-6570
|
Facility
|
IP
|
$514.00
|
|
| Hospital Charge Code |
4640650
|
|
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 TWIST-IN AR-6530
|
Facility
|
OP
|
$534.00
|
|
| Hospital Charge Code |
4520229
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$155.50 |
| Max. Negotiated Rate |
$510.93 |
| Rate for Payer: Aetna Commercial |
$499.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$477.61
|
| Rate for Payer: Aetna Managed Medicare |
$155.50
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$360.98
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$277.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$266.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$294.34
|
| Rate for Payer: Cash Price |
$160.20
|
| Rate for Payer: Cigna Commercial |
$510.93
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$310.79
|
| Rate for Payer: Health EOS Commercial |
$494.27
|
| Rate for Payer: HFN Commercial |
$510.93
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$416.52
|
| Rate for Payer: Multiplan Commercial |
$444.29
|
| Rate for Payer: NAPHCARE Commercial |
$333.22
|
| Rate for Payer: Preferred Network Access Commercial |
$510.93
|
| Rate for Payer: Quartz Beloit One Network |
$272.13
|
| Rate for Payer: Quartz Commercial |
$360.98
|
| Rate for Payer: Quartz Medicare Advantage |
$333.22
|
| Rate for Payer: The Alliance Commercial |
$277.68
|
| Rate for Payer: WEA Trust Commercial |
$305.45
|
| Rate for Payer: WPS Commercial |
$411.34
|
|
|
CANNULA TWIST-IN AR-6530
|
Facility
|
IP
|
$534.00
|
|
| Hospital Charge Code |
4520229
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$272.13 |
| Max. Negotiated Rate |
$510.93 |
| Rate for Payer: Aetna Commercial |
$499.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$477.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$294.34
|
| Rate for Payer: Cash Price |
$160.20
|
| Rate for Payer: Cigna Commercial |
$510.93
|
| Rate for Payer: Health EOS Commercial |
$494.27
|
| Rate for Payer: HFN Commercial |
$510.93
|
| Rate for Payer: Multiplan Commercial |
$444.29
|
| Rate for Payer: Preferred Network Access Commercial |
$510.93
|
| Rate for Payer: Quartz Beloit One Network |
$272.13
|
| Rate for Payer: Quartz Commercial |
$333.22
|
| Rate for Payer: WEA Trust Commercial |
$305.45
|
| Rate for Payer: WPS Commercial |
$411.34
|
|
|
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 |
$195.69 |
| Max. Negotiated Rate |
$642.97 |
| Rate for Payer: Aetna Commercial |
$628.99
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$601.04
|
| Rate for Payer: Aetna Managed Medicare |
$195.69
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$454.27
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$349.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$335.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$370.41
|
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: Cigna Commercial |
$642.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$391.10
|
| Rate for Payer: Health EOS Commercial |
$622.00
|
| Rate for Payer: HFN Commercial |
$642.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$524.16
|
| Rate for Payer: Multiplan Commercial |
$559.10
|
| Rate for Payer: NAPHCARE Commercial |
$419.33
|
| Rate for Payer: Preferred Network Access Commercial |
$642.97
|
| Rate for Payer: Quartz Beloit One Network |
$342.45
|
| Rate for Payer: Quartz Commercial |
$454.27
|
| Rate for Payer: Quartz Medicare Advantage |
$419.33
|
| Rate for Payer: The Alliance Commercial |
$349.44
|
| Rate for Payer: WEA Trust Commercial |
$384.38
|
| Rate for Payer: WPS Commercial |
$517.64
|
|
|
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 |
$342.45 |
| Max. Negotiated Rate |
$642.97 |
| Rate for Payer: Aetna Commercial |
$628.99
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$601.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$370.41
|
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: Cigna Commercial |
$642.97
|
| Rate for Payer: Health EOS Commercial |
$622.00
|
| Rate for Payer: HFN Commercial |
$642.97
|
| Rate for Payer: Multiplan Commercial |
$559.10
|
| Rate for Payer: Preferred Network Access Commercial |
$642.97
|
| Rate for Payer: Quartz Beloit One Network |
$342.45
|
| Rate for Payer: Quartz Commercial |
$419.33
|
| Rate for Payer: WEA Trust Commercial |
$384.38
|
| Rate for Payer: WPS Commercial |
$517.64
|
|
|
CANNULA VEIN GRAFT 10010
|
Facility
|
IP
|
$259.00
|
|
| Hospital Charge Code |
2965378
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$131.99 |
| Max. Negotiated Rate |
$247.81 |
| Rate for Payer: Aetna Commercial |
$242.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$231.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$142.76
|
| Rate for Payer: Cash Price |
$77.70
|
| Rate for Payer: Cigna Commercial |
$247.81
|
| Rate for Payer: Health EOS Commercial |
$239.73
|
| Rate for Payer: HFN Commercial |
$247.81
|
| Rate for Payer: Multiplan Commercial |
$215.49
|
| Rate for Payer: Preferred Network Access Commercial |
$247.81
|
| Rate for Payer: Quartz Beloit One Network |
$131.99
|
| Rate for Payer: Quartz Commercial |
$161.62
|
| Rate for Payer: WEA Trust Commercial |
$148.15
|
| Rate for Payer: WPS Commercial |
$199.51
|
|
|
CANNULA VEIN GRAFT 10010
|
Facility
|
OP
|
$259.00
|
|
| Hospital Charge Code |
2965378
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$75.42 |
| Max. Negotiated Rate |
$247.81 |
| Rate for Payer: Aetna Commercial |
$242.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$231.65
|
| Rate for Payer: Aetna Managed Medicare |
$75.42
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$175.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$134.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$129.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$142.76
|
| Rate for Payer: Cash Price |
$77.70
|
| Rate for Payer: Cigna Commercial |
$247.81
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$150.74
|
| Rate for Payer: Health EOS Commercial |
$239.73
|
| Rate for Payer: HFN Commercial |
$247.81
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$202.02
|
| Rate for Payer: Multiplan Commercial |
$215.49
|
| Rate for Payer: NAPHCARE Commercial |
$161.62
|
| Rate for Payer: Preferred Network Access Commercial |
$247.81
|
| Rate for Payer: Quartz Beloit One Network |
$131.99
|
| Rate for Payer: Quartz Commercial |
$175.08
|
| Rate for Payer: Quartz Medicare Advantage |
$161.62
|
| Rate for Payer: The Alliance Commercial |
$134.68
|
| Rate for Payer: WEA Trust Commercial |
$148.15
|
| Rate for Payer: WPS Commercial |
$199.51
|
|
|
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 |
$287.41 |
| Max. Negotiated Rate |
$539.64 |
| Rate for Payer: Aetna Commercial |
$527.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$504.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$310.88
|
| Rate for Payer: Cash Price |
$169.20
|
| Rate for Payer: Cigna Commercial |
$539.64
|
| Rate for Payer: Health EOS Commercial |
$522.04
|
| Rate for Payer: HFN Commercial |
$539.64
|
| Rate for Payer: Multiplan Commercial |
$469.25
|
| Rate for Payer: Preferred Network Access Commercial |
$539.64
|
| Rate for Payer: Quartz Beloit One Network |
$287.41
|
| Rate for Payer: Quartz Commercial |
$351.94
|
| Rate for Payer: WEA Trust Commercial |
$322.61
|
| Rate for Payer: WPS Commercial |
$434.45
|
|
|
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 |
$164.24 |
| Max. Negotiated Rate |
$539.64 |
| Rate for Payer: Aetna Commercial |
$527.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$504.44
|
| Rate for Payer: Aetna Managed Medicare |
$164.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$381.26
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$293.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$281.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$310.88
|
| Rate for Payer: Cash Price |
$169.20
|
| Rate for Payer: Cigna Commercial |
$539.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$328.25
|
| Rate for Payer: Health EOS Commercial |
$522.04
|
| Rate for Payer: HFN Commercial |
$539.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$439.92
|
| Rate for Payer: Multiplan Commercial |
$469.25
|
| Rate for Payer: NAPHCARE Commercial |
$351.94
|
| Rate for Payer: Preferred Network Access Commercial |
$539.64
|
| Rate for Payer: Quartz Beloit One Network |
$287.41
|
| Rate for Payer: Quartz Commercial |
$381.26
|
| Rate for Payer: Quartz Medicare Advantage |
$351.94
|
| Rate for Payer: The Alliance Commercial |
$293.28
|
| Rate for Payer: WEA Trust Commercial |
$322.61
|
| Rate for Payer: WPS Commercial |
$434.45
|
|
|
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 |
$164.24 |
| Max. Negotiated Rate |
$539.64 |
| Rate for Payer: Aetna Commercial |
$527.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$504.44
|
| Rate for Payer: Aetna Managed Medicare |
$164.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$381.26
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$293.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$281.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$310.88
|
| Rate for Payer: Cash Price |
$169.20
|
| Rate for Payer: Cigna Commercial |
$539.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$328.25
|
| Rate for Payer: Health EOS Commercial |
$522.04
|
| Rate for Payer: HFN Commercial |
$539.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$439.92
|
| Rate for Payer: Multiplan Commercial |
$469.25
|
| Rate for Payer: NAPHCARE Commercial |
$351.94
|
| Rate for Payer: Preferred Network Access Commercial |
$539.64
|
| Rate for Payer: Quartz Beloit One Network |
$287.41
|
| Rate for Payer: Quartz Commercial |
$381.26
|
| Rate for Payer: Quartz Medicare Advantage |
$351.94
|
| Rate for Payer: The Alliance Commercial |
$293.28
|
| Rate for Payer: WEA Trust Commercial |
$322.61
|
| Rate for Payer: WPS Commercial |
$434.45
|
|
|
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 |
$287.41 |
| Max. Negotiated Rate |
$539.64 |
| Rate for Payer: Aetna Commercial |
$527.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$504.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$310.88
|
| Rate for Payer: Cash Price |
$169.20
|
| Rate for Payer: Cigna Commercial |
$539.64
|
| Rate for Payer: Health EOS Commercial |
$522.04
|
| Rate for Payer: HFN Commercial |
$539.64
|
| Rate for Payer: Multiplan Commercial |
$469.25
|
| Rate for Payer: Preferred Network Access Commercial |
$539.64
|
| Rate for Payer: Quartz Beloit One Network |
$287.41
|
| Rate for Payer: Quartz Commercial |
$351.94
|
| Rate for Payer: WEA Trust Commercial |
$322.61
|
| Rate for Payer: WPS Commercial |
$434.45
|
|
|
CANNULA VISCOAT 27GA 8065480120
|
Facility
|
OP
|
$165.00
|
|
| Hospital Charge Code |
4518846
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$48.05 |
| Max. Negotiated Rate |
$157.87 |
| Rate for Payer: Aetna Commercial |
$154.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$147.58
|
| Rate for Payer: Aetna Managed Medicare |
$48.05
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$111.54
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$85.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$82.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$90.95
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cigna Commercial |
$157.87
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$96.03
|
| Rate for Payer: Health EOS Commercial |
$152.72
|
| Rate for Payer: HFN Commercial |
$157.87
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$128.70
|
| Rate for Payer: Multiplan Commercial |
$137.28
|
| Rate for Payer: NAPHCARE Commercial |
$102.96
|
| Rate for Payer: Preferred Network Access Commercial |
$157.87
|
| Rate for Payer: Quartz Beloit One Network |
$84.08
|
| Rate for Payer: Quartz Commercial |
$111.54
|
| Rate for Payer: Quartz Medicare Advantage |
$102.96
|
| Rate for Payer: The Alliance Commercial |
$85.80
|
| Rate for Payer: WEA Trust Commercial |
$94.38
|
| Rate for Payer: WPS Commercial |
$127.10
|
|
|
CANNULA VISCOAT 27GA 8065480120
|
Facility
|
IP
|
$165.00
|
|
| Hospital Charge Code |
4518846
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$84.08 |
| Max. Negotiated Rate |
$157.87 |
| Rate for Payer: Aetna Commercial |
$154.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$147.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$90.95
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cigna Commercial |
$157.87
|
| Rate for Payer: Health EOS Commercial |
$152.72
|
| Rate for Payer: HFN Commercial |
$157.87
|
| Rate for Payer: Multiplan Commercial |
$137.28
|
| Rate for Payer: Preferred Network Access Commercial |
$157.87
|
| Rate for Payer: Quartz Beloit One Network |
$84.08
|
| Rate for Payer: Quartz Commercial |
$102.96
|
| Rate for Payer: WEA Trust Commercial |
$94.38
|
| Rate for Payer: WPS Commercial |
$127.10
|
|
|
CANNULA ZONE NAVIGATOR ANTERIOR AR-7905
|
Facility
|
IP
|
$1,920.00
|
|
| Hospital Charge Code |
5685684
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$978.43 |
| Max. Negotiated Rate |
$1,837.06 |
| Rate for Payer: Aetna Commercial |
$1,797.12
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,717.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,058.30
|
| Rate for Payer: Cash Price |
$576.00
|
| Rate for Payer: Cigna Commercial |
$1,837.06
|
| Rate for Payer: Health EOS Commercial |
$1,777.15
|
| Rate for Payer: HFN Commercial |
$1,837.06
|
| Rate for Payer: Multiplan Commercial |
$1,597.44
|
| Rate for Payer: Preferred Network Access Commercial |
$1,837.06
|
| Rate for Payer: Quartz Beloit One Network |
$978.43
|
| Rate for Payer: Quartz Commercial |
$1,198.08
|
| Rate for Payer: WEA Trust Commercial |
$1,098.24
|
| Rate for Payer: WPS Commercial |
$1,478.98
|
|
|
CANNULA ZONE NAVIGATOR ANTERIOR AR-7905
|
Facility
|
OP
|
$1,920.00
|
|
| Hospital Charge Code |
5685684
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$559.10 |
| Max. Negotiated Rate |
$1,837.06 |
| Rate for Payer: Aetna Commercial |
$1,797.12
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,717.25
|
| Rate for Payer: Aetna Managed Medicare |
$559.10
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,297.92
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$998.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$958.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,058.30
|
| Rate for Payer: Cash Price |
$576.00
|
| Rate for Payer: Cigna Commercial |
$1,837.06
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,117.44
|
| Rate for Payer: Health EOS Commercial |
$1,777.15
|
| Rate for Payer: HFN Commercial |
$1,837.06
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,497.60
|
| Rate for Payer: Multiplan Commercial |
$1,597.44
|
| Rate for Payer: NAPHCARE Commercial |
$1,198.08
|
| Rate for Payer: Preferred Network Access Commercial |
$1,837.06
|
| Rate for Payer: Quartz Beloit One Network |
$978.43
|
| Rate for Payer: Quartz Commercial |
$1,297.92
|
| Rate for Payer: Quartz Medicare Advantage |
$1,198.08
|
| Rate for Payer: The Alliance Commercial |
$998.40
|
| Rate for Payer: WEA Trust Commercial |
$1,098.24
|
| Rate for Payer: WPS Commercial |
$1,478.98
|
|
|
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 |
$665.97 |
| Max. Negotiated Rate |
$2,188.20 |
| Rate for Payer: Aetna Commercial |
$2,140.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,045.49
|
| Rate for Payer: Aetna Managed Medicare |
$665.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,546.01
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,189.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,141.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,260.59
|
| Rate for Payer: Cash Price |
$686.10
|
| Rate for Payer: Cigna Commercial |
$2,188.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,331.03
|
| Rate for Payer: Health EOS Commercial |
$2,116.85
|
| Rate for Payer: HFN Commercial |
$2,188.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,783.86
|
| Rate for Payer: Multiplan Commercial |
$1,902.78
|
| Rate for Payer: NAPHCARE Commercial |
$1,427.09
|
| Rate for Payer: Preferred Network Access Commercial |
$2,188.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,165.46
|
| Rate for Payer: Quartz Commercial |
$1,546.01
|
| Rate for Payer: Quartz Medicare Advantage |
$1,427.09
|
| Rate for Payer: The Alliance Commercial |
$1,189.24
|
| Rate for Payer: WEA Trust Commercial |
$1,308.16
|
| Rate for Payer: WPS Commercial |
$1,761.68
|
|
|
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 |
$1,165.46 |
| Max. Negotiated Rate |
$2,188.20 |
| Rate for Payer: Aetna Commercial |
$2,140.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,045.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,260.59
|
| Rate for Payer: Cash Price |
$686.10
|
| Rate for Payer: Cigna Commercial |
$2,188.20
|
| Rate for Payer: Health EOS Commercial |
$2,116.85
|
| Rate for Payer: HFN Commercial |
$2,188.20
|
| Rate for Payer: Multiplan Commercial |
$1,902.78
|
| Rate for Payer: Preferred Network Access Commercial |
$2,188.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,165.46
|
| Rate for Payer: Quartz Commercial |
$1,427.09
|
| Rate for Payer: WEA Trust Commercial |
$1,308.16
|
| Rate for Payer: WPS Commercial |
$1,761.68
|
|
|
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 |
$615.60 |
| Max. Negotiated Rate |
$2,022.68 |
| Rate for Payer: Aetna Commercial |
$1,978.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,890.76
|
| Rate for Payer: Aetna Managed Medicare |
$615.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,429.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,099.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,055.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,165.24
|
| Rate for Payer: Cash Price |
$634.20
|
| Rate for Payer: Cigna Commercial |
$2,022.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,230.35
|
| Rate for Payer: Health EOS Commercial |
$1,956.72
|
| Rate for Payer: HFN Commercial |
$2,022.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,648.92
|
| Rate for Payer: Multiplan Commercial |
$1,758.85
|
| Rate for Payer: NAPHCARE Commercial |
$1,319.14
|
| Rate for Payer: Preferred Network Access Commercial |
$2,022.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,077.29
|
| Rate for Payer: Quartz Commercial |
$1,429.06
|
| Rate for Payer: Quartz Medicare Advantage |
$1,319.14
|
| Rate for Payer: The Alliance Commercial |
$1,099.28
|
| Rate for Payer: WEA Trust Commercial |
$1,209.21
|
| Rate for Payer: WPS Commercial |
$1,628.41
|
|
