|
CANNULA 17FR FEMORAL ARTERIAL 96530-117
|
Facility
OP
|
$3,278.00
|
|
| Hospital Charge Code |
2965355
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$917.84 |
| Max. Negotiated Rate |
$13,112.00 |
| Rate for Payer: Aetna Commercial |
$2,950.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,819.08
|
| Rate for Payer: Aetna Managed Medicare |
$917.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,130.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,639.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,573.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,737.34
|
| Rate for Payer: Cash Price |
$983.40
|
| Rate for Payer: Cigna Commercial |
$3,015.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,834.37
|
| Rate for Payer: Health EOS Commercial |
$2,917.42
|
| Rate for Payer: HFN Commercial |
$3,015.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,458.50
|
| Rate for Payer: Multiplan Commercial |
$2,622.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,966.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,015.76
|
| Rate for Payer: Quartz Beloit One Network |
$1,606.22
|
| Rate for Payer: Quartz Commercial |
$2,130.70
|
| Rate for Payer: Quartz Medicare Advantage |
$1,966.80
|
| Rate for Payer: The Alliance Commercial |
$13,112.00
|
| Rate for Payer: WEA Trust Commercial |
$1,802.90
|
| Rate for Payer: WPS Commercial |
$2,428.01
|
|
|
CANNULA 19FR FEMORAL ARTERIAL 96530-119
|
Facility
OP
|
$3,278.00
|
|
| Hospital Charge Code |
2965356
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$917.84 |
| Max. Negotiated Rate |
$13,112.00 |
| Rate for Payer: Aetna Commercial |
$2,950.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,819.08
|
| Rate for Payer: Aetna Managed Medicare |
$917.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,130.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,639.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,573.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,737.34
|
| Rate for Payer: Cash Price |
$983.40
|
| Rate for Payer: Cigna Commercial |
$3,015.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,834.37
|
| Rate for Payer: Health EOS Commercial |
$2,917.42
|
| Rate for Payer: HFN Commercial |
$3,015.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,458.50
|
| Rate for Payer: Multiplan Commercial |
$2,622.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,966.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,015.76
|
| Rate for Payer: Quartz Beloit One Network |
$1,606.22
|
| Rate for Payer: Quartz Commercial |
$2,130.70
|
| Rate for Payer: Quartz Medicare Advantage |
$1,966.80
|
| Rate for Payer: The Alliance Commercial |
$13,112.00
|
| Rate for Payer: WEA Trust Commercial |
$1,802.90
|
| Rate for Payer: WPS Commercial |
$2,428.01
|
|
|
CANNULA 19FR FEMORAL ARTERIAL 96530-119
|
Facility
IP
|
$3,278.00
|
|
| Hospital Charge Code |
2965356
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,606.22 |
| Max. Negotiated Rate |
$3,015.76 |
| Rate for Payer: Aetna Commercial |
$2,950.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,737.34
|
| Rate for Payer: Cash Price |
$983.40
|
| Rate for Payer: Cigna Commercial |
$3,015.76
|
| Rate for Payer: Health EOS Commercial |
$2,917.42
|
| Rate for Payer: HFN Commercial |
$3,015.76
|
| Rate for Payer: Multiplan Commercial |
$2,622.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,966.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,015.76
|
| Rate for Payer: Quartz Beloit One Network |
$1,606.22
|
| Rate for Payer: Quartz Commercial |
$1,966.80
|
| Rate for Payer: WEA Trust Commercial |
$1,802.90
|
| Rate for Payer: WPS Commercial |
$2,428.01
|
|
|
CANNULA 21FR FEMORAL ARTERIAL 96530-121
|
Facility
OP
|
$3,278.00
|
|
| Hospital Charge Code |
2965357
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$917.84 |
| Max. Negotiated Rate |
$13,112.00 |
| Rate for Payer: Aetna Commercial |
$2,950.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,819.08
|
| Rate for Payer: Aetna Managed Medicare |
$917.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,130.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,639.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,573.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,737.34
|
| Rate for Payer: Cash Price |
$983.40
|
| Rate for Payer: Cigna Commercial |
$3,015.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,834.37
|
| Rate for Payer: Health EOS Commercial |
$2,917.42
|
| Rate for Payer: HFN Commercial |
$3,015.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,458.50
|
| Rate for Payer: Multiplan Commercial |
$2,622.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,966.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,015.76
|
| Rate for Payer: Quartz Beloit One Network |
$1,606.22
|
| Rate for Payer: Quartz Commercial |
$2,130.70
|
| Rate for Payer: Quartz Medicare Advantage |
$1,966.80
|
| Rate for Payer: The Alliance Commercial |
$13,112.00
|
| Rate for Payer: WEA Trust Commercial |
$1,802.90
|
| Rate for Payer: WPS Commercial |
$2,428.01
|
|
|
CANNULA 21FR FEMORAL ARTERIAL 96530-121
|
Facility
IP
|
$3,278.00
|
|
| Hospital Charge Code |
2965357
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,606.22 |
| Max. Negotiated Rate |
$3,015.76 |
| Rate for Payer: Aetna Commercial |
$2,950.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,737.34
|
| Rate for Payer: Cash Price |
$983.40
|
| Rate for Payer: Cigna Commercial |
$3,015.76
|
| Rate for Payer: Health EOS Commercial |
$2,917.42
|
| Rate for Payer: HFN Commercial |
$3,015.76
|
| Rate for Payer: Multiplan Commercial |
$2,622.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,966.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,015.76
|
| Rate for Payer: Quartz Beloit One Network |
$1,606.22
|
| Rate for Payer: Quartz Commercial |
$1,966.80
|
| Rate for Payer: WEA Trust Commercial |
$1,802.90
|
| Rate for Payer: WPS Commercial |
$2,428.01
|
|
|
CANNULA 21FR VENOUS FEMORAL MULTI-STAGE PERCUTANEOUS KIT 96880-021
|
Facility
OP
|
$4,968.00
|
|
| Hospital Charge Code |
2965343
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,391.04 |
| Max. Negotiated Rate |
$19,872.00 |
| Rate for Payer: Aetna Commercial |
$4,471.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,272.48
|
| Rate for Payer: Aetna Managed Medicare |
$1,391.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,229.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,484.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,384.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,633.04
|
| Rate for Payer: Cash Price |
$1,490.40
|
| Rate for Payer: Cigna Commercial |
$4,570.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,780.09
|
| Rate for Payer: Health EOS Commercial |
$4,421.52
|
| Rate for Payer: HFN Commercial |
$4,570.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,726.00
|
| Rate for Payer: Multiplan Commercial |
$3,974.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,980.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,570.56
|
| Rate for Payer: Quartz Beloit One Network |
$2,434.32
|
| Rate for Payer: Quartz Commercial |
$3,229.20
|
| Rate for Payer: Quartz Medicare Advantage |
$2,980.80
|
| Rate for Payer: The Alliance Commercial |
$19,872.00
|
| Rate for Payer: WEA Trust Commercial |
$2,732.40
|
| Rate for Payer: WPS Commercial |
$3,679.80
|
|
|
CANNULA 21FR VENOUS FEMORAL MULTI-STAGE PERCUTANEOUS KIT 96880-021
|
Facility
IP
|
$4,968.00
|
|
| Hospital Charge Code |
2965343
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,434.32 |
| Max. Negotiated Rate |
$4,570.56 |
| Rate for Payer: Aetna Commercial |
$4,471.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,633.04
|
| Rate for Payer: Cash Price |
$1,490.40
|
| Rate for Payer: Cigna Commercial |
$4,570.56
|
| Rate for Payer: Health EOS Commercial |
$4,421.52
|
| Rate for Payer: HFN Commercial |
$4,570.56
|
| Rate for Payer: Multiplan Commercial |
$3,974.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,980.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,570.56
|
| Rate for Payer: Quartz Beloit One Network |
$2,434.32
|
| Rate for Payer: Quartz Commercial |
$2,980.80
|
| Rate for Payer: WEA Trust Commercial |
$2,732.40
|
| Rate for Payer: WPS Commercial |
$3,679.80
|
|
|
CANNULA 25FR VENOUS FEMORAL MULTI-STAGE PERCUTANEOUS KIT 96880-025
|
Facility
IP
|
$4,781.00
|
|
| Hospital Charge Code |
3767526
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,342.69 |
| Max. Negotiated Rate |
$4,398.52 |
| Rate for Payer: Aetna Commercial |
$4,302.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,533.93
|
| Rate for Payer: Cash Price |
$1,434.30
|
| Rate for Payer: Cigna Commercial |
$4,398.52
|
| Rate for Payer: Health EOS Commercial |
$4,255.09
|
| Rate for Payer: HFN Commercial |
$4,398.52
|
| Rate for Payer: Multiplan Commercial |
$3,824.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,868.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,398.52
|
| Rate for Payer: Quartz Beloit One Network |
$2,342.69
|
| Rate for Payer: Quartz Commercial |
$2,868.60
|
| Rate for Payer: WEA Trust Commercial |
$2,629.55
|
| Rate for Payer: WPS Commercial |
$3,541.29
|
|
|
CANNULA 25FR VENOUS FEMORAL MULTI-STAGE PERCUTANEOUS KIT 96880-025
|
Facility
OP
|
$4,781.00
|
|
| Hospital Charge Code |
3767526
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,338.68 |
| Max. Negotiated Rate |
$19,124.00 |
| Rate for Payer: Aetna Commercial |
$4,302.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,111.66
|
| Rate for Payer: Aetna Managed Medicare |
$1,338.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,107.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,390.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,294.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,533.93
|
| Rate for Payer: Cash Price |
$1,434.30
|
| Rate for Payer: Cigna Commercial |
$4,398.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,675.45
|
| Rate for Payer: Health EOS Commercial |
$4,255.09
|
| Rate for Payer: HFN Commercial |
$4,398.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,585.75
|
| Rate for Payer: Multiplan Commercial |
$3,824.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,868.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,398.52
|
| Rate for Payer: Quartz Beloit One Network |
$2,342.69
|
| Rate for Payer: Quartz Commercial |
$3,107.65
|
| Rate for Payer: Quartz Medicare Advantage |
$2,868.60
|
| Rate for Payer: The Alliance Commercial |
$19,124.00
|
| Rate for Payer: WEA Trust Commercial |
$2,629.55
|
| Rate for Payer: WPS Commercial |
$3,541.29
|
|
|
CANNULA 26FR VENOUS ANGLED 67526
|
Facility
IP
|
$1,020.00
|
|
| Hospital Charge Code |
2965373
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$499.80 |
| Max. Negotiated Rate |
$938.40 |
| Rate for Payer: Aetna Commercial |
$918.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$540.60
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Cigna Commercial |
$938.40
|
| Rate for Payer: Health EOS Commercial |
$907.80
|
| Rate for Payer: HFN Commercial |
$938.40
|
| Rate for Payer: Multiplan Commercial |
$816.00
|
| Rate for Payer: NAPHCARE Commercial |
$612.00
|
| Rate for Payer: Preferred Network Access Commercial |
$938.40
|
| Rate for Payer: Quartz Beloit One Network |
$499.80
|
| Rate for Payer: Quartz Commercial |
$612.00
|
| Rate for Payer: WEA Trust Commercial |
$561.00
|
| Rate for Payer: WPS Commercial |
$755.51
|
|
|
CANNULA 26FR VENOUS ANGLED 67526
|
Facility
OP
|
$1,020.00
|
|
| Hospital Charge Code |
2965373
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$285.60 |
| Max. Negotiated Rate |
$4,080.00 |
| Rate for Payer: Aetna Commercial |
$918.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$877.20
|
| Rate for Payer: Aetna Managed Medicare |
$285.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$663.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$510.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$489.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$540.60
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Cigna Commercial |
$938.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$570.79
|
| Rate for Payer: Health EOS Commercial |
$907.80
|
| Rate for Payer: HFN Commercial |
$938.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$765.00
|
| Rate for Payer: Multiplan Commercial |
$816.00
|
| Rate for Payer: NAPHCARE Commercial |
$612.00
|
| Rate for Payer: Preferred Network Access Commercial |
$938.40
|
| Rate for Payer: Quartz Beloit One Network |
$499.80
|
| Rate for Payer: Quartz Commercial |
$663.00
|
| Rate for Payer: Quartz Medicare Advantage |
$612.00
|
| Rate for Payer: The Alliance Commercial |
$4,080.00
|
| Rate for Payer: WEA Trust Commercial |
$561.00
|
| Rate for Payer: WPS Commercial |
$755.51
|
|
|
CANNULA 26FR VENOUS L7208
|
Facility
OP
|
$1,296.00
|
|
| Hospital Charge Code |
2965151
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$362.88 |
| Max. Negotiated Rate |
$5,184.00 |
| Rate for Payer: Aetna Commercial |
$1,166.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,114.56
|
| Rate for Payer: Aetna Managed Medicare |
$362.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$842.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$648.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$622.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$686.88
|
| Rate for Payer: Cash Price |
$388.80
|
| Rate for Payer: Cigna Commercial |
$1,192.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$725.24
|
| Rate for Payer: Health EOS Commercial |
$1,153.44
|
| Rate for Payer: HFN Commercial |
$1,192.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$972.00
|
| Rate for Payer: Multiplan Commercial |
$1,036.80
|
| Rate for Payer: NAPHCARE Commercial |
$777.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,192.32
|
| Rate for Payer: Quartz Beloit One Network |
$635.04
|
| Rate for Payer: Quartz Commercial |
$842.40
|
| Rate for Payer: Quartz Medicare Advantage |
$777.60
|
| Rate for Payer: The Alliance Commercial |
$5,184.00
|
| Rate for Payer: WEA Trust Commercial |
$712.80
|
| Rate for Payer: WPS Commercial |
$959.95
|
|
|
CANNULA 26FR VENOUS L7208
|
Facility
IP
|
$1,296.00
|
|
| Hospital Charge Code |
2965151
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$635.04 |
| Max. Negotiated Rate |
$1,192.32 |
| Rate for Payer: Aetna Commercial |
$1,166.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$686.88
|
| Rate for Payer: Cash Price |
$388.80
|
| Rate for Payer: Cigna Commercial |
$1,192.32
|
| Rate for Payer: Health EOS Commercial |
$1,153.44
|
| Rate for Payer: HFN Commercial |
$1,192.32
|
| Rate for Payer: Multiplan Commercial |
$1,036.80
|
| Rate for Payer: NAPHCARE Commercial |
$777.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,192.32
|
| Rate for Payer: Quartz Beloit One Network |
$635.04
|
| Rate for Payer: Quartz Commercial |
$777.60
|
| Rate for Payer: WEA Trust Commercial |
$712.80
|
| Rate for Payer: WPS Commercial |
$959.95
|
|
|
CANNULA 27FR FEMORAL VENOUS 96370-027
|
Facility
IP
|
$4,260.00
|
|
| Hospital Charge Code |
2965358
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,087.40 |
| Max. Negotiated Rate |
$3,919.20 |
| Rate for Payer: Aetna Commercial |
$3,834.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,257.80
|
| Rate for Payer: Cash Price |
$1,278.00
|
| Rate for Payer: Cigna Commercial |
$3,919.20
|
| Rate for Payer: Health EOS Commercial |
$3,791.40
|
| Rate for Payer: HFN Commercial |
$3,919.20
|
| Rate for Payer: Multiplan Commercial |
$3,408.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,556.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,919.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,087.40
|
| Rate for Payer: Quartz Commercial |
$2,556.00
|
| Rate for Payer: WEA Trust Commercial |
$2,343.00
|
| Rate for Payer: WPS Commercial |
$3,155.38
|
|
|
CANNULA 27FR FEMORAL VENOUS 96370-027
|
Facility
OP
|
$4,260.00
|
|
| Hospital Charge Code |
2965358
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,192.80 |
| Max. Negotiated Rate |
$17,040.00 |
| Rate for Payer: Aetna Commercial |
$3,834.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,663.60
|
| Rate for Payer: Aetna Managed Medicare |
$1,192.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,769.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,130.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,044.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,257.80
|
| Rate for Payer: Cash Price |
$1,278.00
|
| Rate for Payer: Cigna Commercial |
$3,919.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,383.90
|
| Rate for Payer: Health EOS Commercial |
$3,791.40
|
| Rate for Payer: HFN Commercial |
$3,919.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,195.00
|
| Rate for Payer: Multiplan Commercial |
$3,408.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,556.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,919.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,087.40
|
| Rate for Payer: Quartz Commercial |
$2,769.00
|
| Rate for Payer: Quartz Medicare Advantage |
$2,556.00
|
| Rate for Payer: The Alliance Commercial |
$17,040.00
|
| Rate for Payer: WEA Trust Commercial |
$2,343.00
|
| Rate for Payer: WPS Commercial |
$3,155.38
|
|
|
CANNULA 27G CHANG HYDRODISSECTION K20-3168
|
Facility
IP
|
$140.00
|
|
| Hospital Charge Code |
5803642
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$68.60 |
| Max. Negotiated Rate |
$128.80 |
| Rate for Payer: Aetna Commercial |
$126.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$74.20
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cigna Commercial |
$128.80
|
| Rate for Payer: Health EOS Commercial |
$124.60
|
| Rate for Payer: HFN Commercial |
$128.80
|
| Rate for Payer: Multiplan Commercial |
$112.00
|
| Rate for Payer: NAPHCARE Commercial |
$84.00
|
| Rate for Payer: Preferred Network Access Commercial |
$128.80
|
| Rate for Payer: Quartz Beloit One Network |
$68.60
|
| Rate for Payer: Quartz Commercial |
$84.00
|
| Rate for Payer: WEA Trust Commercial |
$77.00
|
| Rate for Payer: WPS Commercial |
$103.70
|
|
|
CANNULA 27G CHANG HYDRODISSECTION K20-3168
|
Facility
OP
|
$140.00
|
|
| Hospital Charge Code |
5803642
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$39.20 |
| Max. Negotiated Rate |
$560.00 |
| Rate for Payer: Aetna Commercial |
$126.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$120.40
|
| Rate for Payer: Aetna Managed Medicare |
$39.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$91.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$70.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$67.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$74.20
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cigna Commercial |
$128.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$78.34
|
| Rate for Payer: Health EOS Commercial |
$124.60
|
| Rate for Payer: HFN Commercial |
$128.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$105.00
|
| Rate for Payer: Multiplan Commercial |
$112.00
|
| Rate for Payer: NAPHCARE Commercial |
$84.00
|
| Rate for Payer: Preferred Network Access Commercial |
$128.80
|
| Rate for Payer: Quartz Beloit One Network |
$68.60
|
| Rate for Payer: Quartz Commercial |
$91.00
|
| Rate for Payer: Quartz Medicare Advantage |
$84.00
|
| Rate for Payer: The Alliance Commercial |
$560.00
|
| Rate for Payer: WEA Trust Commercial |
$77.00
|
| Rate for Payer: WPS Commercial |
$103.70
|
|
|
CANNULA 27G HYDRODISSECTION 8065441920
|
Facility
OP
|
$283.00
|
|
| Hospital Charge Code |
2969447
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$79.24 |
| Max. Negotiated Rate |
$1,132.00 |
| Rate for Payer: Aetna Commercial |
$254.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$243.38
|
| Rate for Payer: Aetna Managed Medicare |
$79.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$183.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$141.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$135.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$149.99
|
| Rate for Payer: Cash Price |
$84.90
|
| Rate for Payer: Cigna Commercial |
$260.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$158.37
|
| Rate for Payer: Health EOS Commercial |
$251.87
|
| Rate for Payer: HFN Commercial |
$260.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$212.25
|
| Rate for Payer: Multiplan Commercial |
$226.40
|
| Rate for Payer: NAPHCARE Commercial |
$169.80
|
| Rate for Payer: Preferred Network Access Commercial |
$260.36
|
| Rate for Payer: Quartz Beloit One Network |
$138.67
|
| Rate for Payer: Quartz Commercial |
$183.95
|
| Rate for Payer: Quartz Medicare Advantage |
$169.80
|
| Rate for Payer: The Alliance Commercial |
$1,132.00
|
| Rate for Payer: WEA Trust Commercial |
$155.65
|
| Rate for Payer: WPS Commercial |
$209.62
|
|
|
CANNULA 27G HYDRODISSECTION 8065441920
|
Facility
IP
|
$283.00
|
|
| Hospital Charge Code |
2969447
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$138.67 |
| Max. Negotiated Rate |
$260.36 |
| Rate for Payer: Aetna Commercial |
$254.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$149.99
|
| Rate for Payer: Cash Price |
$84.90
|
| Rate for Payer: Cigna Commercial |
$260.36
|
| Rate for Payer: Health EOS Commercial |
$251.87
|
| Rate for Payer: HFN Commercial |
$260.36
|
| Rate for Payer: Multiplan Commercial |
$226.40
|
| Rate for Payer: NAPHCARE Commercial |
$169.80
|
| Rate for Payer: Preferred Network Access Commercial |
$260.36
|
| Rate for Payer: Quartz Beloit One Network |
$138.67
|
| Rate for Payer: Quartz Commercial |
$169.80
|
| Rate for Payer: WEA Trust Commercial |
$155.65
|
| Rate for Payer: WPS Commercial |
$209.62
|
|
|
CANNULA 28FR FEMORAL VENOUS 96370-028
|
Facility
OP
|
$4,260.00
|
|
| Hospital Charge Code |
2965338
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,192.80 |
| Max. Negotiated Rate |
$17,040.00 |
| Rate for Payer: Aetna Commercial |
$3,834.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,663.60
|
| Rate for Payer: Aetna Managed Medicare |
$1,192.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,769.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,130.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,044.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,257.80
|
| Rate for Payer: Cash Price |
$1,278.00
|
| Rate for Payer: Cigna Commercial |
$3,919.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,383.90
|
| Rate for Payer: Health EOS Commercial |
$3,791.40
|
| Rate for Payer: HFN Commercial |
$3,919.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,195.00
|
| Rate for Payer: Multiplan Commercial |
$3,408.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,556.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,919.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,087.40
|
| Rate for Payer: Quartz Commercial |
$2,769.00
|
| Rate for Payer: Quartz Medicare Advantage |
$2,556.00
|
| Rate for Payer: The Alliance Commercial |
$17,040.00
|
| Rate for Payer: WEA Trust Commercial |
$2,343.00
|
| Rate for Payer: WPS Commercial |
$3,155.38
|
|
|
CANNULA 28FR FEMORAL VENOUS 96370-028
|
Facility
IP
|
$4,260.00
|
|
| Hospital Charge Code |
2965338
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,087.40 |
| Max. Negotiated Rate |
$3,919.20 |
| Rate for Payer: Aetna Commercial |
$3,834.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,257.80
|
| Rate for Payer: Cash Price |
$1,278.00
|
| Rate for Payer: Cigna Commercial |
$3,919.20
|
| Rate for Payer: Health EOS Commercial |
$3,791.40
|
| Rate for Payer: HFN Commercial |
$3,919.20
|
| Rate for Payer: Multiplan Commercial |
$3,408.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,556.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,919.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,087.40
|
| Rate for Payer: Quartz Commercial |
$2,556.00
|
| Rate for Payer: WEA Trust Commercial |
$2,343.00
|
| Rate for Payer: WPS Commercial |
$3,155.38
|
|
|
CANNULA 28 FR MALLEABLE VENOUS 68128
|
Facility
IP
|
$733.00
|
|
| Hospital Charge Code |
4307167
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$359.17 |
| Max. Negotiated Rate |
$674.36 |
| Rate for Payer: Aetna Commercial |
$659.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$388.49
|
| Rate for Payer: Cash Price |
$219.90
|
| Rate for Payer: Cigna Commercial |
$674.36
|
| Rate for Payer: Health EOS Commercial |
$652.37
|
| Rate for Payer: HFN Commercial |
$674.36
|
| Rate for Payer: Multiplan Commercial |
$586.40
|
| Rate for Payer: NAPHCARE Commercial |
$439.80
|
| Rate for Payer: Preferred Network Access Commercial |
$674.36
|
| Rate for Payer: Quartz Beloit One Network |
$359.17
|
| Rate for Payer: Quartz Commercial |
$439.80
|
| Rate for Payer: WEA Trust Commercial |
$403.15
|
| Rate for Payer: WPS Commercial |
$542.93
|
|
|
CANNULA 28 FR MALLEABLE VENOUS 68128
|
Facility
OP
|
$733.00
|
|
| Hospital Charge Code |
4307167
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$205.24 |
| Max. Negotiated Rate |
$2,932.00 |
| Rate for Payer: Aetna Commercial |
$659.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$630.38
|
| Rate for Payer: Aetna Managed Medicare |
$205.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$476.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$366.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$351.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$388.49
|
| Rate for Payer: Cash Price |
$219.90
|
| Rate for Payer: Cigna Commercial |
$674.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$410.19
|
| Rate for Payer: Health EOS Commercial |
$652.37
|
| Rate for Payer: HFN Commercial |
$674.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$549.75
|
| Rate for Payer: Multiplan Commercial |
$586.40
|
| Rate for Payer: NAPHCARE Commercial |
$439.80
|
| Rate for Payer: Preferred Network Access Commercial |
$674.36
|
| Rate for Payer: Quartz Beloit One Network |
$359.17
|
| Rate for Payer: Quartz Commercial |
$476.45
|
| Rate for Payer: Quartz Medicare Advantage |
$439.80
|
| Rate for Payer: The Alliance Commercial |
$2,932.00
|
| Rate for Payer: WEA Trust Commercial |
$403.15
|
| Rate for Payer: WPS Commercial |
$542.93
|
|
|
CANNULA 28FR VENOUS ANGLED 67528
|
Facility
OP
|
$1,020.00
|
|
| Hospital Charge Code |
2965374
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$285.60 |
| Max. Negotiated Rate |
$4,080.00 |
| Rate for Payer: Aetna Commercial |
$918.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$877.20
|
| Rate for Payer: Aetna Managed Medicare |
$285.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$663.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$510.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$489.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$540.60
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Cigna Commercial |
$938.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$570.79
|
| Rate for Payer: Health EOS Commercial |
$907.80
|
| Rate for Payer: HFN Commercial |
$938.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$765.00
|
| Rate for Payer: Multiplan Commercial |
$816.00
|
| Rate for Payer: NAPHCARE Commercial |
$612.00
|
| Rate for Payer: Preferred Network Access Commercial |
$938.40
|
| Rate for Payer: Quartz Beloit One Network |
$499.80
|
| Rate for Payer: Quartz Commercial |
$663.00
|
| Rate for Payer: Quartz Medicare Advantage |
$612.00
|
| Rate for Payer: The Alliance Commercial |
$4,080.00
|
| Rate for Payer: WEA Trust Commercial |
$561.00
|
| Rate for Payer: WPS Commercial |
$755.51
|
|
|
CANNULA 28FR VENOUS ANGLED 67528
|
Facility
IP
|
$1,020.00
|
|
| Hospital Charge Code |
2965374
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$499.80 |
| Max. Negotiated Rate |
$938.40 |
| Rate for Payer: Aetna Commercial |
$918.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$540.60
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Cigna Commercial |
$938.40
|
| Rate for Payer: Health EOS Commercial |
$907.80
|
| Rate for Payer: HFN Commercial |
$938.40
|
| Rate for Payer: Multiplan Commercial |
$816.00
|
| Rate for Payer: NAPHCARE Commercial |
$612.00
|
| Rate for Payer: Preferred Network Access Commercial |
$938.40
|
| Rate for Payer: Quartz Beloit One Network |
$499.80
|
| Rate for Payer: Quartz Commercial |
$612.00
|
| Rate for Payer: WEA Trust Commercial |
$561.00
|
| Rate for Payer: WPS Commercial |
$755.51
|
|
