|
ADAPTER URETERAL CATHETER CONNECTOR UCA5-95
|
Facility
|
OP
|
$410.00
|
|
| Hospital Charge Code |
2965124
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$119.39 |
| Max. Negotiated Rate |
$392.29 |
| Rate for Payer: Aetna Commercial |
$383.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$366.70
|
| Rate for Payer: Aetna Managed Medicare |
$119.39
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$277.16
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$213.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$204.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$225.99
|
| Rate for Payer: Cash Price |
$123.00
|
| Rate for Payer: Cigna Commercial |
$392.29
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$238.62
|
| Rate for Payer: Health EOS Commercial |
$379.50
|
| Rate for Payer: HFN Commercial |
$392.29
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$319.80
|
| Rate for Payer: Multiplan Commercial |
$341.12
|
| Rate for Payer: NAPHCARE Commercial |
$255.84
|
| Rate for Payer: Preferred Network Access Commercial |
$392.29
|
| Rate for Payer: Quartz Beloit One Network |
$208.94
|
| Rate for Payer: Quartz Commercial |
$277.16
|
| Rate for Payer: Quartz Medicare Advantage |
$255.84
|
| Rate for Payer: The Alliance Commercial |
$213.20
|
| Rate for Payer: WEA Trust Commercial |
$234.52
|
| Rate for Payer: WPS Commercial |
$315.82
|
|
|
ADAPTER URETERAL CATHETER CONNECTOR UCA5-95
|
Facility
|
IP
|
$410.00
|
|
| Hospital Charge Code |
2965124
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$208.94 |
| Max. Negotiated Rate |
$392.29 |
| Rate for Payer: Aetna Commercial |
$383.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$366.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$225.99
|
| Rate for Payer: Cash Price |
$123.00
|
| Rate for Payer: Cigna Commercial |
$392.29
|
| Rate for Payer: Health EOS Commercial |
$379.50
|
| Rate for Payer: HFN Commercial |
$392.29
|
| Rate for Payer: Multiplan Commercial |
$341.12
|
| Rate for Payer: Preferred Network Access Commercial |
$392.29
|
| Rate for Payer: Quartz Beloit One Network |
$208.94
|
| Rate for Payer: Quartz Commercial |
$255.84
|
| Rate for Payer: WEA Trust Commercial |
$234.52
|
| Rate for Payer: WPS Commercial |
$315.82
|
|
|
ADAPTER VALVED TEE #002061
|
Facility
|
IP
|
$86.00
|
|
| Hospital Charge Code |
2974634
|
|
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
|
|
|
ADAPTER VALVED TEE #002061
|
Facility
|
OP
|
$86.00
|
|
| Hospital Charge Code |
2974634
|
|
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: 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 |
$44.72
|
| Rate for Payer: WEA Trust Commercial |
$49.19
|
| Rate for Payer: WPS Commercial |
$66.25
|
|
|
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 |
$731.49 |
| Max. Negotiated Rate |
$2,403.48 |
| Rate for Payer: Aetna Commercial |
$2,351.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,246.73
|
| Rate for Payer: Aetna Managed Medicare |
$731.49
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,698.11
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,306.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,253.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,384.61
|
| Rate for Payer: Cash Price |
$753.60
|
| Rate for Payer: Cigna Commercial |
$2,403.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,461.98
|
| Rate for Payer: Health EOS Commercial |
$2,325.11
|
| Rate for Payer: HFN Commercial |
$2,403.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,959.36
|
| Rate for Payer: Multiplan Commercial |
$2,089.98
|
| Rate for Payer: NAPHCARE Commercial |
$1,567.49
|
| Rate for Payer: Preferred Network Access Commercial |
$2,403.48
|
| Rate for Payer: Quartz Beloit One Network |
$1,280.12
|
| Rate for Payer: Quartz Commercial |
$1,698.11
|
| Rate for Payer: Quartz Medicare Advantage |
$1,567.49
|
| Rate for Payer: The Alliance Commercial |
$1,306.24
|
| Rate for Payer: WEA Trust Commercial |
$1,436.86
|
| Rate for Payer: WPS Commercial |
$1,934.99
|
|
|
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 |
$1,280.12 |
| Max. Negotiated Rate |
$2,403.48 |
| Rate for Payer: Aetna Commercial |
$2,351.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,246.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,384.61
|
| Rate for Payer: Cash Price |
$753.60
|
| Rate for Payer: Cigna Commercial |
$2,403.48
|
| Rate for Payer: Health EOS Commercial |
$2,325.11
|
| Rate for Payer: HFN Commercial |
$2,403.48
|
| Rate for Payer: Multiplan Commercial |
$2,089.98
|
| Rate for Payer: Preferred Network Access Commercial |
$2,403.48
|
| Rate for Payer: Quartz Beloit One Network |
$1,280.12
|
| Rate for Payer: Quartz Commercial |
$1,567.49
|
| Rate for Payer: WEA Trust Commercial |
$1,436.86
|
| Rate for Payer: WPS Commercial |
$1,934.99
|
|
|
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 |
$1,098.19 |
| Max. Negotiated Rate |
$2,061.90 |
| Rate for Payer: Aetna Commercial |
$2,017.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,927.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,187.84
|
| Rate for Payer: Cash Price |
$646.50
|
| Rate for Payer: Cigna Commercial |
$2,061.90
|
| Rate for Payer: Health EOS Commercial |
$1,994.67
|
| Rate for Payer: HFN Commercial |
$2,061.90
|
| Rate for Payer: Multiplan Commercial |
$1,792.96
|
| Rate for Payer: Preferred Network Access Commercial |
$2,061.90
|
| Rate for Payer: Quartz Beloit One Network |
$1,098.19
|
| Rate for Payer: Quartz Commercial |
$1,344.72
|
| Rate for Payer: WEA Trust Commercial |
$1,232.66
|
| Rate for Payer: WPS Commercial |
$1,660.00
|
|
|
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 |
$627.54 |
| Max. Negotiated Rate |
$2,061.90 |
| Rate for Payer: Aetna Commercial |
$2,017.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,927.43
|
| Rate for Payer: Aetna Managed Medicare |
$627.54
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,456.78
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,120.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,075.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,187.84
|
| Rate for Payer: Cash Price |
$646.50
|
| Rate for Payer: Cigna Commercial |
$2,061.90
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,254.21
|
| Rate for Payer: Health EOS Commercial |
$1,994.67
|
| Rate for Payer: HFN Commercial |
$2,061.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,680.90
|
| Rate for Payer: Multiplan Commercial |
$1,792.96
|
| Rate for Payer: NAPHCARE Commercial |
$1,344.72
|
| Rate for Payer: Preferred Network Access Commercial |
$2,061.90
|
| Rate for Payer: Quartz Beloit One Network |
$1,098.19
|
| Rate for Payer: Quartz Commercial |
$1,456.78
|
| Rate for Payer: Quartz Medicare Advantage |
$1,344.72
|
| Rate for Payer: The Alliance Commercial |
$1,120.60
|
| Rate for Payer: WEA Trust Commercial |
$1,232.66
|
| Rate for Payer: WPS Commercial |
$1,660.00
|
|
|
ADAPTER Y DLP 10005OS
|
Facility
|
IP
|
$271.00
|
|
| Hospital Charge Code |
2965370
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$138.10 |
| Max. Negotiated Rate |
$259.29 |
| Rate for Payer: Aetna Commercial |
$253.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$242.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$149.38
|
| Rate for Payer: Cash Price |
$81.30
|
| Rate for Payer: Cigna Commercial |
$259.29
|
| Rate for Payer: Health EOS Commercial |
$250.84
|
| Rate for Payer: HFN Commercial |
$259.29
|
| Rate for Payer: Multiplan Commercial |
$225.47
|
| Rate for Payer: Preferred Network Access Commercial |
$259.29
|
| Rate for Payer: Quartz Beloit One Network |
$138.10
|
| Rate for Payer: Quartz Commercial |
$169.10
|
| Rate for Payer: WEA Trust Commercial |
$155.01
|
| Rate for Payer: WPS Commercial |
$208.75
|
|
|
ADAPTER Y DLP 10005OS
|
Facility
|
OP
|
$271.00
|
|
| Hospital Charge Code |
2965370
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$78.92 |
| Max. Negotiated Rate |
$259.29 |
| Rate for Payer: Aetna Commercial |
$253.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$242.38
|
| Rate for Payer: Aetna Managed Medicare |
$78.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$183.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$140.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$135.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$149.38
|
| Rate for Payer: Cash Price |
$81.30
|
| Rate for Payer: Cigna Commercial |
$259.29
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$157.72
|
| Rate for Payer: Health EOS Commercial |
$250.84
|
| Rate for Payer: HFN Commercial |
$259.29
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$211.38
|
| Rate for Payer: Multiplan Commercial |
$225.47
|
| Rate for Payer: NAPHCARE Commercial |
$169.10
|
| Rate for Payer: Preferred Network Access Commercial |
$259.29
|
| Rate for Payer: Quartz Beloit One Network |
$138.10
|
| Rate for Payer: Quartz Commercial |
$183.20
|
| Rate for Payer: Quartz Medicare Advantage |
$169.10
|
| Rate for Payer: The Alliance Commercial |
$140.92
|
| Rate for Payer: WEA Trust Commercial |
$155.01
|
| Rate for Payer: WPS Commercial |
$208.75
|
|
|
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 |
$3,255.32 |
| Max. Negotiated Rate |
$6,112.04 |
| Rate for Payer: Aetna Commercial |
$5,979.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,713.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,521.07
|
| Rate for Payer: Cash Price |
$1,916.40
|
| Rate for Payer: Cigna Commercial |
$6,112.04
|
| Rate for Payer: Health EOS Commercial |
$5,912.73
|
| Rate for Payer: HFN Commercial |
$6,112.04
|
| Rate for Payer: Multiplan Commercial |
$5,314.82
|
| Rate for Payer: Preferred Network Access Commercial |
$6,112.04
|
| Rate for Payer: Quartz Beloit One Network |
$3,255.32
|
| Rate for Payer: Quartz Commercial |
$3,986.11
|
| Rate for Payer: WEA Trust Commercial |
$3,653.94
|
| Rate for Payer: WPS Commercial |
$4,920.68
|
|
|
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 |
$1,860.19 |
| Max. Negotiated Rate |
$6,112.04 |
| Rate for Payer: Aetna Commercial |
$5,979.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,713.43
|
| Rate for Payer: Aetna Managed Medicare |
$1,860.19
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,318.29
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,321.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,188.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,521.07
|
| Rate for Payer: Cash Price |
$1,916.40
|
| Rate for Payer: Cigna Commercial |
$6,112.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,717.82
|
| Rate for Payer: Health EOS Commercial |
$5,912.73
|
| Rate for Payer: HFN Commercial |
$6,112.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,982.64
|
| Rate for Payer: Multiplan Commercial |
$5,314.82
|
| Rate for Payer: NAPHCARE Commercial |
$3,986.11
|
| Rate for Payer: Preferred Network Access Commercial |
$6,112.04
|
| Rate for Payer: Quartz Beloit One Network |
$3,255.32
|
| Rate for Payer: Quartz Commercial |
$4,318.29
|
| Rate for Payer: Quartz Medicare Advantage |
$3,986.11
|
| Rate for Payer: The Alliance Commercial |
$3,321.76
|
| Rate for Payer: WEA Trust Commercial |
$3,653.94
|
| Rate for Payer: WPS Commercial |
$4,920.68
|
|
|
Adaptor,Clave Vial
|
Facility
|
OP
|
$4.00
|
|
| Hospital Charge Code |
3040296
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.16 |
| Max. Negotiated Rate |
$3.83 |
| Rate for Payer: Aetna Commercial |
$3.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3.58
|
| Rate for Payer: Aetna Managed Medicare |
$1.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2.20
|
| Rate for Payer: Cash Price |
$1.20
|
| Rate for Payer: Cigna Commercial |
$3.83
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2.33
|
| Rate for Payer: Health EOS Commercial |
$3.70
|
| Rate for Payer: HFN Commercial |
$3.83
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3.12
|
| Rate for Payer: Multiplan Commercial |
$3.33
|
| Rate for Payer: NAPHCARE Commercial |
$2.50
|
| Rate for Payer: Preferred Network Access Commercial |
$3.83
|
| Rate for Payer: Quartz Beloit One Network |
$2.04
|
| Rate for Payer: Quartz Commercial |
$2.70
|
| Rate for Payer: Quartz Medicare Advantage |
$2.50
|
| Rate for Payer: The Alliance Commercial |
$2.08
|
| Rate for Payer: WEA Trust Commercial |
$2.29
|
| Rate for Payer: WPS Commercial |
$3.08
|
|
|
Adaptor,Clave Vial
|
Facility
|
IP
|
$4.00
|
|
| Hospital Charge Code |
3040296
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$2.04 |
| Max. Negotiated Rate |
$3.83 |
| Rate for Payer: Aetna Commercial |
$3.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2.20
|
| Rate for Payer: Cash Price |
$1.20
|
| Rate for Payer: Cigna Commercial |
$3.83
|
| Rate for Payer: Health EOS Commercial |
$3.70
|
| Rate for Payer: HFN Commercial |
$3.83
|
| Rate for Payer: Multiplan Commercial |
$3.33
|
| Rate for Payer: Preferred Network Access Commercial |
$3.83
|
| Rate for Payer: Quartz Beloit One Network |
$2.04
|
| Rate for Payer: Quartz Commercial |
$2.50
|
| Rate for Payer: WEA Trust Commercial |
$2.29
|
| Rate for Payer: WPS Commercial |
$3.08
|
|
|
ADAPTOR LF AIRWAY 1103414
|
Facility
|
IP
|
$222.00
|
|
| Hospital Charge Code |
2972301
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$113.13 |
| Max. Negotiated Rate |
$212.41 |
| Rate for Payer: Aetna Commercial |
$207.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$198.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$122.37
|
| Rate for Payer: Cash Price |
$66.60
|
| Rate for Payer: Cigna Commercial |
$212.41
|
| Rate for Payer: Health EOS Commercial |
$205.48
|
| Rate for Payer: HFN Commercial |
$212.41
|
| Rate for Payer: Multiplan Commercial |
$184.70
|
| Rate for Payer: Preferred Network Access Commercial |
$212.41
|
| Rate for Payer: Quartz Beloit One Network |
$113.13
|
| Rate for Payer: Quartz Commercial |
$138.53
|
| Rate for Payer: WEA Trust Commercial |
$126.98
|
| Rate for Payer: WPS Commercial |
$171.01
|
|
|
ADAPTOR LF AIRWAY 1103414
|
Facility
|
OP
|
$222.00
|
|
| Hospital Charge Code |
2972301
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$64.65 |
| Max. Negotiated Rate |
$212.41 |
| Rate for Payer: Aetna Commercial |
$207.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$198.56
|
| Rate for Payer: Aetna Managed Medicare |
$64.65
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$150.07
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$115.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$110.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$122.37
|
| Rate for Payer: Cash Price |
$66.60
|
| Rate for Payer: Cigna Commercial |
$212.41
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$129.20
|
| Rate for Payer: Health EOS Commercial |
$205.48
|
| Rate for Payer: HFN Commercial |
$212.41
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$173.16
|
| Rate for Payer: Multiplan Commercial |
$184.70
|
| Rate for Payer: NAPHCARE Commercial |
$138.53
|
| Rate for Payer: Preferred Network Access Commercial |
$212.41
|
| Rate for Payer: Quartz Beloit One Network |
$113.13
|
| Rate for Payer: Quartz Commercial |
$150.07
|
| Rate for Payer: Quartz Medicare Advantage |
$138.53
|
| Rate for Payer: The Alliance Commercial |
$115.44
|
| Rate for Payer: WEA Trust Commercial |
$126.98
|
| Rate for Payer: WPS Commercial |
$171.01
|
|
|
ADAPTOR MULTI #V1422
|
Facility
|
OP
|
$10.00
|
|
| Hospital Charge Code |
2974400
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.91 |
| Max. Negotiated Rate |
$9.57 |
| Rate for Payer: Aetna Commercial |
$9.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8.94
|
| Rate for Payer: Aetna Managed Medicare |
$2.91
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6.76
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5.51
|
| Rate for Payer: Cash Price |
$3.00
|
| Rate for Payer: Cigna Commercial |
$9.57
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.82
|
| Rate for Payer: Health EOS Commercial |
$9.26
|
| Rate for Payer: HFN Commercial |
$9.57
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7.80
|
| Rate for Payer: Multiplan Commercial |
$8.32
|
| Rate for Payer: NAPHCARE Commercial |
$6.24
|
| Rate for Payer: Preferred Network Access Commercial |
$9.57
|
| Rate for Payer: Quartz Beloit One Network |
$5.10
|
| Rate for Payer: Quartz Commercial |
$6.76
|
| Rate for Payer: Quartz Medicare Advantage |
$6.24
|
| Rate for Payer: The Alliance Commercial |
$5.20
|
| Rate for Payer: WEA Trust Commercial |
$5.72
|
| Rate for Payer: WPS Commercial |
$7.70
|
|
|
ADAPTOR MULTI #V1422
|
Facility
|
IP
|
$10.00
|
|
| Hospital Charge Code |
2974400
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.10 |
| Max. Negotiated Rate |
$9.57 |
| Rate for Payer: Aetna Commercial |
$9.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5.51
|
| Rate for Payer: Cash Price |
$3.00
|
| Rate for Payer: Cigna Commercial |
$9.57
|
| Rate for Payer: Health EOS Commercial |
$9.26
|
| Rate for Payer: HFN Commercial |
$9.57
|
| Rate for Payer: Multiplan Commercial |
$8.32
|
| Rate for Payer: Preferred Network Access Commercial |
$9.57
|
| Rate for Payer: Quartz Beloit One Network |
$5.10
|
| Rate for Payer: Quartz Commercial |
$6.24
|
| Rate for Payer: WEA Trust Commercial |
$5.72
|
| Rate for Payer: WPS Commercial |
$7.70
|
|
|
ADAPTOR PRESSURE LINE 1642
|
Facility
|
IP
|
$21.00
|
|
| Hospital Charge Code |
2974449
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.70 |
| Max. Negotiated Rate |
$20.09 |
| Rate for Payer: Aetna Commercial |
$19.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$18.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11.58
|
| Rate for Payer: Cash Price |
$6.30
|
| Rate for Payer: Cigna Commercial |
$20.09
|
| Rate for Payer: Health EOS Commercial |
$19.44
|
| Rate for Payer: HFN Commercial |
$20.09
|
| Rate for Payer: Multiplan Commercial |
$17.47
|
| Rate for Payer: Preferred Network Access Commercial |
$20.09
|
| Rate for Payer: Quartz Beloit One Network |
$10.70
|
| Rate for Payer: Quartz Commercial |
$13.10
|
| Rate for Payer: WEA Trust Commercial |
$12.01
|
| Rate for Payer: WPS Commercial |
$16.18
|
|
|
ADAPTOR PRESSURE LINE 1642
|
Facility
|
OP
|
$21.00
|
|
| Hospital Charge Code |
2974449
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.12 |
| Max. Negotiated Rate |
$20.09 |
| Rate for Payer: Aetna Commercial |
$19.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$18.78
|
| Rate for Payer: Aetna Managed Medicare |
$6.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$14.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11.58
|
| Rate for Payer: Cash Price |
$6.30
|
| Rate for Payer: Cigna Commercial |
$20.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12.22
|
| Rate for Payer: Health EOS Commercial |
$19.44
|
| Rate for Payer: HFN Commercial |
$20.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$16.38
|
| Rate for Payer: Multiplan Commercial |
$17.47
|
| Rate for Payer: NAPHCARE Commercial |
$13.10
|
| Rate for Payer: Preferred Network Access Commercial |
$20.09
|
| Rate for Payer: Quartz Beloit One Network |
$10.70
|
| Rate for Payer: Quartz Commercial |
$14.20
|
| Rate for Payer: Quartz Medicare Advantage |
$13.10
|
| Rate for Payer: The Alliance Commercial |
$10.92
|
| Rate for Payer: WEA Trust Commercial |
$12.01
|
| Rate for Payer: WPS Commercial |
$16.18
|
|
|
ADAPTOR SUR NATURA 45ml#401993
|
Facility
|
IP
|
$21.00
|
|
| Hospital Charge Code |
2970505
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.70 |
| Max. Negotiated Rate |
$20.09 |
| Rate for Payer: Aetna Commercial |
$19.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$18.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11.58
|
| Rate for Payer: Cash Price |
$6.30
|
| Rate for Payer: Cigna Commercial |
$20.09
|
| Rate for Payer: Health EOS Commercial |
$19.44
|
| Rate for Payer: HFN Commercial |
$20.09
|
| Rate for Payer: Multiplan Commercial |
$17.47
|
| Rate for Payer: Preferred Network Access Commercial |
$20.09
|
| Rate for Payer: Quartz Beloit One Network |
$10.70
|
| Rate for Payer: Quartz Commercial |
$13.10
|
| Rate for Payer: WEA Trust Commercial |
$12.01
|
| Rate for Payer: WPS Commercial |
$16.18
|
|
|
ADAPTOR SUR NATURA 45ml#401993
|
Facility
|
OP
|
$21.00
|
|
| Hospital Charge Code |
2970505
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.12 |
| Max. Negotiated Rate |
$20.09 |
| Rate for Payer: Aetna Commercial |
$19.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$18.78
|
| Rate for Payer: Aetna Managed Medicare |
$6.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$14.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11.58
|
| Rate for Payer: Cash Price |
$6.30
|
| Rate for Payer: Cigna Commercial |
$20.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12.22
|
| Rate for Payer: Health EOS Commercial |
$19.44
|
| Rate for Payer: HFN Commercial |
$20.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$16.38
|
| Rate for Payer: Multiplan Commercial |
$17.47
|
| Rate for Payer: NAPHCARE Commercial |
$13.10
|
| Rate for Payer: Preferred Network Access Commercial |
$20.09
|
| Rate for Payer: Quartz Beloit One Network |
$10.70
|
| Rate for Payer: Quartz Commercial |
$14.20
|
| Rate for Payer: Quartz Medicare Advantage |
$13.10
|
| Rate for Payer: The Alliance Commercial |
$10.92
|
| Rate for Payer: WEA Trust Commercial |
$12.01
|
| Rate for Payer: WPS Commercial |
$16.18
|
|
|
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 |
$956.18 |
| Max. Negotiated Rate |
$30,304.56 |
| Rate for Payer: Aetna Commercial |
$6,693.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,395.85
|
| Rate for Payer: Aetna Managed Medicare |
$2,082.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$30,304.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$27,476.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$26,104.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,941.63
|
| 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 |
$6,842.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,161.88
|
| Rate for Payer: Health EOS Commercial |
$6,618.97
|
| Rate for Payer: HFN Commercial |
$6,842.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,577.78
|
| Rate for Payer: Multiplan Commercial |
$5,949.63
|
| Rate for Payer: NAPHCARE Commercial |
$4,462.22
|
| Rate for Payer: Preferred Network Access Commercial |
$6,842.08
|
| Rate for Payer: Quartz Beloit One Network |
$3,644.15
|
| Rate for Payer: Quartz Commercial |
$4,834.08
|
| Rate for Payer: Quartz Medicare Advantage |
$4,462.22
|
| Rate for Payer: The Alliance Commercial |
$956.18
|
| Rate for Payer: WEA Trust Commercial |
$4,090.37
|
| Rate for Payer: WPS Commercial |
$5,508.42
|
|
|
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 |
$3,644.15 |
| Max. Negotiated Rate |
$6,842.08 |
| Rate for Payer: Aetna Commercial |
$6,693.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,395.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,941.63
|
| Rate for Payer: Cash Price |
$2,145.30
|
| Rate for Payer: Cigna Commercial |
$6,842.08
|
| Rate for Payer: Health EOS Commercial |
$6,618.97
|
| Rate for Payer: HFN Commercial |
$6,842.08
|
| Rate for Payer: Multiplan Commercial |
$5,949.63
|
| Rate for Payer: Preferred Network Access Commercial |
$6,842.08
|
| Rate for Payer: Quartz Beloit One Network |
$3,644.15
|
| Rate for Payer: Quartz Commercial |
$4,462.22
|
| Rate for Payer: WEA Trust Commercial |
$4,090.37
|
| Rate for Payer: WPS Commercial |
$5,508.42
|
|
|
Additional 30 min Increments, Critical Care >74 min - 99292
|
Facility
|
IP
|
$1,832.00
|
|
|
Service Code
|
CPT 99292
|
| Hospital Charge Code |
5516692
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$933.59 |
| Max. Negotiated Rate |
$1,752.86 |
| Rate for Payer: Aetna Commercial |
$1,714.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,638.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,009.80
|
| Rate for Payer: Cash Price |
$549.60
|
| Rate for Payer: Cigna Commercial |
$1,752.86
|
| Rate for Payer: Health EOS Commercial |
$1,695.70
|
| Rate for Payer: HFN Commercial |
$1,752.86
|
| Rate for Payer: Multiplan Commercial |
$1,524.22
|
| Rate for Payer: Preferred Network Access Commercial |
$1,752.86
|
| Rate for Payer: Quartz Beloit One Network |
$933.59
|
| Rate for Payer: Quartz Commercial |
$1,143.17
|
| Rate for Payer: WEA Trust Commercial |
$1,047.90
|
| Rate for Payer: WPS Commercial |
$1,411.19
|
|
