|
ADAPTER SLEEVE STRYKER UNIVERSAL V40 TAPER -25MM 6519-T-025
|
Facility
IP
|
$916.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
4167703
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$448.84 |
| Max. Negotiated Rate |
$842.72 |
| Rate for Payer: Aetna Commercial |
$824.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$485.48
|
| Rate for Payer: Cash Price |
$274.80
|
| Rate for Payer: Cigna Commercial |
$842.72
|
| Rate for Payer: Health EOS Commercial |
$815.24
|
| Rate for Payer: HFN Commercial |
$842.72
|
| Rate for Payer: Multiplan Commercial |
$732.80
|
| Rate for Payer: NAPHCARE Commercial |
$549.60
|
| Rate for Payer: Preferred Network Access Commercial |
$842.72
|
| Rate for Payer: Quartz Beloit One Network |
$448.84
|
| Rate for Payer: Quartz Commercial |
$549.60
|
| Rate for Payer: WEA Trust Commercial |
$503.80
|
| Rate for Payer: WPS Commercial |
$678.48
|
|
|
ADAPTER SLEEVE STRYKER UNIVERSAL V40 TAPER 6519-T-204
|
Facility
OP
|
$915.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
3779522
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$256.20 |
| Max. Negotiated Rate |
$841.80 |
| Rate for Payer: Aetna Commercial |
$823.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$786.90
|
| Rate for Payer: Aetna Managed Medicare |
$256.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$594.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$457.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$439.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$484.95
|
| Rate for Payer: Cash Price |
$274.50
|
| Rate for Payer: Cigna Commercial |
$841.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$512.03
|
| Rate for Payer: Health EOS Commercial |
$814.35
|
| Rate for Payer: HFN Commercial |
$841.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$686.25
|
| Rate for Payer: Multiplan Commercial |
$732.00
|
| Rate for Payer: NAPHCARE Commercial |
$549.00
|
| Rate for Payer: Preferred Network Access Commercial |
$841.80
|
| Rate for Payer: Quartz Beloit One Network |
$448.35
|
| Rate for Payer: Quartz Commercial |
$594.75
|
| Rate for Payer: Quartz Medicare Advantage |
$549.00
|
| Rate for Payer: WEA Trust Commercial |
$503.25
|
| Rate for Payer: WPS Commercial |
$677.74
|
|
|
ADAPTER SLEEVE STRYKER UNIVERSAL V40 TAPER 6519-T-204
|
Facility
IP
|
$915.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
3779522
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$448.35 |
| Max. Negotiated Rate |
$841.80 |
| Rate for Payer: Aetna Commercial |
$823.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$484.95
|
| Rate for Payer: Cash Price |
$274.50
|
| Rate for Payer: Cigna Commercial |
$841.80
|
| Rate for Payer: Health EOS Commercial |
$814.35
|
| Rate for Payer: HFN Commercial |
$841.80
|
| Rate for Payer: Multiplan Commercial |
$732.00
|
| Rate for Payer: NAPHCARE Commercial |
$549.00
|
| Rate for Payer: Preferred Network Access Commercial |
$841.80
|
| Rate for Payer: Quartz Beloit One Network |
$448.35
|
| Rate for Payer: Quartz Commercial |
$549.00
|
| Rate for Payer: WEA Trust Commercial |
$503.25
|
| Rate for Payer: WPS Commercial |
$677.74
|
|
|
ADAPTER URETERAL CATHETER CONNECTOR UCA5-95
|
Facility
IP
|
$410.00
|
|
| Hospital Charge Code |
2965124
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$200.90 |
| Max. Negotiated Rate |
$377.20 |
| Rate for Payer: Aetna Commercial |
$369.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$217.30
|
| Rate for Payer: Cash Price |
$123.00
|
| Rate for Payer: Cigna Commercial |
$377.20
|
| Rate for Payer: Health EOS Commercial |
$364.90
|
| Rate for Payer: HFN Commercial |
$377.20
|
| Rate for Payer: Multiplan Commercial |
$328.00
|
| Rate for Payer: NAPHCARE Commercial |
$246.00
|
| Rate for Payer: Preferred Network Access Commercial |
$377.20
|
| Rate for Payer: Quartz Beloit One Network |
$200.90
|
| Rate for Payer: Quartz Commercial |
$246.00
|
| Rate for Payer: WEA Trust Commercial |
$225.50
|
| Rate for Payer: WPS Commercial |
$303.69
|
|
|
ADAPTER URETERAL CATHETER CONNECTOR UCA5-95
|
Facility
OP
|
$410.00
|
|
| Hospital Charge Code |
2965124
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$114.80 |
| Max. Negotiated Rate |
$1,640.00 |
| Rate for Payer: Aetna Commercial |
$369.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$352.60
|
| Rate for Payer: Aetna Managed Medicare |
$114.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$266.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$205.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$196.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$217.30
|
| Rate for Payer: Cash Price |
$123.00
|
| Rate for Payer: Cigna Commercial |
$377.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$229.44
|
| Rate for Payer: Health EOS Commercial |
$364.90
|
| Rate for Payer: HFN Commercial |
$377.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$307.50
|
| Rate for Payer: Multiplan Commercial |
$328.00
|
| Rate for Payer: NAPHCARE Commercial |
$246.00
|
| Rate for Payer: Preferred Network Access Commercial |
$377.20
|
| Rate for Payer: Quartz Beloit One Network |
$200.90
|
| Rate for Payer: Quartz Commercial |
$266.50
|
| Rate for Payer: Quartz Medicare Advantage |
$246.00
|
| Rate for Payer: The Alliance Commercial |
$1,640.00
|
| Rate for Payer: WEA Trust Commercial |
$225.50
|
| Rate for Payer: WPS Commercial |
$303.69
|
|
|
ADAPTER VALVED TEE #002061
|
Facility
IP
|
$86.00
|
|
| Hospital Charge Code |
2974634
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$42.14 |
| Max. Negotiated Rate |
$79.12 |
| Rate for Payer: Aetna Commercial |
$77.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$45.58
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Cigna Commercial |
$79.12
|
| Rate for Payer: Health EOS Commercial |
$76.54
|
| Rate for Payer: HFN Commercial |
$79.12
|
| Rate for Payer: Multiplan Commercial |
$68.80
|
| Rate for Payer: NAPHCARE Commercial |
$51.60
|
| Rate for Payer: Preferred Network Access Commercial |
$79.12
|
| Rate for Payer: Quartz Beloit One Network |
$42.14
|
| Rate for Payer: Quartz Commercial |
$51.60
|
| Rate for Payer: WEA Trust Commercial |
$47.30
|
| Rate for Payer: WPS Commercial |
$63.70
|
|
|
ADAPTER VALVED TEE #002061
|
Facility
OP
|
$86.00
|
|
| Hospital Charge Code |
2974634
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$24.08 |
| Max. Negotiated Rate |
$344.00 |
| Rate for Payer: Aetna Commercial |
$77.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$73.96
|
| Rate for Payer: Aetna Managed Medicare |
$24.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$55.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$43.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$41.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$45.58
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Cigna Commercial |
$79.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$48.13
|
| Rate for Payer: Health EOS Commercial |
$76.54
|
| Rate for Payer: HFN Commercial |
$79.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$64.50
|
| Rate for Payer: Multiplan Commercial |
$68.80
|
| Rate for Payer: NAPHCARE Commercial |
$51.60
|
| Rate for Payer: Preferred Network Access Commercial |
$79.12
|
| Rate for Payer: Quartz Beloit One Network |
$42.14
|
| Rate for Payer: Quartz Commercial |
$55.90
|
| Rate for Payer: Quartz Medicare Advantage |
$51.60
|
| Rate for Payer: The Alliance Commercial |
$344.00
|
| Rate for Payer: WEA Trust Commercial |
$47.30
|
| Rate for Payer: WPS Commercial |
$63.70
|
|
|
ADAPTER WIRE BOLT LONG HOFFMANN LIMB 4933-1-005
|
Facility
IP
|
$2,512.00
|
|
| Hospital Charge Code |
6181532
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,230.88 |
| Max. Negotiated Rate |
$2,311.04 |
| Rate for Payer: Aetna Commercial |
$2,260.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,331.36
|
| Rate for Payer: Cash Price |
$753.60
|
| Rate for Payer: Cigna Commercial |
$2,311.04
|
| Rate for Payer: Health EOS Commercial |
$2,235.68
|
| Rate for Payer: HFN Commercial |
$2,311.04
|
| Rate for Payer: Multiplan Commercial |
$2,009.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,507.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,311.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,230.88
|
| Rate for Payer: Quartz Commercial |
$1,507.20
|
| Rate for Payer: WEA Trust Commercial |
$1,381.60
|
| Rate for Payer: WPS Commercial |
$1,860.64
|
|
|
ADAPTER WIRE BOLT LONG HOFFMANN LIMB 4933-1-005
|
Facility
OP
|
$2,512.00
|
|
| Hospital Charge Code |
6181532
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$703.36 |
| Max. Negotiated Rate |
$10,048.00 |
| Rate for Payer: Aetna Commercial |
$2,260.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,160.32
|
| Rate for Payer: Aetna Managed Medicare |
$703.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,632.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,256.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,205.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,331.36
|
| Rate for Payer: Cash Price |
$753.60
|
| Rate for Payer: Cigna Commercial |
$2,311.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,405.72
|
| Rate for Payer: Health EOS Commercial |
$2,235.68
|
| Rate for Payer: HFN Commercial |
$2,311.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,884.00
|
| Rate for Payer: Multiplan Commercial |
$2,009.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,507.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,311.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,230.88
|
| Rate for Payer: Quartz Commercial |
$1,632.80
|
| Rate for Payer: Quartz Medicare Advantage |
$1,507.20
|
| Rate for Payer: The Alliance Commercial |
$10,048.00
|
| Rate for Payer: WEA Trust Commercial |
$1,381.60
|
| Rate for Payer: WPS Commercial |
$1,860.64
|
|
|
ADAPTER WIRE BOLT SHORT HOFFMANN LIMB 4933-1-004
|
Facility
IP
|
$2,155.00
|
|
| Hospital Charge Code |
6181531
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,055.95 |
| Max. Negotiated Rate |
$1,982.60 |
| Rate for Payer: Aetna Commercial |
$1,939.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,142.15
|
| Rate for Payer: Cash Price |
$646.50
|
| Rate for Payer: Cigna Commercial |
$1,982.60
|
| Rate for Payer: Health EOS Commercial |
$1,917.95
|
| Rate for Payer: HFN Commercial |
$1,982.60
|
| Rate for Payer: Multiplan Commercial |
$1,724.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,293.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,982.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,055.95
|
| Rate for Payer: Quartz Commercial |
$1,293.00
|
| Rate for Payer: WEA Trust Commercial |
$1,185.25
|
| Rate for Payer: WPS Commercial |
$1,596.21
|
|
|
ADAPTER WIRE BOLT SHORT HOFFMANN LIMB 4933-1-004
|
Facility
OP
|
$2,155.00
|
|
| Hospital Charge Code |
6181531
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$603.40 |
| Max. Negotiated Rate |
$8,620.00 |
| Rate for Payer: Aetna Commercial |
$1,939.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,853.30
|
| Rate for Payer: Aetna Managed Medicare |
$603.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,400.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,077.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,034.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,142.15
|
| Rate for Payer: Cash Price |
$646.50
|
| Rate for Payer: Cigna Commercial |
$1,982.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,205.94
|
| Rate for Payer: Health EOS Commercial |
$1,917.95
|
| Rate for Payer: HFN Commercial |
$1,982.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,616.25
|
| Rate for Payer: Multiplan Commercial |
$1,724.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,293.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,982.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,055.95
|
| Rate for Payer: Quartz Commercial |
$1,400.75
|
| Rate for Payer: Quartz Medicare Advantage |
$1,293.00
|
| Rate for Payer: The Alliance Commercial |
$8,620.00
|
| Rate for Payer: WEA Trust Commercial |
$1,185.25
|
| Rate for Payer: WPS Commercial |
$1,596.21
|
|
|
ADAPTER Y DLP 10005OS
|
Facility
OP
|
$271.00
|
|
| Hospital Charge Code |
2965370
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$75.88 |
| Max. Negotiated Rate |
$1,084.00 |
| Rate for Payer: Aetna Commercial |
$243.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$233.06
|
| Rate for Payer: Aetna Managed Medicare |
$75.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$176.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$135.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$130.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$143.63
|
| Rate for Payer: Cash Price |
$81.30
|
| Rate for Payer: Cigna Commercial |
$249.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$151.65
|
| Rate for Payer: Health EOS Commercial |
$241.19
|
| Rate for Payer: HFN Commercial |
$249.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$203.25
|
| Rate for Payer: Multiplan Commercial |
$216.80
|
| Rate for Payer: NAPHCARE Commercial |
$162.60
|
| Rate for Payer: Preferred Network Access Commercial |
$249.32
|
| Rate for Payer: Quartz Beloit One Network |
$132.79
|
| Rate for Payer: Quartz Commercial |
$176.15
|
| Rate for Payer: Quartz Medicare Advantage |
$162.60
|
| Rate for Payer: The Alliance Commercial |
$1,084.00
|
| Rate for Payer: WEA Trust Commercial |
$149.05
|
| Rate for Payer: WPS Commercial |
$200.73
|
|
|
ADAPTER Y DLP 10005OS
|
Facility
IP
|
$271.00
|
|
| Hospital Charge Code |
2965370
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$132.79 |
| Max. Negotiated Rate |
$249.32 |
| Rate for Payer: Aetna Commercial |
$243.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$143.63
|
| Rate for Payer: Cash Price |
$81.30
|
| Rate for Payer: Cigna Commercial |
$249.32
|
| Rate for Payer: Health EOS Commercial |
$241.19
|
| Rate for Payer: HFN Commercial |
$249.32
|
| Rate for Payer: Multiplan Commercial |
$216.80
|
| Rate for Payer: NAPHCARE Commercial |
$162.60
|
| Rate for Payer: Preferred Network Access Commercial |
$249.32
|
| Rate for Payer: Quartz Beloit One Network |
$132.79
|
| Rate for Payer: Quartz Commercial |
$162.60
|
| Rate for Payer: WEA Trust Commercial |
$149.05
|
| Rate for Payer: WPS Commercial |
$200.73
|
|
|
ADAPTION PLATE MATRIX MIDFACE 20HL 0.8MM THICK TI 04.503.396
|
Facility
OP
|
$6,388.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6226131
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,788.64 |
| Max. Negotiated Rate |
$5,876.96 |
| Rate for Payer: Aetna Commercial |
$5,749.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,493.68
|
| Rate for Payer: Aetna Managed Medicare |
$1,788.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,152.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,194.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,066.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,385.64
|
| Rate for Payer: Cash Price |
$1,916.40
|
| Rate for Payer: Cigna Commercial |
$5,876.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,574.72
|
| Rate for Payer: Health EOS Commercial |
$5,685.32
|
| Rate for Payer: HFN Commercial |
$5,876.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,791.00
|
| Rate for Payer: Multiplan Commercial |
$5,110.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,832.80
|
| Rate for Payer: Preferred Network Access Commercial |
$5,876.96
|
| Rate for Payer: Quartz Beloit One Network |
$3,130.12
|
| Rate for Payer: Quartz Commercial |
$4,152.20
|
| Rate for Payer: Quartz Medicare Advantage |
$3,832.80
|
| Rate for Payer: WEA Trust Commercial |
$3,513.40
|
| Rate for Payer: WPS Commercial |
$4,731.59
|
|
|
ADAPTION PLATE MATRIX MIDFACE 20HL 0.8MM THICK TI 04.503.396
|
Facility
IP
|
$6,388.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6226131
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,130.12 |
| Max. Negotiated Rate |
$5,876.96 |
| Rate for Payer: Aetna Commercial |
$5,749.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,385.64
|
| Rate for Payer: Cash Price |
$1,916.40
|
| Rate for Payer: Cigna Commercial |
$5,876.96
|
| Rate for Payer: Health EOS Commercial |
$5,685.32
|
| Rate for Payer: HFN Commercial |
$5,876.96
|
| Rate for Payer: Multiplan Commercial |
$5,110.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,832.80
|
| Rate for Payer: Preferred Network Access Commercial |
$5,876.96
|
| Rate for Payer: Quartz Beloit One Network |
$3,130.12
|
| Rate for Payer: Quartz Commercial |
$3,832.80
|
| Rate for Payer: WEA Trust Commercial |
$3,513.40
|
| Rate for Payer: WPS Commercial |
$4,731.59
|
|
|
Adaptor,Clave Vial
|
Facility
IP
|
$4.00
|
|
| Hospital Charge Code |
3040296
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.96 |
| Max. Negotiated Rate |
$3.68 |
| Rate for Payer: Aetna Commercial |
$3.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2.12
|
| Rate for Payer: Cash Price |
$1.20
|
| Rate for Payer: Cigna Commercial |
$3.68
|
| Rate for Payer: Health EOS Commercial |
$3.56
|
| Rate for Payer: HFN Commercial |
$3.68
|
| Rate for Payer: Multiplan Commercial |
$3.20
|
| Rate for Payer: NAPHCARE Commercial |
$2.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3.68
|
| Rate for Payer: Quartz Beloit One Network |
$1.96
|
| Rate for Payer: Quartz Commercial |
$2.40
|
| Rate for Payer: WEA Trust Commercial |
$2.20
|
| Rate for Payer: WPS Commercial |
$2.96
|
|
|
Adaptor,Clave Vial
|
Facility
OP
|
$4.00
|
|
| Hospital Charge Code |
3040296
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.12 |
| Max. Negotiated Rate |
$16.00 |
| Rate for Payer: Aetna Managed Medicare |
$1.12
|
| Rate for Payer: Aetna Commercial |
$3.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2.12
|
| Rate for Payer: Cash Price |
$1.20
|
| Rate for Payer: Cigna Commercial |
$3.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2.24
|
| Rate for Payer: Health EOS Commercial |
$3.56
|
| Rate for Payer: HFN Commercial |
$3.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3.00
|
| Rate for Payer: Multiplan Commercial |
$3.20
|
| Rate for Payer: NAPHCARE Commercial |
$2.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3.68
|
| Rate for Payer: Quartz Beloit One Network |
$1.96
|
| Rate for Payer: Quartz Commercial |
$2.60
|
| Rate for Payer: Quartz Medicare Advantage |
$2.40
|
| Rate for Payer: The Alliance Commercial |
$16.00
|
| Rate for Payer: WEA Trust Commercial |
$2.20
|
| Rate for Payer: WPS Commercial |
$2.96
|
|
|
ADAPTOR LF AIRWAY 1103414
|
Facility
IP
|
$222.00
|
|
| Hospital Charge Code |
2972301
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$108.78 |
| Max. Negotiated Rate |
$204.24 |
| Rate for Payer: Aetna Commercial |
$199.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$117.66
|
| Rate for Payer: Cash Price |
$66.60
|
| Rate for Payer: Cigna Commercial |
$204.24
|
| Rate for Payer: Health EOS Commercial |
$197.58
|
| Rate for Payer: HFN Commercial |
$204.24
|
| Rate for Payer: Multiplan Commercial |
$177.60
|
| Rate for Payer: NAPHCARE Commercial |
$133.20
|
| Rate for Payer: Preferred Network Access Commercial |
$204.24
|
| Rate for Payer: Quartz Beloit One Network |
$108.78
|
| Rate for Payer: Quartz Commercial |
$133.20
|
| Rate for Payer: WEA Trust Commercial |
$122.10
|
| Rate for Payer: WPS Commercial |
$164.44
|
|
|
ADAPTOR LF AIRWAY 1103414
|
Facility
OP
|
$222.00
|
|
| Hospital Charge Code |
2972301
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$62.16 |
| Max. Negotiated Rate |
$888.00 |
| Rate for Payer: Aetna Commercial |
$199.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$190.92
|
| Rate for Payer: Aetna Managed Medicare |
$62.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$144.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$111.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$106.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$117.66
|
| Rate for Payer: Cash Price |
$66.60
|
| Rate for Payer: Cigna Commercial |
$204.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$124.23
|
| Rate for Payer: Health EOS Commercial |
$197.58
|
| Rate for Payer: HFN Commercial |
$204.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$166.50
|
| Rate for Payer: Multiplan Commercial |
$177.60
|
| Rate for Payer: NAPHCARE Commercial |
$133.20
|
| Rate for Payer: Preferred Network Access Commercial |
$204.24
|
| Rate for Payer: Quartz Beloit One Network |
$108.78
|
| Rate for Payer: Quartz Commercial |
$144.30
|
| Rate for Payer: Quartz Medicare Advantage |
$133.20
|
| Rate for Payer: The Alliance Commercial |
$888.00
|
| Rate for Payer: WEA Trust Commercial |
$122.10
|
| Rate for Payer: WPS Commercial |
$164.44
|
|
|
ADAPTOR MULTI #V1422
|
Facility
OP
|
$10.00
|
|
| Hospital Charge Code |
2974400
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$40.00 |
| Rate for Payer: Aetna Commercial |
$9.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8.60
|
| Rate for Payer: Aetna Managed Medicare |
$2.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5.30
|
| Rate for Payer: Cash Price |
$3.00
|
| Rate for Payer: Cigna Commercial |
$9.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.60
|
| Rate for Payer: Health EOS Commercial |
$8.90
|
| Rate for Payer: HFN Commercial |
$9.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7.50
|
| Rate for Payer: Multiplan Commercial |
$8.00
|
| Rate for Payer: NAPHCARE Commercial |
$6.00
|
| Rate for Payer: Preferred Network Access Commercial |
$9.20
|
| Rate for Payer: Quartz Beloit One Network |
$4.90
|
| Rate for Payer: Quartz Commercial |
$6.50
|
| Rate for Payer: Quartz Medicare Advantage |
$6.00
|
| Rate for Payer: The Alliance Commercial |
$40.00
|
| Rate for Payer: WEA Trust Commercial |
$5.50
|
| Rate for Payer: WPS Commercial |
$7.41
|
|
|
ADAPTOR MULTI #V1422
|
Facility
IP
|
$10.00
|
|
| Hospital Charge Code |
2974400
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.90 |
| Max. Negotiated Rate |
$9.20 |
| Rate for Payer: Aetna Commercial |
$9.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5.30
|
| Rate for Payer: Cash Price |
$3.00
|
| Rate for Payer: Cigna Commercial |
$9.20
|
| Rate for Payer: Health EOS Commercial |
$8.90
|
| Rate for Payer: HFN Commercial |
$9.20
|
| Rate for Payer: Multiplan Commercial |
$8.00
|
| Rate for Payer: NAPHCARE Commercial |
$6.00
|
| Rate for Payer: Preferred Network Access Commercial |
$9.20
|
| Rate for Payer: Quartz Beloit One Network |
$4.90
|
| Rate for Payer: Quartz Commercial |
$6.00
|
| Rate for Payer: WEA Trust Commercial |
$5.50
|
| Rate for Payer: WPS Commercial |
$7.41
|
|
|
ADAPTOR SUR NATURA 45ml#401993
|
Facility
OP
|
$21.00
|
|
| Hospital Charge Code |
2970505
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.88 |
| Max. Negotiated Rate |
$84.00 |
| Rate for Payer: Aetna Commercial |
$18.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$18.06
|
| Rate for Payer: Aetna Managed Medicare |
$5.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$13.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11.13
|
| Rate for Payer: Cash Price |
$6.30
|
| Rate for Payer: Cigna Commercial |
$19.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11.75
|
| Rate for Payer: Health EOS Commercial |
$18.69
|
| Rate for Payer: HFN Commercial |
$19.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15.75
|
| Rate for Payer: Multiplan Commercial |
$16.80
|
| Rate for Payer: NAPHCARE Commercial |
$12.60
|
| Rate for Payer: Preferred Network Access Commercial |
$19.32
|
| Rate for Payer: Quartz Beloit One Network |
$10.29
|
| Rate for Payer: Quartz Commercial |
$13.65
|
| Rate for Payer: Quartz Medicare Advantage |
$12.60
|
| Rate for Payer: The Alliance Commercial |
$84.00
|
| Rate for Payer: WEA Trust Commercial |
$11.55
|
| Rate for Payer: WPS Commercial |
$15.55
|
|
|
ADAPTOR SUR NATURA 45ml#401993
|
Facility
IP
|
$21.00
|
|
| Hospital Charge Code |
2970505
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.29 |
| Max. Negotiated Rate |
$19.32 |
| Rate for Payer: Aetna Commercial |
$18.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11.13
|
| Rate for Payer: Cash Price |
$6.30
|
| Rate for Payer: Cigna Commercial |
$19.32
|
| Rate for Payer: Health EOS Commercial |
$18.69
|
| Rate for Payer: HFN Commercial |
$19.32
|
| Rate for Payer: Multiplan Commercial |
$16.80
|
| Rate for Payer: NAPHCARE Commercial |
$12.60
|
| Rate for Payer: Preferred Network Access Commercial |
$19.32
|
| Rate for Payer: Quartz Beloit One Network |
$10.29
|
| Rate for Payer: Quartz Commercial |
$12.60
|
| Rate for Payer: WEA Trust Commercial |
$11.55
|
| Rate for Payer: WPS Commercial |
$15.55
|
|
|
ADD ABLATION OF AF AFTER PVI
|
Facility
OP
|
$7,151.00
|
|
|
Service Code
|
CPT 93657
|
| Hospital Charge Code |
5464770
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,002.28 |
| Max. Negotiated Rate |
$29,139.00 |
| Rate for Payer: Aetna Commercial |
$6,435.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,149.86
|
| Rate for Payer: Aetna Managed Medicare |
$2,002.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$29,139.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$26,420.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$25,100.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,790.03
|
| Rate for Payer: Cash Price |
$2,145.30
|
| Rate for Payer: Cash Price |
$2,145.30
|
| Rate for Payer: Cash Price |
$2,145.30
|
| Rate for Payer: Cigna Commercial |
$6,578.92
|
| Rate for Payer: Health EOS Commercial |
$6,364.39
|
| Rate for Payer: HFN Commercial |
$6,578.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,363.25
|
| Rate for Payer: Multiplan Commercial |
$5,720.80
|
| Rate for Payer: NAPHCARE Commercial |
$4,290.60
|
| Rate for Payer: Preferred Network Access Commercial |
$6,578.92
|
| Rate for Payer: Quartz Beloit One Network |
$3,503.99
|
| Rate for Payer: Quartz Commercial |
$4,648.15
|
| Rate for Payer: Quartz Medicare Advantage |
$4,290.60
|
| Rate for Payer: WEA Trust Commercial |
$3,933.05
|
| Rate for Payer: WPS Commercial |
$5,296.75
|
|
|
ADD ABLATION OF AF AFTER PVI
|
Facility
IP
|
$7,151.00
|
|
|
Service Code
|
CPT 93657
|
| Hospital Charge Code |
5464770
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,503.99 |
| Max. Negotiated Rate |
$6,578.92 |
| Rate for Payer: Aetna Commercial |
$6,435.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,790.03
|
| Rate for Payer: Cash Price |
$2,145.30
|
| Rate for Payer: Cigna Commercial |
$6,578.92
|
| Rate for Payer: Health EOS Commercial |
$6,364.39
|
| Rate for Payer: HFN Commercial |
$6,578.92
|
| Rate for Payer: Multiplan Commercial |
$5,720.80
|
| Rate for Payer: NAPHCARE Commercial |
$4,290.60
|
| Rate for Payer: Preferred Network Access Commercial |
$6,578.92
|
| Rate for Payer: Quartz Beloit One Network |
$3,503.99
|
| Rate for Payer: Quartz Commercial |
$4,290.60
|
| Rate for Payer: WEA Trust Commercial |
$3,933.05
|
| Rate for Payer: WPS Commercial |
$5,296.75
|
|
