|
CANNULA 36/46FR 2-STAGE VENOUS 91265C
|
Facility
IP
|
$647.00
|
|
| Hospital Charge Code |
2965302
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$317.03 |
| Max. Negotiated Rate |
$595.24 |
| Rate for Payer: Aetna Commercial |
$582.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$342.91
|
| Rate for Payer: Cash Price |
$194.10
|
| Rate for Payer: Cigna Commercial |
$595.24
|
| Rate for Payer: Health EOS Commercial |
$575.83
|
| Rate for Payer: HFN Commercial |
$595.24
|
| Rate for Payer: Multiplan Commercial |
$517.60
|
| Rate for Payer: NAPHCARE Commercial |
$388.20
|
| Rate for Payer: Preferred Network Access Commercial |
$595.24
|
| Rate for Payer: Quartz Beloit One Network |
$317.03
|
| Rate for Payer: Quartz Commercial |
$388.20
|
| Rate for Payer: WEA Trust Commercial |
$355.85
|
| Rate for Payer: WPS Commercial |
$479.23
|
|
|
CANNULA 36FR VENOUS L7213
|
Facility
IP
|
$1,296.00
|
|
| Hospital Charge Code |
2965156
|
|
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 36FR VENOUS L7213
|
Facility
OP
|
$1,296.00
|
|
| Hospital Charge Code |
2965156
|
|
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 4X26 ACCELERATOR III 426-COP
|
Facility
IP
|
$367.00
|
|
| Hospital Charge Code |
2965387
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$179.83 |
| Max. Negotiated Rate |
$337.64 |
| Rate for Payer: Aetna Commercial |
$330.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$194.51
|
| Rate for Payer: Cash Price |
$110.10
|
| Rate for Payer: Cigna Commercial |
$337.64
|
| Rate for Payer: Health EOS Commercial |
$326.63
|
| Rate for Payer: HFN Commercial |
$337.64
|
| Rate for Payer: Multiplan Commercial |
$293.60
|
| Rate for Payer: NAPHCARE Commercial |
$220.20
|
| Rate for Payer: Preferred Network Access Commercial |
$337.64
|
| Rate for Payer: Quartz Beloit One Network |
$179.83
|
| Rate for Payer: Quartz Commercial |
$220.20
|
| Rate for Payer: WEA Trust Commercial |
$201.85
|
| Rate for Payer: WPS Commercial |
$271.84
|
|
|
CANNULA 4X26 ACCELERATOR III 426-COP
|
Facility
OP
|
$367.00
|
|
| Hospital Charge Code |
2965387
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$102.76 |
| Max. Negotiated Rate |
$1,468.00 |
| Rate for Payer: Aetna Commercial |
$330.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$315.62
|
| Rate for Payer: Aetna Managed Medicare |
$102.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$238.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$183.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$176.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$194.51
|
| Rate for Payer: Cash Price |
$110.10
|
| Rate for Payer: Cigna Commercial |
$337.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$205.37
|
| Rate for Payer: Health EOS Commercial |
$326.63
|
| Rate for Payer: HFN Commercial |
$337.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$275.25
|
| Rate for Payer: Multiplan Commercial |
$293.60
|
| Rate for Payer: NAPHCARE Commercial |
$220.20
|
| Rate for Payer: Preferred Network Access Commercial |
$337.64
|
| Rate for Payer: Quartz Beloit One Network |
$179.83
|
| Rate for Payer: Quartz Commercial |
$238.55
|
| Rate for Payer: Quartz Medicare Advantage |
$220.20
|
| Rate for Payer: The Alliance Commercial |
$1,468.00
|
| Rate for Payer: WEA Trust Commercial |
$201.85
|
| Rate for Payer: WPS Commercial |
$271.84
|
|
|
CANNULA 5xX6 ACCELERATOR III 526-COP
|
Facility
IP
|
$367.00
|
|
| Hospital Charge Code |
2965388
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$179.83 |
| Max. Negotiated Rate |
$337.64 |
| Rate for Payer: Aetna Commercial |
$330.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$194.51
|
| Rate for Payer: Cash Price |
$110.10
|
| Rate for Payer: Cigna Commercial |
$337.64
|
| Rate for Payer: Health EOS Commercial |
$326.63
|
| Rate for Payer: HFN Commercial |
$337.64
|
| Rate for Payer: Multiplan Commercial |
$293.60
|
| Rate for Payer: NAPHCARE Commercial |
$220.20
|
| Rate for Payer: Preferred Network Access Commercial |
$337.64
|
| Rate for Payer: Quartz Beloit One Network |
$179.83
|
| Rate for Payer: Quartz Commercial |
$220.20
|
| Rate for Payer: WEA Trust Commercial |
$201.85
|
| Rate for Payer: WPS Commercial |
$271.84
|
|
|
CANNULA 5xX6 ACCELERATOR III 526-COP
|
Facility
OP
|
$367.00
|
|
| Hospital Charge Code |
2965388
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$102.76 |
| Max. Negotiated Rate |
$1,468.00 |
| Rate for Payer: Aetna Commercial |
$330.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$315.62
|
| Rate for Payer: Aetna Managed Medicare |
$102.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$238.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$183.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$176.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$194.51
|
| Rate for Payer: Cash Price |
$110.10
|
| Rate for Payer: Cigna Commercial |
$337.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$205.37
|
| Rate for Payer: Health EOS Commercial |
$326.63
|
| Rate for Payer: HFN Commercial |
$337.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$275.25
|
| Rate for Payer: Multiplan Commercial |
$293.60
|
| Rate for Payer: NAPHCARE Commercial |
$220.20
|
| Rate for Payer: Preferred Network Access Commercial |
$337.64
|
| Rate for Payer: Quartz Beloit One Network |
$179.83
|
| Rate for Payer: Quartz Commercial |
$238.55
|
| Rate for Payer: Quartz Medicare Advantage |
$220.20
|
| Rate for Payer: The Alliance Commercial |
$1,468.00
|
| Rate for Payer: WEA Trust Commercial |
$201.85
|
| Rate for Payer: WPS Commercial |
$271.84
|
|
|
CANNULA 6MM AORTIC 7072
|
Facility
OP
|
$920.00
|
|
| Hospital Charge Code |
2975076
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$257.60 |
| Max. Negotiated Rate |
$3,680.00 |
| Rate for Payer: Aetna Commercial |
$828.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$791.20
|
| Rate for Payer: Aetna Managed Medicare |
$257.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$598.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$460.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$441.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$487.60
|
| Rate for Payer: Cash Price |
$276.00
|
| Rate for Payer: Cigna Commercial |
$846.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$514.83
|
| Rate for Payer: Health EOS Commercial |
$818.80
|
| Rate for Payer: HFN Commercial |
$846.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$690.00
|
| Rate for Payer: Multiplan Commercial |
$736.00
|
| Rate for Payer: NAPHCARE Commercial |
$552.00
|
| Rate for Payer: Preferred Network Access Commercial |
$846.40
|
| Rate for Payer: Quartz Beloit One Network |
$450.80
|
| Rate for Payer: Quartz Commercial |
$598.00
|
| Rate for Payer: Quartz Medicare Advantage |
$552.00
|
| Rate for Payer: The Alliance Commercial |
$3,680.00
|
| Rate for Payer: WEA Trust Commercial |
$506.00
|
| Rate for Payer: WPS Commercial |
$681.44
|
|
|
CANNULA 6MM AORTIC 7072
|
Facility
IP
|
$920.00
|
|
| Hospital Charge Code |
2975076
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$450.80 |
| Max. Negotiated Rate |
$846.40 |
| Rate for Payer: Aetna Commercial |
$828.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$487.60
|
| Rate for Payer: Cash Price |
$276.00
|
| Rate for Payer: Cigna Commercial |
$846.40
|
| Rate for Payer: Health EOS Commercial |
$818.80
|
| Rate for Payer: HFN Commercial |
$846.40
|
| Rate for Payer: Multiplan Commercial |
$736.00
|
| Rate for Payer: NAPHCARE Commercial |
$552.00
|
| Rate for Payer: Preferred Network Access Commercial |
$846.40
|
| Rate for Payer: Quartz Beloit One Network |
$450.80
|
| Rate for Payer: Quartz Commercial |
$552.00
|
| Rate for Payer: WEA Trust Commercial |
$506.00
|
| Rate for Payer: WPS Commercial |
$681.44
|
|
|
CANNULA 6X32 ACCELERATOR III 632-COP
|
Facility
IP
|
$367.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
2965390
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$179.83 |
| Max. Negotiated Rate |
$337.64 |
| Rate for Payer: Aetna Commercial |
$330.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$194.51
|
| Rate for Payer: Cash Price |
$110.10
|
| Rate for Payer: Cigna Commercial |
$337.64
|
| Rate for Payer: Health EOS Commercial |
$326.63
|
| Rate for Payer: HFN Commercial |
$337.64
|
| Rate for Payer: Multiplan Commercial |
$293.60
|
| Rate for Payer: NAPHCARE Commercial |
$220.20
|
| Rate for Payer: Preferred Network Access Commercial |
$337.64
|
| Rate for Payer: Quartz Beloit One Network |
$179.83
|
| Rate for Payer: Quartz Commercial |
$220.20
|
| Rate for Payer: WEA Trust Commercial |
$201.85
|
| Rate for Payer: WPS Commercial |
$271.84
|
|
|
CANNULA 6X32 ACCELERATOR III 632-COP
|
Facility
OP
|
$367.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
2965390
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$102.76 |
| Max. Negotiated Rate |
$337.64 |
| Rate for Payer: Aetna Commercial |
$330.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$315.62
|
| Rate for Payer: Aetna Managed Medicare |
$102.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$238.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$183.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$176.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$194.51
|
| Rate for Payer: Cash Price |
$110.10
|
| Rate for Payer: Cigna Commercial |
$337.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$205.37
|
| Rate for Payer: Health EOS Commercial |
$326.63
|
| Rate for Payer: HFN Commercial |
$337.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$275.25
|
| Rate for Payer: Multiplan Commercial |
$293.60
|
| Rate for Payer: NAPHCARE Commercial |
$220.20
|
| Rate for Payer: Preferred Network Access Commercial |
$337.64
|
| Rate for Payer: Quartz Beloit One Network |
$179.83
|
| Rate for Payer: Quartz Commercial |
$238.55
|
| Rate for Payer: Quartz Medicare Advantage |
$220.20
|
| Rate for Payer: WEA Trust Commercial |
$201.85
|
| Rate for Payer: WPS Commercial |
$271.84
|
|
|
CANNULA 6 X 7 SHOULDER AR-6535
|
Facility
IP
|
$645.00
|
|
| Hospital Charge Code |
2964660
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$316.05 |
| Max. Negotiated Rate |
$593.40 |
| Rate for Payer: Aetna Commercial |
$580.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$341.85
|
| Rate for Payer: Cash Price |
$193.50
|
| Rate for Payer: Cigna Commercial |
$593.40
|
| Rate for Payer: Health EOS Commercial |
$574.05
|
| Rate for Payer: HFN Commercial |
$593.40
|
| Rate for Payer: Multiplan Commercial |
$516.00
|
| Rate for Payer: NAPHCARE Commercial |
$387.00
|
| Rate for Payer: Preferred Network Access Commercial |
$593.40
|
| Rate for Payer: Quartz Beloit One Network |
$316.05
|
| Rate for Payer: Quartz Commercial |
$387.00
|
| Rate for Payer: WEA Trust Commercial |
$354.75
|
| Rate for Payer: WPS Commercial |
$477.75
|
|
|
CANNULA 6 X 7 SHOULDER AR-6535
|
Facility
OP
|
$645.00
|
|
| Hospital Charge Code |
2964660
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$180.60 |
| Max. Negotiated Rate |
$2,580.00 |
| Rate for Payer: Aetna Commercial |
$580.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$554.70
|
| Rate for Payer: Aetna Managed Medicare |
$180.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$419.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$322.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$309.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$341.85
|
| Rate for Payer: Cash Price |
$193.50
|
| Rate for Payer: Cigna Commercial |
$593.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$360.94
|
| Rate for Payer: Health EOS Commercial |
$574.05
|
| Rate for Payer: HFN Commercial |
$593.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$483.75
|
| Rate for Payer: Multiplan Commercial |
$516.00
|
| Rate for Payer: NAPHCARE Commercial |
$387.00
|
| Rate for Payer: Preferred Network Access Commercial |
$593.40
|
| Rate for Payer: Quartz Beloit One Network |
$316.05
|
| Rate for Payer: Quartz Commercial |
$419.25
|
| Rate for Payer: Quartz Medicare Advantage |
$387.00
|
| Rate for Payer: The Alliance Commercial |
$2,580.00
|
| Rate for Payer: WEA Trust Commercial |
$354.75
|
| Rate for Payer: WPS Commercial |
$477.75
|
|
|
CANNULA 8.25 X 7 SHOULDER AR-6530N
|
Facility
OP
|
$645.00
|
|
| Hospital Charge Code |
2964661
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$180.60 |
| Max. Negotiated Rate |
$2,580.00 |
| Rate for Payer: Aetna Commercial |
$580.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$554.70
|
| Rate for Payer: Aetna Managed Medicare |
$180.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$419.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$322.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$309.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$341.85
|
| Rate for Payer: Cash Price |
$193.50
|
| Rate for Payer: Cigna Commercial |
$593.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$360.94
|
| Rate for Payer: Health EOS Commercial |
$574.05
|
| Rate for Payer: HFN Commercial |
$593.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$483.75
|
| Rate for Payer: Multiplan Commercial |
$516.00
|
| Rate for Payer: NAPHCARE Commercial |
$387.00
|
| Rate for Payer: Preferred Network Access Commercial |
$593.40
|
| Rate for Payer: Quartz Beloit One Network |
$316.05
|
| Rate for Payer: Quartz Commercial |
$419.25
|
| Rate for Payer: Quartz Medicare Advantage |
$387.00
|
| Rate for Payer: The Alliance Commercial |
$2,580.00
|
| Rate for Payer: WEA Trust Commercial |
$354.75
|
| Rate for Payer: WPS Commercial |
$477.75
|
|
|
CANNULA 8.25 X 7 SHOULDER AR-6530N
|
Facility
IP
|
$645.00
|
|
| Hospital Charge Code |
2964661
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$316.05 |
| Max. Negotiated Rate |
$593.40 |
| Rate for Payer: Aetna Commercial |
$580.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$341.85
|
| Rate for Payer: Cash Price |
$193.50
|
| Rate for Payer: Cigna Commercial |
$593.40
|
| Rate for Payer: Health EOS Commercial |
$574.05
|
| Rate for Payer: HFN Commercial |
$593.40
|
| Rate for Payer: Multiplan Commercial |
$516.00
|
| Rate for Payer: NAPHCARE Commercial |
$387.00
|
| Rate for Payer: Preferred Network Access Commercial |
$593.40
|
| Rate for Payer: Quartz Beloit One Network |
$316.05
|
| Rate for Payer: Quartz Commercial |
$387.00
|
| Rate for Payer: WEA Trust Commercial |
$354.75
|
| Rate for Payer: WPS Commercial |
$477.75
|
|
|
CANNULA ADULT ORAL NASAL #3471ADH-00
|
Facility
IP
|
$410.00
|
|
| Hospital Charge Code |
2973055
|
|
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
|
|
|
CANNULA ADULT ORAL NASAL #3471ADH-00
|
Facility
OP
|
$410.00
|
|
| Hospital Charge Code |
2973055
|
|
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
|
|
|
CANNULA ANTERIOR CHAMBER 27GA 8065420120
|
Facility
OP
|
$102.00
|
|
| Hospital Charge Code |
4518847
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$28.56 |
| Max. Negotiated Rate |
$408.00 |
| Rate for Payer: Aetna Commercial |
$91.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$87.72
|
| Rate for Payer: Aetna Managed Medicare |
$28.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$66.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$51.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$48.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$54.06
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cigna Commercial |
$93.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$57.08
|
| Rate for Payer: Health EOS Commercial |
$90.78
|
| Rate for Payer: HFN Commercial |
$93.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$76.50
|
| Rate for Payer: Multiplan Commercial |
$81.60
|
| Rate for Payer: NAPHCARE Commercial |
$61.20
|
| Rate for Payer: Preferred Network Access Commercial |
$93.84
|
| Rate for Payer: Quartz Beloit One Network |
$49.98
|
| Rate for Payer: Quartz Commercial |
$66.30
|
| Rate for Payer: Quartz Medicare Advantage |
$61.20
|
| Rate for Payer: The Alliance Commercial |
$408.00
|
| Rate for Payer: WEA Trust Commercial |
$56.10
|
| Rate for Payer: WPS Commercial |
$75.55
|
|
|
CANNULA ANTERIOR CHAMBER 27GA 8065420120
|
Facility
IP
|
$102.00
|
|
| Hospital Charge Code |
4518847
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$49.98 |
| Max. Negotiated Rate |
$93.84 |
| Rate for Payer: Aetna Commercial |
$91.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$54.06
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cigna Commercial |
$93.84
|
| Rate for Payer: Health EOS Commercial |
$90.78
|
| Rate for Payer: HFN Commercial |
$93.84
|
| Rate for Payer: Multiplan Commercial |
$81.60
|
| Rate for Payer: NAPHCARE Commercial |
$61.20
|
| Rate for Payer: Preferred Network Access Commercial |
$93.84
|
| Rate for Payer: Quartz Beloit One Network |
$49.98
|
| Rate for Payer: Quartz Commercial |
$61.20
|
| Rate for Payer: WEA Trust Commercial |
$56.10
|
| Rate for Payer: WPS Commercial |
$75.55
|
|
|
CANNULA AORTIC 21FR EZF21TA
|
Facility
OP
|
$926.00
|
|
| Hospital Charge Code |
5384872
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$259.28 |
| Max. Negotiated Rate |
$3,704.00 |
| Rate for Payer: Aetna Commercial |
$833.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$796.36
|
| Rate for Payer: Aetna Managed Medicare |
$259.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$601.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$463.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$444.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$490.78
|
| Rate for Payer: Cash Price |
$277.80
|
| Rate for Payer: Cigna Commercial |
$851.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$518.19
|
| Rate for Payer: Health EOS Commercial |
$824.14
|
| Rate for Payer: HFN Commercial |
$851.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$694.50
|
| Rate for Payer: Multiplan Commercial |
$740.80
|
| Rate for Payer: NAPHCARE Commercial |
$555.60
|
| Rate for Payer: Preferred Network Access Commercial |
$851.92
|
| Rate for Payer: Quartz Beloit One Network |
$453.74
|
| Rate for Payer: Quartz Commercial |
$601.90
|
| Rate for Payer: Quartz Medicare Advantage |
$555.60
|
| Rate for Payer: The Alliance Commercial |
$3,704.00
|
| Rate for Payer: WEA Trust Commercial |
$509.30
|
| Rate for Payer: WPS Commercial |
$685.89
|
|
|
CANNULA AORTIC 21FR EZF21TA
|
Facility
IP
|
$926.00
|
|
| Hospital Charge Code |
5384872
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$453.74 |
| Max. Negotiated Rate |
$851.92 |
| Rate for Payer: Aetna Commercial |
$833.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$490.78
|
| Rate for Payer: Cash Price |
$277.80
|
| Rate for Payer: Cigna Commercial |
$851.92
|
| Rate for Payer: Health EOS Commercial |
$824.14
|
| Rate for Payer: HFN Commercial |
$851.92
|
| Rate for Payer: Multiplan Commercial |
$740.80
|
| Rate for Payer: NAPHCARE Commercial |
$555.60
|
| Rate for Payer: Preferred Network Access Commercial |
$851.92
|
| Rate for Payer: Quartz Beloit One Network |
$453.74
|
| Rate for Payer: Quartz Commercial |
$555.60
|
| Rate for Payer: WEA Trust Commercial |
$509.30
|
| Rate for Payer: WPS Commercial |
$685.89
|
|
|
CANNULA AORTIC 22 FR 78422
|
Facility
OP
|
$833.00
|
|
| Hospital Charge Code |
4519627
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$233.24 |
| Max. Negotiated Rate |
$3,332.00 |
| Rate for Payer: Aetna Commercial |
$749.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$716.38
|
| Rate for Payer: Aetna Managed Medicare |
$233.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$541.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$416.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$399.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$441.49
|
| Rate for Payer: Cash Price |
$249.90
|
| Rate for Payer: Cigna Commercial |
$766.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$466.15
|
| Rate for Payer: Health EOS Commercial |
$741.37
|
| Rate for Payer: HFN Commercial |
$766.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$624.75
|
| Rate for Payer: Multiplan Commercial |
$666.40
|
| Rate for Payer: NAPHCARE Commercial |
$499.80
|
| Rate for Payer: Preferred Network Access Commercial |
$766.36
|
| Rate for Payer: Quartz Beloit One Network |
$408.17
|
| Rate for Payer: Quartz Commercial |
$541.45
|
| Rate for Payer: Quartz Medicare Advantage |
$499.80
|
| Rate for Payer: The Alliance Commercial |
$3,332.00
|
| Rate for Payer: WEA Trust Commercial |
$458.15
|
| Rate for Payer: WPS Commercial |
$617.00
|
|
|
CANNULA AORTIC 22 FR 78422
|
Facility
IP
|
$833.00
|
|
| Hospital Charge Code |
4519627
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$408.17 |
| Max. Negotiated Rate |
$766.36 |
| Rate for Payer: Aetna Commercial |
$749.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$441.49
|
| Rate for Payer: Cash Price |
$249.90
|
| Rate for Payer: Cigna Commercial |
$766.36
|
| Rate for Payer: Health EOS Commercial |
$741.37
|
| Rate for Payer: HFN Commercial |
$766.36
|
| Rate for Payer: Multiplan Commercial |
$666.40
|
| Rate for Payer: NAPHCARE Commercial |
$499.80
|
| Rate for Payer: Preferred Network Access Commercial |
$766.36
|
| Rate for Payer: Quartz Beloit One Network |
$408.17
|
| Rate for Payer: Quartz Commercial |
$499.80
|
| Rate for Payer: WEA Trust Commercial |
$458.15
|
| Rate for Payer: WPS Commercial |
$617.00
|
|
|
CANNULA AORTIC 24 FR 78424
|
Facility
OP
|
$833.00
|
|
| Hospital Charge Code |
4519628
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$233.24 |
| Max. Negotiated Rate |
$3,332.00 |
| Rate for Payer: Aetna Commercial |
$749.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$716.38
|
| Rate for Payer: Aetna Managed Medicare |
$233.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$541.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$416.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$399.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$441.49
|
| Rate for Payer: Cash Price |
$249.90
|
| Rate for Payer: Cigna Commercial |
$766.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$466.15
|
| Rate for Payer: Health EOS Commercial |
$741.37
|
| Rate for Payer: HFN Commercial |
$766.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$624.75
|
| Rate for Payer: Multiplan Commercial |
$666.40
|
| Rate for Payer: NAPHCARE Commercial |
$499.80
|
| Rate for Payer: Preferred Network Access Commercial |
$766.36
|
| Rate for Payer: Quartz Beloit One Network |
$408.17
|
| Rate for Payer: Quartz Commercial |
$541.45
|
| Rate for Payer: Quartz Medicare Advantage |
$499.80
|
| Rate for Payer: The Alliance Commercial |
$3,332.00
|
| Rate for Payer: WEA Trust Commercial |
$458.15
|
| Rate for Payer: WPS Commercial |
$617.00
|
|
|
CANNULA AORTIC 24 FR 78424
|
Facility
IP
|
$833.00
|
|
| Hospital Charge Code |
4519628
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$408.17 |
| Max. Negotiated Rate |
$766.36 |
| Rate for Payer: Aetna Commercial |
$749.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$441.49
|
| Rate for Payer: Cash Price |
$249.90
|
| Rate for Payer: Cigna Commercial |
$766.36
|
| Rate for Payer: Health EOS Commercial |
$741.37
|
| Rate for Payer: HFN Commercial |
$766.36
|
| Rate for Payer: Multiplan Commercial |
$666.40
|
| Rate for Payer: NAPHCARE Commercial |
$499.80
|
| Rate for Payer: Preferred Network Access Commercial |
$766.36
|
| Rate for Payer: Quartz Beloit One Network |
$408.17
|
| Rate for Payer: Quartz Commercial |
$499.80
|
| Rate for Payer: WEA Trust Commercial |
$458.15
|
| Rate for Payer: WPS Commercial |
$617.00
|
|
