|
CANNULA AORTIC 24FR EZF24TA
|
Facility
IP
|
$926.00
|
|
| Hospital Charge Code |
5384873
|
|
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 24FR EZF24TA
|
Facility
OP
|
$926.00
|
|
| Hospital Charge Code |
5384873
|
|
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 8.0 5762 ***DISC 7/15
|
Facility
IP
|
$920.00
|
|
| Hospital Charge Code |
2965149
|
|
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 AORTIC 8.0 5762 ***DISC 7/15
|
Facility
OP
|
$920.00
|
|
| Hospital Charge Code |
2965149
|
|
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 AORTIC ROOT 9FR (12GA) 10012/AR-11012/11012
|
Facility
IP
|
$328.00
|
|
| Hospital Charge Code |
2965371
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$160.72 |
| Max. Negotiated Rate |
$301.76 |
| Rate for Payer: Aetna Commercial |
$295.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$173.84
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cigna Commercial |
$301.76
|
| Rate for Payer: Health EOS Commercial |
$291.92
|
| Rate for Payer: HFN Commercial |
$301.76
|
| Rate for Payer: Multiplan Commercial |
$262.40
|
| Rate for Payer: NAPHCARE Commercial |
$196.80
|
| Rate for Payer: Preferred Network Access Commercial |
$301.76
|
| Rate for Payer: Quartz Beloit One Network |
$160.72
|
| Rate for Payer: Quartz Commercial |
$196.80
|
| Rate for Payer: WEA Trust Commercial |
$180.40
|
| Rate for Payer: WPS Commercial |
$242.95
|
|
|
CANNULA AORTIC ROOT 9FR (12GA) 10012/AR-11012/11012
|
Facility
OP
|
$328.00
|
|
| Hospital Charge Code |
2965371
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$91.84 |
| Max. Negotiated Rate |
$1,312.00 |
| Rate for Payer: Aetna Commercial |
$295.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$282.08
|
| Rate for Payer: Aetna Managed Medicare |
$91.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$213.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$164.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$157.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$173.84
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cigna Commercial |
$301.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$183.55
|
| Rate for Payer: Health EOS Commercial |
$291.92
|
| Rate for Payer: HFN Commercial |
$301.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$246.00
|
| Rate for Payer: Multiplan Commercial |
$262.40
|
| Rate for Payer: NAPHCARE Commercial |
$196.80
|
| Rate for Payer: Preferred Network Access Commercial |
$301.76
|
| Rate for Payer: Quartz Beloit One Network |
$160.72
|
| Rate for Payer: Quartz Commercial |
$213.20
|
| Rate for Payer: Quartz Medicare Advantage |
$196.80
|
| Rate for Payer: The Alliance Commercial |
$1,312.00
|
| Rate for Payer: WEA Trust Commercial |
$180.40
|
| Rate for Payer: WPS Commercial |
$242.95
|
|
|
CANNULA ARTERIAL 21FR/7MM SOFT-FLOW ANGLED TIP SUTURE BULB NON-VENT 5767
|
Facility
OP
|
$1,282.00
|
|
| Hospital Charge Code |
5074615
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$358.96 |
| Max. Negotiated Rate |
$5,128.00 |
| Rate for Payer: Aetna Commercial |
$1,153.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,102.52
|
| Rate for Payer: Aetna Managed Medicare |
$358.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$833.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$641.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$615.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$679.46
|
| Rate for Payer: Cash Price |
$384.60
|
| Rate for Payer: Cigna Commercial |
$1,179.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$717.41
|
| Rate for Payer: Health EOS Commercial |
$1,140.98
|
| Rate for Payer: HFN Commercial |
$1,179.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$961.50
|
| Rate for Payer: Multiplan Commercial |
$1,025.60
|
| Rate for Payer: NAPHCARE Commercial |
$769.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,179.44
|
| Rate for Payer: Quartz Beloit One Network |
$628.18
|
| Rate for Payer: Quartz Commercial |
$833.30
|
| Rate for Payer: Quartz Medicare Advantage |
$769.20
|
| Rate for Payer: The Alliance Commercial |
$5,128.00
|
| Rate for Payer: WEA Trust Commercial |
$705.10
|
| Rate for Payer: WPS Commercial |
$949.58
|
|
|
CANNULA ARTERIAL 21FR/7MM SOFT-FLOW ANGLED TIP SUTURE BULB NON-VENT 5767
|
Facility
IP
|
$1,282.00
|
|
| Hospital Charge Code |
5074615
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$628.18 |
| Max. Negotiated Rate |
$1,179.44 |
| Rate for Payer: Aetna Commercial |
$1,153.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$679.46
|
| Rate for Payer: Cash Price |
$384.60
|
| Rate for Payer: Cigna Commercial |
$1,179.44
|
| Rate for Payer: Health EOS Commercial |
$1,140.98
|
| Rate for Payer: HFN Commercial |
$1,179.44
|
| Rate for Payer: Multiplan Commercial |
$1,025.60
|
| Rate for Payer: NAPHCARE Commercial |
$769.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,179.44
|
| Rate for Payer: Quartz Beloit One Network |
$628.18
|
| Rate for Payer: Quartz Commercial |
$769.20
|
| Rate for Payer: WEA Trust Commercial |
$705.10
|
| Rate for Payer: WPS Commercial |
$949.58
|
|
|
CANNULA ARTERIAL 21FR/7MM SOFT-FLOW EXTENDED NON-VENT 4948
|
Facility
OP
|
$1,374.00
|
|
| Hospital Charge Code |
5074620
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$384.72 |
| Max. Negotiated Rate |
$5,496.00 |
| Rate for Payer: Aetna Commercial |
$1,236.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,181.64
|
| Rate for Payer: Aetna Managed Medicare |
$384.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$893.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$687.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$659.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$728.22
|
| Rate for Payer: Cash Price |
$412.20
|
| Rate for Payer: Cigna Commercial |
$1,264.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$768.89
|
| Rate for Payer: Health EOS Commercial |
$1,222.86
|
| Rate for Payer: HFN Commercial |
$1,264.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,030.50
|
| Rate for Payer: Multiplan Commercial |
$1,099.20
|
| Rate for Payer: NAPHCARE Commercial |
$824.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,264.08
|
| Rate for Payer: Quartz Beloit One Network |
$673.26
|
| Rate for Payer: Quartz Commercial |
$893.10
|
| Rate for Payer: Quartz Medicare Advantage |
$824.40
|
| Rate for Payer: The Alliance Commercial |
$5,496.00
|
| Rate for Payer: WEA Trust Commercial |
$755.70
|
| Rate for Payer: WPS Commercial |
$1,017.72
|
|
|
CANNULA ARTERIAL 21FR/7MM SOFT-FLOW EXTENDED NON-VENT 4948
|
Facility
IP
|
$1,374.00
|
|
| Hospital Charge Code |
5074620
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$673.26 |
| Max. Negotiated Rate |
$1,264.08 |
| Rate for Payer: Aetna Commercial |
$1,236.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$728.22
|
| Rate for Payer: Cash Price |
$412.20
|
| Rate for Payer: Cigna Commercial |
$1,264.08
|
| Rate for Payer: Health EOS Commercial |
$1,222.86
|
| Rate for Payer: HFN Commercial |
$1,264.08
|
| Rate for Payer: Multiplan Commercial |
$1,099.20
|
| Rate for Payer: NAPHCARE Commercial |
$824.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,264.08
|
| Rate for Payer: Quartz Beloit One Network |
$673.26
|
| Rate for Payer: Quartz Commercial |
$824.40
|
| Rate for Payer: WEA Trust Commercial |
$755.70
|
| Rate for Payer: WPS Commercial |
$1,017.72
|
|
|
CANNULA ARTERIAL 21FR/7MM SOFT-FLOW EXTENDED VENTED 4949
|
Facility
OP
|
$1,374.00
|
|
| Hospital Charge Code |
5074619
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$384.72 |
| Max. Negotiated Rate |
$5,496.00 |
| Rate for Payer: Aetna Commercial |
$1,236.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,181.64
|
| Rate for Payer: Aetna Managed Medicare |
$384.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$893.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$687.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$659.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$728.22
|
| Rate for Payer: Cash Price |
$412.20
|
| Rate for Payer: Cigna Commercial |
$1,264.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$768.89
|
| Rate for Payer: Health EOS Commercial |
$1,222.86
|
| Rate for Payer: HFN Commercial |
$1,264.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,030.50
|
| Rate for Payer: Multiplan Commercial |
$1,099.20
|
| Rate for Payer: NAPHCARE Commercial |
$824.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,264.08
|
| Rate for Payer: Quartz Beloit One Network |
$673.26
|
| Rate for Payer: Quartz Commercial |
$893.10
|
| Rate for Payer: Quartz Medicare Advantage |
$824.40
|
| Rate for Payer: The Alliance Commercial |
$5,496.00
|
| Rate for Payer: WEA Trust Commercial |
$755.70
|
| Rate for Payer: WPS Commercial |
$1,017.72
|
|
|
CANNULA ARTERIAL 21FR/7MM SOFT-FLOW EXTENDED VENTED 4949
|
Facility
IP
|
$1,374.00
|
|
| Hospital Charge Code |
5074619
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$673.26 |
| Max. Negotiated Rate |
$1,264.08 |
| Rate for Payer: Aetna Commercial |
$1,236.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$728.22
|
| Rate for Payer: Cash Price |
$412.20
|
| Rate for Payer: Cigna Commercial |
$1,264.08
|
| Rate for Payer: Health EOS Commercial |
$1,222.86
|
| Rate for Payer: HFN Commercial |
$1,264.08
|
| Rate for Payer: Multiplan Commercial |
$1,099.20
|
| Rate for Payer: NAPHCARE Commercial |
$824.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,264.08
|
| Rate for Payer: Quartz Beloit One Network |
$673.26
|
| Rate for Payer: Quartz Commercial |
$824.40
|
| Rate for Payer: WEA Trust Commercial |
$755.70
|
| Rate for Payer: WPS Commercial |
$1,017.72
|
|
|
CANNULA ARTERIAL 24FR/7MM SOFT-FLOW ANGLED TIP SUTURE BULB NON-VENT 5768
|
Facility
IP
|
$1,331.00
|
|
| Hospital Charge Code |
5074616
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$652.19 |
| Max. Negotiated Rate |
$1,224.52 |
| Rate for Payer: Aetna Commercial |
$1,197.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$705.43
|
| Rate for Payer: Cash Price |
$399.30
|
| Rate for Payer: Cigna Commercial |
$1,224.52
|
| Rate for Payer: Health EOS Commercial |
$1,184.59
|
| Rate for Payer: HFN Commercial |
$1,224.52
|
| Rate for Payer: Multiplan Commercial |
$1,064.80
|
| Rate for Payer: NAPHCARE Commercial |
$798.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,224.52
|
| Rate for Payer: Quartz Beloit One Network |
$652.19
|
| Rate for Payer: Quartz Commercial |
$798.60
|
| Rate for Payer: WEA Trust Commercial |
$732.05
|
| Rate for Payer: WPS Commercial |
$985.87
|
|
|
CANNULA ARTERIAL 24FR/7MM SOFT-FLOW ANGLED TIP SUTURE BULB NON-VENT 5768
|
Facility
OP
|
$1,331.00
|
|
| Hospital Charge Code |
5074616
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$372.68 |
| Max. Negotiated Rate |
$5,324.00 |
| Rate for Payer: Aetna Commercial |
$1,197.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,144.66
|
| Rate for Payer: Aetna Managed Medicare |
$372.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$865.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$665.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$638.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$705.43
|
| Rate for Payer: Cash Price |
$399.30
|
| Rate for Payer: Cigna Commercial |
$1,224.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$744.83
|
| Rate for Payer: Health EOS Commercial |
$1,184.59
|
| Rate for Payer: HFN Commercial |
$1,224.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$998.25
|
| Rate for Payer: Multiplan Commercial |
$1,064.80
|
| Rate for Payer: NAPHCARE Commercial |
$798.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,224.52
|
| Rate for Payer: Quartz Beloit One Network |
$652.19
|
| Rate for Payer: Quartz Commercial |
$865.15
|
| Rate for Payer: Quartz Medicare Advantage |
$798.60
|
| Rate for Payer: The Alliance Commercial |
$5,324.00
|
| Rate for Payer: WEA Trust Commercial |
$732.05
|
| Rate for Payer: WPS Commercial |
$985.87
|
|
|
CANNULA ARTERIAL 24FR/8MM SOFT-FLOW EXTENDED NON-VENT 4950
|
Facility
IP
|
$1,256.00
|
|
| Hospital Charge Code |
5349137
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$615.44 |
| Max. Negotiated Rate |
$1,155.52 |
| Rate for Payer: Aetna Commercial |
$1,130.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$665.68
|
| Rate for Payer: Cash Price |
$376.80
|
| Rate for Payer: Cigna Commercial |
$1,155.52
|
| Rate for Payer: Health EOS Commercial |
$1,117.84
|
| Rate for Payer: HFN Commercial |
$1,155.52
|
| Rate for Payer: Multiplan Commercial |
$1,004.80
|
| Rate for Payer: NAPHCARE Commercial |
$753.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,155.52
|
| Rate for Payer: Quartz Beloit One Network |
$615.44
|
| Rate for Payer: Quartz Commercial |
$753.60
|
| Rate for Payer: WEA Trust Commercial |
$690.80
|
| Rate for Payer: WPS Commercial |
$930.32
|
|
|
CANNULA ARTERIAL 24FR/8MM SOFT-FLOW EXTENDED NON-VENT 4950
|
Facility
OP
|
$1,256.00
|
|
| Hospital Charge Code |
5349137
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$351.68 |
| Max. Negotiated Rate |
$5,024.00 |
| Rate for Payer: Aetna Commercial |
$1,130.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,080.16
|
| Rate for Payer: Aetna Managed Medicare |
$351.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$816.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$628.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$602.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$665.68
|
| Rate for Payer: Cash Price |
$376.80
|
| Rate for Payer: Cigna Commercial |
$1,155.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$702.86
|
| Rate for Payer: Health EOS Commercial |
$1,117.84
|
| Rate for Payer: HFN Commercial |
$1,155.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$942.00
|
| Rate for Payer: Multiplan Commercial |
$1,004.80
|
| Rate for Payer: NAPHCARE Commercial |
$753.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,155.52
|
| Rate for Payer: Quartz Beloit One Network |
$615.44
|
| Rate for Payer: Quartz Commercial |
$816.40
|
| Rate for Payer: Quartz Medicare Advantage |
$753.60
|
| Rate for Payer: The Alliance Commercial |
$5,024.00
|
| Rate for Payer: WEA Trust Commercial |
$690.80
|
| Rate for Payer: WPS Commercial |
$930.32
|
|
|
CANNULA ARTERIAL EOPA 22FR #77622
|
Facility
IP
|
$1,040.00
|
|
| Hospital Charge Code |
4088498
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$509.60 |
| Max. Negotiated Rate |
$956.80 |
| Rate for Payer: Aetna Commercial |
$936.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$551.20
|
| Rate for Payer: Cash Price |
$312.00
|
| Rate for Payer: Cigna Commercial |
$956.80
|
| Rate for Payer: Health EOS Commercial |
$925.60
|
| Rate for Payer: HFN Commercial |
$956.80
|
| Rate for Payer: Multiplan Commercial |
$832.00
|
| Rate for Payer: NAPHCARE Commercial |
$624.00
|
| Rate for Payer: Preferred Network Access Commercial |
$956.80
|
| Rate for Payer: Quartz Beloit One Network |
$509.60
|
| Rate for Payer: Quartz Commercial |
$624.00
|
| Rate for Payer: WEA Trust Commercial |
$572.00
|
| Rate for Payer: WPS Commercial |
$770.33
|
|
|
CANNULA ARTERIAL EOPA 22FR #77622
|
Facility
OP
|
$1,040.00
|
|
| Hospital Charge Code |
4088498
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$291.20 |
| Max. Negotiated Rate |
$4,160.00 |
| Rate for Payer: Aetna Commercial |
$936.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$894.40
|
| Rate for Payer: Aetna Managed Medicare |
$291.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$676.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$520.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$499.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$551.20
|
| Rate for Payer: Cash Price |
$312.00
|
| Rate for Payer: Cigna Commercial |
$956.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$581.98
|
| Rate for Payer: Health EOS Commercial |
$925.60
|
| Rate for Payer: HFN Commercial |
$956.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$780.00
|
| Rate for Payer: Multiplan Commercial |
$832.00
|
| Rate for Payer: NAPHCARE Commercial |
$624.00
|
| Rate for Payer: Preferred Network Access Commercial |
$956.80
|
| Rate for Payer: Quartz Beloit One Network |
$509.60
|
| Rate for Payer: Quartz Commercial |
$676.00
|
| Rate for Payer: Quartz Medicare Advantage |
$624.00
|
| Rate for Payer: The Alliance Commercial |
$4,160.00
|
| Rate for Payer: WEA Trust Commercial |
$572.00
|
| Rate for Payer: WPS Commercial |
$770.33
|
|
|
CANNULA CORONARY ARTERY 9/18FR X 11.4 IN STR PERFUSION (3.0/6.0MM X 290MM) 315806
|
Facility
IP
|
$1,361.00
|
|
| Hospital Charge Code |
3167471
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$666.89 |
| Max. Negotiated Rate |
$1,252.12 |
| Rate for Payer: Aetna Commercial |
$1,224.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$721.33
|
| Rate for Payer: Cash Price |
$408.30
|
| Rate for Payer: Cigna Commercial |
$1,252.12
|
| Rate for Payer: Health EOS Commercial |
$1,211.29
|
| Rate for Payer: HFN Commercial |
$1,252.12
|
| Rate for Payer: Multiplan Commercial |
$1,088.80
|
| Rate for Payer: NAPHCARE Commercial |
$816.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,252.12
|
| Rate for Payer: Quartz Beloit One Network |
$666.89
|
| Rate for Payer: Quartz Commercial |
$816.60
|
| Rate for Payer: WEA Trust Commercial |
$748.55
|
| Rate for Payer: WPS Commercial |
$1,008.09
|
|
|
CANNULA CORONARY ARTERY 9/18FR X 11.4 IN STR PERFUSION (3.0/6.0MM X 290MM) 315806
|
Facility
OP
|
$1,361.00
|
|
| Hospital Charge Code |
3167471
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$381.08 |
| Max. Negotiated Rate |
$5,444.00 |
| Rate for Payer: Aetna Commercial |
$1,224.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,170.46
|
| Rate for Payer: Aetna Managed Medicare |
$381.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$884.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$680.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$653.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$721.33
|
| Rate for Payer: Cash Price |
$408.30
|
| Rate for Payer: Cigna Commercial |
$1,252.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$761.62
|
| Rate for Payer: Health EOS Commercial |
$1,211.29
|
| Rate for Payer: HFN Commercial |
$1,252.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,020.75
|
| Rate for Payer: Multiplan Commercial |
$1,088.80
|
| Rate for Payer: NAPHCARE Commercial |
$816.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,252.12
|
| Rate for Payer: Quartz Beloit One Network |
$666.89
|
| Rate for Payer: Quartz Commercial |
$884.65
|
| Rate for Payer: Quartz Medicare Advantage |
$816.60
|
| Rate for Payer: The Alliance Commercial |
$5,444.00
|
| Rate for Payer: WEA Trust Commercial |
$748.55
|
| Rate for Payer: WPS Commercial |
$1,008.09
|
|
|
CANNULA CORONARY ARTERY PERFUSION 5MM 315805
|
Facility
IP
|
$1,361.00
|
|
| Hospital Charge Code |
5536764
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$666.89 |
| Max. Negotiated Rate |
$1,252.12 |
| Rate for Payer: Aetna Commercial |
$1,224.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$721.33
|
| Rate for Payer: Cash Price |
$408.30
|
| Rate for Payer: Cigna Commercial |
$1,252.12
|
| Rate for Payer: Health EOS Commercial |
$1,211.29
|
| Rate for Payer: HFN Commercial |
$1,252.12
|
| Rate for Payer: Multiplan Commercial |
$1,088.80
|
| Rate for Payer: NAPHCARE Commercial |
$816.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,252.12
|
| Rate for Payer: Quartz Beloit One Network |
$666.89
|
| Rate for Payer: Quartz Commercial |
$816.60
|
| Rate for Payer: WEA Trust Commercial |
$748.55
|
| Rate for Payer: WPS Commercial |
$1,008.09
|
|
|
CANNULA CORONARY ARTERY PERFUSION 5MM 315805
|
Facility
OP
|
$1,361.00
|
|
| Hospital Charge Code |
5536764
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$381.08 |
| Max. Negotiated Rate |
$5,444.00 |
| Rate for Payer: Aetna Commercial |
$1,224.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,170.46
|
| Rate for Payer: Aetna Managed Medicare |
$381.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$884.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$680.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$653.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$721.33
|
| Rate for Payer: Cash Price |
$408.30
|
| Rate for Payer: Cigna Commercial |
$1,252.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$761.62
|
| Rate for Payer: Health EOS Commercial |
$1,211.29
|
| Rate for Payer: HFN Commercial |
$1,252.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,020.75
|
| Rate for Payer: Multiplan Commercial |
$1,088.80
|
| Rate for Payer: NAPHCARE Commercial |
$816.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,252.12
|
| Rate for Payer: Quartz Beloit One Network |
$666.89
|
| Rate for Payer: Quartz Commercial |
$884.65
|
| Rate for Payer: Quartz Medicare Advantage |
$816.60
|
| Rate for Payer: The Alliance Commercial |
$5,444.00
|
| Rate for Payer: WEA Trust Commercial |
$748.55
|
| Rate for Payer: WPS Commercial |
$1,008.09
|
|
|
CANNULA CORONARY ARTERY PERFUSION 7MM 315807
|
Facility
OP
|
$1,361.00
|
|
| Hospital Charge Code |
5536765
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$381.08 |
| Max. Negotiated Rate |
$5,444.00 |
| Rate for Payer: Aetna Commercial |
$1,224.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,170.46
|
| Rate for Payer: Aetna Managed Medicare |
$381.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$884.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$680.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$653.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$721.33
|
| Rate for Payer: Cash Price |
$408.30
|
| Rate for Payer: Cigna Commercial |
$1,252.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$761.62
|
| Rate for Payer: Health EOS Commercial |
$1,211.29
|
| Rate for Payer: HFN Commercial |
$1,252.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,020.75
|
| Rate for Payer: Multiplan Commercial |
$1,088.80
|
| Rate for Payer: NAPHCARE Commercial |
$816.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,252.12
|
| Rate for Payer: Quartz Beloit One Network |
$666.89
|
| Rate for Payer: Quartz Commercial |
$884.65
|
| Rate for Payer: Quartz Medicare Advantage |
$816.60
|
| Rate for Payer: The Alliance Commercial |
$5,444.00
|
| Rate for Payer: WEA Trust Commercial |
$748.55
|
| Rate for Payer: WPS Commercial |
$1,008.09
|
|
|
CANNULA CORONARY ARTERY PERFUSION 7MM 315807
|
Facility
IP
|
$1,361.00
|
|
| Hospital Charge Code |
5536765
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$666.89 |
| Max. Negotiated Rate |
$1,252.12 |
| Rate for Payer: Aetna Commercial |
$1,224.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$721.33
|
| Rate for Payer: Cash Price |
$408.30
|
| Rate for Payer: Cigna Commercial |
$1,252.12
|
| Rate for Payer: Health EOS Commercial |
$1,211.29
|
| Rate for Payer: HFN Commercial |
$1,252.12
|
| Rate for Payer: Multiplan Commercial |
$1,088.80
|
| Rate for Payer: NAPHCARE Commercial |
$816.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,252.12
|
| Rate for Payer: Quartz Beloit One Network |
$666.89
|
| Rate for Payer: Quartz Commercial |
$816.60
|
| Rate for Payer: WEA Trust Commercial |
$748.55
|
| Rate for Payer: WPS Commercial |
$1,008.09
|
|
|
CANNULA CRYSTAL 5.75MM X 7CM AR-6560
|
Facility
IP
|
$514.00
|
|
| Hospital Charge Code |
4520230
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$251.86 |
| Max. Negotiated Rate |
$472.88 |
| Rate for Payer: Aetna Commercial |
$462.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$272.42
|
| Rate for Payer: Cash Price |
$154.20
|
| Rate for Payer: Cigna Commercial |
$472.88
|
| Rate for Payer: Health EOS Commercial |
$457.46
|
| Rate for Payer: HFN Commercial |
$472.88
|
| Rate for Payer: Multiplan Commercial |
$411.20
|
| Rate for Payer: NAPHCARE Commercial |
$308.40
|
| Rate for Payer: Preferred Network Access Commercial |
$472.88
|
| Rate for Payer: Quartz Beloit One Network |
$251.86
|
| Rate for Payer: Quartz Commercial |
$308.40
|
| Rate for Payer: WEA Trust Commercial |
$282.70
|
| Rate for Payer: WPS Commercial |
$380.72
|
|
